World Health Systems
Description
World Health Systems details different health systems, including their related health insurance and drug supply systems, in various parts of the world with both macro- and micro- perspectives. The book is arranged in five parts: the first part presents, from multidisciplinary perspectives, outlines of various health systems throughout the world, as well as current trends in the development and reform of world health systems. The second and third parts expound on the health systems in developed countries, discussing the government's role in the health service market and basic policies on medication administration and expenses, before analyzing the health systems of Britain, Canada, Australia, Sweden, Germany, France, Japan, Poland, USA, Singapore, Hongkong (China), and Taiwan (China).
The fourth and fifth parts discuss health systems in less developed countries and areas, typically the BRICS and other countries in Asia (Thailand, Vietnam, the Philippines, Armenia, and Kyrghyzstan), Africa (Egypt, Morocco), Europe (Hungary, Czech Republic, and Bulgaria) and South America (Cuba, Chile, and Mexico), summarizing their past experiences, while making assessments of their current efforts to shed light on future developments.
* Details a variety of health systems throughout the world
* Compares their fundamental features and characteristics
* Discusses their respective strengths and shortcomings
* Provides insight from an author who holds multiple impressive titles in the health sector
Public health professionals and academics alike will want to add World Health Systems to their library.
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XIAOMING SUN holds a PhD in Health Planning and Management from Keele University, UK. He was a Takemi Fellow at the Harvard School of Public Health, and Professor at Fudan University and Chief Physician at Zhongshan Hospital and the East Hospital, China. Dr. Sun has served as the Vice President of the Shanghai Medical Association, the Vice President of the Shanghai Medical Doctor Association, the Vice Chairman of the Chinese Medical Association General Practice Branch, and President of the Shanghai Community Health Association.
Content
Foreword xvii
Preface xxi
About the Book xxv
About the Author xxvii
Part I: Overview
Chapter 1: Theoretical Foundations for the Establishment of World Health Systems 3
Section I. Theories of Economic Development 3
1. Classical Political Economics 4
2. Welfare Economics 6
3. Keynesian Economics 9
4. Liberal Economics 10
5. Information and Institutional Economics 12
Section II. Theories of Public Goods 20
1. Concept and Characteristics of Public Goods 20
2. Classification Criteria of Public Goods 22
3. Theoretical Analysis of Public Goods 22
Section III. Theories of Social Equality 25
1. Concept of Equality in Classical Liberalism 25
2. Concept of Equality in Utilitarianism 25
3. Concept of Equality in Rawlsianism 26
4. Concept of Equality in the School of New Public Administration 26
5. Concept of Equality in Marxism 26
Section IV. Theories of Universal Health Coverage 27
1. Proposal of UHC Theory 27
2. Definition and Implications of UHC Theory 28
Section V. Theory of Performance Evaluation for World Health Systems 30
1. Definition of Concepts Related to Performance Evaluation 30
2. Model of Performance Evaluation for Health Systems 31
Chapter 2: World Socioeconomic Development and Health Status 33
Section I. World Socioeconomics and Population Aging 33
1. Economic Crisis and Transformational Development 33
2. Current Status and Trends of World Population Aging 35
3. Impact of Population Aging on Healthcare Costs 38
4. Strategies for Actively Coping with Population Aging 39
Section II. Global Health Status and Current Challenges 43
1. Update on the Concepts of Health 43
2. Comparison of World Health Statuses 47
3. Key Issues in Human Health 50
Section III. Proposing the Concept of Global Health and Its Development Trends 55
1. Definition and Evolution of Global Health 55
2. Research Areas Related to Global Health 56
3. Challenges and Opportunities Concerning Global Health 57
Section IV. Exploring the Integration of Healthcare and Prevention in Health Insurance 58
