Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Reviews
Year : 2022 | Month : August | Volume : 16 | Issue : 8 | Page : IR01 - IR08 Full Version

Public and Private Healthcare System in Terms of both Quality and Cost: A Review


Published: August 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/55387.16742
Saad AL Kaabi, Betsy Varughese, Rajvir Singh

1. Chairman, International Medical Affairs Office, Hamad Medical Corporation, Doha, Qatar. 2. Clinical Quality Administrator, Medicine, Hamad Medical Corporation, Doha, Qatar. 3. Principal Academic Research Scientist, Cardiology Research Centre, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.

Correspondence Address :
Dr. Saad Al Kaabi,
Chairman, International Medical Affairs Office, Hamad Medical Corporation, Doha, Qatar.
E-mail: saadalkaabi@hamad.qa

Abstract

A public healthcare system is one in which the Government governs and controls all healthcare services. It offers high-quality medical care to all citizens, regardless of their ability to pay. The benefits of public healthcare against the private healthcare system showed that the former reduces overall healthcare and administrative costs. It helps in standardising the services and creates a healthier workforce, prevents future costs, and guides the population to make better choices. In contrast, private healthcare maintains a business-driven culture and creates unfair competition for non profit organisations. It considers healthcare as a commodity rather than a right of every citizen and may use its considerable economic power to exert undue influence on healthcare policies. Countries with the best healthcare in the world provide free or universal healthcare. These countries regard healthcare as a social good rather than an economic good and provide universal care, which means that healthcare must be affordable and accessible to all the citizens. Considering the ethical issues in the for-profit healthcare system, as well as the drawback of private health insurers, it is advocated that health insurance must be administered by non profit healthcare providers.

Keywords

Non profit organisations, Private health insurance, Public health insurance, Universal healthcare system

The most efficient strategy to achieve one of the Sustainable Development Goals (SDGs) is to ensure that all people have access to a basic standard of healthcare (1). Public and private healthcare sectors are growing in the healthcare market. The responsibilities of each sector are determined primarily by more effective resource allocation, the uncertainty of how the healthcare market will respond to these institutions, and new management ideas (2),(3),(4). The review of the relative benefits of the public versus private healthcare sector intends to address the question, “Who would offer healthcare services more efficiently in terms of quality of care and cost-effectiveness?” The proponents of the private healthcare system advocate its benefits as the duality of profit maximisation and efficiency. They consider that the competitive market model could improve efficiency, quality, consumer choice, responsiveness, transparency and responsibility. However, the empirical evidence shows a different result which cites the failures inherent in the healthcare market. Hollingsworth did a meta-analysis of 317 published papers on efficiency measures (5) and concluded that “public provision is potentially more efficient than private provision” (5),(6),(7). According to Lee K et al., non profit hospitals in the United States are more efficient than for-profit hospitals (8).

The countries having the best healthcare are providing free or universal healthcare. Countries such as Sweden, New Zealand, Spain, Portugal, Japan, Italy, Ireland, Germany, France, Australia, Canada, South Korea, provide healthcare according to guidelines and standards, which affirm the principles of non profit public administration (9). These countries consider healthcare as a social good than economic good and provide “Universal Care,” which means healthcare must be affordable and accessible to all its residents (10).

Serious ethical criticisms of for-profit healthcare have been stated both within and outside the medical profession. For-profit healthcare exacerbates the problem of access to healthcare and creates unfair competition against non profit organisations. It regards healthcare as a commodity rather than a fundamental human right. It includes incentives and organisational controls that adversely affect the physician-patient relationship creating conflicts of interest that can diminish the quality of care. It undermines medical education and forms a medical-industrial complex that exert undue influence on public policy concerning healthcare and by using its great economic power (11).

