World Health Systems

Your all-in-one companion for health personnel

World Health Systems details different health systems, including their related health insurance and drug supply systems, in various parts of the world with both macro- and micro- perspectives. The book is arranged in five parts: the first part presents, from multidisciplinary perspectives, outlines of various health systems throughout the world, as well as current trends in the development and reform of world health systems. The second and third parts expound on the health systems in developed countries, discussing the government's role in the health service market and basic policies on medication administration and expenses, before analyzing the health systems of Britain, Canada, Australia, Sweden, Germany, France, Japan, Poland, USA, Singapore, Hongkong (China), and Taiwan (China).

The fourth and fifth parts discuss health systems in less developed countries and areas, typically the BRICS and other countries in Asia (Thailand, Vietnam, the Philippines, Armenia, and Kyrghyzstan), Africa (Egypt, Morocco), Europe (Hungary, Czech Republic, and Bulgaria) and South America (Cuba, Chile, and Mexico), summarizing their past experiences, while making assessments of their current efforts to shed light on future developments.

• Details a variety of health systems throughout the world
• Compares their fundamental features and characteristics
• Discusses their respective strengths and shortcomings
• Provides insight from an author who holds multiple impressive titles in the health sector

Public health professionals and academics alike will want to add World Health Systems to their library.

XIAOMING SUN holds a PhD in Health Planning and Management from Keele University, UK. He was a Takemi Fellow at the Harvard School of Public Health, and Professor at Fudan University and Chief Physician at Zhongshan Hospital and the East Hospital, China. Dr. Sun has served as the Vice President of the Shanghai Medical Association, the Vice President of the Shanghai Medical Doctor Association, the Vice Chairman of the Chinese Medical Association General Practice Branch, and President of the Shanghai Community Health Association.

Foreword xvii

Preface xxi

About the Book xxv

About the Author xxvii

Part I: Overview

Chapter 1: Theoretical Foundations for the Establishment of World Health Systems 3

Section I. Theories of Economic Development 3

1. Classical Political Economics 4

2. Welfare Economics 6

3. Keynesian Economics 9

4. Liberal Economics 10

5. Information and Institutional Economics 12

Section II. Theories of Public Goods 20

1. Concept and Characteristics of Public Goods 20

2. Classification Criteria of Public Goods 22

3. Theoretical Analysis of Public Goods 22

Section III. Theories of Social Equality 25

1. Concept of Equality in Classical Liberalism 25

2. Concept of Equality in Utilitarianism 25

3. Concept of Equality in Rawlsianism 26

4. Concept of Equality in the School of New Public Administration 26

5. Concept of Equality in Marxism 26

Section IV. Theories of Universal Health Coverage 27

1. Proposal of UHC Theory 27

2. Definition and Implications of UHC Theory 28

Section V. Theory of Performance Evaluation for World Health Systems 30

1. Definition of Concepts Related to Performance Evaluation 30

2. Model of Performance Evaluation for Health Systems 31

Chapter 2: World Socioeconomic Development and Health Status 33

Section I. World Socioeconomics and Population Aging 33

1. Economic Crisis and Transformational Development 33

2. Current Status and Trends of World Population Aging 35

3. Impact of Population Aging on Healthcare Costs 38

4. Strategies for Actively Coping with Population Aging 39

Section II. Global Health Status and Current Challenges 43

1. Update on the Concepts of Health 43

2. Comparison of World Health Statuses 47

3. Key Issues in Human Health 50

Section III. Proposing the Concept of Global Health and Its Development Trends 55

1. Definition and Evolution of Global Health 55

2. Research Areas Related to Global Health 56

3. Challenges and Opportunities Concerning Global Health 57

Section IV. Exploring the Integration of Healthcare and Prevention in Health Insurance 58

