Introduction
Healthcare delivery refers to the systems or methods through which medical care is made accessible to patients. The delivery model impacts quality, cost, access to care, and health outcomes. Many models exist worldwide with their advantages and disadvantages. This article explores prevailing healthcare delivery models, including key features, pros and cons, and examples from countries that have successfully adopted them.
Fee-For-Service Model
Overview
In the fee-for-service care model, doctors and healthcare facilities are paid separately for each patient visit, test, procedure, or other provided service. Payers reimburse all justified services rendered. This has long been the dominant US healthcare delivery model.
Pros:
Patient Choice
Patients enjoy wide provider choice since most participate. This spurs competition based on care quality and cost.
Cons:
Overutilization Charging per service creates financial incentives to over-provide services. This drives up system costs and out-of-pocket patient fees.
Examples The US has relied on the fee-for-service systems funded through private commercial insurance, Medicaid and Medicare.
Capitation Models
Overview
Capitation models pay healthcare providers fixed rates per patient for covered services over set timeframes – usually monthly. The fee remains the same whether patients need minimal or substantial care. Providers must budget appropriately to cover all patient care needs within the set caps or else face losses.
Pros:
Reduced Costs Paying providers steady fees incentivizes them to implement cost controls and focus on preventative care to keep patients healthier at lower overall costs.
Cons:
Limited Services In extreme cases, providers restrict patient access and ration services to avoid financial losses under tight budgets. This negatively impacts care.
Examples Some US Accountable Care Organizations work on capitation models with per-month charges per patient. New Zealand and Australia adopted capitation models for family doctors.
Beveridge Model
Overview
Britain’s single-payer Beveridge healthcare model funds health services predominantly through central taxation. The national government centrally controls the system including planning infrastructure, budgets, staffing needs and more for public hospitals and clinics. Healthcare is free or low-cost for citizens.
Pros:
Universality Central funding makes healthcare available to all based on need, not ability to pay. This aligns with the WHO’s universal coverage aim.
Cons:
Government Dependence Government budget decisions greatly shape quality, access, efficiency and innovation in healthcare services. Funding shortages strain the system.
Examples The UK, Spain, most Scandinavian countries, and New Zealand have adopted healthcare systems based on the Beveridge model framework.
Bismarck Model
Overview
The Bismark model uses compulsory payroll deductions to fund a health insurance system covering nearly all citizens. Patients can freely choose providers and appointments with very limited waiting times.
Pros:
Stable Funding
Mandatory payroll-based insurance contributions provide reliable, stable funding for the multi-payer system. Providers get reimbursed rapidly.
Cons:
High Costs
Maintaining short wait times and full choice drives higher delivery costs. Germany spends over 11% of GDP on healthcare – among the highest globally.
Examples
Germany pioneered this model. France, Belgium, Netherlands, Japan and Switzerland later adopted modified versions.
Out-Of-Pocket Model
Overview
Also called the direct payment system, this model sees patients paying for all healthcare goods and services out-of-pocket with no third party payers. It passes all costs directly to users.
Pros
Service Quality Focus
With revenue coming directly from patients, healthcare providers strive for greater service quality and responsiveness to attract business and maintain loyalty.
Cons:
Inequality
The sick and poor struggle to pay for care. Without financial protections, costs become barriers that exacerbate health inequities.
Examples
Low-income nations like Cambodia frequently use this model due to lack of government or insurance funds. Even the US sees high out-of-pocket spending.
Conclusion
All healthcare models have inherent trade-offs. While most economies incorporate multiple systems tailored to local needs, understanding model frameworks helps inform useful health system reforms. The right balance of models provides quality, affordable healthcare access for entire populations.
