Question

After studying different national health care systems and their different approaches to achieving the same basic societal goals: health, wealth, and equity, answer the following question. Unfortunately, moving closer to one of these goals means moving further away from another…in other words society faces trade-offs. Every health care system must also deal with a common set of problems, or “pathogens” in the language of the text. The four pathogens of health policy are: moral hazard, adverse selection, health disparities, and monopolistic suppliers (markets that aren’t very competitive).

a. Compare and contrast the approaches of Beveridge and Bismark countries to the United States. In particular, how does each type of system attempt to achieve the three basic policy goals above? How are the four pathogens addressed in each of these types of systems? What trade-offs do each system make, either implicitly or explicitly? What is your assessment of how well specific countries are organizing and operating their health care systems? Specific examples from specific countries are going to be necessary

Answer 1

1. Bismarck and "Social Health Insurance" (1883):

-Compulsory funding by employers and employees, administered by pre-existing "sickness funds"

–Similar laws in Japan (1922) and elsewhere in Europe

•A "right" associated with labor status

–Keep workers healthy to improve productivity

–Pre-empt labor unrest

•Was not aimed at "universal coverage

2. Beveridge: the National Health Service (1948)

–Funded from general government revenues, coverage for entire population

–Funding base similar to that of USSR system, but providers much more independent

• More generally in high income countries (and then globally), a shift from health coverage as a right of labor, to "health as a human right" or health coverage as a constitutional or legal right

–Concern with universality, social cohesion/solidarity

Feature	Bismark	Beveridge
Entitlement Basis	Contribution	Citizenship/Residence
Funding Basis	Wages	All Public Revenues
Insurer	Occupational	State
Benefit Package	Explicit	Implicit
Management	Independent	Government
Providers	Privately contracted	Publicly contracted and salarid