World Health Systems

XIAOMING SUN holds a PhD in Health Planning and Management from Keele University, UK. He was a Takemi Fellow at the Harvard School of Public Health, and Professor at Fudan University and Chief Physician at Zhongshan Hospital and the East Hospital, China. Dr. Sun has served as the Vice President of the Shanghai Medical Association, the Vice President of the Shanghai Medical Doctor Association, the Vice Chairman of the Chinese Medical Association General Practice Branch, and President of the Shanghai Community Health Association.

• Foreword xviiPreface xxiAbout the Book xxvAbout the Author xxviiPart I: OverviewChapter 1: Theoretical Foundations for the Establishment of World Health Systems 3Section I. Theories of Economic Development 31. Classical Political Economics 42. Welfare Economics 63. Keynesian Economics 94. Liberal Economics 105. Information and Institutional Economics 12Section II. Theories of Public Goods 201. Concept and Characteristics of Public Goods 202. Classification Criteria of Public Goods 223. Theoretical Analysis of Public Goods 22Section III. Theories of Social Equality 251. Concept of Equality in Classical Liberalism 252. Concept of Equality in Utilitarianism 253. Concept of Equality in Rawlsianism 264. Concept of Equality in the School of New Public Administration 265. Concept of Equality in Marxism 26Section IV. Theories of Universal Health Coverage 271. Proposal of UHC Theory 272. Definition and Implications of UHC Theory 28Section V. Theory of Performance Evaluation for World Health Systems 301. Definition of Concepts Related to Performance Evaluation 302. Model of Performance Evaluation for Health Systems 31Chapter 2: World Socioeconomic Development and Health Status 33Section I. World Socioeconomics and Population Aging 331. Economic Crisis and Transformational Development 332. Current Status and Trends of World Population Aging 353. Impact of Population Aging on Healthcare Costs 384. Strategies for Actively Coping with Population Aging 39Section II. Global Health Status and Current Challenges 431. Update on the Concepts of Health 432. Comparison of World Health Statuses 473. Key Issues in Human Health 50Section III. Proposing the Concept of Global Health and Its Development Trends 551. Definition and Evolution of Global Health 552. Research Areas Related to Global Health 563. Challenges and Opportunities Concerning Global Health 57Section IV. Exploring the Integration of Healthcare and Prevention in Health Insurance 581. Gradual Transition from Disease Insurance to Health Insurance 582. Strengthening Health Education and Advocating Healthy Lifestyles 593. Promoting the Capitation System to Enhance Preventive Healthcare 60Section V. Progress in Medical Technology and Its Impact on Healthcare Costs 611. Current Status of and Trends in the Development of Medical Technology 612. Impact of High-Tech Medicine on Healthcare Costs 62Chapter 3: Health System Structure and Determinants of Health 65Section I. Structure of Health Systems and Their Relationships 651. Goals and Boundaries of Health Systems 652. Medical and Health Resources 673. Organizations and Institutions 834. Economic Support 1005. Health Management 1036. Service Provision 111Section II. Key Factors Influencing Health Systems 1151. Economic Factors 1162. Political Factors 1173. Cultural Factors 121Section III. Analysis of the Social Determinants of Health 1251. Conceptual Framework of the Social Determinants of Health 1262. Policy Values of the Social Determinants of Health 128Chapter 4: Basic Models and Evaluation of World Health Systems 131Section I. Two-Dimensional Classification of World Health Systems 1311. Principal Models of International Health and Social Security Systems 1312. Selection of System Models for Countries with Different Development Levels 133Section II. System Model of the National Health Service 1351. National Health Service and General Practitioner System 1352. The Social Welfare Model of Nordic Countries 1393. Main Policies and Features of Developing Countries 141Section III. System Model of Social Health Insurance 1441. National Health Insurance Systems of Germany and France 1442. Health System and Insurance in Japan 1463. Health System and Insurance in South Korea 1484. Main Policies and Features of Developing Countries 149Section IV. System Models of Commercial Health Insurance 1531. Basic Characteristics of the Commercial Health Insurance Model in the US 1532. Features and Existing Problems of the US Model 1553. Private Health Insurance in Developing Countries 157Section V. System Models of Savings-Type Health Insurance 1591. Establishment of 3M System Policies 1592. Basic Evaluation of the Singaporean Model 160Section VI. Other