Secrets Of Survival (S.O.S.) with Dr. Susan Rashid

Global Healthcare Systems: Models of Delivery Around the World Part 2

Episode Summary

In this episode of Secrets of Survival (S.O.S.), Dr. Susan Rashid takes listeners on a scholarly exploration of the diverse healthcare delivery systems that sustain populations worldwide. From the equitable access of the Beveridge Model to the efficiency of the Bismarck Model, from the universal reach of the National Health Insurance Model to the stark realities of out-of-pocket systems, this episode examines the intricate frameworks that define global healthcare. Through thoughtful analysis, Dr. Rashid highlights the strengths and challenges of each model, drawing insights from renowned studies and real-world applications. The episode also delves into the emerging trends shaping the future of healthcare, including telemedicine and universal health coverage initiatives. Concluding with a reflective call to action, the episode underscores the shared responsibility of advancing global health through collaboration, innovation, and equity. This is a must-listen for healthcare professionals, policymakers, and anyone intrigued by the systems that safeguard humanity’s survival. Join us on Secrets of Survival to uncover the profound connections between healthcare delivery, societal values, and the future of global well-being.

Episode Notes

In this episode of Secrets of Survival (S.O.S.), Dr. Susan Rashid takes listeners on a scholarly exploration of the diverse healthcare delivery systems that sustain populations worldwide. From the equitable access of the Beveridge Model to the efficiency of the Bismarck Model, from the universal reach of the National Health Insurance Model to the stark realities of out-of-pocket systems, this episode examines the intricate frameworks that define global healthcare. Through thoughtful analysis, Dr. Rashid highlights the strengths and challenges of each model, drawing insights from renowned studies and real-world applications. The episode also delves into the emerging trends shaping the future of healthcare, including telemedicine and universal health coverage initiatives. Concluding with a reflective call to action, the episode underscores the shared responsibility of advancing global health through collaboration, innovation, and equity. This is a must-listen for healthcare professionals, policymakers, and anyone intrigued by the systems that safeguard humanity’s survival. Join us on Secrets of Survival (S.O.S.) to uncover the profound connections between healthcare delivery, societal values, and the future of global well-being. 

Mysterious Way, Music by Treize Akatfeuye, from Jamendo Music/Jamendo Licensing 

Episode Transcription

Podcast Episode Script: Global Healthcare Systems: Models of Delivery Around the World

Narrator: [00:00:00] 

Thank you for joining us on this journey of discovery and reflection. Dr. Susan Rashid, Rashid Media Productions, and Rashid Publications (RP) media work are founded on a steadfast dedication to meaningful original content. Rashid Media Productions and Rashid Publications (RP) are dedicated to creating immersive and thought-provoking content that truly resonates with today's audiences. With each piece, we aim to offer work that is intellectually rich, culturally profound and emotionally resonant content that sparks curiosity and inspires genuine connection. Through this unique blend of media, we honor timeless stories and amplify voices that offer fresh perspectives inviting, thoughtful reflection along the way. Our vision extends beyond entertainment. We aim to educate, enlighten and empower. We are passionate about fostering, understanding, advocating for justice, and championing the underrepresented. We are committed to excellence and integrity. We envision a future where our work leaves a lasting, positive imprint on individuals, communities and society as a whole. In this spirit, we are honored to announce the upcoming production of the following distinguished podcasts: On The Streets: A Documentary Podcast on Homelessness, Whispers From Beyond, Whispers From The Heart, Having the Last Word Disappear, White Coat Reads, Gothic, Elegant Reads, Beyond the Last Breath, Silent Stillness: A Journey in Buddhism, Secrets of Survival (S.O.S.), Practicing Correctional Medicine, Rooted in Health, On the Road With Susan, Echoes Through Eternity, Whispers of the Ancient: A Journey in Shamanism,  Baking Through Time, Moondust Noir, and Moonlight Madness. Each of these projects is conceived with a steadfast dedication to meaningful and original content, and they remain fully protected under the comprehensive scope of United States copyright and trademark law and international (IP) protections. Any unauthorized use, reproduction or infringement shall invoke immediate and resolute legal action to uphold the integrity of these works and the principles they represent. Dr. Rashid, Rashid Media Productions, and Rashid Publications (RP) extends their sincere gratitude to all who honor and respect these values. 