1. Gradual Transition from Disease Insurance to Health Insurance 58
2. Strengthening Health Education and Advocating Healthy Lifestyles 59
3. Promoting the Capitation System to Enhance Preventive Healthcare 60
Section V. Progress in Medical Technology and Its Impact on Healthcare Costs 61
1. Current Status of and Trends in the Development of Medical Technology 61
2. Impact of High-Tech Medicine on Healthcare Costs 62
Chapter 3: Health System Structure and Determinants of Health 65
Section I. Structure of Health Systems and Their Relationships 65
1. Goals and Boundaries of Health Systems 65
2. Medical and Health Resources 67
3. Organizations and Institutions 83
4. Economic Support 100
5. Health Management 103
6. Service Provision 111
Section II. Key Factors Influencing Health Systems 115
1. Economic Factors 116
2. Political Factors 117
3. Cultural Factors 121
Section III. Analysis of the Social Determinants of Health 125
1. Conceptual Framework of the Social Determinants of Health 126
2. Policy Values of the Social Determinants of Health 128
Chapter 4: Basic Models and Evaluation of World Health Systems 131
Section I. Two-Dimensional Classification of World Health Systems 131
1. Principal Models of International Health and Social Security Systems 131
2. Selection of System Models for Countries with Different Development Levels 133
Section II. System Model of the National Health Service 135
1. National Health Service and General Practitioner System 135
2. The Social Welfare Model of Nordic Countries 139
3. Main Policies and Features of Developing Countries 141
Section III. System Model of Social Health Insurance 144
1. National Health Insurance Systems of Germany and France 144
2. Health System and Insurance in Japan 146
3. Health System and Insurance in South Korea 148
4. Main Policies and Features of Developing Countries 149
Section IV. System Models of Commercial Health Insurance 153
1. Basic Characteristics of the Commercial Health Insurance Model in the US 153
2. Features and Existing Problems of the US Model 155
3. Private Health Insurance in Developing Countries 157
Section V. System Models of Savings-Type Health Insurance 159
1. Establishment of 3M System Policies 159
2. Basic Evaluation of the Singaporean Model 160
Section VI. Other Health Insurance System Models 161
1. Situations in Hong Kong, Macau, and Taiwan 161
2. The 30-Baht Universal Health Insurance Scheme in Thailand 164
Chapter 5: Social Medical Aid System and Its Analysis 169
Section I. Theoretical Foundations of Social Medical Aid Systems 169
1. Theory of Baseline Equality 169
2. Theory of Social Citizenship 170
3. Maslow's Hierarchy of Needs 171
4. Theory of Tertiary Distribution 172
Section II. Major Policies of Social Medical Aid Systems 172
1. Recipients of Medical Aid 172
2. Determining the Eligibility of Medical Aid Recipients 174
3. Methods of Medical Aid 175
4. Funding Sources for Medical Aid 176
5. Treatment Standards for Medical Aid 177
6. Provision of Medical Aid Services 178
Section III. Models and Features of Social Medical Aid Systems 179
1. Models of Social Medical Aid Systems in Developed Countries 179
2. Features of Social Medical Aid Systems in Developed Countries 181
3. Cost Containment for Social Medical Aid Systems in Developed Countries 182
4. Governmental Medical Aid Systems in Developing Countries 185
Chapter 6: Features and Trends of Reforms in World Health Systems 189
Section I. Features of Health System Reforms in Developed Countries and Areas 189
1. Common Features and Trends of Health Economic Policies in Developed Countries and Areas 189
2. Major Health Economic Reforms in Developed Countries and Areas 191
3. Exploration of Private Financing Initiatives 198
Section II. Features and Reform Trends of Health Systems in Developing Countries 201
1. Features and Reforms of Health Systems in Asian Countries 201
2. Features and Reforms of Health Systems in African Countries 204
3. Features and Reforms of Health Systems in European Countries 207
4. Features and Reforms of Health Systems in South American Countries 208
Part II: Characteristics of Health Systems in Developed Countries and Areas
Chapter 7: Overview of Health Systems in Developed Countries and Areas 213
