Bismarck model

The Bismarck model (also referred as "Social Health Insurance Model") is a health care system in which people pay a fee to a fund that in turn pays health care activities, that can be provided by State-owned institutions, other Government body-owned institutions, or a private institution.[1] The first Bismarck model was instituted by Otto von Bismarck in 1883 and focused its effort in providing cures to the workers and their family.[2] Since the establishment of the first Beveridge Model in 1946, where the focus was into providing healthcare as a human right to everyone with funding through taxation, nearly every Bismarck system became universal and the State started providing insurance or contributions to those unable to pay.[3]

Otto von Bismarck

Examples

States such as Germany, Austria, Switzerland and Czech Republic have Bismarck healthcare, while States such as South Korea[4] and the Netherlands,[5] while having a basic state insurance, have a much stronger private presence in the healthcare providers and insurances systems.[6]

In Europe, countries like France, Hungary and Slovakia, while theoretically Beveridge system, have some degree of Bismarck politics in their laws.[7] Some in Italy argue that the Lombard socio-health system, which prescribe equality between the private and public sector and payment by performance, has some typical characteristic of a Bismarck system.[6]

Advantages

The Euro health consumer index calls the statement "Bismarck beats Beveridge" a "permanent feature" since 2014. Bismarck systems usually have significantly higher accessibility, lower waiting times and, thanks to the competition between operators, higher quality and more consumer-oriented healthcare.[8]

Studies show that the introduction of the Bismarck system in Germany led to a significant drop in mortality.[9]

Criticism

Since in the Bismarck health system the core financing are contributions, people in poverty can't pay and get limited coverage. In some countries, like Switzerland, the cost of insurance is high and continues to grow, leading part of the population to be under-insured.[10]

Another criticism is that since institutions are paid by performance some isolated localities may have little hospital coverage. [1]

While primary care is significantly faster to get in a Bismarck system than in a Beveridge system some argue that some elective care may be slow to get even in a Bismarck system than in a free-market healthcare, like the US.[1]

See also

References
  1. International Health Care Systems Part 3: The Bismarck Model
  2. German health care: a bit of Bismarck plus more science
  3. L’EVOLUZIONE DEI MODELLI SANITARI INTERNAZIONALI A CONFRONTO - AIOP Giovani
  4. Republic of Korea health system review
  5. The Dutch Health Care System - The Commonwealth Fund
  6. Newsletter WYO
  7. "How European nations run national health services: Belgium, France, Germany and Sweden". The Guardian. 2011-05-11. Archived from the original on 2023-02-05.
  8. Single-Payer Isn’t The Answer
  9. Bismarck’s health insurance and its impact on mortality
  10. In 170'000 non pagano l'assicurazione sanitaria
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