Health Insurance System Models 1611. Situations in Hong Kong, Macau, and Taiwan 1612. The 30-Baht Universal Health Insurance Scheme in Thailand 164Chapter 5: Social Medical Aid System and Its Analysis 169Section I. Theoretical Foundations of Social Medical Aid Systems 1691. Theory of Baseline Equality 1692. Theory of Social Citizenship 1703. Maslow’s Hierarchy of Needs 1714. Theory of Tertiary Distribution 172Section II. Major Policies of Social Medical Aid Systems 1721. Recipients of Medical Aid 1722. Determining the Eligibility of Medical Aid Recipients 1743. Methods of Medical Aid 1754. Funding Sources for Medical Aid 1765. Treatment Standards for Medical Aid 1776. Provision of Medical Aid Services 178Section III. Models and Features of Social Medical Aid Systems 1791. Models of Social Medical Aid Systems in Developed Countries 1792. Features of Social Medical Aid Systems in Developed Countries 1813. Cost Containment for Social Medical Aid Systems in Developed Countries 1824. Governmental Medical Aid Systems in Developing Countries 185Chapter 6: Features and Trends of Reforms in World Health Systems 189Section I. Features of Health System Reforms in Developed Countries and Areas 1891. Common Features and Trends of Health Economic Policies in Developed Countries and Areas 1892. Major Health Economic Reforms in Developed Countries and Areas 1913. Exploration of Private Financing Initiatives 198Section II. Features and Reform Trends of Health Systems in Developing Countries 2011. Features and Reforms of Health Systems in Asian Countries 2012. Features and Reforms of Health Systems in African Countries 2043. Features and Reforms of Health Systems in European Countries 2074. Features and Reforms of Health Systems in South American Countries 208Part II: Characteristics of Health Systems in Developed Countries and AreasChapter 7: Overview of Health Systems in Developed Countries and Areas 213Section I. Status of Health Investment in Developed Countries and Areas 213Section II. Status of Health Services in Developed Countries and Areas 2141. Equity in Health Outcomes 2142. Accessibility of Healthcare Services 2153. Differences in Health Service Utilization 2174. Impact of Health Insurance on Health Services 217Section III. Status of Health Insurance in Developed Countries and Areas 2181. Health Insurance Systems for Different Income Groups 2182. Responsibilities of the Government in the Health Insurance System 2203. Functions of the Health Insurance System 221Chapter 8: The Role of the Government in the Health Service Markets of Developed Countries and Areas 223Section I. Healthcare Market Failures and Government Intervention 2231. Basic Concepts of Healthcare Markets 2232. Significance of Government Intervention in Healthcare Markets 2233. Consequences of Government Nonintervention in Healthcare Markets 2284. Goals and Policy Orientations of Government Intervention in Healthcare Markets 2305. Failures and Rectifications of Government Intervention 234Section II. Macro-Level Planning by Governments in Developed Countries and Areas to Strengthen Healthcare Institutions 2371. Implementation of Regional Healthcare Planning 2372. Government Intervention in the Formulation of Healthcare Service Contracts via Market Coordination Mechanisms 2383. Vertical Integration of Healthcare Resources via Clusters 238Section III. Government Regulation of Human Resources in Developed Countries and Areas 2431. Regulating the Total Supply of Physicians Based on Healthcare Demand 2432. Government Efforts and Outcomes in Improving the Regional Imbalances of Physician Supply and Demand 245Section IV. Government Intervention in Drugs and the Control of Healthcare Quality in Developed Countries and Areas 2471. Government Intervention in Drugs 2472. Government Control of Healthcare Quality 248Section V. Government Measures for Healthcare Cost Containment in Developed Countries and Areas 2501. Managed Healthcare and Managed Competition 2502. Hospital Global Budget System 2523. Regulating the Provision of Elderly Healthcare Services 252Section VI. Government Measures to Address Health Service Problems in Developed Countries and Areas 2531. Measures to Address Long Waiting Lists for Inpatient and Outpatient Services 2532. Introduction of the “Community Healthcare over Inpatient Treatment” Policy 2553. Adjustments for Reasonable Compensation Policies 2564. Improving Service Quality by Increasing the Number of Healthcare Workers 2565. Regulatory Roles in Stabilizing National Healthcare Needs 2576. Compensation Measures for the Inadequate Supply of Public Health and Basic Healthcare 258Chapter 9: Basic Drug Administration Policies in Developed Countries and Areas 259Section I. Government Policies Related