KeywordsHealthcare Developing countries Global inequalities
A good health system delivers quality services to all people, when and where they need them. The exact configuration of services varies from country to country, but in all cases requires a robust financing mechanism; a well-trained and adequately paid workforce; reliable information on which to base decisions and policies; well maintained facilities and logistics to deliver quality medicines and technologies. (WHO 2018)
“Organized health care systems that benefited the greater population barely existed a century ago” (Hill 2010a). Since the nineteenth century, three main healthcare system models have emerged: the single-payer system, the shared-responsibility system, and, the third model, the mostly privatized system (Hill 2010a). These models diverge from each other based on two criteria: financing and the scope of the recipients.
The United Kingdom or the Scandinavian countries use the single-payer model. The main feature of this system is that every citizen is entitled to free healthcare. Healthcare is solely financed and regulated by the state. The main disadvantage of this system is that long waiting lists are common. The Bismarckian or shared-responsibility model is used by the majority of the European countries. In one assessment: “Although this is a multi-payer model – Germany has about 240 different funds – tight regulation gives government much of the cost-control clout that the single-payer Beveridge Model provides” (Health Care Systems – Four Basic Models 2018). This could be considered the golden mean of healthcare due to its reliability and flexibility. Reliability refers to the strict and quality-seeking legal regulation and governmental control, while flexibility covers a wide range of private healthcare providers and state-provided healthcare services, which are “usually financed jointly by employers and employees through payroll deduction” (Health Care Systems – Four Basic Models 2018).
The last one, the private sector-dominated model, prevalent in the United States, is a debated solution, due to its territorial, social, and financial dividedness. As Hill points out, “That’s because the quality of health care in the United States’s patchwork system depends greatly on your income level and job situation” (Hill 2010b).
Health Systems of Industrialized Countries
The health system of a country is shaped not just by the abovementioned models but also by a triangle of participants: governmental institutions, private sector providers, and NGOs. In order to better understand the construction and operation of a specific system, the health policy formulation process should be considered.
The most influential regulatory body is the government. Its regulations govern the operation of healthcare units, workers’ protection laws, and even registration and the trade of intellectual properties and pharmaceutical products. There are systemic factors – political, economic, and social, both national and international – which may have an effect on health policy. There are many ways of categorizing such factors, but one useful way is suggested, for instance, by Leichter: thus one may speak of situational (e.g., war, epidemiology), structural (e.g., polity, economic system, or national wealth), cultural (religious beliefs or traditions), and international or exogenous factors (e.g., international agreements, terrorism) (Buse et al. 2005).
The object of a national health policy is the population of a given country. Since it is not homogenous, some groups of society could remain uncovered by the existing policies. The implementation of policy was traditionally solely the duty of the government – recently, however, this trend has changed, and more and more segments of healthcare provision are dominated by private companies, e.g., private ambulance, dentistry, or clinics. The more complex and expensive treatments, such as chemotherapy or transplantations, remain state-dominated areas.
NGOs play a versatile and significant role in all types of healthcare systems. NGOs could be national or international, strongly affecting the scope of their activities. National NGOs focus on regional difficulties and governance gaps. They look after poor, marginalized, minority, or otherwise vulnerable groups. They provide treatments, palliative care, or public health consultations for these disenfranchised groups. International NGOs, such as Médecins Sans Frontières (Doctors Without Borders, MSF) or the International Committee of the Red Cross (ICRC), work in conflict-ridden or developing areas of the world, where healthcare systems usually perform at a sub-optimal level. The spectrum of these NGOs’ activities is broader, in comparison to the national ones. Their main goal is to establish the foundation of a functioning healthcare system and to work on improving already existing systems. The work of these actors is overseen by supranational organizations, such as the WHO, the World Trade Organization (WTO), or the World Bank. These supranational organizations aim to establish global standards, which serve the improvement of global public health.
Health Systems of Developing Countries
“The health care systems of many developing countries emerged from colonial medical services that emphasized costly high-technology, urban-based, curative care” (Magnussen et al. 2004).When these countries became independent in the 1950s and 1960s, they inherited healthcare systems modeled after the systems in industrialized nations (Magnussen et al. 2004). In addition, these governments must exist in a world which is based on the western idea of nation and state, as well as a similar expectation of welfare services, even as its requirements, such as a prospering economy, a highly educated workforce, a homogenous society, and stable political institutions which may be lacking.
The social and financial tensions and the lack of appropriate infrastructure threaten the reliable operation of the healthcare system. Although the root cause of these circumstances varies from country to country, the outcome is similar, constant domestic turmoil, which leads to weak governments with fragile healthcare systems. The former colonies have always been sources of severe epidemics which, with the emergence of globalization, pose a serious threat to global health security. Therefore the industrialized nations launched healthcare interventions in these countries to eradicate such threats largely in the form of single-disease programs, but their endeavors were at least partly successful.
“In the 1960s and 1970s, it was the failure of single-disease programmes, such as those for malaria and yaws, and the lack of coordination between them that prompted countries to ask WHO for help in building their health services” (Alma-Ata 2008). In 1978, in the middle of the Cold War and in spite of the bipolar world order, a new era of global cooperation began with the Declaration of Alma-Ata on primary healthcare, which was adopted by 134 member states of the conference and 67 international organizations (Alma-Ata 2008). The aim of the declaration was to define the components of primary healthcare, which is the foundation of a well-functioning healthcare system, thus helping the developing countries establish good healthcare systems (Alma-Ata 1978).
These components, such as health education, nutrition, immunization, and prevention programs, are supported, at times established and provided, by international NGOs (e.g., in missionary hospitals) and the private sector (e.g., at private clinics) in developing countries.
The Ebola epidemic between 2014 and 2016 drew attention to another problem, the dearth of regional umbrella organizations. This scarcity sought to be tackled “with the establishment of Africa’s own CDC [reference to the U.S. Center for Disease Control and Prevention] in Addis Ababa, Ethiopia and another regional prevention center … in Abuja, Nigeria”; thus, “post-Ebola efforts to prepare for the next major outbreak appear to be gaining momentum” (Romaniuk et al. 2017). In the long run, these tendencies, with the combination of foreign contributions, could lead to the development of better and more sustainable healthcare systems, although some question the sustainability of dependence on external actors in the vital area of public health and raise concerns about how “NGO-ization” and related processes may weaken governance in the countries concerned.
Contemporary healthcare systems face new challenges in the digital revolution, terrorism, and global inequalities. The introduction of electronic health records administration in the industrial nations brings up a lot of questions, most notably data security issues. As a consequence, countries which have already introduced it, for instance, Switzerland, offer this as a voluntary option (De Pietro and Francetic 2017). Lack of education and gender inequality are major problems in both developing and developed countries.
In developed countries (but to some extent, and at an increasing rate, even in advanced countries), the proliferations of inappropriate information, such as delusions about the probability of the side effects of vaccines and certain modern medicines, are sources of difficulties. The vast illicit trade in counterfeit drugs and vaccines does not serve to increase public trust in this respect.
As a consequence of gender inequality in developing countries, women may be prohibited or discouraged from going to school, that is, even though the schooling of women can have a greater impact on the improvement of public health than the education of men, because educated women have fewer children and raise them in better and healthier conditions than their uneducated peers (Egger et al. 2018).
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