Two: Meeting the health system challenges
In Chapter One, the value of a comparative approach in describing and understanding health systems was mentioned albeit with an acknowledgement of the limitations of such an approach and the tendency to overlook key cultural and historical differences between countries and their health systems. These cultural and historical factors often play a major role in the way those systems function regardless of the details of their funding and organisation. Through making comparisons it is possible to identify both commonalities and differences. The notion of convergence in an increasingly globalised world was also considered in Chapter One. Whatever the value, and reality, of the convergence thesis, a variety of health systems exists and important differences remain. This chapter describes the principal features of health systems and explores the powerful appeal of managerialism and markets to provide an overall context against which to consider the various policy cleavages that occupy the rest of the book.
In this section, we describe the various types and key features of health systems. The principal types are set out in Box 2.1.
The US ‘non-system’ of health comes closest to the free market system, while, at least until recently, the UK’s NHS comes closest to a system representing a government monopoly at the other extreme. Box 2.2 shows the principal types of funding.
The UK’s NHS is an example of a health system funded principally by direct taxation, although there are user charges for some groups of patients in the form of prescription charges. However, these charges only apply to England and, since devolution, no longer apply in Wales and Scotland.
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