Section I. Status of Health Investment in Developed Countries and Areas 213
Section II. Status of Health Services in Developed Countries and Areas 214
1. Equity in Health Outcomes 214
2. Accessibility of Healthcare Services 215
3. Differences in Health Service Utilization 217
4. Impact of Health Insurance on Health Services 217
Section III. Status of Health Insurance in Developed Countries and Areas 218
1. Health Insurance Systems for Different Income Groups 218
2. Responsibilities of the Government in the Health Insurance System 220
3. Functions of the Health Insurance System 221
Chapter 8: The Role of the Government in the Health Service Markets of Developed Countries and Areas 223
Section I. Healthcare Market Failures and Government Intervention 223
1. Basic Concepts of Healthcare Markets 223
2. Significance of Government Intervention in Healthcare Markets 223
3. Consequences of Government Nonintervention in Healthcare Markets 228
4. Goals and Policy Orientations of Government Intervention in Healthcare Markets 230
5. Failures and Rectifications of Government Intervention 234
Section II. Macro-Level Planning by Governments in Developed Countries and Areas to Strengthen Healthcare Institutions 237
1. Implementation of Regional Healthcare Planning 237
2. Government Intervention in the Formulation of Healthcare Service Contracts via Market Coordination Mechanisms 238
3. Vertical Integration of Healthcare Resources via Clusters 238
Section III. Government Regulation of Human Resources in Developed Countries and Areas 243
1. Regulating the Total Supply of Physicians Based on Healthcare Demand 243
2. Government Efforts and Outcomes in Improving the Regional Imbalances of Physician Supply and Demand 245
Section IV. Government Intervention in Drugs and the Control of Healthcare Quality in Developed Countries and Areas 247
1. Government Intervention in Drugs 247
2. Government Control of Healthcare Quality 248
Section V. Government Measures for Healthcare Cost Containment in Developed Countries and Areas 250
1. Managed Healthcare and Managed Competition 250
2. Hospital Global Budget System 252
3. Regulating the Provision of Elderly Healthcare Services 252
Section VI. Government Measures to Address Health Service Problems in Developed Countries and Areas 253
1. Measures to Address Long Waiting Lists for Inpatient and Outpatient Services 253
2. Introduction of the "Community Healthcare over Inpatient Treatment" Policy 255
3. Adjustments for Reasonable Compensation Policies 256
4. Improving Service Quality by Increasing the Number of Healthcare Workers 256
5. Regulatory Roles in Stabilizing National Healthcare Needs 257
6. Compensation Measures for the Inadequate Supply of Public Health and Basic Healthcare 258
Chapter 9: Basic Drug Administration Policies in Developed Countries and Areas 259
Section I. Government Policies Related to Drug Manufacturing in Developed Countries and Areas 259
1. Stage 1: Market Management and Legal System Improvements 259
2. Stage 2: Reduction of Drug Costs 260
3. Stage 3: Emphasis on Health Economic Benefits 261
Section II. Government Policies Related to Drug Marketing in Developed Countries and Areas 262
1. Price Control on Manufacturers 262
2. Policies for Distributors 265
3. Policies for Pharmacies (or Pharmacists) 265
4. Policies for Hospitals 266
Section III. Drug Reimbursement Policies in Developed Countries and Areas 267
1. Increasing Consumer Copayment of Drug Expenses 267
2. Encouraging Physicians to Prescribe Cheaper Drugs 267
3. Strict Control Over Manufacturers 269
Section IV. Policies for Essential Medicines in Developed Countries and Areas 270
1. Conceptual Development and Impact of Essential Medicines 270
2. Selection and Utilization of Essential Medicines in Developed Countries and Areas 272
Section V. Separation of Prescribing and Dispensing Policies and Relevant Insights in Developed Countries and Areas 275
1. Conceptual Definition of the Separation of Prescribing and Dispensing 275
2. Rationale and Policy Implementation of the Separation of Prescribing and Dispensing in Western Developed Countries 276
3. Reforms and Evaluation of the Separation of Prescribing and Dispensing in Asian Developed Countries and Areas 280
4. Value of and Insights for the Separation of Prescribing and Dispensing in China 284