to Drug Manufacturing in Developed Countries and Areas 2591. Stage 1: Market Management and Legal System Improvements 2592. Stage 2: Reduction of Drug Costs 2603. Stage 3: Emphasis on Health Economic Benefits 261Section II. Government Policies Related to Drug Marketing in Developed Countries and Areas 2621. Price Control on Manufacturers 2622. Policies for Distributors 2653. Policies for Pharmacies (or Pharmacists) 2654. Policies for Hospitals 266Section III. Drug Reimbursement Policies in Developed Countries and Areas 2671. Increasing Consumer Copayment of Drug Expenses 2672. Encouraging Physicians to Prescribe Cheaper Drugs 2673. Strict Control Over Manufacturers 269Section IV. Policies for Essential Medicines in Developed Countries and Areas 2701. Conceptual Development and Impact of Essential Medicines 2702. Selection and Utilization of Essential Medicines in Developed Countries and Areas 272Section V. Separation of Prescribing and Dispensing Policies and Relevant Insights in Developed Countries and Areas 2751. Conceptual Definition of the Separation of Prescribing and Dispensing 2752. Rationale and Policy Implementation of the Separation of Prescribing and Dispensing in Western Developed Countries 2763. Reforms and Evaluation of the Separation of Prescribing and Dispensing in Asian Developed Countries and Areas 2804. Value of and Insights for the Separation of Prescribing and Dispensing in China 284Chapter 10: Models and Policies of Healthcare Cost Containment in Developed Countries and Areas 287Section I. Background of Healthcare Cost Containment in Developed Countries and Areas 2871. Changes in Healthcare Costs in Developed Countries and Areas 2872. Causes of the Rapid Growth of Healthcare Costs 2883. Three Stages in the Economic Model of Health Service Development 290Section II. Main Measures of Healthcare Cost Containment in Developed Countries and Areas 2921. Strict Control over the Allocation of Large Medical Equipment 2922. Establishing Healthcare Cost-Sharing Mechanisms 2933. Strengthening the Management of Healthcare Services 2934. Implementing a Global Budget System 294Section III. Comparison of Models for Healthcare Cost Containment in Developed Countries and Areas 2951. Five Models of Healthcare Cost Containment 2952. Comparison of Models for Healthcare Cost Containment and Conclusions 297Section IV. Policies of Healthcare Cost Containment and Their Trends in Developed Countries and Areas 2981. Policies of Healthcare Cost Containment in Developed Countries and Areas 2982. Future Trends and Directions 299Part III: Health Systems in Developed Countries and AreasChapter 11: National Health Service Systems of Representative Countries 305Section I. The Health System in the United Kingdom 3051. Establishment of the National Health Service 3072. Developments and Changes in the NHS Management System 3093. NHS Funding 3144. Community Health Services 3165. Hospital Services 3246. Other Healthcare Services 3277. Settlement of Medical Disputes 3298. NHS Reforms and Future Policies 334Section II. The Health System in Canada 3381. Establishment and Development of the Health System 3392. Healthcare Providers 3453. Current Status and Future Trends in Health Insurance 3494. Management of Health Insurance 3575. Trends in Healthcare Expenditure and Containment Policies 362Section III. The Health System in Australia 3691. National Health Status and Current Challenges 3702. Health Service System 3743. Universal Health Insurance System 3854. Commercial Health Insurance 3925. Reforms in Healthcare Services and Payment Systems 3966. Plans for a New Round of Healthcare Reforms 399Section IV. The Health System in Sweden 4051. Healthcare Provision System 4062. Health Insurance System 4103. Formulation and Value Orientation of Health Policies 4144. Healthcare Cost-Containment Policies 4165. Difficulties in the Healthcare System and Reform Attempts 4196. The Path of Swedish Health System Reforms in the Twenty-First Century 429Chapter 12: Social Health Insurance Systems of Representative Countries 431Section I. The Health System in Germany 4311. Health Service System 4322. Health Insurance System 4453. Health Insurance Operations 4474. Current Status and Future Trends of Health Insurance Policy 4535. Health Reforms in the Twenty-First Century 4586. Health Insurance System Reforms by the Grand Coalition Government 460Section II. The Health System in France 4621. Health Service System 4622. Healthcare Practitioners and Mobility 4713. Health System Reforms 4764. Health Insurance System 4785. Health Insurance Issues and Reforms 4966. Healthcare Cost-Containment Policies 501Section III. The Health System in Japan 5071. Health System 5102. Health System Issues and Reforms 5173. Health