1. Gradual Transition from Disease Insurance to Health Insurance 58

2. Strengthening Health Education and Advocating Healthy Lifestyles 59

3. Promoting the Capitation System to Enhance Preventive Healthcare 60

Section V. Progress in Medical Technology and Its Impact on Healthcare Costs 61

1. Current Status of and Trends in the Development of Medical Technology 61

2. Impact of High-Tech Medicine on Healthcare Costs 62

Chapter 3: Health System Structure and Determinants of Health 65

Section I. Structure of Health Systems and Their Relationships 65

1. Goals and Boundaries of Health Systems 65

2. Medical and Health Resources 67

3. Organizations and Institutions 83

4. Economic Support 100

5. Health Management 103

6. Service Provision 111

Section II. Key Factors Influencing Health Systems 115

1. Economic Factors 116

2. Political Factors 117

3. Cultural Factors 121

Section III. Analysis of the Social Determinants of Health 125

1. Conceptual Framework of the Social Determinants of Health 126

2. Policy Values of the Social Determinants of Health 128

Chapter 4: Basic Models and Evaluation of World Health Systems 131

Section I. Two-Dimensional Classification of World Health Systems 131

1. Principal Models of International Health and Social Security Systems 131

2. Selection of System Models for Countries with Different Development Levels 133

Section II. System Model of the National Health Service 135

1. National Health Service and General Practitioner System 135

2. The Social Welfare Model of Nordic Countries 139

3. Main Policies and Features of Developing Countries 141

Section III. System Model of Social Health Insurance 144

1. National Health Insurance Systems of Germany and France 144

2. Health System and Insurance in Japan 146

3. Health System and Insurance in South Korea 148

4. Main Policies and Features of Developing Countries 149

Section IV. System Models of Commercial Health Insurance 153

1. Basic Characteristics of the Commercial Health Insurance Model in the US 153

2. Features and Existing Problems of the US Model 155

3. Private Health Insurance in Developing Countries 157

Section V. System Models of Savings-Type Health Insurance 159

1. Establishment of 3M System Policies 159

2. Basic Evaluation of the Singaporean Model 160

Section VI. Other Health Insurance System Models 161

1. Situations in Hong Kong, Macau, and Taiwan 161

2. The 30-Baht Universal Health Insurance Scheme in Thailand 164

Chapter 5: Social Medical Aid System and Its Analysis 169

Section I. Theoretical Foundations of Social Medical Aid Systems 169

1. Theory of Baseline Equality 169

2. Theory of Social Citizenship 170

3. Maslow’s Hierarchy of Needs 171

4. Theory of Tertiary Distribution 172

Section II. Major Policies of Social Medical Aid Systems 172

1. Recipients of Medical Aid 172

2. Determining the Eligibility of Medical Aid Recipients 174

3. Methods of Medical Aid 175

4. Funding Sources for Medical Aid 176

5. Treatment Standards for Medical Aid 177

6. Provision of Medical Aid Services 178

Section III. Models and Features of Social Medical Aid Systems 179

1. Models of Social Medical Aid Systems in Developed Countries 179

2. Features of Social Medical Aid Systems in Developed Countries 181

3. Cost Containment for Social Medical Aid Systems in Developed Countries 182

4. Governmental Medical Aid Systems in Developing Countries 185

Chapter 6: Features and Trends of Reforms in World Health Systems 189

Section I. Features of Health System Reforms in Developed Countries and Areas 189

1. Common Features and Trends of Health Economic Policies in Developed Countries and Areas 189

2. Major Health Economic Reforms in Developed Countries and Areas 191

3. Exploration of Private Financing Initiatives 198

Section II. Features and Reform Trends of Health Systems in Developing Countries 201

1. Features and Reforms of Health Systems in Asian Countries 201

2. Features and Reforms of Health Systems in African Countries 204

3. Features and Reforms of Health Systems in European Countries 207

4. Features and Reforms of Health Systems in South American Countries 208

Part II: Characteristics of Health Systems in Developed Countries and Areas

Chapter 7: Overview of Health Systems in Developed Countries and Areas 213

Section I. Status of Health Investment in Developed Countries and Areas 213

Section II. Status of Health Services in Developed Countries and Areas 214

1. Equity in Health Outcomes 214

2. Accessibility of Healthcare Services 215

3. Differences in Health Service Utilization 217

4. Impact of Health Insurance on Health Services 217

Section III. Status of Health Insurance in Developed Countries and Areas 218

1. Health Insurance Systems for Different Income Groups 218

2. Responsibilities of the Government in the Health Insurance System 220

3. Functions of the Health Insurance System 221

Chapter 8: The Role of the Government in the Health Service Markets of Developed Countries and Areas 223

