Editing Health system (section)

==Financial resources==
{{See also|Single-payer health care|Universal health care|National health insurance}}

[[File:NorfolkAndNorwichUniversityHospital(KatyAppleton)Aug2005.jpg|thumb|upright=0.9|[[Norfolk and Norwich University Hospital]], a [[National Health Service]] hospital in the [[United Kingdom]]]]
There are generally five primary methods of funding health systems:<ref name="WHO2">[http://www.searo.who.int/EN/Section1243/Section1382/Section1731.htm "Regional Overview of Social Health Insurance in South-East Asia] {{webarchive|url=https://web.archive.org/web/20070224050244/http://www.searo.who.int/en/Section1243/Section1382/Section1731.htm|date=24 February 2007}}, [[World Health Organization]]. And [http://whqlibdoc.who.int/searo/2004/SEA_HSD_274_eng.pdf] {{Webarchive|url=https://web.archive.org/web/20120903195354/http://whqlibdoc.who.int/searo/2004/SEA_HSD_274_eng.pdf|date=3 September 2012}}. Retrieved 18 August 2006.</ref>

# general [[Tax|taxation]] to the state, county or municipality
# [[national health insurance]]
# voluntary or private [[health insurance]]
# [[Out-of-pocket expense|out-of-pocket payments]]
# [[donation]]s to [[Charitable organization|charities]]

{| class="wikitable"
|+Healthcare models
!
! colspan="2" |Universal
! colspan="2" |Non-universal
|-
!
![[Single-payer healthcare|Single payer]]
!Multi-payer
!Multi-payer
!No insurance
|-
![[Public hospital|Single provider]]
|[[Beveridge model|Beveridge Model]], [[Semashko model]]
|
|
|
|-
![[Private hospital|Multiple Providers]]
|[[National health insurance|National Health Insurance]]
|[[Bismarck model]]
|Private health insurance
|[[Out-of-pocket expense|Out-of-pocket]]
|}
Most countries' systems feature a mix of all five models. One study<ref>[[Sherry Glied|Glied, Sherry A.]] [http://papers.nber.org/papers/w13881 "Health Care Financing, Efficiency, and Equity."] {{Webarchive|url=https://web.archive.org/web/20120224220954/http://papers.nber.org/papers/w13881 |date=24 February 2012 }} ''National Bureau of Economic Research'', March 2008. Accessed 20 March 2008.</ref> based on data from the [[OECD]] concluded that all types of health care finance "are compatible with" an efficient health system. The study also found no relationship between financing and cost control.{{citation needed|date=June 2023}} Another study examining single payer and multi payer systems in OECD countries found that single payer systems have significantly less hospital beds per 100,000 people than in multi payer systems.<ref>{{cite web |last1=Bengali |first1=Shawn M |title=A COMPARISON OF HOSPITAL CAPACITIES BETWEEN SINGLE-PAYER AND MULTIPAYER HEALTHCARE SYSTEMS AMONG OECD NATIONS |url=https://repository.library.georgetown.edu/bitstream/handle/10822/1062290/Bengali_georgetown_0076M_14878.pdf?sequence=1&isAllowed=y |access-date=5 July 2024 |location=Washington, D.C. |date=April 13, 2021}}</ref>

The term health insurance is generally used to describe a form of [[insurance]] that pays for medical expenses. It is sometimes used more broadly to include insurance covering [[Disability insurance|disability]] or [[Long-term care insurance|long-term nursing or custodial care]] needs. It may be provided through a [[social insurance]] program, or from private insurance companies. It may be obtained on a group basis (e.g., by a firm to cover its employees) or purchased by individual consumers. In each case premiums or taxes protect the insured from high or unexpected health care expenses.{{citation needed|date=August 2022}}