It is a well-known fact that for-profit hospital boards maintain a business-driven culture. It must do so because it is held accountable to its shareholders. It does not always prioritise the quality of care over profitability (11). To regulate healthcare systems, private health insurance markets are also expanding and consider its role as an alternative source of health financing and a means of increasing system capacity. However, it has a complex financing mechanism that affects and interacts with public systems (12). It is essential to monitor and regulate private health insurance, especially in areas where resources are scarce and considering the recent economic downturn and rising healthcare needs. Therefore, policymakers must evaluate the current and potential role of private health insurance in the healthcare system, considering the complex interactions between private and public coverage, with the goals of health improvement, responsiveness and financial equity (12). On the other hand, non profit healthcare organisations typically promote a service-driven culture and become more aggressive negotiators when managing expenses like managed care contracts (13). The benefits and drawbacks of public and private health insurance are discussed in the (Table/Fig 1) (14),(15),(16),(17),(18),(19),(20),(21),(22).

Though most Organisation for Economic Co-operation and Development (OECD) countries have attained universal or nearly universal health coverage, the specific implementation varies from one nation to the other (23). For example, the United Kingdom provides free healthcare through Government-owned public facilities, whereas Germany has a Government fund that pays for coverage from private doctors and hospitals (24). Some of the most well-known healthcare systems in the world are discussed in the present review.

Countries Offering Universal Healthcare System

Many countries around the world provide free or universal healthcare (9). This does not mean that every citizen or resident in each of these countries has access to free healthcare. Many of these countries’ employers and individuals contribute to the cost of healthcare through contributions, cost sharing arrangements, copays and other related fees. These programs, however, are aimed at “Universal Care,” which means making healthcare affordable and accessible for as many people as possible (10),(23) which is not in the case of private health insurance.

Healthcare in Sweden

Sweden has one of the best universal public healthcare systems in the world and the 5th highest life expectancy in Europe, at 79.1 years for men and 83.2 years for women in 2010 (25),(26). The cost of healthcare is primarily funded by the Government through taxation (26). Patients, on the other hand, pay about 3% of the cost directly (27). Patients must pay a small copay for each doctor’s visit. Exemptions are available for those under the age of 16 and those who qualify as vulnerable persons. Prescription drugs are not free, but they are very affordable. The total amount a patient pays for a year is capped, and if the prescription bill exceeds this amount, the Government pays the difference. Everything from wellness physicals to specialist appointments to emergency care is covered or heavily subsidised in Sweden. As a result, private healthcare is not widely used there (25), but it is gradually gaining popularity. Their main motivation is to reduce waiting times (25), which can be quite long in public hospitals. Expats who are permanent residents of Sweden or have a work permit in Sweden are eligible for public health insurance universal health coverage. Visitors from the European Union (EU) or European Economic Area (EEA) are also treated at the same rate as locals if they have a European Health Insurance Card (EHIC) (28).

Healthcare in the United Kingdom

The National Health Service (NHS) is one of the largest public healthcare systems in the world, responsible for all aspects of the United Kingdom’s healthcare system, and founded on the principles of universality, free delivery, equity, and central funding (29). The NHS now serves an average of one million people every 36 hours and is funded by taxes (30). The NHS receives about 18% of each person’s income tax, which equates to about 4.5% of the average person’s income (31). On a national scale, healthcare accounts for 12.8% of the UK’s GDP by 2020 (32). There are no copays, deductibles, or excesses for medical services in the United Kingdom because the NHS covers all aspects of medical services for free, including ambulance services, Emergency Department visits, preventative measures, and ongoing treatment programs such as chemotherapy (33). Furthermore, the cost of prescription medication is very low at pharmacies, with most prescriptions costing only a few pounds.

Approximately, 12% of UK residents have private insurance (34). Many people do so as part of their employee benefits package. Otherwise, anyone who is legally residing in the UK is eligible for free NHS healthcare (33).

Healthcare in New Zealand

New Zealand’s healthcare system is an excellent universal public system in which all citizens have equal access to the same standard of care from an integrated preventative system (35). New Zealand spends approximately 9% of its GDP on healthcare (36), and the system runs as a single-payer system. Most healthcare costs are borne by the Government through public taxation (37). The healthcare system is either free or heavily subsidised for patients, depending on the service required. For children under the age of six, free medical services include standard diagnostic tests, immunisations, and prescription medication. Moreover, if the patient is referred by a general practitioner, the Government covers hospital and specialist care. Furthermore, people with low incomes are eligible for a Community Services Card (CSC), which reduces the cost of after-hours doctor visits and prescription medication costs (38). All permanent residents of New Zealand who have been in the country for at least two years are eligible for public health insurance (39). Australia and the United Kingdom have reciprocal healthcare agreements with New Zealand. These citizens can receive emergency healthcare in New Zealand at the same cost as locals. Everyone in New Zealand, including visitors, tourists, and expatriates, is entitled to free medical care in the event of an accident. This is known as the Accident Compensation Corporation (ACC) program in New Zealand (40).