[Intro Music: Background Music - Mysterious Ways]

Narrator: [00:02:36] 
Welcome to Secrets of Survival (S.O.S.), the gripping and informative podcast that takes you into the heart of modern medicine’s most pressing challenges and extraordinary stories.  Here, we explore the pulse of global healthcare, uncovering groundbreaking research, personal narratives, and expert insights that shape the way we care for one another in the 21st century. 

I’m thrilled to introduce your host—an extraordinary family medicine physician, visionary, and advocate for the medically underserved—Dr. Susan Rashid.  In today’s episode, "Global Healthcare Systems: Models of Delivery Around the World", we will dive deep into how different nations approach healthcare delivery.  

We’ll explore the strengths and weaknesses of various models—from universal healthcare systems to private and hybrid models—and discuss what these systems can teach us about improving access and quality of care for all. Join us for a compelling journey through the dynamic world of healthcare delivery systems. Part 1 will cover the Beveridge Model and the Bismarck Model, and Part 2 will cover the National Health Insurance (NHI) System and the Out-Of-Pocket System. 

Segment 3: The National Health Insurance (NHI) Model

Historical Development

Dr. Susan Rashid: Today, we will explore the National Health Insurance (NHI) Model and the Out-Of-Pocket Model healthcare delivery systems.  The National Health Insurance (NHI) Model was developed to create healthcare systems that ensure fair, high-quality, and efficient care for all. It combines ideas from two other major systems: the Beveridge Model, which funds healthcare through taxes, and the Bismarck Model, which relies on insurance-based funding.

Key Features, Strengths, and Challenges of the NHI Model

Key Features

  1. Universal Insurance Funded by Taxes:
    Healthcare is funded primarily through taxation, ensuring that everyone is covered regardless of income or employment status. This approach eliminates financial barriers to accessing care and promotes equity.
  2. Choice Between Public and Private Providers:
    Patients can choose to receive care from public hospitals and clinics or private providers. This flexibility allows individuals to tailor their healthcare experience based on their preferences.
  3. Single-Payer System:
    The government acts as the single payer for healthcare services, which reduces administrative complexity. Providers bill one entity (the government), minimizing overhead costs and simplifying the process for patients and healthcare workers alike.
  4. Adopted by Multiple Countries:
    Countries like Canada, Taiwan, and South Korea have implemented this model, adapting it to meet the specific needs of their populations while maintaining universal coverage.

Strengths

  1. Universal Coverage:
    The NHI Model ensures that healthcare is accessible to all citizens, reducing health disparities and improving public health outcomes.
  2. Cost Savings:
    Administrative costs are significantly lower in single-payer systems compared to multi-payer systems. This reduces overhead expenses and makes the system more efficient.
  3. Flexibility for Patients:
    The ability to choose between public and private providers enhances patient satisfaction and allows for greater customization of care.
  4. Promotes Equity:
    Universal coverage ensures that access to care is based on need rather than ability to pay, fostering a more equitable healthcare system.

Challenges

  1. Long Wait Times:
    In some countries, patients face delays for non-urgent services, such as specialist appointments or elective surgeries. For example, Canada’s system is known for its long wait times.
  2. Budgetary Constraints:
    Since the system relies on government funding, budget limits can lead to rationing of care, prioritizing some services over others.
  3. Sustainability Concerns:
    An aging population and rising demand for healthcare services can strain resources, requiring governments to find innovative ways to maintain system sustainability.
  4. Healthcare Workforce Issues:
    Ensuring an adequate supply of healthcare workers is a persistent challenge, particularly in rural or underserved areas.

