There are four basic models of health system in the world which includes-
- Beveridge model
- Bismarck model
- National health insurance model
- Out of pocket model
Most of the developing countries [Around 150] falls under out of pocket model in which patients can sometimes scratch together enough money to pay a doctor bill, otherwise, most of the time they pay in potatoes or goat’s milk or child care or whatever else they may have to give. If they have nothing, they don’t get medical care. Thus poor becomes poorer and overall health keeps on deteriorating.
I believe a nation should have a proper and well organized health system to achieve optimum state of health. Today some of the European countries like Germany, France, Switzerland, Belgium, Netherland as Well as Japan have a very successful health system with affordable health expenditure per capita and this system in BISMARCK MODEL named after German chancellor Otto von Bismarck which comprises of following traits-
- Insurance system (called sickness funds) funded jointly by employers and employees through payroll deduction.
- Privatization– Private health care sector, private doctors, private hospitals and private health insurance plans.
- Equal health care facilities for all– Insurance plans must cover everyone. Tight regulation of insurance which is often (but not always) sold on a non-profit basis.
- Decentralization– Prices for most procedures fixed by the district and state with tight government cost‐control.
Why Bismarck healthcare model for developing countries?-
- I think privatization in health care system can reduce widespread on-going corruption of government based health care system. Privatization can result in a diminution of corrupt practices by shifting the emphasis of an operation from an amorphous and opaque public sector to the transparent discipline of the private sector’s pursuit of profit. Let me give you example- 90% condom vending machines[10,990] installed at public places by the National Aids Control Organisation (NACO) for HIV/AIDS prevention have gone missing in India in September 2013 with loss of 11cores INR [1 Billion rupees]. This is just one example of many more examples to explain need of involvement of private sectors to fight against corruption in government based health systems.
- Decentralization i.e. Localization helps to break the monopoly of power at the national level by bringing decision making closer to people. Localization strengthens government accountability to citizens by involving citizens in monitoring government performance and demanding corrective actions. Localization as a means to make government responsive and accountable to people can help reduce corruption and improve service delivery.
- As “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care…” (Declaration of Human Rights (UDHR), article 25). Through insurance plans which cover everyone’s health in Bismarck model, equal health facilities can be achieved for poor’s as well as rich without any inequality.
Thus as BISMARCK which was one of the most powerful warships of world war 2, similarly Bismarck model of health care system will definitely be helpful to strengthen the health system of developing countries if implemented.