Access, quality, and cost are essential components of a health care system. These three umbrella categories are collectively referred to as the three-legged stool of health care, because any changes in one area will inevitably affect the others. The challenge healthcare systems in the developed world face is striking that elusive balance where all three are strong enough to support optimal health. In reality, the healthcare system is perpetually imbalanced and policymakers are constantly over-correcting in the area that is the hot topic of the moment.
In this context, it is not surprising that most of these healthcare systems in Europe, Asia and the United States deal with the issue of financial sustainability. It is one thing to aim for universal coverage, to ensure that all people obtain the health services they need without suffering financial hardship when paying for them (WHO constitution of 1948), but to fulfil all requirements of a strong, efficient, well-run health system has appeared to be challenging for most countries. These features include a system for financing health services; access to essential medicines and technologies; and a sufficient capacity of well-trained, motivated health workers. (WHO constitution of 1948). Clearly, the latter two depend on the first.
To say that there is any system that is financially sustainable, European, Asian or U.S. would be to say that we had found the ideal healthcare system. If this were the case, policymakers around the world would not be struggling to design a system that would be optimal. Indeed, there are differences between health care systems and the way they are financed. This publication summarizes the differences in tax funded healthcare systems and social health insurance systems. It clarifies how culture and context define differences between healthcare systems around the world and the way they deal with an efficient allocation of financial resources, financial sustainability of the healthcare system and risk pooling. It concludes by looking at the question whether any successful healthcare system, or parts of it, can be exported to other parts of the world.
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