Canada’s Introduction of the NHI Model

Canada is the second-largest country in the world by land area, located in North America. It stretches from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward to the Arctic Ocean. Canada shares its southern border with the United States.

Canada was one of the first countries to adopt the NHI approach. In the 1940s, the province of Saskatchewan, located in the western part of the country and known for its expansive prairies, introduced a hospital insurance plan under Premier Tommy Douglas. Saskatchewan’s progressive policies ensured that all residents could access hospital care regardless of income. This plan became the foundation for publicly funded healthcare across Canada. By 1984, the Canada Health Act officially established universal healthcare nationwide, 

*Marchildon, Gregory P et al. “Canada: Health System Review.” Health systems in transition vol. 22,3 (2020): 1-194.

*Maioni, Antonia. “Parting at the Crossroads: The Development of Health Insurance in Canada and the United States, 1940-1965.” Comparative Politics, vol. 29, no. 4, 1997, pp. 411–31. JSTOR, https://doi.org/10.2307/422012. Accessed 3 Jan. 2025.

Canada’s Strengths and Current Challenges with the National Health Insurance (NHI) Model

Strengths of Canada’s NHI Model

  1. Universal Coverage:
  2. Equity:
  3. Cost Efficiency:
  4. Comprehensive and Portable Coverage:
  5. Public Satisfaction:

Current Challenges of Canada’s NHI Model

  1. Long Wait Times:
  2. Unequal Access in Rural Areas:
  3. Healthcare Workforce Shortages:
  4. Rising Costs and Sustainability:
  5. Limited Prescription Drug Coverage:
  6. Fragmentation Across Provinces:

Conclusion (redo recording)

Canada’s NHI Model is a globally admired system that prioritizes equity and universal access. However, addressing challenges such as long wait times, rural healthcare gaps, workforce shortages, and rising costs will require innovative policy solutions and increased collaboration between federal and provincial governments. Continued investment in technology, preventive care, and systemic reforms will be critical for ensuring the sustainability and effectiveness of Canada’s healthcare system.

Taiwan’s Introduction of the NHI Model

Taiwan is an island nation located in East Asia, off the southeastern coast of mainland China. It is separated from China by the Taiwan Strait, and its neighboring countries include Japan to the north and the Philippines to the south. 

Before 1995, Taiwan had several separate insurance schemes that covered only parts of the population, such as civil servants, military personnel, and workers in specific industries. Many people, particularly those in rural areas or informal employment, were left without coverage. In response to growing public demand for universal healthcare and concerns about inequities in the system, Taiwan introduced its NHI Model in 1995. This reform unified all existing schemes into a single government-administered program, ensuring that nearly every citizen had access to healthcare. The reform also aimed to improve cost efficiency and reduce administrative complexity.

Taiwan’s Strengths and Current Challenges with the NHI Model

Strengths of Taiwan’s NHI Model

  1. Universal Coverage:
  2. Administrative Efficiency:
  3. Cost Control:
  4. Advanced Health IT Infrastructure:
  5. Accessibility and Equity:
  6. High Public Satisfaction:

Current Challenges of Taiwan’s NHI Model (recording redo)

  1. Financial Sustainability:
  2. Aging Population:
  3. Underpaid Healthcare Providers:
  4. Overutilization of Services:
  5. Limited Funding Mechanisms:
  6. Provider Distribution:
  7. Technological Costs:

Conclusion

Taiwan’s NHI Model is globally recognized for its comprehensive, efficient, and equitable healthcare delivery. However, challenges such as an aging population, financial sustainability, and workforce satisfaction require focused reforms. Innovative solutions that are currently being explored include revising funding mechanisms, investing in geriatric and preventive care, and addressing regional disparities and these solutions will be essential to ensuring the system’s long-term success.

South Korea’s Introduction of the NHI Model

South Korea is a nation located in East Asia, occupying the southern portion of the Korean Peninsula. It is bordered by North Korea to the north, the Yellow Sea to the west, and the Sea of Japan (East Sea) to the east. 