Through the calculation of the comprehensive cost of healthcare expenditures, it becomes feasible to construct a standard financial framework, which may involve mechanisms like monthly premiums or annual taxes. This ensures the availability of funds to cover the healthcare benefits delineated in the insurance agreement. Typically, the administration of these benefits is overseen by a government agency, a nonprofit health fund, or a commercial corporation.<ref>[http://www.kff.org/insurance/upload/How-Private-Insurance-Works-A-Primer-Report.pdf How Private Insurance Works: A Primer] {{webarchive|url=https://web.archive.org/web/20081221100523/http://www.kff.org/insurance/upload/How-Private-Insurance-Works-A-Primer-Report.pdf |date=21 December 2008 }} by Gary Claxton, Institution for Health Care Research and Policy, Georgetown University, on behalf of the Henry J. Kaiser Family Foundation</ref>

Many commercial health insurers control their costs by restricting the benefits provided, by such means as [[deductible]]s, [[Copayment|copayments]], [[co-insurance]], policy exclusions, and total coverage limits. They will also severely restrict or refuse coverage of pre-existing conditions. Many government systems also have co-payment arrangements but express exclusions are rare or limited because of political pressure. The larger insurance systems may also negotiate fees with providers.{{citation needed|date=June 2023}}

Many forms of social insurance systems control their costs by using the bargaining power of the community they are intended to serve to control costs in the health care delivery system. They may attempt to do so by, for example, negotiating drug prices directly with pharmaceutical companies, negotiating standard fees with the medical profession, or reducing [[unnecessary health care]] costs. Social systems sometimes feature contributions related to earnings as part of a system to deliver [[universal health care]], which may or may not also involve the use of commercial and non-commercial insurers. Essentially the wealthier users pay proportionately more into the system to cover the needs of the poorer users who therefore contribute proportionately less. There are usually caps on the contributions of the wealthy and minimum payments that must be made by the insured (often in the form of a minimum contribution, similar to a deductible in commercial insurance models).{{citation needed|date=March 2024}}

In addition to these traditional health care financing methods, some lower income countries and development partners are also implementing non-traditional or [[innovative financing]] mechanisms for scaling up delivery and sustainability of health care,<ref>{{cite journal|last=Bloom|first=G|title=Markets, Information Asymmetry And Health Care: Towards New Social Contracts|journal=Social Science and Medicine|year=2008|volume=66|issue=10|pages=2076–2087|url=http://www.futurehealthsystems.org/publications/markets-information-asymmetry-and-health-care-towards-new-so.html|access-date=26 May 2012|doi=10.1016/j.socscimed.2008.01.034|pmid=18316147|display-authors=etal|archive-date=27 April 2021|archive-url=https://web.archive.org/web/20210427220501/http://www.futurehealthsystems.org/publications/markets-information-asymmetry-and-health-care-towards-new-so.html|url-status=dead}}</ref> such as micro-contributions, [[Public–private partnership|public-private partnerships]], and market-based [[financial transaction tax]]es. For example, as of June 2011, [[Unitaid]] had collected more than one billion dollars from 29 member countries, including several from Africa, through an air ticket solidarity levy to expand access to care and treatment for HIV/AIDS, tuberculosis and malaria in 94 countries.<ref name="UNITAID">UNITAID. [http://www.unitaid.eu/en/resources/news/347-republic-of-guinea-introduces-air-solidarity-levy-to-fight-aids-tb-and-malaria.html ''Republic of Guinea Introduces Air Solidarity Levy to Fight AIDS, TB and Malaria.''] {{webarchive|url=https://web.archive.org/web/20111112114051/http://www.unitaid.eu/en/resources/news/347-republic-of-guinea-introduces-air-solidarity-levy-to-fight-aids-tb-and-malaria.html |date=12 November 2011 }} Geneva, 30 June 2011. Accessed 5 July 2011.</ref>