Healthcare in Spain

Spain has a universal healthcare system and ranks 19th in Europe according to the 2018 Euro health consumer index (41). The Spanish National Health System called Sistema Nacional de Salud (NHS) is mainly funded by taxes and runs through a public provider network. The health responsibilities have been moved to regional levels since 2002, resulting in 17 regional health ministries for the organisation and delivery of health services within their respective territories (42). The Ministry of Health, Social Services, and equality oversees specific strategic areas and national health system performance monitoring. The NHS Interterritorial Council brings together national and regional health ministers. Its principal goal is to operate as a coordinator rather than a regulatory agency, to organise the national response to disease outbreaks, and to discuss the regional implications of new laws (42). In addition to NHS, there are three alternative voluntary health insurance for Spanish citizens: substitutive voluntary health insurance, complementary voluntary health insurance, and supplementary voluntary health insurance. Substitutive voluntary health insurance is an alternative to statutory health insurance, available to people who choose not to participate in the public system or are not eligible for public health coverage, while complimentary health insurance offers full or partial coverage for services that are excluded or not fully covered by the statutory healthcare system. Supplementary health insurance is an option for those Spanish citizens who use the available universal healthcare but would like additional private insurance that may provide them with better or more suitable options and benefits (43).

Healthcare in Portugal

The quality of healthcare in Portugal is high and steadily improving. It consists of three components. The first is the National Health Service or NHS (in Portuguese: Servico Nacional de Saude or SNS), a form of subsidised state care for people who contribute to the social security system that was established in 1979 and is overseen by the Ministry of Health (44). It is defined as national, universal, and free, and it covers the entirety of mainland Portugal. The second system, the health subsystem program, is a special social healthcare initiative provides medical care to members of specific professions or organisations such as police, military, and banking services. The ADSE (AssistĂŞncia na Doença aos Servidores Civis do Estado) is the most important public health subsystem, covering over 1.3 million public servants. The third option is voluntary private healthcare (44). The public NHS system in Portugal is funded through general taxation and is also subsidised by contributions from workers paying into the social security system (45). It also covers people who are not employed, as well as dependent family members and retirees. The NHS services include everything from general practitioner’s services and maternity care to hospital treatments and community medical programs (45). Residents of Portugal are required to contribute a small portion of their medical expenses, including doctor and specialist visits, hospitalisation, and prescriptions. Around 20% of Portuguese residents have private health insurance to supplement their public health insurance, which includes dental and vision care. It can also be used to cover out-of-pocket expenses for patients. Portuguese citizens and permanent residents have access to the Portuguese public health system. Furthermore, European residents with a European Health Insurance Card have the same access to public services as Portuguese residents (45).

Healthcare in Japan

Japanese citizens have a higher life expectancy than the rest of the world, which could be attributed to the country’s excellent healthcare system (46). The system prioritizes preventative care over reactive care. The Japanese Medical System is based on universal healthcare, which is known as Social Health Insurance (SHI). The SHI applies to everyone who is employed full-time with a medium or large company (47). Approximately 5% is deducted from salaries to pay for SHI, and employers match this cost. Those who do not qualify for SHI are covered by the Japan National Health Insurance (NHI) plan. Self employed individuals, such as expatriates and digital nomads, are eligible for the NHI plan. It also applies to those who work for small businesses and the unemployed. Their income determines the amount they pay into the NHI. In general, 70% of the costs of medical appointments, hospital visits, and even prescriptions are paid by the Government and patients only pay the remaining 30% of healthcare costs. However, this ratio may shift in favour of the patient depending on the patient’s income level. For-profit organisations are not permitted to operate hospitals and clinics in Japan, except for hospitals established by for-profit companies for their employees (48). The SHI covers 98.3% of the population, while the Public Social Assistance Program covers the remaining 1.7%. Also, 70% of the population holds secondary, voluntary private health insurance, which plays only a supplementary or complementary role in covering the copayments or non covered costs (48).

