56 pages • 1 hour read
T.R. ReidThe Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care
Nonfiction | Book | Adult | Published in 2009A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Index of Terms
Bismarck Model
The Bismarck model refers to a system of health care based on sickness funds (krankenkasse), and it was invented by the statesman and unifier of Germany, Otto von Bismarck. To keep the German workforce healthy, Bismarck made health care accessible and affordable to the entire population.
Within the Bismarck model, employers and employees purchase private health insurance plans and split the cost of premiums. The Bismarck model is used in its native Germany, France, Japan, Switzerland, Belgium, and some Latin American countries. Health care providers operate privately, but the funds are nonprofit and offer universal coverage. In some countries, such as Japan, a ministry negotiates fees with health care providers.
The United States employs some aspects of the Bismarck model—that is, employers and employees share the cost of premiums. However, health insurance is a for-profit industry in the US; there is no universal coverage; and insurance companies reserve the right to refuse some claims, which is forbidden in Bismarck countries. Also, in Bismarck countries, patients still have coverage—premiums are paid by the government—when they are unemployed. In the US, when patients lose their employment, they lose their health care coverage.
Beveridge Model
The Beveridge model of health care, named after British politician and reformer William Beveridge, is the basis of Great Britain’s National Health Service (NHS). Italy, Spain, Hong Kong, and most Scandinavian countries use this model. In the Beveridge system, health care is financed by the government through taxation. All hospitals and clinics are government-owned and many doctors are government employees, though some still operate privately. Private doctors, however, must still collect their payments from the government. Ironically, the two “purest” examples of the Beveridge model do not exist in Europe. Cuba operates one pure model, and the US Department of Veterans Affairs operates another when providing health care to retired military personnel.
National Health Insurance Model
The National Health Insurance model uses aspects of both Beveridge and Bismarck systems. Health care providers operate privately, but the insurance system is run by the government and funded through taxation. Like the Beveridge system, NHI countries manage costs by limiting what they will agree to pay for. It is also common for patients to wait for treatment—a practice that was notorious in Canada, which is a “paradigmatic NHI system” (19). Other NHI countries are Australia, and newly industrialized nations, such as Taiwan and South Korea.
Out-of-Pocket
The phrase “out-of-pocket” refers to health insurance fees that are paid directly and completely to health care providers due to an absence of a health care infrastructure that cares for and treats all patients, regardless of income. Though the out-of-pocket health care model is most common in developing countries in Africa and Asia, where only the wealthiest patients receive the best health care services, the out-of-pocket model also works, to some degree, in the United States. Before the passage of the Affordable Care Act, insurance companies could refuse some patients coverage due to preexisting conditions, thereby requiring them to pay for treatment out of their own income or savings. Even after the passage of the ACA, insurance companies still reserve the right to refuse some claims, which then forces the patient to cover the cost.
