This year 2020 will also be remembered as the year in which the health systems of different European countries were put to the test by the crisis of the new coronavirus.
Bismarck and Beveridge are the health systems that prevail in Europe and are based on universality, solidarity, and equity, according to Magda Rosenmöller. The member states of the European Union are divided between these two models. While in the German system the administration is a mere manager, in the English system the State groups and offers all services. The differences between the two reside, above all, in the way the different services are financed and operated.
Experts point out that pure systems no longer exist, but European health consists of two main models: the Bismarck model (Social Security System) and the Beveridge model (National Health Service). Financing, waiting lists, and co-payments are some of the most obvious differences between the Bismarck and Beveridge health models. Thanks to these historic systems, Europeans enjoy different degrees of health care, albeit at different costs.
Portugal and Finland, for example, are more similar countries than they appear, since they share Beveridge's health model. In the same situation, but different terms, are France and Greece, which used the Bismarck health model as the basis for their health care.
The health systems established in Europe are based on “universality, solidarity, and equity”. Each health system has three fundamental objectives: “to improve the patient's health, optimize his experience and perform the procedures with the best possible resources”.
Born in Germany in 1883, the Bismarck model is a health system that is based on the fact that citizens enjoy health care through private organizations and, for that, both employers and workers pay fees that go directly to medical service management companies.
These payments are transferred to “funds”, which are non-governmental entities regulated by law and which manage the resources. With the resources, health professionals and equipment are hired.
In this case, the State is a mere manager and it is the private companies that operate it. In other words, it is up to the State to collect financing through taxes and then channel it to the private sector, and also ensure the harmonization of the system. It is a system in which health centers are generally private and where there are co-payments for some of the health benefits, such as ambulance transport, medicines, or hospital care.
The Bismarck model is the one that continues to operate in Germany, but it has also been incorporated and is used by 17 countries such as Belgium, Switzerland, France, Holland, Austria, Greece, Luxembourg, and the Netherlands.
The Beveridge model, in turn, originated in the United Kingdom and emerged in the 1940s. This system is based on universal access to healthcare and all medical services are managed directly by the Government.
Financed by the State Budget, the State assumes all control and management of the system. Its financing comes from 100% of the State's General Budgets, a model in which the citizen does not pay directly for assistance. In general, the Beveridge model finances health care through taxes paid by all citizens.
Unlike Bismarck's model, health centers are public and it is a system in which the state is charged with management. Also, the price of medicines is regulated through the Reference Price Index. In this system, eleven states are governed by the Beveridge model, among them Denmark, Italy, Portugal, Ireland, and Spain that have already adopted the system.
If the Spanish health system is so good, why does it not reproduce in other countries?
Spain is a unique case where health costs coexisted by the Administration and private care so that private services are a complement to the health service. Thus, those who take advantage of private insurance do not fail to pay for public health, that is, they pay double. Despite this, for the specialist professor at IESE “the health system in Spain is one of the best in the world”, although it can be improved with more innovation, flexibility, and participation.
For Jaume Raventós, professor at the Instituto de Formación Continua IL3 specializing in health management, the competition for services “is always good and will improve efficiency”. For the specialist, moreover, in the countries of the Bismarck system, the private sector makes money thanks to the public sector, but in states like the Netherlands, the benefit of these companies is regulated.