Question

three dimensions of performance: cost containment/affordability, access to care (defined as the availability of services when required), and health outcomes/responsiveness. In general, how do the Beveridge-type system and Bismarck-type systems compare on each of these dimensions? Use examples.

Answer 1

ANSWER-

Beveridge vs Bismarck

Beveridge era

• Historically interesting, but no longer conceptually relevant

– Sources are not systems

• The shift from a right of labor to universal coverage marked the end of the "pure"

Bismarckian era

– Coverage of non-contributors

– General revenue transfers

• Economic/demographic pressures will continue

– De-link coverage from employment, broaden base to all income

Health System Models -

• Bismarck (decentralized)

– Established end of 19th century by Bismarck in
newly-unified Germany
– Patients pay insurance premiums to a sick fund
– Local/regional social insurance model

• Beveridge(centralized)

– Established in 1948 by Lord Beveridgein the UK
as the National Health Service (NHS)
– State owns and runs hospitals
– Funded through general taxation
• Market-Based

Public Policy Conundrum

Outcomes vs. Popularity

• Outcomes
– Bismarck has higher rates of per capita growth
in health expenditures
– Beveridgehas a cost advantage
– Beveridgehas a possible advantage in health
outcomes related to diseases requiring
systematic, organized population-based
screening (e.g., breast cancer, TB)

• Popularity
– Satisfaction in decentralized Bismarck systems
generally higher than in centralized Beveridge
systems