Considering Entrepreneurial Mandated Insurance And National

Considering Entrepreneurial Mandated Insurance And National Health S

Considering entrepreneurial, mandated insurance, and national health service models: a. Which model do you think results in the greatest equity of access to health services? Why? b. Which model is most likely to deliver the highest-quality care? c. Which is the best model? Would this model work in the United States or your own country of origin (if not the US)? Why or why not? Text Book: Fried, BJ and Gaydos, LM. (2012). World Health Systems: Challenges & Perspectives (2nd Ed.). ISBN:

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The comparison of different healthcare system models—entrepreneurial, mandated insurance, and national health service—raises important questions about equity of access, quality of care, and suitability within specific national contexts. Each model embodies distinctive principles and mechanisms that influence health outcomes, efficiency, and fairness. Analyzing these models through academic and pragmatic lenses reveals their strengths and limitations, especially concerning societal health equity and the feasibility of implementation.

Greatest Equity of Access to Health Services: Among the three models, the national health service (NHS) is typically regarded as providing the greatest equity of access. This model, exemplified by systems in the United Kingdom and Scandinavian countries, is primarily funded through taxation, ensuring that health services are universally available regardless of socioeconomic status. Because services are largely free at the point of delivery, barriers such as affordability are substantially reduced. In contrast, entrepreneurial and mandated insurance models often involve cost-sharing mechanisms—premiums, copayments, or deductibles—that can limit access for disadvantaged populations. These financial barriers tend to disproportionately impact low-income groups, thereby reducing overall equity. Empirical studies, such as Holland et al. (2011), have shown that universal, publicly funded systems maximize equitable access by emphasizing health as a right rather than a commodity.

Highest-Quality Care: While the NHS excels in equity, the model most likely to deliver the highest-quality care often resides within entrepreneurial or mandated insurance systems, especially in contexts like the United States. The entrepreneurial model, characterized by competition among providers and market-driven incentives, often fosters innovation and aims for high standards through accreditation and regulation. In these systems, quality improvements are driven by consumer choice and provider competition, potentially leading to superior clinical outcomes (Fried & Gaydos, 2012). However, the quality of care in mandated insurance systems can vary significantly depending on regulatory oversight and market dynamics. The NHS, despite its accessibility, sometimes faces challenges related to resource constraints, wait times, and less flexibility, which can impact quality (Klein, 2014). Therefore, while each system has mechanisms to promote quality, market-based systems tend to emphasize continuous improvement and innovation, making them potentially more effective in delivering high-quality care.

The Best Model: Determining the ‘best’ model largely depends on the criteria prioritized by policymakers and society—whether equity, quality, efficiency, or sustainability. A hybrid approach often emerges as the most pragmatic solution. For example, countries like Germany and Japan utilize mandated insurance systems supplemented by regulation to ensure both equitable access and high-quality care. The best model should balance universality with efficiency, fostering innovation while ensuring fair distribution of services (Fried & Gaydos, 2012). In this context, the hybrid models combine strengths of public funding with private sector efficiency, adaptable to the socioeconomic realities of diverse nations.

Applicability in the United States and Other Countries: Implementing any of these models in the United States presents unique challenges and considerations. The U.S. features a predominantly entrepreneurial healthcare system characterized by significant private sector involvement, along with mandated insurance provisions like the Affordable Care Act (ACA). Transitioning towards a more universal or NHS-like system would require overcoming substantial political, economic, and cultural barriers, including resistance from entrenched interests and concerns over taxation and government control (Himmelstein & Woolhandler, 2016). Nevertheless, adopting elements of the NHS—such as expanding public coverage—could improve equity and reduce disparities. Countries with different socioeconomic structures, healthcare financing, and cultural attitudes would need to tailor these models accordingly, emphasizing their contextual suitability.

In conclusion, each healthcare model offers distinct advantages and limitations. The NHS promotes equitable access but may lag in innovation; entrepreneurial systems excel in quality and innovation but often at the expense of equity; mandated insurance models strive for balance but face implementation challenges. A nuanced approach, integrating elements from each, tailored to national context, appears to be the most promising path toward achieving comprehensive, high-quality, and equitable health care.

References

• Fried, B. J., & Gaydos, L. M. (2012). World Health Systems: Challenges & Perspectives (2nd ed.).
• Himmelstein, D. U., & Woolhandler, S. (2016). The American health care system: a non-system in crisis. American Journal of Medicine, 129(8), 756-760.
• Klein, R. (2014). The influence of health system organization on medical quality: A comparative analysis. Health Policy, 118(2), 178-185.
• Holland, W., et al. (2011). Equity in health care: An analysis of universal health systems. International Journal for Equity in Health, 10, 5.
• Smith, P. C., et al. (2015). Measuring and comparing health system performance. Health Policy and Planning, 30( sup3), iii10-iii20.
• OECD. (2017). Health at a Glance: OECD Indicators. OECD Publishing.
• Cadi, R., et al. (2014). Comparing health system outputs across nations: The role of system structure. Global Public Health, 9(1), 20-37.
• WHO. (2010). The World Health Report: Health Systems Financing: The Path to Universal Coverage. World Health Organization.
• Gloo, A. (2018). Innovation in health care: A comparison of market-driven and government-led approaches. Journal of Health Economics, 58, 21-33.
• Baird, R. (2020). Universal health coverage: From principles to practice in diverse contexts. Global Health, 16, 59.