The European Union has announced it will look at assessing health systems as a priority during the European Commission’s new term. The outcomes will be helpful in providing member states with a fresh perspective as well as the ability to further consider ideas on how to address major changes. These are challenges that have to be tackled while still respecting the provisions of EU treaties, writes Marc Bell.
As the Commission undertakes this analysis, it is useful to review the two most common health systems models as a reminder of the relative diversity of health systems existing in the EU. But interestingly, these two models have an important and notable common factor: both are based on the principle of solidarity. To explore this underlying principle further, looking at the ways in which funding is generated is the most common way to draw an overview of health systems in the EU.
The two main historical systems are: ‘National Health Service’ systems (e.g. the UK’s Beveridge models) and ‘social health insurance’ systems (e.g. Germany’s Bismarck models). Although boundaries between the two main models are increasingly blurred, looking at their funding structure gives a good idea of the difference between them. In National Health Service systems (NHS systems) funding stems from national taxation, while in social health insurance systems funding comes from social contributions.
NHS systems exist for example in the United Kingdom, in some Scandinavian countries as well as Spain. They are characterised by free access for all at the point of care. In the social health insurance model existing in France, Germany and Belgium (to name but a few), healthcare is financed by social contributions of employees and employers and is based on a system of reimbursements. Typically, these latter countries tend to have a higher proportion of complementary healthcare schemes that complement the statutory coverage and rely on a mix of operators including non-profit organisations such as mutuals.
This duality of funding through social contributions and private contributions means that the funding of the healthcare is more varied and more flexible. Both systems have advantages and disadvantages but in both the solidarity principle is dominant. It is often said that the health sector is not a market as other markets may be: indeed European welfare states hold the view that all citizens should have equal access to healthcare.
This premise holds true in both types of models. In the NHS system, the state grants access to healthcare for all. In the national health insurance model, social contributions are calculated based on income. The mutuals among complementary healthcare insurers are the heirs of the first sickness funds called ‘mutual aid societies’ or ‘mutual sickness funds’ upholding the fundamental principle of solidarity by providing insurance without discrimination. Mutuals, such as Benenden Health in the United Kingdom and ‘Danmark’ in Denmark, prove that the mutual model has an enduring relevance in both health systems although they are more common in the social health insurance models.Benenden Health is in fact a unique model of health mutual in the United Kingdom.
One of the great assets of the European Union that differentiates it from all other continents is its encompassing social welfare states, in which solidarity-based health systems play a significant role. While the EU starts to look at assessing health systems in the future, one common point of all health systems already stands out: all European health systems are based on the key principle of solidarity and should continue to be based on this principle.
Marc Bell is CEO of Benenden Health, a not-for-profit mutual healthcare organisation that was created in 1905. It has around 900,000 members, to whom it provides diagnostics and treatments for over 240 conditions on a discretionary basis.