Section I. Healthcare Market Failures and Government Intervention 223

1. Basic Concepts of Healthcare Markets 223

2. Significance of Government Intervention in Healthcare Markets 223

3. Consequences of Government Nonintervention in Healthcare Markets 228

4. Goals and Policy Orientations of Government Intervention in Healthcare Markets 230

5. Failures and Rectifications of Government Intervention 234

Section II. Macro-Level Planning by Governments in Developed Countries and Areas to Strengthen Healthcare Institutions 237

1. Implementation of Regional Healthcare Planning 237

2. Government Intervention in the Formulation of Healthcare Service Contracts via Market Coordination Mechanisms 238

3. Vertical Integration of Healthcare Resources via Clusters 238

Section III. Government Regulation of Human Resources in Developed Countries and Areas 243

1. Regulating the Total Supply of Physicians Based on Healthcare Demand 243

2. Government Efforts and Outcomes in Improving the Regional Imbalances of Physician Supply and Demand 245

Section IV. Government Intervention in Drugs and the Control of Healthcare Quality in Developed Countries and Areas 247

1. Government Intervention in Drugs 247

2. Government Control of Healthcare Quality 248

Section V. Government Measures for Healthcare Cost Containment in Developed Countries and Areas 250

1. Managed Healthcare and Managed Competition 250

2. Hospital Global Budget System 252

3. Regulating the Provision of Elderly Healthcare Services 252

Section VI. Government Measures to Address Health Service Problems in Developed Countries and Areas 253

1. Measures to Address Long Waiting Lists for Inpatient and Outpatient Services 253

2. Introduction of the “Community Healthcare over Inpatient Treatment” Policy 255

3. Adjustments for Reasonable Compensation Policies 256

4. Improving Service Quality by Increasing the Number of Healthcare Workers 256

5. Regulatory Roles in Stabilizing National Healthcare Needs 257

6. Compensation Measures for the Inadequate Supply of Public Health and Basic Healthcare 258

Chapter 9: Basic Drug Administration Policies in Developed Countries and Areas 259

Section I. Government Policies Related to Drug Manufacturing in Developed Countries and Areas 259

1. Stage 1: Market Management and Legal System Improvements 259

2. Stage 2: Reduction of Drug Costs 260

3. Stage 3: Emphasis on Health Economic Benefits 261

Section II. Government Policies Related to Drug Marketing in Developed Countries and Areas 262

1. Price Control on Manufacturers 262

2. Policies for Distributors 265

3. Policies for Pharmacies (or Pharmacists) 265

4. Policies for Hospitals 266

Section III. Drug Reimbursement Policies in Developed Countries and Areas 267

1. Increasing Consumer Copayment of Drug Expenses 267

2. Encouraging Physicians to Prescribe Cheaper Drugs 267

3. Strict Control Over Manufacturers 269

Section IV. Policies for Essential Medicines in Developed Countries and Areas 270

1. Conceptual Development and Impact of Essential Medicines 270

2. Selection and Utilization of Essential Medicines in Developed Countries and Areas 272

Section V. Separation of Prescribing and Dispensing Policies and Relevant Insights in Developed Countries and Areas 275

1. Conceptual Definition of the Separation of Prescribing and Dispensing 275

2. Rationale and Policy Implementation of the Separation of Prescribing and Dispensing in Western Developed Countries 276

3. Reforms and Evaluation of the Separation of Prescribing and Dispensing in Asian Developed Countries and Areas 280

4. Value of and Insights for the Separation of Prescribing and Dispensing in China 284

Chapter 10: Models and Policies of Healthcare Cost Containment in Developed Countries and Areas 287

Section I. Background of Healthcare Cost Containment in Developed Countries and Areas 287

1. Changes in Healthcare Costs in Developed Countries and Areas 287

2. Causes of the Rapid Growth of Healthcare Costs 288

3. Three Stages in the Economic Model of Health Service Development 290

Section II. Main Measures of Healthcare Cost Containment in Developed Countries and Areas 292

