HEALTH CARE SYSTEM FINANCING SYSTEMS: AN INTER-COUNTRY COMPARISON

mainly in private hands, though federal, state, county, and Health care system is the organization of people, city governments also own certain facilities. Figure 1 institutions, and resources to deliver health care services in shows that more money per person is spent on health care order to meet the health needs of target populations. in the USA than in any other nation in the world (2),even According to the World |Health |Organization (WHO), the though the USA does not ensure that all citizens have goals for health systems, are good health, responsiveness health service coverage, and the system does not deliver to the expectations of the population, and fair financial equivalent value for the money spent. In 2004, the Institute contribution. There is a wide variety of health care systems of Medicine report observed "lack of health insurance around the world, and these systems generally have five causes roughly around 18,000 unnecessary deaths every primary methods of funding, such as: i.) General taxation year in the United States"(3), while a 2009 Harvard study to the state, county or municipality, ii). Social health estimated that 44,800 excess deaths occurred annually due insurance, iii.) Voluntary or private health insurance, iv.) to lack of health insurance. Also, the WHO ), in 2000, Out-of-pocket payments, and v). Donations to charities ranked the U.S. health care system as the highest in cost, (1). first in responsiveness, 37th in overall performance, and Classifications of Health Care Systems 72nd by overall level of health. Figure 1


Traditional Sickness Insurance: fundamentally a
The U.S. system has some huge holes compared with the private insurance market approach with a state subsidy.
coverage in many other systems.In December 2011, the (Example: Germany) outgoing Administrator of the Centers for Medicare & Medicaid Services, Dr. Donald Berwick, asserted that 20% 2. National Health Insurance: a national-level health to 30% of health care spending in USA is a waste due to the insurance system.(Examples: Canada, Finland, following five causes (4), Norway, Spain, and Sweden.)

United Kingdom
According to the World Health Organization, Germany's health care system was 77% government-funded and 23% Most health care in the U.K is provided free at the point of privately funded as of 2004 (7).The system is need, being paid for from general taxation to all permanent decentralized with private practice physicians providing residents by the National Health Service (NHS).It is a ambulatory care, and independent, mostly non-profit publicly funded healthcare system, which accounts for hospitals providing the majority of inpatient care.most of the Department of Health's budget.In addition, there is a private healthcare sector which is considerably In Germany the delivery of health care is similar to that smaller than its public equivalent.
found in the United States, but in U.S., for the most part, large numbers of employee groups, independent insurers, The general practitioner (GP) is the gatekeeper to the and providers reach agreements without direct government health care system.(GPs are not government employees. intervention.Also in Germany co payments were Rather, they are self-employed and receive about half their introduced in the 1980s in an attempt to prevent over income from capitation contracts.). .All patients must be utilization and control costs.As a result , German health referred to consultants by GPs.
system has been relatively successful at controlling costs.The World Health Organization, in 2000, ranked the China provision of healthcare in the United Kingdom as the In China the New Rural Co-operative Medical Care fifteenth best in Europe and eighteenth in the world (5).The System is a 2005 initiative to overhaul the healthcare NHS has a high level of popular public support within the system, particularly intended to make it more affordable country: an independent survey conducted in 2004 found for the rural poor.Under this system, the annual cost of that users of the NHS often expressed very high levels of medical coverage is 50 yuan (US$7) per person.Of that, 20 satisfaction about their personal experience of the medical yuan is paid in by the central government, 20 yuan by the services they received: 92% of hospital in-patients, 87% of provincial government and a contribution of 10 yuan by GP users, 87% of hospital outpatients, and 70% of the patient.As of September 2007, around 80% of the rural Accident and Emergency department users (6).
population of China had signed up for this which amounted Although the United Kingdom spends less on health care to about 685 million people.than the United States and many other countries, by most Chinese Federal Health Expenditure as % of Total Health Expenditures Germany Germany has a universal multi-payer health care system with two main types of health insurance: Sickness Insurance Funds and Private Insurance.Legislation required workers in various occupations to enroll in sickness insurance funds, which is paid for with joint employer-employee contributions.Small numbers of persons are covered by tax-funded government employee insurance or social welfare insurance.Persons with incomes above the prescribed compulsory insurance level may opt into the sickness fund system, which a majority do,.The sickness funds are required by law to provide a comprehensive set of benefits.(e.g.physician ambulatory care provided by physicians in private practice, hospital care, home nursing care, and a wide range of preventive services).
Figure 2 shows that China reduced federal funding of healthcare from 32% to 15% between 1978 to 2002.The The German health care system is characterized by the provincial or local governments have more "control" over "three S's"-Social solidarity (the sense that all citizens are the health care service in China.If patients go to a small concerned with the provision of equal access to health hospital or clinic in their local town, the system will cover care).Subsidiary (decentralization to public and private roughly 70-80% of their bill.If the patient visits a county organizations), and Self-governance.clinic, the percentage of the cost being covered falls to health services.Tax-based financing is currently insufficient and there needs to be greater emphasis on about 60%.If the patient requires a specialist in a modern social health insurance.Sri Lanka would benefit from a city hospital, the plan would cover about 30% of the bill social insurance model where a health insurance fund (8).
would be established with contributions made statutory by India law.The share of public financing in total health care in India is With the existing resource allocation mechanisms of Sri just about 1% of GDP compared to 2.8% in other Lanka there is little opportunity for significant developing countries.Health system of India is a complex improvement in service efficiency, cost effectiveness, mixed health system.It is a system of publicly financed quality or ability to focus on the poor without a substantial government health system and a fee-levying private health change.This necessitates the inclusion of more sector.Over 80% of the total health financing is private management autonomy, improvements in finance and financing, much of which is out-of-pocket payments (i.e.management systems and financing including allocations User charges) and not any prepayment schemes.
based on needs, together with more rational planning and funding of services.

