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Nephrol Dial Transplant (1999) 14: 3-9
© 1999 European Renal Association-European Dialysis and Transplant Association

Article

Healthcare systems—an international review: an overview

N. Lameire, P. Joffe1 and M. Wiedemann2

University Hospital, Gent, Belgium 1 Renal Division, Holbaek County Hospital, Holbaek, Denmark 2 Baxter Deutschland GmbH, Munich, Germany

Correspondence and offprint requests to: Correspondence and offprint requests to: N. Lameire, Renal Division, Department of Internal Medicine, University Hospital, 185, De Pintelaan, B-9000 Gent, Belgium.

Based on the source of their funding, three main models of healthcare can be distinguished. The first is the Beveridge model, which is based on taxation and has many public providers. The second is the Bismarck ‘mixed’ model, funded by a premium financed social insurance system and with a mixture of public and private providers. Finally, the ‘Private Insurance model’ is only in existence in the US. The present report explores the impact of these healthcare models on the access to, quality and cost of healthcare in selected European countries. Access is nearly 100% in countries with a public provider system, while in most of the ‘mixed’ countries, the difference from 100% is made up by supplementary private insurance. No differences are seen between public and mixed provider systems in terms of quality of care, despite the fact that the countries with the former model spend, in general, less of their Gross National Product on healthcare. The Private Insurance/private provider model of the US produces the highest costs, but is lowest in access and is close to lowest ranking in quality parameters.


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