1. Strict Control over the Allocation of Large Medical Equipment 292

2. Establishing Healthcare Cost-Sharing Mechanisms 293

3. Strengthening the Management of Healthcare Services 293

4. Implementing a Global Budget System 294

Section III. Comparison of Models for Healthcare Cost Containment in Developed Countries and Areas 295

1. Five Models of Healthcare Cost Containment 295

2. Comparison of Models for Healthcare Cost Containment and Conclusions 297

Section IV. Policies of Healthcare Cost Containment and Their Trends in Developed Countries and Areas 298

1. Policies of Healthcare Cost Containment in Developed Countries and Areas 298

2. Future Trends and Directions 299

Part III: Health Systems in Developed Countries and Areas

Chapter 11: National Health Service Systems of Representative Countries 305

Section I. The Health System in the United Kingdom 305

1. Establishment of the National Health Service 307

2. Developments and Changes in the NHS Management System 309

3. NHS Funding 314

4. Community Health Services 316

5. Hospital Services 324

6. Other Healthcare Services 327

7. Settlement of Medical Disputes 329

8. NHS Reforms and Future Policies 334

Section II. The Health System in Canada 338

1. Establishment and Development of the Health System 339

2. Healthcare Providers 345

3. Current Status and Future Trends in Health Insurance 349

4. Management of Health Insurance 357

5. Trends in Healthcare Expenditure and Containment Policies 362

Section III. The Health System in Australia 369

1. National Health Status and Current Challenges 370

2. Health Service System 374

3. Universal Health Insurance System 385

4. Commercial Health Insurance 392

5. Reforms in Healthcare Services and Payment Systems 396

6. Plans for a New Round of Healthcare Reforms 399

Section IV. The Health System in Sweden 405

1. Healthcare Provision System 406

2. Health Insurance System 410

3. Formulation and Value Orientation of Health Policies 414

4. Healthcare Cost-Containment Policies 416

5. Difficulties in the Healthcare System and Reform Attempts 419

6. The Path of Swedish Health System Reforms in the Twenty-First Century 429

Chapter 12: Social Health Insurance Systems of Representative Countries 431

Section I. The Health System in Germany 431

1. Health Service System 432

2. Health Insurance System 445

3. Health Insurance Operations 447

4. Current Status and Future Trends of Health Insurance Policy 453

5. Health Reforms in the Twenty-First Century 458

6. Health Insurance System Reforms by the Grand Coalition Government 460

Section II. The Health System in France 462

1. Health Service System 462

2. Healthcare Practitioners and Mobility 471

3. Health System Reforms 476

4. Health Insurance System 478

5. Health Insurance Issues and Reforms 496

6. Healthcare Cost-Containment Policies 501

Section III. The Health System in Japan 507

1. Health System 510

2. Health System Issues and Reforms 517

3. Health Insurance System 522

4. Framework of the Long-Term Care Insurance System 532

5. Healthcare Cost-Containment Policies 535

Section IV. The Health System in Poland 540

1. Overview of Socioeconomic Development 540

2. Health Service System 543

3. Health Insurance System 557

4. Reforms to the Health System and Social Security Planning 566

Chapter 13: Commercial Health Insurance and Medical

Savings Account Systems of Representative Countries 569

Section I. The Commercial Health Insurance System in the United States 569

1. Healthcare Institutions 570

2. Healthcare Workforce 575

3. Health Insurance System 578

4. Medicare 581

5. Medicaid for Low-Income Earners 597

6. Healthcare Cost-containment Policies 607

7. Plan and Progress of Obamacare 615

Section II. The Medical Savings Account System in Singapore 620

1. Healthcare System 620

2. Reforms of the Public Hospital System 636

3. Health Security and Health Insurance 643

4. Healthcare Funding Policies 651

5. Healthcare Cost-Containment Mechanisms 660

Chapter 14: Improved Health Systems in Hong Kong and Taiwan 665

Section I. The Health System in Hong Kong 665

1. Health System 667

2. Reforms in Public Hospital Management 674

3. New Development Ideas of the Hospital Authority 678

4. Health Security System 681

5. Hong Kong’s Health System Reforms in the Twenty-First Century 687

Section II. The Health System in Taiwan 690

1. Overview and Features of the Health System 690

2. National Health Insurance (NHI) 694

3. Point-for-Service Global Budget Payment System 706

4. Drug Administration System 709

5. Challenges Facing the Health System in Taiwan 712

Part IV: Characteristics of Health Systems in Developing Countries

Chapter 15: Definition of Developing Countries and Challenges in Health Systems 717

