BEVERIDGE MODEL: THE BEST HEALTH CARE MODEL
University of California San Diego
Health is the most important and necessary aspect of anyones life. So, Maintaining and improving population health should also be an important aspect of a country’s policies to survive and succeed. For this, to work there is a necessity for health care to be organized. But less than 40 countries in the world have organized health care system. And even in the countries that have organized health care, there are a lot of issues in regards to quality, coverage, cost, and choice which are the important factors to evaluate any countries health care system. There are different health care models around which countries built their health care systems. They are Bismarck, Beveridge, National health insurance model and Out of pocket model. The best model is the one that gives universal coverage which is safe, effective, affordable with better outcomes and can be accessed at the right time. There is no denying the fact that there is an increasing social gap between rich and poor around the world and with this increase in the social gap, the poor cannot afford health care and the middle class find it difficult to afford and the rich are the only ones who could afford. Almost all the constitutions mention right to dignity but, how can a person enjoy dignity when he cannot afford health care and get treated. The countries that built their healthcare systems around models like Bismarck, Beveridge, national health insurance models tried to bridge this gap. Every country as room for development. But in my opinion, the model that can best bridge this gap and can maintain balance among all the necessary factors and will be able to sustain is the Beveridge model. The countries that built their health care system based on Beveridge are Great Britain, Italy, Spain, New Zealand, Norway, Sweden, Denmark, Finland, Brazil, and Cuba. Cuba & USAs VA for the military is the purest form of the Beveridge model. But the UK has implemented it in the best way. In the following paragraphs, I would delve deeper into each factor and use UK majorly as an example to explain how Beveridge based health policies and methods make them better than the other countries that are built on other models.
History and background
Beveridge model was named after its architect Lord William Beveridge who was an aristocratic social reformer. As a child Beveridge group in mansions and had a high-class life with all the luxuries a man could get. During his university years at Oxford, he explored a couple of professional studies like clergy, civil services, law, all of which didnt interest him. When an Oxford don suggested him to look into the mystery of poverty, he took a job at the charity house in the slums of east London. It was there where he witnessed misery and deaths of millions of poor people who do not have access to health care, food, employment, shelter. He realized that there was nothing those people can do about it and that there was the need to bring change in how the system works. He then started championing for the poor by writing revolutionary ideas in the newspaper columns to help the unfortunate. That is when he made the most revolutionary proposal: A national health service for prevention and comprehensive treatment for all (Harris). In the year 1942, he published a report on Social insurance and allied services. The report proposed to unite all the different assistance programs, health care insurances and payment under one roof and administer it in a uniform system. The report was a sensational success that laid the foundations for the modern British welfare state. Nye Bevan, the man who was born into poverty and fought his way up to parliament was responsible for making Beveridges report into reality by implementing British national health services the worlds first tax-funded health care system which is free at the point of service
Organization, Cost and Financing
In the Beveridge model of health care, the government provides and finances health care through tax payments. For example, In Britain NHS is financed majorly by general taxes and a very small amount by payroll taxes. NHS also receives income from copayments and patients using NHS as private services (commonwealthfund). In Sweden too it is financed through taxes by regional governments and municipalities. Whereas in Italy, corporate tax is earmarked for health care services. The health care expenditures of the countries that are inspired by the Beveridge model are comparatively less to that of countries that are inspired by other models (U.K – 9.9%, Italy- 9.1%, Japan- 11%, France 12%) (David U. Himmelstein, 2014). By having single-payer and no medical bills, countries can also save on administrative costs which are in a few countries a very high burden where health care financing is very complex. As in the USA, the administrative cost for the health care systems alone is 1.5% of GDP (Emily Gee, 2019). Along with Government-funded health care, there is private health insurance. These private insurances are for people who want to jump up que to get faster service and also for the services that the government doesnt cover but it counts only for 10% for the population (T.R.Reid, 2010). Co-payments are very limited for the publicly covered services and are asked for services like health check-ups for employment, insurance, and travel. Co-payments are also made for Dental services & outpatient drugs but drugs prescribed in NHS are free. When it comes to payments to the doctors, governments negotiate with the doctors association to pay them in a mixture of capitation rate for essential service, additional services like vaccinations, and performance-based incentives. Capitation rates are adjusted based on age, gender, morbidity and mortality of the locality, staff costs, number of patients registered with the practitioner, number of hospitalized patients. Specialists are usually salaried government employees paid depending on their branch of specialty. Cost controlling in these countries is usually done by setting the fixed global budget that does not exceed, rather than increasing cost-sharing or decreasing the supply which sometimes happens in insurance-based models. NHS closely monitors all the spending, so that they can control it beforehand and take actions. They also freeze pay increases for practitioners, supportS generic drugs. Cost for branded drugs is controlled by placing a profit cap on the pharmaceutical companies that sell new drugs to NHS and also suggest doctors use these drugs by evaluating the cost-effectiveness of these drugs with the help of NICE