Insurance System 5224. Framework of the Long-Term Care Insurance System 5325. Healthcare Cost-Containment Policies 535Section IV. The Health System in Poland 5401. Overview of Socioeconomic Development 5402. Health Service System 5433. Health Insurance System 5574. Reforms to the Health System and Social Security Planning 566Chapter 13: Commercial Health Insurance and MedicalSavings Account Systems of Representative Countries 569Section I. The Commercial Health Insurance System in the United States 5691. Healthcare Institutions 5702. Healthcare Workforce 5753. Health Insurance System 5784. Medicare 5815. Medicaid for Low-Income Earners 5976. Healthcare Cost-containment Policies 6077. Plan and Progress of Obamacare 615Section II. The Medical Savings Account System in Singapore 6201. Healthcare System 6202. Reforms of the Public Hospital System 6363. Health Security and Health Insurance 6434. Healthcare Funding Policies 6515. Healthcare Cost-Containment Mechanisms 660Chapter 14: Improved Health Systems in Hong Kong and Taiwan 665Section I. The Health System in Hong Kong 6651. Health System 6672. Reforms in Public Hospital Management 6743. New Development Ideas of the Hospital Authority 6784. Health Security System 6815. Hong Kong’s Health System Reforms in the Twenty-First Century 687Section II. The Health System in Taiwan 6901. Overview and Features of the Health System 6902. National Health Insurance (NHI) 6943. Point-for-Service Global Budget Payment System 7064. Drug Administration System 7095. Challenges Facing the Health System in Taiwan 712Part IV: Characteristics of Health Systems in Developing CountriesChapter 15: Definition of Developing Countries and Challenges in Health Systems 717Section I. Definition and Structural Formation of Developing Countries 7171. Concept and Definition of Developing Countries 7172. Social Formation and Structure of Developing Countries 7193. Proposal of Representative Countries and Its Implications 721Section II. Health Systems and Health Statuses of Developing Countries 7221. Exploration of Universal Health Security Systems 7222. Transition of Health Statuses in Developing Countries 723Section III. Challenges of Health Systems in Developing Countries 7261. Inadequacies in Overall Health Resources 7262. Poor Implementation of Health System Reforms 7263. Uneven Distribution of Health Statuses and Human Resources 7274. Low Willingness to Invest in Adult Healthcare 7275. Low Input into Health Research 7286. Overdependence on Aid May Weaken the Government’s Sense of Responsibility Toward National Health 728Chapter 16: Comparison of Healthcare and Social Security Systems in BRICS Countries 729Section I. Comparison of Socioeconomics and Health Resources in BRICS Countries 7291. Origin of BRICS Countries 7292. Health Resources of BRICS Countries 730Section II. Comparison of Health Insurance Systems in BRICS Countries 7321. Establishment of Universal Healthcare Security Systems 7322. Encouraging the Development of Private Healthcare Institutions and Commercial Health Insurance 7343. Emphasis on the Construction of Primary Healthcare Services 735Section III. Comparison of Health Systems in BRICS Countries 7371. From Models of Centralized Government Management to Commercial Fund Management 7372. “Super-Ministry System” Bureaucratic Management 7383. Multipronged Management 739Section IV. Performance Evaluation of Health Systems in BRICS Countries 7401. Differences in Health System Reforms 7402. Comparison of Health System Performances 746Chapter 17: Insights from Health System Reforms in Developing Countries 747Section I. Common Challenges in the Development of Health Systems 7471. Limited Funding Sources and Insufficient Investment 7472. Imbalances in Regional and Vertical Resource Allocation 7473. Lack of Incentive and Restraint Mechanisms in Public Healthcare Institutions 7484. Lagging in the Funding and Payment of Health Insurance 7485. Ineffective Use of Health Insurance Funds 7506. Inadequate Efficiency and Capacity of Health Insurance Management 750Section II. Key Issues Facing the Health System in China 7511. Equality – The Coexistence of Wastage and Shortage of Healthcare Resources 7512. Accessibility – Deviations in Service Focus and Technology Orientation 7523. Coordination – The Decentralization and Fragmentation of Different Healthcare Resources 7524. Marginalized Groups and Blind Spots in Social Insurance Coverage 7535. Increased Healthcare Demand and Inadequate Health Security 7536. Flaws in Management Capacity and Institutional Design 754Section III. Experiences and Insights from Health System Reforms in Developing Countries 7571. System Planning – Optimized Integration of Health Resource Allocation 7572. Primary Care – Fully Utilizing the Role of Family Physicians 7573. Nongovernmental Healthcare Institutions – Guiding the Development of Private Healthcare Institutions 7584. Policy Orientation – Emphasis on Equality and Supporting Vulnerable Groups 7595. System Design – Payment System Reforms and Fund Supervision 7606. Sustainable Funding – Advocating a Multichannel Model of Increasing Revenue and Reducing Expenditure 761Part V: Health Systems in Developing CountriesChapter 18: Health Systems in Seven Asian Countries 765Section I. The Health System in China 7651. Overview of Socioeconomics and National Health 7652. Healthcare System 7673. Health Security System 7734. Progress of Health System Reforms 788Section II. The Health System in India 7941. Overview of Socioeconomics and National Health 7942. Healthcare Organizations and Regulatory Systems 7963. Healthcare Funding and Payment Systems 8014. Health System Reforms 8165. Outcomes, Characteristics, and Challenges 818Section III. The Health System in Thailand 8191. Overview of Socioeconomics and National Health 8192. Healthcare System 8203. Health Insurance System 8224. Health System Reforms and Evaluation 824Section IV. The Health System in Vietnam 8311. Overview of Socioeconomics and National Health 8312. Healthcare System 8323. Health Insurance System 8344. Health System Reforms and Evaluation 836Section V. Health System in the Philippines 8461. Overview of Socioeconomics and National Health 8462. Healthcare System 8473. Health Security System 8504. Issues and Development Trends in Health System Reforms 860Section VI. The Health System in Armenia 8641. Overview of Socioeconomics and National Health 8642. Healthcare System 8653. Healthcare Funding 8694. Health System Reforms 871Section VII. The Health System in Kyrgyzstan 8741. Overview of Socioeconomics and National Health 8742. Healthcare System 8753. Healthcare Funding and Expenditure 8784. Health System Reforms 882Chapter 19: Health Systems in Three African Countries 889Section I. The Health System in South Africa 8891. Overview of Socioeconomics and National Health 8892. Healthcare System 8923. Health Security System 8934. Status of Healthcare Funding 8965. Health System Reforms 898Section II. The Health System in Egypt 9041. Overview of Socioeconomics and National Health 9042. Healthcare System and Structure 9043. Health System Reforms and Prospects 905Section III. The Health System in Morocco 9081. Overview of Socioeconomics and National Health 9082. Healthcare System 9083. Difficulties in Health Industry Development 910Chapter 20: Health Systems in Four Selected European Countries 913Section I. The Health System in Russia 9131. Overview of Socioeconomics and National Health 9132. Healthcare System 9143. Health Insurance System 9184. Healthcare Funding System and Financial Allocation 9365. Health System Reforms 948Section II. The Health System in Hungary 9511. Overview of Socioeconomics and National Health 9512. Healthcare System 9523. Reform Changes and Characteristics of the Healthcare System 9604. Existing Issues and Development Trends in the Healthcare System 962Section III. The Health System in the Czech Republic 9651. Overview of Socioeconomics and National Health 9652. Healthcare Organizations and the Regulatory System 9663. Healthcare Funding and Universal Social Health Insurance 9694. Trends in Health System Reforms 977Section IV. The Health System in Bulgaria 9811. Overview of Socioeconomics and National Health 9812. Healthcare System 9833. Healthcare Resource Allocation 9914. Healthcare Funding Mechanism 9945. Characteristics and Direction of Health System Reforms 997Chapter 21: Health Systems in Four American Countries 1001Section I. The Health System in Brazil 10011. Overview of Socioeconomics and National Health 10012. Healthcare System 10043. Status of Rural and Primary Healthcare 10084. Health Insurance System and Financing 10105. Challenges and Reforms 1012Section II. The Health System in Cuba 10151. Overview of Socioeconomics and National Health 10152. Establishment and Development of the Health System 10163. Healthcare Delivery and Regulatory Systems 10194. Healthcare Funding System 10315. Healthcare Development and Reform Experiences 1033Section III. The Health System in Chile 10391. Overview of Socioeconomics and National Health 10392. Healthcare System 10403. Analysis of the Health Insurance System 10464. Evaluation and Summary of the Health System 1049Section IV. The Health System in Mexico 10531. Overview of Socioeconomics and National Health 10532. Historical Evolution of the Health System 10543. Healthcare Organizations and Service System 10594. Health Security Financing and Allocation Mechanism 1062Afterword 1069Bibliography 1071Index 1099