Section I. Definition and Structural Formation of Developing Countries 717

1. Concept and Definition of Developing Countries 717

2. Social Formation and Structure of Developing Countries 719

3. Proposal of Representative Countries and Its Implications 721

Section II. Health Systems and Health Statuses of Developing Countries 722

1. Exploration of Universal Health Security Systems 722

2. Transition of Health Statuses in Developing Countries 723

Section III. Challenges of Health Systems in Developing Countries 726

1. Inadequacies in Overall Health Resources 726

2. Poor Implementation of Health System Reforms 726

3. Uneven Distribution of Health Statuses and Human Resources 727

4. Low Willingness to Invest in Adult Healthcare 727

5. Low Input into Health Research 728

6. Overdependence on Aid May Weaken the Government’s Sense of Responsibility Toward National Health 728

Chapter 16: Comparison of Healthcare and Social Security Systems in BRICS Countries 729

Section I. Comparison of Socioeconomics and Health Resources in BRICS Countries 729

1. Origin of BRICS Countries 729

2. Health Resources of BRICS Countries 730

Section II. Comparison of Health Insurance Systems in BRICS Countries 732

1. Establishment of Universal Healthcare Security Systems 732

2. Encouraging the Development of Private Healthcare Institutions and Commercial Health Insurance 734

3. Emphasis on the Construction of Primary Healthcare Services 735

Section III. Comparison of Health Systems in BRICS Countries 737

1. From Models of Centralized Government Management to Commercial Fund Management 737

2. “Super-Ministry System” Bureaucratic Management 738

3. Multipronged Management 739

Section IV. Performance Evaluation of Health Systems in BRICS Countries 740

1. Differences in Health System Reforms 740

2. Comparison of Health System Performances 746

Chapter 17: Insights from Health System Reforms in Developing Countries 747

Section I. Common Challenges in the Development of Health Systems 747

1. Limited Funding Sources and Insufficient Investment 747

2. Imbalances in Regional and Vertical Resource Allocation 747

3. Lack of Incentive and Restraint Mechanisms in Public Healthcare Institutions 748

4. Lagging in the Funding and Payment of Health Insurance 748

5. Ineffective Use of Health Insurance Funds 750

6. Inadequate Efficiency and Capacity of Health Insurance Management 750

Section II. Key Issues Facing the Health System in China 751

1. Equality – The Coexistence of Wastage and Shortage of Healthcare Resources 751

2. Accessibility – Deviations in Service Focus and Technology Orientation 752

3. Coordination – The Decentralization and Fragmentation of Different Healthcare Resources 752

4. Marginalized Groups and Blind Spots in Social Insurance Coverage 753

5. Increased Healthcare Demand and Inadequate Health Security 753

6. Flaws in Management Capacity and Institutional Design 754

Section III. Experiences and Insights from Health System Reforms in Developing Countries 757