South Korea began implementing its NHI system in 1977 to address the lack of affordable healthcare for industrial workers and their families. Initially focused on urban workers, the system expanded rapidly due to political pressure and public demand for more inclusive healthcare. By 1989, South Korea achieved universal healthcare, extending coverage to rural populations and self-employed individuals. The push for an NHI system was driven by the need to address inequalities in healthcare access, promote economic productivity by ensuring a healthy workforce, and align with the country’s broader social and economic development goals. The NHI system also helped stabilize healthcare costs and improve efficiency by centralizing funding and administration.

South Korea’s Strengths and Current Challenges with the National Health Insurance (NHI) Model

Strengths of South Korea’s NHI Model

  1. Universal Coverage:
  2. Cost Efficiency:
  3. Technological Integration:
  4. Comprehensive Benefits:
  5. Equity and Accessibility:
  6. High Public Satisfaction:

Current Challenges of South Korea’s NHI Model

  1. Aging Population:
  2. Financial Sustainability:
  3. Overutilization of Services:
  4. Provider Reimbursement Rates:
  5. Inequalities in Regional Access:
  6. Mental Health Gaps:
  7. Impact of Technological Advancements:

Conclusion

South Korea’s NHI Model is celebrated for achieving universal coverage and administrative efficiency. However, it faces significant challenges from an aging population, financial sustainability concerns, and regional disparities in access. Addressing these issues will require strategic reforms, such as increasing funding sources, revising reimbursement policies, and investing in rural healthcare infrastructure. South Korea’s ongoing commitment to innovation and policy adaptation will be critical in ensuring the long-term success of its NHI system

The National Health Insurance (NHI) Model with Indonesia's Example

Indonesia’s NHI Model

Indonesia is a Southeast Asian nation located between the Indian and Pacific Oceans. It is the world’s largest archipelago, consisting of over 17,000 islands, including major ones like Java, Sumatra, Borneo (shared with Malaysia and Brunei). The country spans a distance of about 5,100 kilometers from east to west, making it one of the most geographically dispersed nations in the world. Indonesia shares maritime borders with countries such as Malaysia, the Philippines, Singapore, and Australia.

Indonesia launched the Jaminan Kesehatan Nasional (JKN) program in 2014, managed by the Social Security Agency for Health (BPJS-Kesehatan), aiming to achieve universal health coverage (UHC) by 2024. 

*Reference: Agustina, R., Dartanto, T., Sitompul, R., et al. (2019). Universal health coverage in Indonesia: Concept, progress, and challenges. The Lancet, 393(10166), 75-102.

Indonesia’s Strengths and Current Challenges with the National Health Insurance (NHI) Model

Strengths of Indonesia’s NHI Model

Universal Coverage Goals:
Indonesia started the Jaminan Kesehatan Nasional (JKN) program in 2014, run by the Social Security Agency for Health (BPJS-Kesehatan), with the goal of providing healthcare for everyone by 2024. By 2023, it had become the largest single-payer healthcare system in the world, covering over 222 million people.

*Reference:Agustina, Rina et al. “Universal health coverage in Indonesia: concept, progress, and challenges.” Lancet (London, England) vol. 393,10166 (2019): 75-102. doi:10.1016/S0140-6736(18)31647-7. 

Accessibility for Low-Income Groups:

The government subsidizes premiums for low-income citizens, ensuring equitable access to healthcare services regardless of income. The Penerima Bantuan Iuran (PBI) scheme provides coverage for over 96 million poor and vulnerable people.

*Reference: Rokx, C., Giles, J., Satriawan, E., et al. (2019). Health financing in Indonesia: A reform road map. World Bank Publications. World Bank Document.

Comprehensive Benefit Package:

The JKN scheme covers a wide range of services, including inpatient and outpatient care, maternal health, vaccinations, and chronic disease management, without significant out-of-pocket payments.