Various measures have been initiated to raise the resources for health, such as public private partnerships (tele
There is a need to ensure that equitable and fair distribution medicine), voluntary and community health insurance, mechanisms are in place between and within provinces to income tax exemption to set up private hospitals in the reduce overcrowding in large hospitals by considering rural areas, and encouragement to private agencies in quality and cost-effectiveness.Therefore, Sri Lanka will secondary and tertiary levels of healthcare.
have to make effective decisions on health-care service management by considering the following: Figure 3 1.Regular surveys to ascertain the patients' and the Figure 3 shows the healthcare financing structures in public's views on the responsiveness of the health China and India in 2005.In both systems out of pocket system, and their views which will facilitate their funding is more than government funding.
increased participation in the planning and Experience from Other Countries for Sri Lanka to management of services.Also consulting policy Enhance the Health System makers on what changes are needed to develop a responsive and people centered service.Sri Lanka has achieved a relatively high health status given a low level of spending on its health-care services, and 2. Clinical accountability and the development of peer provides universal health services for all its citizens free at group reviews and clinical audits as well as other the point of delivery.In the face of rising health care costs methods of monitoring patient satisfaction and the the actual government expenditure cannot meet the quality of service delivery.financial requirements of health needs, and many governments in developing countries are considering 3. Quality assurance in a systematic manner that options other than general tax revenue to finance their enhances team spirit.

1 .
Over-treatment of patients, 3. National Health Services: state provides the health care.(Examples: United Kingdom, Denmark, Greece, 2. Failure to coordinate care, Italy, New Zealand, Portugal, and Turkey.) 3. Administrative complexity of the health care system, Mixed systems: contain elements of both traditional 4. Burdensome rules sickness insurance and national health coverage.5. Fraud (Examples: Switzerland, and the United States of America) *Director, National Hospital of Sri Lanka, Colombo; sdrsujatha@gmail.com

Figure 2
measures of mortality and morbidity the UK does about as well than those countries.
Policies to be developed to share investment in this Hong W.; Tuohong Z.; Licheng Z.; Shuo Z.; Yide Y.; area between the state and private sector where it is Jiaying C.; Qicheng J.; Zhaoyang Z.; Jun Y.; Xuesheng cost-effective.L. Source: Social Science and Medicine, Volume 48, 7. The state sector to be encouraged to purchase services Number 7, April 1999, pp.961-972(12) (950 people are from the private health sector for state sector patients allowed per person in china.based on cost effective studies, and vice versa.8. Re-certification of doctors, nurses and other health care workers at regular intervals with discussions of the appropriate professional bodies.9. Develop a proper Health Care system for Sri Lanka to succeed all the health challenges by studying the experiences of other countries.