1. System Planning – Optimized Integration of Health Resource Allocation 757

2. Primary Care – Fully Utilizing the Role of Family Physicians 757

3. Nongovernmental Healthcare Institutions – Guiding the Development of Private Healthcare Institutions 758

4. Policy Orientation – Emphasis on Equality and Supporting Vulnerable Groups 759

5. System Design – Payment System Reforms and Fund Supervision 760

6. Sustainable Funding – Advocating a Multichannel Model of Increasing Revenue and Reducing Expenditure 761

Part V: Health Systems in Developing Countries

Chapter 18: Health Systems in Seven Asian Countries 765

Section I. The Health System in China 765

1. Overview of Socioeconomics and National Health 765

2. Healthcare System 767

3. Health Security System 773

4. Progress of Health System Reforms 788

Section II. The Health System in India 794

1. Overview of Socioeconomics and National Health 794

2. Healthcare Organizations and Regulatory Systems 796

3. Healthcare Funding and Payment Systems 801

4. Health System Reforms 816

5. Outcomes, Characteristics, and Challenges 818

Section III. The Health System in Thailand 819

1. Overview of Socioeconomics and National Health 819

2. Healthcare System 820

3. Health Insurance System 822

4. Health System Reforms and Evaluation 824

Section IV. The Health System in Vietnam 831

1. Overview of Socioeconomics and National Health 831

2. Healthcare System 832

3. Health Insurance System 834

4. Health System Reforms and Evaluation 836

Section V. Health System in the Philippines 846

1. Overview of Socioeconomics and National Health 846

2. Healthcare System 847

3. Health Security System 850

4. Issues and Development Trends in Health System Reforms 860

Section VI. The Health System in Armenia 864

1. Overview of Socioeconomics and National Health 864

2. Healthcare System 865

3. Healthcare Funding 869

4. Health System Reforms 871

Section VII. The Health System in Kyrgyzstan 874

1. Overview of Socioeconomics and National Health 874

2. Healthcare System 875

3. Healthcare Funding and Expenditure 878

4. Health System Reforms 882

Chapter 19: Health Systems in Three African Countries 889

Section I. The Health System in South Africa 889

1. Overview of Socioeconomics and National Health 889

2. Healthcare System 892

3. Health Security System 893

4. Status of Healthcare Funding 896

5. Health System Reforms 898

Section II. The Health System in Egypt 904

1. Overview of Socioeconomics and National Health 904

2. Healthcare System and Structure 904

3. Health System Reforms and Prospects 905

Section III. The Health System in Morocco 908

1. Overview of Socioeconomics and National Health 908

2. Healthcare System 908

3. Difficulties in Health Industry Development 910

Chapter 20: Health Systems in Four Selected European Countries 913

Section I. The Health System in Russia 913

1. Overview of Socioeconomics and National Health 913

2. Healthcare System 914

3. Health Insurance System 918

4. Healthcare Funding System and Financial Allocation 936

5. Health System Reforms 948

Section II. The Health System in Hungary 951

1. Overview of Socioeconomics and National Health 951

2. Healthcare System 952

3. Reform Changes and Characteristics of the Healthcare System 960

4. Existing Issues and Development Trends in the Healthcare System 962

Section III. The Health System in the Czech Republic 965

1. Overview of Socioeconomics and National Health 965

2. Healthcare Organizations and the Regulatory System 966

3. Healthcare Funding and Universal Social Health Insurance 969

4. Trends in Health System Reforms 977

Section IV. The Health System in Bulgaria 981

1. Overview of Socioeconomics and National Health 981

2. Healthcare System 983

3. Healthcare Resource Allocation 991

4. Healthcare Funding Mechanism 994

5. Characteristics and Direction of Health System Reforms 997

Chapter 21: Health Systems in Four American Countries 1001

Section I. The Health System in Brazil 1001

1. Overview of Socioeconomics and National Health 1001

2. Healthcare System 1004

3. Status of Rural and Primary Healthcare 1008

4. Health Insurance System and Financing 1010

5. Challenges and Reforms 1012

Section II. The Health System in Cuba 1015

1. Overview of Socioeconomics and National Health 1015

2. Establishment and Development of the Health System 1016

3. Healthcare Delivery and Regulatory Systems 1019

4. Healthcare Funding System 1031

5. Healthcare Development and Reform Experiences 1033

Section III. The Health System in Chile 1039

1. Overview of Socioeconomics and National Health 1039

2. Healthcare System 1040

3. Analysis of the Health Insurance System 1046

4. Evaluation and Summary of the Health System 1049

Section IV. The Health System in Mexico 1053

1. Overview of Socioeconomics and National Health 1053

2. Historical Evolution of the Health System 1054

3. Healthcare Organizations and Service System 1059

4. Health Security Financing and Allocation Mechanism 1062

Afterword 1069

Bibliography 1071

Index 1099

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