Healthcare in Italy

The Italian National Health Service (Servizio Sanitario Nazionale, or SSN) is the country’s public health system, and it is based on the principles of universal coverage, solidarity, human dignity, and health (49). The Italian healthcare system is ranked second in the world in 2000, just behind the French healthcare system, according to the World Health Organisation (WHO) (50),(51). The health insurance system in Italy is extremely affordable. Inpatient care, primary care, and doctor’s visits are all free of charge (52). Diagnostic procedures and prescription medication, on the other hand, have a copay. Copays can be as much as 30% of the total cost. Vulnerable people, such as the elderly, pregnant women, and children, are exempt from these copay costs. The free appointments and low copays are the results of Italy’s tax funded public health system. The system is primarily supported by a payroll tax system. The system is also supported by federal and regional general taxation, such as income taxes and value added taxes on goods and services. The Ministry of Health provides funding to various regions of Italy. The funding allocated to each region is determined by a formula that considers previous spending and other factors. The funds are then allocated to the local health authority by the regions (53). This system keeps the cost of health insurance in Italy low. In general, the public health system and medical care are excellent, with almost all patient costs covered. The system emphasises both preventative and curative care. The SSN does not allow people to opt-out of the system and seek solely private treatment hence, substitute insurance is not available, however, complementary and supplementary private health insurance, on the other hand, play a minor role in the healthcare system, accounting for less than 1% of total spending in 2014. Private health insurance is divided into two categories: corporate, which covers employees and their families, and noncorporate, which is purchased by individuals for themselves or their families (52),(54). In addition to citizens and legal foreign residents, European Union citizens with a European Health Insurance Card can also use the SSN’s services.

Healthcare in Ireland

The national medical system in Ireland is governed by the 2004 Health Act, which established the Irish Health Service Executive to provide medical and social services (55). Almost 40% of the population receives free medical care, while the rest receives heavily subsidised services through the public system or choose private insurance coverage. The Irish public healthcare system is funded by taxes and is available to all legal residents (56). Depending on their income,

• Approximately 37% of the population has access to completely free public services through the Medical Card System, also known as Category 1 care, which includes all doctor visits, hospital care, tests, and medication. There is also the General Practitioner (GP) visit card, which is available to those who are just above the eligibility threshold for a medical card and provides free general practitioner visits but does not include the other benefits that come with a medical card.
• Furthermore, people who are not eligible for the medical card or the GP visit card are still a part of the universal healthcare system, which is referred to as category 2 care, and are entitled to discounted public hospital treatments and prescription drugs, but must pay the full cost of GP and other primary care services (57).

There are some services and programs available, if anyone proactively signs up for them. For example, the Drugs Payment Scheme limits the amount spent on prescription drugs, the long-term Illness Scheme covers the costs of a long term condition and the Maternity and Infant Care Scheme provides medical care to expectant and new mothers and babies (58).

Healthcare in Germany

The German healthcare system is regarded as one of the best in the world. It’s a universal, multipayer healthcare system funded by a statutory contribution system that ensures that everyone has access to free healthcare through health insurance funds (59). There are two types of health insurance in Germany:

• Public Health Insurance: Gesetzliche Krankenversicherung (GKV)
• Private Health Insurance: Private Krankenversicherung (PKV)

Approximately 86% of the population is covered by statutory health insurance, which includes coverage for inpatient, outpatient, mental health, and prescription drug costs. The Government plays almost no role in delivering healthcare directly, whereas the administration is handled by non Governmental insurers known as sickness funds. These funds are financed by general wage contributions (14.6% of wages) and supplementary contributions (1% of wages, on average) by employers and employees. Copayments apply to inpatient services and drugs, and sickness funds offer a range of deductibles. The Germans who earn more than $68,000 can opt-out of SHI and switch to private health insurance, which is not subsidised by the Government (60).

