Healthcare systems and access Notes

How Do Different Systems Influence Wellbeing?

1. When people talk about “healthcare,” they often think about hospitals, doctors, or medicine.
2. But the system behind all of that: how care is organised, funded, and accessed is just as important.
3. Different countries make different choices, and those choices can dramatically shape people’s wellbeing, life expectancy, and even financial security.

What Do We Mean by a “Healthcare System”?

1. A healthcare system is the way a country organises, funds, and delivers medical care.
2. It determines who gets care, how quickly, and how much they pay.
3. Systems reflect a country’s values e.g., fairness, individual responsibility, or national solidarity.
4. No system is perfect; each one involves trade-offs in cost, access, and quality.

Universal Healthcare: “Care Based on Need, Not Ability to Pay”

1. Used in countries like the UK, Canada, Spain, Sweden, and Japan.
2. Everyone is covered automatically, usually through taxes.
3. Care is free (or very cheap) at point of use.
4. Strong focus on equity: everyone gets access no matter their income.
5. Usually strong in preventive care (check-ups, vaccination, screening).
6. Strengths:
   1. Reduces financial stress: no one avoids treatment due to cost.
   2. Lower national spending per person compared to private systems.
   3. Higher life expectancy and lower infant mortality in many countries.
7. Trade-offs:
   1. Longer waiting times for non-urgent procedures.
   2. Systems can be underfunded if taxes don’t keep up with population needs.

Social Insurance Systems: “Everybody Pays In, Everybody Gets Covered”

1. Found in Germany, France, the Netherlands, South Korea.
2. Funded by mandatory insurance shared by employers and workers.
3. Insurers are heavily regulated so they can’t deny coverage.
4. Patients often have a lot of choice in doctors and hospitals.
5. Strengths:
   1. High-quality care, short waiting times.
   2. Strong patient choice and competition between providers.
   3. Good balance between public regulation and private delivery.
6. Trade-offs:
   1. Can be expensive for governments to manage.
   2. Premiums may still be high for some groups.

Private or Market-Based Systems: “Care As a Personal Responsibility”

1. The U.S. is the most famous example.
2. Care is funded primarily through private insurance, often tied to employment.
3. Government programs exist for the elderly (Medicare) and low-income people (Medicaid).
4. Patients typically pay more out-of-pocket (co-pays, deductibles).
5. Strengths:
   1. Cutting-edge technology, top global hospitals.
   2. Very fast access if you have good insurance.
   3. High levels of innovation and research funding.
6. Trade-offs:
   1. Millions remain uninsured or underinsured.
   2. Medical bills can lead to debt or bankruptcy.
   3. Care is highly unequal depending on income, job, and insurance quality.

Mixed Systems: “Public Safety Net + Private Options”

1. Countries like Australia, Singapore, and many middle-income nations use hybrid approaches.
2. Government ensures basic coverage; private insurance offers faster or more specialised care.
3. Encourages citizens to share responsibility for their health costs.
4. Strengths:
   1. People can choose public or private care.
   2. Reduces strain on public hospitals.
5. Trade-offs:
   1. Risk of inequality: wealthier people access faster care.
   2. Public system must remain well-funded or quality declines.

What Shapes People’s Actual Access to Care?

1. Cost (insurance, fees, medicine prices)
2. Geography (urban vs rural healthcare deserts)
3. Education and awareness
4. Cultural beliefs and trust in the system
5. Discrimination or exclusion (gender, ethnicity, disability, legal status)
6. Strength of public health infrastructure

Case Studies

Case study

The NHS (UK): Universal Tax-Funded Care

• Founded in 1948 after WWII.
• “Free at the point of use” based on need.
• Improves equity, but underfunding can lead to long waits.
• Preventive care and cancer screening are major strengths.

Case study

The U.S. System: Innovation vs Inequality

• World-leading research and technology.
• High medical costs and lack of universal coverage.
• Millions skip care because of cost.
• Life expectancy is often lower than other wealthy countries.

Case study

Germany: Social Health Insurance

• All residents must have insurance.
• High levels of patient choice.
• Strong coordination between government and insurers.
• Excellent outcomes with moderate costs.

Case study

Rural India: Geography as a Barrier

• Many villages lack clinics, doctors, or clean water.
• Long travel distances reduce access to care.
• Government programs aim to recruit health workers to rural areas.
• Highlights that access is not just about money, it’s also about location.