Chapter 10: Models and Policies of Healthcare Cost Containment in Developed Countries and Areas 287
Section I. Background of Healthcare Cost Containment in Developed Countries and Areas 287
1. Changes in Healthcare Costs in Developed Countries and Areas 287
2. Causes of the Rapid Growth of Healthcare Costs 288
3. Three Stages in the Economic Model of Health Service Development 290
Section II. Main Measures of Healthcare Cost Containment in Developed Countries and Areas 292
1. Strict Control over the Allocation of Large Medical Equipment 292
2. Establishing Healthcare Cost-Sharing Mechanisms 293
3. Strengthening the Management of Healthcare Services 293
4. Implementing a Global Budget System 294
Section III. Comparison of Models for Healthcare Cost Containment in Developed Countries and Areas 295
1. Five Models of Healthcare Cost Containment 295
2. Comparison of Models for Healthcare Cost Containment and Conclusions 297
Section IV. Policies of Healthcare Cost Containment and Their Trends in Developed Countries and Areas 298
1. Policies of Healthcare Cost Containment in Developed Countries and Areas 298
2. Future Trends and Directions 299
Part III: Health Systems in Developed Countries and Areas
Chapter 11: National Health Service Systems of Representative Countries 305
Section I. The Health System in the United Kingdom 305
1. Establishment of the National Health Service 307
2. Developments and Changes in the NHS Management System 309
3. NHS Funding 314
4. Community Health Services 316
5. Hospital Services 324
6. Other Healthcare Services 327
7. Settlement of Medical Disputes 329
8. NHS Reforms and Future Policies 334
Section II. The Health System in Canada 338
1. Establishment and Development of the Health System 339
2. Healthcare Providers 345
3. Current Status and Future Trends in Health Insurance 349
4. Management of Health Insurance 357
5. Trends in Healthcare Expenditure and Containment Policies 362
Section III. The Health System in Australia 369
1. National Health Status and Current Challenges 370
2. Health Service System 374
3. Universal Health Insurance System 385
4. Commercial Health Insurance 392
5. Reforms in Healthcare Services and Payment Systems 396
6. Plans for a New Round of Healthcare Reforms 399
Section IV. The Health System in Sweden 405
1. Healthcare Provision System 406
2. Health Insurance System 410
3. Formulation and Value Orientation of Health Policies 414
4. Healthcare Cost-Containment Policies 416
5. Difficulties in the Healthcare System and Reform Attempts 419
6. The Path of Swedish Health System Reforms in the Twenty-First Century 429
Chapter 12: Social Health Insurance Systems of Representative Countries 431
Section I. The Health System in Germany 431
1. Health Service System 432
2. Health Insurance System 445
3. Health Insurance Operations 447
4. Current Status and Future Trends of Health Insurance Policy 453
5. Health Reforms in the Twenty-First Century 458
6. Health Insurance System Reforms by the Grand Coalition Government 460
Section II. The Health System in France 462
1. Health Service System 462
2. Healthcare Practitioners and Mobility 471
3. Health System Reforms 476
4. Health Insurance System 478
5. Health Insurance Issues and Reforms 496
6. Healthcare Cost-Containment Policies 501
Section III. The Health System in Japan 507
1. Health System 510
2. Health System Issues and Reforms 517
3. Health Insurance System 522
4. Framework of the Long-Term Care Insurance System 532
5. Healthcare Cost-Containment Policies 535
Section IV. The Health System in Poland 540
1. Overview of Socioeconomic Development 540
2. Health Service System 543
3. Health Insurance System 557
4. Reforms to the Health System and Social Security Planning 566
Chapter 13: Commercial Health Insurance and Medical
Savings Account Systems of Representative Countries 569
Section I. The Commercial Health Insurance System in the United States 569
1. Healthcare Institutions 570
2. Healthcare Workforce 575
3. Health Insurance System 578
4. Medicare 581
5. Medicaid for Low-Income Earners 597
6. Healthcare Cost-containment Policies 607
7. Plan and Progress of Obamacare 615
Section II. The Medical Savings Account System in Singapore 620
