Since the beginning of time, all animals have been besieged by different types of diseases that we have been coping with naturally and with the help of our immune system. For this reason the mortality rate has been relatively high in humans throughout history, and continues to be so in other animals.

With the passage of time and the exponential growth of the human population, people tended to concentrate more and more in urban centers, which helped many diseases to multiply by leaps and bounds.  The advent of modern medicine and improved hygiene habits allowed diseases to begin to be better controlled, although many of them are still beyond our control, as is the example of COVID.

What has helped enormously to improve our quality of life and life expectancy, without the slightest doubt, is the implementation of national health systems, which allow us a much better organization and rapid response to diseases.


What is a health care system and what are its stakeholders?


Tobar (2016) defines national health systems as a set of components (institutions, resources, organizations…) and their relationships organized and coordinated to develop activities with a view to achieving certain health objectives.

Thus, a health system is a profoundly complex and abstract organism involving the State, health professionals, patients and, depending on the model, other private organizations providing services and products.

This may not help much to clarify the term, but what we must be clear about is that a health system must be aimed at providing an organized response to the health problems of a given population.


What types of health systems exist?


Depending on the type of model, we can distinguish 3 types (UAM, 2011):

  • Liberal model or free market model: this is the one that prevails in the U.S. Health is considered a “consumer good” and is governed according to the laws of supply and demand.
  • Socialist model: The “pure” model has only been produced in communist countries, of which the only examples at present are Cuba and North Korea. In this model, healthcare is universal and accessible to all, financed by the State, although its excessive rigidity and bureaucracy make access to it particularly complicated.
  • Mixed model: Most of the financing is public and tax-based, but there is some private participation in those services demanded directly by citizens.

From this last model, other models have emerged in Latin American countries with historical and social characteristics specific to each region, including the Segmented Model, the Public Contract and Structured Pluralism (PiPP, 2011). 


What models are found in different countries around the world?


In Europe there are two types of healthcare systems, the Beveridge model and the Bismark model, both categorized within a mixed model (Ministerio de Sanidad, Servicios Sociales e igualdad, 2014). 

  • Beveridge model: in this type of health system there is tax financing based mainly on the fact that whoever has more, pays more and the rest of the taxes pivots fundamentally on value added, although some financing would be obtained from levies on hydrocarbons, alcohol, electricity or tobacco. In the EU, Denmark, Finland, Ireland, Italy, Portugal, Sweden and Spain follow this model. It is also used by the United Kingdom with the NHS (National Health Service), for which it is a world reference and which was created in 1984, inspired by the Beveridge Report.
  • Bismarck model: this type of social security system, which originated in 1881 in Germany, is financed by mandatory social contributions. The contributions must be paid by companies and workers, this being the main source of financing, although general taxes also play an important role in financing the premiums of the most disadvantaged and uncovered sectors. 

Both models have 100% or very close to 100% coverage, but drugs used in outpatient care are all co-payable, either at fixed or co-insurance rates.

In the United States, however, and despite being one of the wealthiest countries, as we saw previously, it does not have a health system with universal health coverage, but rather its system is based on the free market, where healthcare is managed by private companies and insurance companies that rely on government networks (López et al. 2021).

There they have two types of insurance; managed and direct. The former being cheaper and with fewer centers and hospitals to go to compared to the direct ones.

In addition, there is “public health care” within the Medicare program for veterans over 65 years of age. They have 60 days of free hospital care, but must pay about 20% of the bills and a monthly fee.

For people without resources or without a job, there is the Medicaid program. Finally, the State Children’s Health Insurance Program is a program that provides health coverage for children whose families do not qualify for Medicaid but cannot afford private insurance.

Japan also has a universal healthcare system, considered by some to be the best healthcare system in the world. It provides its citizens with two different programs, the Statutory Health Insurance System (SHIS), which covers 98.3% of the population, and the Public Welfare Program, which covers those with low income (the remaining 1.7%) (Araujo, 2021).


What universal health care coverage is there in the world? What is the goal?


Nowadays, as we have seen, not all countries have a universal healthcare system.

We have seen the cases of some of the most developed countries in the world, but the reality is that nearly half of the world’s population lacks comprehensive access to basic health services, in addition, approximately 12% of the world’s population spends at least 10% of their household budget on paying for healthcare and not only that, but also close to 100 million people are pushed into extreme poverty because they have to pay out of pocket for healthcare services (WHO, 2021).

For all these reasons, all Member States of the United Nations have pledged to strive to achieve universal health care by 2030. This goal is within the framework of the Sustainable Development Goals (SDGs).