Healthcare is the maintenance or improvement of health through the prevention, diagnosis, and treatment of disease, injury, and other physical and mental impairments in humans. Healthcare is delivered by practitioners in allied health, dentistry, midwifery, medicine, nursing, optometry, pharmacy, psychology, and other health professions. It includes the work done in providing primary care services such as family planning; preventive medicine; outpatient services; home healthcare services; and day-to-day public health activities.
The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Healthcare systems are organizations established to meet the health needs of target populations within specific geographies. The delivery of modern healthcare depends on interdisciplinary teams of trained professionals and paraprofessionals coming together to provide a patient with optimum care. This article will focus on discussing different aspects of healthcare delivery around the world.
There are many different models of healthcare delivery that have been implemented globally. In some cases a single model predominates in an entire country or region (e.g., the United Kingdom’s National Health Service), while in others there is a mix of models (e.g., Germany). The commonest models are summarized below:
The Beveridge Model is based on access to free universal coverage for all citizens paid for out of general taxation revenue with no direct payment at the point-of-service required from patients (“free at the point-of-service”). This model originated in post-war Britain where it was designed to be applied universally regardless of ability to pay for medical care services (“cradle to grave” coverage). The key feature distinguishing this model from others is that it does not include private sector provision nor any form user fees/co-payments (“no fault” insurance).
Bismarck Model also known as sickness funds system which requires workers contribute towards their future medical costs through payroll deductions (“prepaid”). These funds are then used to reimburse workers when they incur medical expenses (“pay as you go” insurance). This system originated in 19th century Germany where it was designed so that only those who contributed would be eligible for benefits thereby creating an incentive for people stay employed (and contributing) even if they were sick – otherwise they would have to wait until they had recovered before resuming employment (and reentering the scheme) which could prove financially devastating particularly during periods of prolonged illness. The key feature distinguishing this model from others is that contributions are linked directly with employment making it a de facto form unemployment insurance as well since people who lose their jobs also lose their coverage (“employer mandate”). There are usually waiting periods before benefits commence ranging from a few days up to several months but once covered expenses incurred for treatments falling within scope should be reimbursed by fund irrespective whether person has returned to work or not(“first dollar” coverage).
Inpatient services provided either overnight or lasting more than 24 hours requiring admission into hospital(“acute care”). These services can be broadly divided into two categories: elective which covers nonemergency procedures scheduled in advance such as surgery; and nonelective which covers emergency procedures such as trauma resulting from accidents(“unplanned”) . Services may also be distinguished according preadmission stage(s) involved such as diagnostic testing prior to surgery(“outpatient”), during hospital stay(“inpatient”), after discharge back into community(“postacute care”), or followup visits arranged after initial consultation with GP but taking place outside usual surgeries opening hours often conducted by nurse instead(“extended hour clinics”). Elective Nonemergent/unscheduled/”walk-in” Preoperative/”outpatient”-testing & preparation Same day/”acute”-surgery & immediate postoperative period Inpatient-“recovery”-room & wards Postoperative/”postacute”-discharge & followup Afterhours clinic/”extended hour clinic”-nights & weekends