===Payment models===
In most countries, [[wage]] costs for healthcare practitioners are estimated to represent between 65% and 80% of renewable health system expenditures.<ref>Saltman RB, Von Otter C. ''Implementing Planned Markets in Health Care: Balancing Social and Economic Responsibility''. Buckingham: Open University Press 1995.</ref><ref>{{cite journal | author = Kolehamainen-Aiken RL | year = 1997 | title = Decentralization and human resources: implications and impact | journal = Human Resources for Health Development | volume = 2 | issue = 1| pages = 1–14 }}</ref> There are three ways to pay medical practitioners: fee for service, capitation, and salary. There has been growing interest in blending elements of these systems.<ref name="docteur/oxley"/>

====Fee-for-service====
[[Fee-for-service]] arrangements pay [[general practitioner]]s (GPs) based on the service.<ref name="docteur/oxley"/> They are even more widely used for specialists working in [[ambulatory care]].<ref name="docteur/oxley"/>

There are two ways to set fee levels:<ref name="docteur/oxley">{{cite web|url=http://www.oecd.org/dataoecd/5/53/22364122.pdf|title=Health-Care Systems: Lessons from the Reform Experience|publisher=OECD|author1=Elizabeth Docteur|author2=Howard Oxley|year=2003|access-date=22 January 2009|archive-date=22 December 2015|archive-url=https://web.archive.org/web/20151222130354/http://www.oecd.org/dataoecd/5/53/22364122.pdf|url-status=live}}</ref>
* By individual practitioners.
* Central negotiations (as in Japan, Germany, Canada and in France) or hybrid model (such as in Australia, France's sector 2, and New Zealand) where GPs can charge extra fees on top of standardized patient reimbursement rates.

====Capitation====
In [[Capitation (healthcare)|capitation payment systems]], GPs are paid for each patient on their "list", usually with adjustments for factors such as age and gender.<ref name="docteur/oxley"/> According to OECD (Organization for Economic Co-operation and Development), "these systems are used in Italy (with some fees), in all four countries of the United Kingdom (with some fees and allowances for specific services), Austria (with fees for specific services), Denmark (one third of income with remainder fee for service), Ireland (since 1989), the Netherlands (fee-for-service for privately insured patients and public employees) and Sweden (from 1994). Capitation payments have become more frequent in "managed care" environments in the United States."<ref name="docteur/oxley"/>

According to OECD, "capitation systems allow funders to control the overall level of primary health expenditures, and the allocation of funding among GPs is determined by patient registrations". However, under this approach, GPs may register too many patients and under-serve them, select the better risks and refer on patients who could have been treated by the GP directly. Freedom of [[consumer choice]] over doctors, coupled with the principle of "money following the patient" may moderate some of these risks. Aside from selection, these problems are likely to be less marked than under salary-type arrangements.'{{citation needed|date=August 2022}}

====Salary arrangements====
In several OECD countries, general practitioners (GPs) are employed on ''[[salary|salaries]]'' for the government.<ref name="docteur/oxley"/> According to OECD, "Salary arrangements allow funders to control primary care costs directly; however, they may lead to under-provision of services (to ease workloads), excessive referrals to secondary providers and lack of attention to the preferences of patients."<ref name="docteur/oxley"/> There has been movement away from this system.<ref name="docteur/oxley"/>

====Value-based care====
In recent years, providers have been switching from fee-for-service payment models to a [[Pay for performance (healthcare)|value-based care]] payment system, where they are compensated for providing value to patients. In this system, providers are given incentives to close gaps in care and provide better quality care for patients.
<ref>{{Cite web |url=https://measuresmanager.com/blogs/articles/the-what-why-and-how-of-the-value-based-healthcare-model |title=What is Value-Based Care and How to Make the Transition - Measures Manager |access-date=13 May 2019 |archive-date=13 May 2019 |archive-url=https://web.archive.org/web/20190513153412/https://measuresmanager.com/blogs/articles/the-what-why-and-how-of-the-value-based-healthcare-model |url-status=dead }}</ref>