1. Healthcare System 620
2. Reforms of the Public Hospital System 636
3. Health Security and Health Insurance 643
4. Healthcare Funding Policies 651
5. Healthcare Cost-Containment Mechanisms 660
Chapter 14: Improved Health Systems in Hong Kong and Taiwan 665
Section I. The Health System in Hong Kong 665
1. Health System 667
2. Reforms in Public Hospital Management 674
3. New Development Ideas of the Hospital Authority 678
4. Health Security System 681
5. Hong Kong's Health System Reforms in the Twenty-First Century 687
Section II. The Health System in Taiwan 690
1. Overview and Features of the Health System 690
2. National Health Insurance (NHI) 694
3. Point-for-Service Global Budget Payment System 706
4. Drug Administration System 709
5. Challenges Facing the Health System in Taiwan 712
Part IV: Characteristics of Health Systems in Developing Countries
Chapter 15: Definition of Developing Countries and Challenges in Health Systems 717
Section I. Definition and Structural Formation of Developing Countries 717
1. Concept and Definition of Developing Countries 717
2. Social Formation and Structure of Developing Countries 719
3. Proposal of Representative Countries and Its Implications 721
Section II. Health Systems and Health Statuses of Developing Countries 722
1. Exploration of Universal Health Security Systems 722
2. Transition of Health Statuses in Developing Countries 723
Section III. Challenges of Health Systems in Developing Countries 726
1. Inadequacies in Overall Health Resources 726
2. Poor Implementation of Health System Reforms 726
3. Uneven Distribution of Health Statuses and Human Resources 727
4. Low Willingness to Invest in Adult Healthcare 727
5. Low Input into Health Research 728
6. Overdependence on Aid May Weaken the Government's Sense of Responsibility Toward National Health 728
Chapter 16: Comparison of Healthcare and Social Security Systems in BRICS Countries 729
Section I. Comparison of Socioeconomics and Health Resources in BRICS Countries 729
1. Origin of BRICS Countries 729
2. Health Resources of BRICS Countries 730
Section II. Comparison of Health Insurance Systems in BRICS Countries 732
1. Establishment of Universal Healthcare Security Systems 732
2. Encouraging the Development of Private Healthcare Institutions and Commercial Health Insurance 734
3. Emphasis on the Construction of Primary Healthcare Services 735
Section III. Comparison of Health Systems in BRICS Countries 737
1. From Models of Centralized Government Management to Commercial Fund Management 737
2. "Super-Ministry System" Bureaucratic Management 738
3. Multipronged Management 739
Section IV. Performance Evaluation of Health Systems in BRICS Countries 740
1. Differences in Health System Reforms 740
2. Comparison of Health System Performances 746
Chapter 17: Insights from Health System Reforms in Developing Countries 747
Section I. Common Challenges in the Development of Health Systems 747
1. Limited Funding Sources and Insufficient Investment 747
2. Imbalances in Regional and Vertical Resource Allocation 747
3. Lack of Incentive and Restraint Mechanisms in Public Healthcare Institutions 748
4. Lagging in the Funding and Payment of Health Insurance 748
5. Ineffective Use of Health Insurance Funds 750
6. Inadequate Efficiency and Capacity of Health Insurance Management 750
Section II. Key Issues Facing the Health System in China 751
1. Equality - The Coexistence of Wastage and Shortage of Healthcare Resources 751
2. Accessibility - Deviations in Service Focus and Technology Orientation 752
3. Coordination - The Decentralization and Fragmentation of Different Healthcare Resources 752
4. Marginalized Groups and Blind Spots in Social Insurance Coverage 753
5. Increased Healthcare Demand and Inadequate Health Security 753
6. Flaws in Management Capacity and Institutional Design 754
Section III. Experiences and Insights from Health System Reforms in Developing Countries 757
1. System Planning - Optimized Integration of Health Resource Allocation 757
2. Primary Care - Fully Utilizing the Role of Family Physicians 757
3. Nongovernmental Healthcare Institutions - Guiding the Development of Private Healthcare Institutions 758
4. Policy Orientation - Emphasis on Equality and Supporting Vulnerable Groups 759