Healthcare in France

The French healthcare system is based on the principle of universal healthcare and is known as the Protection Maladie Universale (PUMA) (61). The public healthcare system is estimated to cover 96% of all French residents. In France, most of the hospitals are publicly owned and for non profit. Preventive healthcare is highly valued, and every patient is entitled to a comprehensive preventative physical every five years. Alternative healthcare methodologies are respected, and if a patient wishes to consult with an alternative practitioner for weight loss or smoking cessation assistance, the healthcare system will accommodate them. The French healthcare system costs a lot of money to run. Approximately 8% of salaries are automatically withheld to help fund the system. The system is funded by all citizens, and the rates that doctors and hospitals can charge are regulated by the state. Agence Nationale d’Accréditation et d’Evaluation en Santé (ANAES) is the Government agency responsible for accrediting health facilities, evaluating clinical practice and guidelines, and defining the interventions that are reimbursed by health insurance (62). The total health expenditures accounted for 11.5% of GDP in 2017, with 77% of those spending being funded by the Government. The following are the terms of statutory health insurance financing i.e, employers pay 80% of the tax and employees pay the balance. Payroll taxes account for 53% of total funding. A 34% contribution comes from a national designated income tax. Tobacco and alcohol taxes, pharmaceutical sector taxes, and Voluntary Health Insurance (VHI) firms all provide 12% of funding. Subsidies from the state contribute to 1% of total funding. Coverage is compulsory and is provided to all the residents. A majority of voluntary health insurance is complementary, covering primarily copayments and balance billing, as well as vision and dental care, which are only minimally covered by SHI (61).

Healthcare in Australia

In Australia, public healthcare is provided through Medicare, a single-payer, universal healthcare program that covers all Australian citizens and permanent residents (63). Medicare covers medical appointments, medications, and hospitalisation at a reduced or no cost (64). The taxes cover the costs of healthcare. The Medicare Levy, which funds the public system, is paid by residents at a rate of 2% of their income (65). As a result, most patients never pay medical fees at their appointments, and if they do, they can get reimbursed. Medicare pays for general physician visits, hospital visits, and 85% of specialist costs. It also subsidizes prescription medications, allowing them to be purchased at a reduced price. Medicare also pays for some costs associated with physiotherapy, community nursing programs, and basic dental care for children. However, expatriates in Australia, including workers and students, are paying for their healthcare through cash or private health insurance. People who are not eligible for Medicare benefits can apply for an exemption from paying the Medicare levy or a reduction in the amount they pay (66). Healthcare in the country is also enhanced through Primary Health Networks (PHNs). There are 31 PHNs across the country that are in charge of assisting community health centres, hospitals, doctors, and nurses. PHNs also help to coordinate activities across the healthcare system and may provide more services, if the need arises in different regions (67).

Healthcare in Canada

Canada’s healthcare system is unique in the world since it has a decentralized, universal, publicly funded health system known as Canadian Medicare, which is primarily funded and administered by the country’s 13 provinces and territories (68). Each has its own insurance plan and receives per capita cash assistance from the federal Government (68). The norms and standards are established by the federal Government, and they affirm five foundational principles: non profit public administration by a public authority, comprehensiveness, universality, portability, and accessibility (69). Benefits and delivery methods differ. Medically essential hospital and physician services are, however, provided free of charge to all citizens and permanent residents. Provinces and territories provide some coverage for excluded services, such as outpatient prescription medicines and dental care. In 2017, overall health spending was anticipated to be 11.5% of GDP, with the public and private sectors accounting for roughly 70% and 30% of total health spending, respectively (68). All medically essential hospital and physician services are covered by each patient’s health insurance plan. Supplementary services, or those not covered by Canadian Medicare, are generally funded privately, either through patient fees or through employer based or private insurance. Provinces and territories are responsible for all of their own residents, based on their residency criteria. Taxes account for the majority of the patient revenue. The Canada Health Transfer, a federal program that pays healthcare for provinces and territories, provides almost a quarter of the funding (an estimated CAD 37 billion, or USD 29.4 billion in 2017 to 2018) (68).