While the Bismarck countries Health coverage is a right associated with labor status, the Beveridge models is Right to health care regardless of age, gender, employment, rich or poor, or any preexisting disease conditions. In this model, countries have Universal and automatic coverage. Sweden has made universal health care possible by making Three basic principles that apply to all citizens in Sweden: Human dignity, Need & solidarity and finally cost-effectiveness (commonwealthfund). The services that are actually covered are not defined but in practice, they cover almost all the services. For instance, the British NHS pays for preventive services (screening, immunizations, and vaccinations) inpatient & outpatient hospital care and drugs, necessary dental care, some eye care and long-term care, community nurses, rehabilitation (fund).NHS has another office called the National Institute for health and clinical excellence (NICE) which provides evidence-based guidance and advice for public health and social practices. And when it comes to copayments done by patients or few services not offered in NHS, like few dental procedures, eye care exceptions are given. And these exceptions are for children under age 18, people with less income, aged over 60, pregnant women & women who have given birth 12 months prior, cancer patients, disabled, some long-term conditions. And it is also made easy for those who dont come under these exceptions by creating safety nets. For instance, people who need large amounts of prescription drugs can buy affordable prepayment certificates for 3 months and 12 months which costs around $42 and $150 respectively (commonwealthfund). Patients need not pay any extra money for drugs for the duration of the certificate. Even the transportation charges are covered for low-income people. In this way, Britains health care takes full responsibility to provide citizens healthcare and covers the health care of all their citizens with equity allowing co-payment done only to few services and by only people who can afford it. This kind of system doesnt allow people to go bankrupt due to out of pocket costs or delay hospital visits that may lead to complications or death, or get services denied, which happens in the USA or other countries where people cannot pay their insurance, do not have employment, make co-payments are made for many number of services.
Governments and people around the world spend a lot of money on health care but are they getting quality health care? Lack of quality health care increases the burden of illness and costs. Quality is the most important factor that needs to be addressed. Its not just whether all people are covered in health care but whether if there is universal coverage with quality. There are different factors that determine the level of quality in health care like care process, access, efficiency of administration, equity, health outcomes. Beveridge model addresses the Care process by giving preference to preventive care, coordinated care, engagement care. In England, NHS provides high incentives for the practitioners who make evidence-based decisions and care coordination for patients with chronic illness. People can visit their providers anytime they want. As it is free treatment at the point of service in this model, patients dont have to worry about the money or their insurance and this ensures access to health care with affordability and timeliness which improves the avoidable mortality rate. Tax-funded systems are very transparent, that they dont provide any room for biased decisions that usually happen in a profit-based insurance system. For instance, NHS in England as strong support from the public because of its transparency and it makes the system efficient. To ensure quality NHS makes it mandatory for practitioners to register with their office and sets quality standards. when concerns are raised, they investigate the situation, rate hospital inspection results, national patient experience and takes actions where it is necessary. Innovation ensures that care gets better over time which is important for quality improvement. To improve innovation NHS conducts surveys and collects data and finds out the challenges they are facing and make strategies to address them. Like the implementation of the pilot programs called vanguards to test new models of health care.NHS provides high-quality care by covering all quality parameters and outdoes every country in the world in terms of quality (Karen Davis, 2014)
Primary care delivery is mainly provided through general practitioners they are the gatekeepers for secondary care. People have the choice to choose their general practitioner and register with them, Unlike the USA where citizens are not given the choice to select their doctors but rather decided by the insurance providers, who give them limited options for general practitioner visits, drugs, and inpatient facility. If by chance the practitioner’s list is full, NHS has opened walk-in centers for primary services in few places for which registration is not required. Filling every small gap in the system is what makes NHS the best.
Although there is a lot of room for improvement in Beveridge, the development is not impossible. We need more innovative ideas or policies to overcome these issues. Like Earmarking taxes to fund NHS to spending fluctuations and waiting time by recruiting more health care providers and improving management capability towards patient-centered treatment and not at the convenience of the producers.
Universal health care is an important issue which every country has to address. United Nations has addressed this in sustainable development goals for the members to commit to achieving universal health care by 2030 (UNDP, 2015). Countries that are looking for providing universal health care to their citizens can draw inspiration from the UKs NHS. NHS balances and maintains all the necessary factors like cost, coverage, quality, choice and moves forward in a sustainable way. The system’s effectiveness is reflected by the amount of public support it receives in England.
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UNDP. (2015). What are sustainable goals ?