5. System Design - Payment System Reforms and Fund Supervision 760
6. Sustainable Funding - Advocating a Multichannel Model of Increasing Revenue and Reducing Expenditure 761
Part V: Health Systems in Developing Countries
Chapter 18: Health Systems in Seven Asian Countries 765
Section I. The Health System in China 765
1. Overview of Socioeconomics and National Health 765
2. Healthcare System 767
3. Health Security System 773
4. Progress of Health System Reforms 788
Section II. The Health System in India 794
1. Overview of Socioeconomics and National Health 794
2. Healthcare Organizations and Regulatory Systems 796
3. Healthcare Funding and Payment Systems 801
4. Health System Reforms 816
5. Outcomes, Characteristics, and Challenges 818
Section III. The Health System in Thailand 819
1. Overview of Socioeconomics and National Health 819
2. Healthcare System 820
3. Health Insurance System 822
4. Health System Reforms and Evaluation 824
Section IV. The Health System in Vietnam 831
1. Overview of Socioeconomics and National Health 831
2. Healthcare System 832
3. Health Insurance System 834
4. Health System Reforms and Evaluation 836
Section V. Health System in the Philippines 846
1. Overview of Socioeconomics and National Health 846
2. Healthcare System 847
3. Health Security System 850
4. Issues and Development Trends in Health System Reforms 860
Section VI. The Health System in Armenia 864
1. Overview of Socioeconomics and National Health 864
2. Healthcare System 865
3. Healthcare Funding 869
4. Health System Reforms 871
Section VII. The Health System in Kyrgyzstan 874
1. Overview of Socioeconomics and National Health 874
2. Healthcare System 875
3. Healthcare Funding and Expenditure 878
4. Health System Reforms 882
Chapter 19: Health Systems in Three African Countries 889
Section I. The Health System in South Africa 889
1. Overview of Socioeconomics and National Health 889
2. Healthcare System 892
3. Health Security System 893
4. Status of Healthcare Funding 896
5. Health System Reforms 898
Section II. The Health System in Egypt 904
1. Overview of Socioeconomics and National Health 904
2. Healthcare System and Structure 904
3. Health System Reforms and Prospects 905
Section III. The Health System in Morocco 908
1. Overview of Socioeconomics and National Health 908
2. Healthcare System 908
3. Difficulties in Health Industry Development 910
Chapter 20: Health Systems in Four Selected European Countries 913
Section I. The Health System in Russia 913
1. Overview of Socioeconomics and National Health 913
2. Healthcare System 914
3. Health Insurance System 918
4. Healthcare Funding System and Financial Allocation 936
5. Health System Reforms 948
Section II. The Health System in Hungary 951
1. Overview of Socioeconomics and National Health 951
2. Healthcare System 952
3. Reform Changes and Characteristics of the Healthcare System 960
4. Existing Issues and Development Trends in the Healthcare System 962
Section III. The Health System in the Czech Republic 965
1. Overview of Socioeconomics and National Health 965
2. Healthcare Organizations and the Regulatory System 966
3. Healthcare Funding and Universal Social Health Insurance 969
4. Trends in Health System Reforms 977
Section IV. The Health System in Bulgaria 981
1. Overview of Socioeconomics and National Health 981
2. Healthcare System 983
3. Healthcare Resource Allocation 991
4. Healthcare Funding Mechanism 994
5. Characteristics and Direction of Health System Reforms 997
Chapter 21: Health Systems in Four American Countries 1001
Section I. The Health System in Brazil 1001
1. Overview of Socioeconomics and National Health 1001
2. Healthcare System 1004
3. Status of Rural and Primary Healthcare 1008
4. Health Insurance System and Financing 1010
5. Challenges and Reforms 1012
Section II. The Health System in Cuba 1015
1. Overview of Socioeconomics and National Health 1015
2. Establishment and Development of the Health System 1016
3. Healthcare Delivery and Regulatory Systems 1019
4. Healthcare Funding System 1031
5. Healthcare Development and Reform Experiences 1033
Section III. The Health System in Chile 1039
1. Overview of Socioeconomics and National Health 1039
2. Healthcare System 1040
3. Analysis of the Health Insurance System 1046