Reference: National Health Insurance (JKN) Reforms & Results. Program-For-Results (PFOR) P172707. Environmental and Societal Systems Assessment Report (ESSA). Prepared by the World Bank. Final0Environm0s0Program000P172707.docx.

Innovative Digital Solutions:

The introduction of the Mobile JKN app enhances administrative efficiency by allowing members to register, update personal information, pay premiums, and access information about healthcare providers. This innovation reduces bureaucratic delays and improves the user experience.

Reference: World Health Organization (2022). Does Indonesia’s National Health Insurance Scheme mobile phone application, Mobile JKN, support health financing? 9789240100893-eng.pdf. 

Decentralized Healthcare Infrastructure:

Indonesia’s decentralized approach ensures healthcare facilities are spread across the archipelago, providing greater access to remote and rural areas.

Reference: Agustina, Rina et al. “Universal health coverage in Indonesia: concept, progress, and challenges.” Lancet (London, England) vol. 393,10166 (2019): 75-102. doi:10.1016/S0140-6736(18)31647-7. 

High Enrollment Rates:

The mandatory nature of the JKN scheme ensures high enrollment rates, with participation from formal and informal sectors.

Reference: Pratiwi AB, Setiyaningsih H, Kok MO, et alIs Indonesia achieving universal health coverage? Secondary analysis of national data on insurance coverage, health spending and service availabilityBMJ Open 2021;11:e050565. doi: 10.1136/bmjopen-2021-050565. Is Indonesia achieving universal health coverage? Secondary analysis of national data on insurance coverage, health spending and service availability | BMJ Open. 

Current Challenges of Indonesia’s NHI Model

Financial Sustainability:

The JKN system operates under financial strain due to deficits caused by rising healthcare costs and inadequate premium collection, especially from informal sector participants. BPJS-Kesehatan has reported funding gaps in recent years.

Reference: Agustina, R., Dartanto, T., Sitompul, R., et al. (2019). Universal health coverage in Indonesia: Concept, progress, and challenges. The Lancet, 393(10166), 75-102.

Low Premium Contributions:

Premium rates, particularly for informal workers, are often insufficient to cover the actual costs of healthcare services. Many participants fail to pay premiums regularly, exacerbating the system’s financial challenges.

Reference: Pisani, Elizabeth et al. “Indonesia's road to universal health coverage: a political journey.” Health policy and planning vol. 32,2 (2017): 267-276. doi:10.1093/heapol/czw120. 

Uneven Quality of Care:

While healthcare facilities are widely available, the quality of care varies significantly between urban and rural areas. Many rural regions face shortages of trained healthcare professionals and adequate infrastructure.

Reference: Banerjee, A, A Finkelstein, R Hanna, B Olken, A Ornaghi and S Sumarto (2019). “The Challenges of Universal Health Insurance in Developing Countries: Evidence from a Large-Scale Randomized Experiment in Indonesia”, NBER Working Paper No. 25362. 

Overutilization of Services:

Minimal out-of-pocket expenses encourage overutilization of healthcare services, leading to congestion at primary healthcare centers and hospitals, and increased strain on the system.

Reference: National Health Insurance (JKN) Reforms & Results. Program-For-Results (PFOR) P172707. Environmental and Societal Systems Assessment Report (ESSA). Prepared by the World Bank. Final0Environm0s0Program000P172707.docx.

Healthcare Workforce Shortages:

Indonesia faces a shortage of doctors, nurses, and specialists, particularly in rural and remote areas, limiting access to high-quality care.

Reference: Hafez,Reem, Meilissa,Yurdhina, Izati,Yulia Nur. (2023). 

Indonesia's Health Labor Market : A Descriptive Analysis. World Bank Document. 

Complex Geography:

Indonesia’s geographic nature, with over 17,000 islands, creates logistical challenges for healthcare delivery, particularly in remote and isolated regions.

