1.1 Different health care delivery models

We are here concerned with a very broad definition of the health care system that incorporates all the services and organizations which operate to improve health in a society or nation. The World Health Organization adopts a similarly broad definition of the health system but additionally recognizes that delivery of health care involves not only achieving a level of health which is as high as possible, but also that it involves achieving fairness in how that health is delivered.

“Health systems are defined as comprising all the organizations, institutions and resources that are devoted to producing health actions. A health action is defined as any effort, whether in personal health care, public health services or through intersectoral initiatives, whose primary purpose is to improve health”

(WHO, 2000)

 
It is impossible to entirely separate the health care system from other social structures in a society: levels of health are not determined solely by the operation of the health care system, but are also dependent on a mixture of environmental factors such as the quality of food supply, housing, civil security, education and overall standards of living. Resources and policy directed through the health care system will generally focus both on preventive medicine, for example health education and vaccination programmes, and on medical treatment through medical practitioners, health centres and hospitals of varying degrees of specialization. Different nations spend widely varying proportions of their total income on the health system and have very divergent models for how these systems are funded and accessed.

Globally, there has been a shift away from centrally-planned economies such as those of the former USSR and a move towards market-driven economies. Within many economies which have not undergone dramatic economic restructuring there has nevertheless been a shift towards greater individualism and self-responsibility, often characterised as patients becoming ‘consumers’ of health care services. For those with sufficient financial resources this often means an ability to purchase health insurance or to pay directly for health care services. This may allow access to additional services, greater choice or faster treatment than can be accessed under the centrally-provided service. For those without resources it can often mean reliance on relatively underfunded and marginalized ‘safety net’ health care systems. There are international dynamics at work also: the health care systems of the developed world increasingly recruit medical staff from the developing world who are willing to accept lower rewards within the better-resourced health care systems at the cost of increasing shortages of skilled medical staff within their home countries. The presentation below illustrates three national health care systems which display quite different combinations of funding sources and care providers.

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