4. Evaluation and Summary of the Health System 1049
Section IV. The Health System in Mexico 1053
1. Overview of Socioeconomics and National Health 1053
2. Historical Evolution of the Health System 1054
3. Healthcare Organizations and Service System 1059
4. Health Security Financing and Allocation Mechanism 1062
Afterword 1069
Bibliography 1071
Index 1099
Foreword
With the advent of the third healthcare revolution and its gradual inclusion in government agendas, the World Health Report 2013 proposed a key issue of our time, namely, universal health coverage (UHC). The goal of UHC is to provide all people with access to necessary and affordable health services. UHC aims to reduce the inequalities in health coverage within an entire country or area and is a key component in sustainable development and poverty reduction.
As a basic socioeconomic system, a health system is intricately linked with the social, political, and economic development and policies of a specific period in time. It is clear that China is currently in a crucial transitional period of refining a socialist market economy that is operating within the context of rapid industrialization and urbanization. Hence, healthcare reforms in China still face three challenges when resolving the issues of limited access and high costs: First, there is a gap between the high demand for healthcare by the public and the limited capacity of the state. Second, there is a discrepancy between the public's medical needs and the supply of health services. Third, there is a conflict between the satisfaction of medical staff and the satisfaction of the public. A new solution for effectively resolving these differences is to strengthen governance at the source and enhance system construction. By changing the models of healthcare services and health-seeking behaviors, a health system can place greater emphasis on disease prevention and truly shift from a disease-centered model to a health-centered model. This shift, in turn, will enable the health system to achieve the original goal and ultimate target of providing higher-quality healthcare to the population.
There are inherent logical relationships between the healthcare and social security systems of a country and its political system, economic level, traditional history and culture, and other "native" factors. Nevertheless, the global issues encountered by China in healthcare reforms may have also occurred at some stage in certain developed countries or may currently exist in different forms or to different extents in certain developing countries that are also in transition. For example, these issues may involve the relationship between economic development and investment in healthcare, the balanced distribution of health resources, or the establishment of an orderly hierarchical medical system. Tackling these issues will require us to study and understand the recurring patterns in the development of medical and health services and social security systems from a global perspective. We should also draw extensively from the positive experiences of countries at different levels of development and incorporate these experiences within the real-life conditions of China and Shanghai.
This book starts from a multidisciplinary standpoint and provides a comprehensive explanation of the structures of health systems and the determinants of health. This book also summarizes the basic models and selection of world health systems and systematically compares the characteristics of health system models, development processes, reform measures, and performance evaluations of 12 representative developed countries and 18 representative developing countries. In addition, the book summarizes the common characteristics, experiences, insights, and developmental trends of health system reforms in countries with different levels of development in order to reflect on how these countries have overcome the universal challenges that all countries face. Clearly, this discussion is extremely insightful for our current journey as we explore the improvement of new healthcare reforms in China.
Here, three specific questions at different levels, which readers can discuss and explore, may be raised.