Healthcare in South Korea

The healthcare systems of South Korea pursue universal healthcare, where everyone can access healthcare services with a minimal financial burden (70). At the national level, the Ministry of Health and Welfare (MoHW) oversees health policy and planning (71). The MoHW runs several specialty national hospitals where the private market fails to meet the needs of the population, such as the 17 Psychiatric Hospitals and three Tuberculosis Hospitals. However, private hospitals also play an important role in healthcare delivery (71) and the care provided in private clinics and hospitals is covered under the National Health Insurance (NHI) scheme. The NHI program is managed by the National Health Insurance Service (NHIS) and the care it covers is reviewed by the Health Insurance Review and Assessment Service (HIRA). Though the two organisations are separate from the Ministry, they remain under some indirect control of the MoHW. Health insurance coverage has gradually spread from large to medium and small companies, as well as from employees to self employed people. Coverage is provided through a statutory health insurance plan in which recipients pay a premium and cannot opt-out. A 20% co-payment is required for inpatient care, while the copayment for outpatient care varies from 30-60% depending on the provider. The Medical Aid Programme pays both the insurance premium and copayments for low-income people. In 2018, 97.2% of the population was covered by NHI, while 2.8% was covered by the Medical Aid Program (72).

Healthcare in Qatar

Qatar has a rapidly developing healthcare system that has been ranked as the fifth best in the world and the first in the Middle East in 2019 Legatum Prosperity Index in terms of quality of care. It is the region’s only country to rank among the top five in the annual prosperity index (73) and the Government has made significant investments in the country’s public healthcare system with cutting-edge medical equipment, up-to-date facilities and highly-trained specialists. The Hamad Medical Corporation (HMC), a non profit organisation, directs Qatar’s public medical facilities and has overseen major public hospitals in the country since 1979 (74). It operates 12 public hospitals, community clinics, and the national ambulance service. The HMC has created an intricate and efficient network of clinics and hospitals which provide free treatment for Qataris and subsidised treatment for expatriates. Qatari residents can avail of the services through a Government issued health card. Expats can purchase the health card at a marginal cost of QAR100, while Qatari citizens receive it for QAR 50 (75). With this card, emergency treatment is most often free in public hospitals, however, expatriates need to pay nominal charges for tests, consultation and inpatient care. Though Qatar’s public healthcare system is excellent and subsidised, the country also has few private healthcare providers. However, these private hospitals are quite expensive and can be prohibitively high without medical coverage. Under a new healthcare law that goes into effect in May 2022, employers in Qatar are required to provide health insurance coverage for expatriates and their families (76). The new insurance system is intended to help the healthcare sector by providing basic healthcare services to workers through care providers in Government and private health facilities (76). Much more information will be available once it has been put into practice.

Discussion

Although the Coronavirus Disease-2019 (COVID-19) pandemic hampered the availability and ability of health systems to deliver uninterrupted healthcare in many nations, several countries are already making progress toward Universal Health Coverage (UHC) (77). Health systems in all countries must be strengthened to achieve universal health coverage. The importance of strong funding mechanisms cannot be ignored. The poor are often unable to access many of the services they want when they must pay the majority of the cost of healthcare out of their own pockets, and even the wealthy may face financial difficulties in the event of severe or long-term sickness (77). The financial risks of diseases can be managed by pooling cash from mandatory financing sources like Government tax revenue (77).

Many Low and Middle Income Countries (LMICs) have also recently reformed their health systems to promote universal access to healthcare, improve the quality of health services, and increase equity in health financing [78,79]. Many such countries have set UHC as a goal for national healthcare reform (80). According to the WHO, there are three fundamental, interrelated problems that prevent countries from achieving universal health coverage:

• The first one is resource availability, in which every Government must ensure that everyone has rapid access to any technology or intervention that can help them improve their health or live longer.
• The second is an over-reliance on direct payments when people need care, mostly for over-the-counter payments for medicines and fees for consultations and procedures. Millions of people are unable to receive healthcare because they are required to pay directly for services at the time of care and those who seek treatment may also face considerable financial difficulties and impoverishment.
• The third impediment to countries’ progress toward universal coverage is inefficient and unequal resource allocation.