Reference: Rokx, C., Giles, J., Satriawan, E., et al. (2019). Health financing in Indonesia: A reform road map. World Bank Publications. World Bank Document.

Digital Divide:
While the Mobile JKN app has improved accessibility, many Indonesians in rural areas lack smartphones or reliable internet access, limiting the app’s reach.

Reference: World Health Organization (2022). Does Indonesia’s National Health Insurance Scheme mobile phone application, Mobile JKN, support health financing? 9789240100893-eng.pdf. 

Conclusion

Indonesia’s NHI Model demonstrates significant progress toward universal health coverage, leveraging innovations like the Mobile JKN app and a subsidized premium system for the poor. However, financial sustainability, workforce shortages, and geographic barriers remain key challenges. Addressing these issues will require targeted reforms, such as increasing premium collection efficiency, investing in rural healthcare infrastructure, and expanding digital literacy. Continued commitment to equity and innovation will be essential for Indonesia to achieve sustainable UHC.

Understanding the Out-of-Pocket Model for Healthcare Delivery Services

The out-of-pocket model for healthcare delivery is one of the most prevalent systems globally, especially in low-income and middle-income countries. Under this model, individuals pay directly for medical services without intermediaries such as insurance companies or government subsidies. While seemingly straightforward, the implications of this system are profound and far-reaching.

What is the Out-of-Pocket Model?

In the out-of-pocket model, patients bear the full cost of healthcare services at the point of use. This model lacks structured health financing mechanisms like health insurance or government-funded programs. Patients must pay for consultations, treatments, medications, and hospitalizations themselves, making healthcare access highly dependent on financial capacity.

Globally, this model is most commonly found in low- and middle-income countries (LMICs). Countries such as India, Nigeria, Pakistan, Bangladesh, and Indonesia rely heavily on out-of-pocket expenditures for healthcare delivery. According to the World Health Organization (WHO), in 2019, out-of-pocket expenditures accounted for over 60% of total health expenditures in India and more than 70% in Nigeria (WHO, 2020).

Global Prevalence of the Out-of-Pocket Model

Benefits of the Out-of-Pocket Model

  1. Simplicity: The absence of intermediaries reduces administrative complexities and costs.
  2. Transparency: Patients pay for services directly, creating a clear link between cost and care received.
  3. Market Responsiveness: In theory, the model promotes competition among providers, potentially leading to cost reductions.

Drawbacks of the Out-of-Pocket Model

  1. Limited Access to Care: Many individuals cannot afford necessary treatments, leading to delayed care and worse health outcomes. For example, in Nigeria, over 50% of the population foregoes healthcare due to cost. Abubakar, Ibrahim et al. “The Lancet Nigeria Commission: investing in health and the future of the nation.” Lancet (London, England) vol. 399,10330 (2022): 1155-1200. doi:10.1016/S0140-6736(21)02488-0.
  2. Catastrophic Health Expenditures: A single hospitalization can plunge families into poverty. According to the WHO, approximately 100 million people globally are pushed into extreme poverty annually due to out-of-pocket healthcare costs (WHO, 2021). More than half a billion people pushed or pushed further into extreme poverty due to health care costs.
  3. Health Inequities: This model disproportionately affects low-income and marginalized populations, exacerbating disparities in health outcomes.

Conclusion - (redo with ending with recording)

The out-of-pocket model remains a significant barrier to equitable healthcare access globally. While it is simple in design, its impacts are far-reaching, often leading to financial hardships and health inequities. The nations that implement this model should truly understand its implications and explore viable alternatives as it is crucial for creating more inclusive healthcare systems.

A Detailed Analysis of the United States Healthcare Delivery Model System

The United States operates a complex, hybrid healthcare delivery system that incorporates elements of the four primary global healthcare models: the Beveridge Model, the Bismarck Model, the National Health Insurance Model, and the Out-of-Pocket Model. This unique combination reflects the nation’s socio-economic diversity, political structure, and historical evolution of healthcare.