The first question is at the macro level: How can effective institutional arrangements between the government and the market be achieved in the field of healthcare? The world does not currently have an answer to this question. This issue is especially sensitive for China, which is now in a key period of transformation, so the slightest mistake in this regard may affect the progress of socioeconomic transition across the entire country. Among developed countries, the National Health Service in the UK emphasizes planned interventions, whereas the US has implemented a commercial health insurance system that focuses on market regulation. Among the BRICS countries (Brazil, Russia, India, China, and South Africa), the systems in China and Brazil are mainly based on the state's macroeconomic control, which is subject to moderate market regulation; India and South Africa primarily rely on the spontaneous regulation of the market; and Russia depends on the joint forces of market incentives and state regulation. However, there are substantial differences in the improvement of health performance among the BRICS countries, and these differences are not significantly associated with national income levels. On the surface, no two countries share the same health system. However, further investigation reveals that it is still possible to classify these systems and to identify the patterns resulting from their institutional development. The formation of these systems is generally closely related to two factors. The first is the country's level of economic development, and the second is the country's choice of political system. Does the country prioritize market competition to improve the efficiency of healthcare services, or does it prioritize balanced planning to improve the equality of healthcare services? Each country has to choose the emphasis on and extent of these two priorities. If we take the level of economic development as the vertical axis and the degree of marketization and planning in the health system as the horizontal axis, each country will find its own position within this coordinate system. This book aims to classify and explain these patterns by comparing the different health systems of different countries.
Are China's healthcare reforms currently experiencing over- or undermarketization? I believe that both aspects are present. Overmarketization is manifested in the imperfect compensation mechanisms of public hospitals, operational chaos in drug production, and artificially high drug prices, which have led to issues of fairness. Undermarketization is manifested in the inability to reflect the value of labor and technology, barriers to institutional approval, and staff turnover, which may result in lower service efficiency. With regard to basic medical and health services guaranteed by the new healthcare reforms, government leadership should continue to be strengthened for public and quasi-public goods, with simultaneous efforts to resolve internal market failures and inadequacies. For the development of the health service industry, such as private healthcare institutions and high-end medical services, commercial health insurance, biomedicine, and information technology, China should rely more heavily on interventions by the invisible hand of the market to meet public demand for these diversified health services.
The second question is at the meso level: What direction should be taken in the development of administrative systems for health services and health security? In the early twenty-first century, the social and health insurance systems of Japan, Germany, and other countries combined the functions of healthcare and social security, which facilitated the centralization and coordination of health service provision, health insurance, and supervision by the government. Among developing BRICS countries, India has established an integrated health administrative system based on its national conditions (i.e., the Ministry of Health and Family Welfare), and Brazil has also established an administrative system that brings together healthcare, health insurance, and pharmaceuticals under the Ministry of Health. China's health management and health security are currently in a fragmented state. For instance, health insurance is scattered among a number of departments, including the National Health and Family Planning Commission, the People's Insurance Company of China, the Food and Drug Administration, and the Ministry of Civil Affairs, and this fragmentation can easily lead to divided policies and the waste of resources. The relevant departments are more inclined to promote isolated reforms from the perspective of localized interests. Hence, they may fail to integrate effectively into a continuous and coordinated system that is centered on patients' health, which is not beneficial to the efficiency and quality of the overall health system. If China can take advantage of this tide of comprehensive and deepened reforms, discard the obstacles of entrenched interests, and achieve breakthroughs in the organization of the medical and healthcare management systems, then, within the context of a large-department system, will China be able to reap more benefits in the promotion of synergistic and joint reforms in the fields of healthcare, health insurance, and medicine?
The third question is at the micro level: Can the more mature family physician and hierarchical medical system of developed countries be applied to developing countries, and can it be embedded within China's system of health and medical services? Although the family physician system originated in Europe, the US, and other developed countries, it is not exclusive to developed countries. For example, in Latin America, the Cuban government began implementing the family physician system in urban and rural areas in 1984 and promoted the system nationwide...