According to conservative estimates, roughly 20% to 40% of health resources are wasted. The ability of health systems to offer excellent services and improve healthcare would be considerably enhanced, if this waste could be reduced. Improved healthcare efficiency makes it easier for the ministry of health to obtain additional financing from the ministry of finance in most circumstances. To accomplish UHC, countries must raise enough revenues, minimise reliance on direct payments to finance services and increase efficiency and equity (80). There are several ways for countries to raise money for health, including improving revenue collection efficiency, reprioritising Government budgets, and innovative financing, such as rich countries raising more funds for health in poor settings by increasing taxes on air tickets, foreign exchange transactions, tobacco, and other items, and development assistance for health, where the funding shortfall faced by low-income countries highlights the need for high-income countries to honour their commitments on Official Development Assistance (ODA) (80).

Though many of the world’s top healthcare systems provide free or universal healthcare for the purpose of making healthcare affordable and accessible for all citizens (10), it also has certain drawbacks. The treatment of the sickest is paid for by the healthy. Chronic illnesses, mostly caused by lifestyle decisions, account for over 90% of healthcare costs. As a result, many people who live a healthy lifestyle feel burdened and unfairly taxed by others’ poor decisions (81). Patients who do not have to pay a charge may overuse emergency rooms and doctors. Wait times for elective operations also can be much longer because the Government generally focuses on providing basic and emergency healthcare (82). The Government cost-cutting could also result in decreased care provision (83). Moreover, healthcare spending accounts for a significant portion of Government spending (84). The Government may limit services with a low possibility of success, such as rare disease drugs and expensive end-of-life care (85). These disadvantages could easily be mitigated and overcome by excellent health governance, which could enhance the possibility of attaining the benefits of UHC.

Political stability and governance are important factors for developing a country especially for achieving universal health coverage. A cross-sectional study involving 118 countries found a significant association between political stability, governance status, and socio-demographic status with universal health service coverage (86). A study by Fox AM and Reich MR, suggested that health service coverage could not be achieved without political negotiation and conflict settlement (87). According to Bump J in 2010, UHC is intensely political since it requires consistent policies and programs to deliver quality health services to the entire population (88). In addition, Kelsall T, demonstrated that effective public policy, adequate funding, and improved governance could accelerate advancements toward the UHC (89). Also, the World Health Organisation’s action plan affirmed that good governance is a prerequisite for UHC (90), and the World Bank Human Development Network reported that good governance leads to improved health outcomes and coverage (91). According to a Chinese study, improving health governance greatly enhanced health service and health insurance coverage (92). Another study by Yeoh EK et al., found that good governance contributes to progress toward UHC in the Asia-Pacific area (93). Fryatt R et al., also stated that effective governance will help the success of UHC and that people are accountable inside the health system (94).

A study by Reich MR et al., classified LMICs into four different levels (95). The first group consists of countries at the bottom of the UHC ladder, such as Bangladesh and Ethiopia, that are currently working to incorporate UHC into their national policies. The second group consists of nations such as Indonesia, Peru, and Vietnam, which have made tremendous progress toward universal health coverage but still have significant coverage gaps. The third group includes countries such as Brazil, Thailand, and Turkey, which have achieved several UHC policy objectives but are currently facing sustainability issues. Countries like France and Japan are in the fourth group, which have achieved universal health coverage but still need to make significant policy reforms to address demographic and epidemiological concerns such as aging populations and the rising prevalence of degenerative diseases (95).

Conclusion

As countries move toward universal health coverage, private healthcare and private health insurance are also becoming more popular. In the private healthcare system, there are numerous ethical issues, including access to healthcare, unfair competition with non profits, viewing healthcare as a commodity, poor physician-patient relationships, reduced quality of care, diminished value of medical education, and undue influence on public policy regarding healthcare. Also, private health insurance may present significant equity challenges, potentially increasing healthcare spending. Complete coverage of public sector costs by private insurance may encourage moral hazard-induced utilisation. Hence, considering the ethical issues involved in a for-profit healthcare system and the drawbacks of private insurers, health insurance must be administered by non profit organisations.

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DOI and Others

DOI: 10.7860/JCDR/2022/55387.16742

Date of Submission: Feb 06, 2022
Date of Peer Review: Mar 11, 2022
Date of Acceptance: Jul 04, 2022
Date of Publishing: Aug 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 08, 2022
• Manual Googling: Jul 02, 2022
• iThenticate Software: Jul 05, 2022 (23%)

Etymology: Author Origin

JCDR is now Monthly and more widely Indexed .
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  • Academic Search Complete Database
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  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
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