The United States of America (USA) is a large and diverse country located primarily in North America, with territories extending into the Pacific Ocean and the Caribbean. Its geographic, economic, and cultural diversity significantly influences its healthcare delivery system.

  1. Location:
  2. Size and Population:
  3. Regional Diversity and Healthcare Access:
  4. Climate and Environmental Considerations:

1. Beveridge Model: Publicly Funded Systems

The Beveridge Model, characterized by government-funded and government-delivered healthcare, is evident in the U.S. through the Veterans Health Administration (VA), and the Indian Health Service (IHS). 

Veterans Health Administration (VA):
The VA provides healthcare services to eligible military veterans. It is a fully integrated public system funded by federal taxes, where healthcare providers are government employees. Services are offered free of charge to qualified individuals.

2. Bismarck Model: Employer-Sponsored Insurance

The Bismarck Model is evident in the U.S. through employer-sponsored health insurance plans, which cover nearly half of the population.

3. National Health Insurance Model: Medicare

The U.S. Medicare system reflects the National Health Insurance (NHI) Model, where the government acts as a single payer for healthcare services for individuals aged 65 and older, as well as those with specific disabilities.

4. Out-of-Pocket Model

A significant portion of the U.S. population, especially those without insurance, relies on out-of-pocket payments for healthcare.

Unique Features of the U.S. Healthcare System

  1. Privatization:
    The U.S. system is predominantly privatized, with private insurers and healthcare providers playing a central role. This allows for competition, driving innovation and technological advancements. However, it also contributes to administrative inefficiencies and high costs (Health Policy and Planning, 2022).
  2. Mixed Payers:
    The U.S. employs a combination of public programs (Medicare, Medicaid, CHIP) and private insurance, creating a fragmented system that varies significantly across states and demographics.
  3. High Expenditure:
    The U.S. spends more on healthcare than any other nation, accounting for 17.8% of GDP in 2022, yet lags behind in health outcomes such as life expectancy and infant mortality (OECD Health Statistics, 2023).

Challenges in the U.S. Healthcare System

  1. Lack of Universal Coverage:
    Despite reforms such as the Affordable Care Act (ACA), millions remain uninsured or underinsured.
  2. Inefficiency:
    Administrative costs account for nearly 8% of total healthcare spending, significantly higher than in countries with single-payer systems (The Commonwealth Fund, 2023).
  3. Disparities in Access:
    Socioeconomic, racial, and geographic disparities persist, with rural and minority populations often facing significant barriers to care (Health Affairs, 2022).
  4. Cost Burden:
    Rising healthcare costs strain both individual households and the federal budget, with an increasing share of income dedicated to healthcare expenses.

Conclusion with the United States Healthcare Delivery System

The United States healthcare delivery system is a multifaceted structure that reflects the country’s diversity and values. Incorporating elements of the Beveridge, Bismarck, National Health Insurance, and Out-of-Pocket models, it delivers both opportunities and challenges. While its innovation and advanced medical technology are unmatched, significant barriers remain in ensuring equitable access, cost efficiency, and improved health outcomes. Addressing these challenges will require bold reforms, collaboration, and a commitment to health equity for all.

References

  1. Government Accountability Office. (2023). Veterans Health Administration: Addressing Wait Times.
  2. Reducing Disparities In Health Care Coverage And Access Under The ACA", Health Affairs Forefront, June 7, 2024. DOI: 10.1377/forefront.20240606.506567
  3. Jacobson, Gretchen, and David Blumenthal. “The Predominance of Medicare Advantage.” The New England journal of medicine vol. 389,24 (2023): 2291-2298. doi:10.1056/NEJMhpr2302315.
  4. Bundorf MK, Gupta S, Kim C. Trends in US Health Insurance Coverage During the COVID-19 Pandemic. JAMA Health Forum. 2021;2(9):e212487. doi:10.1001/jamahealthforum.2021.2487.
  5. OECD Health Statistics. (2023). Global Healthcare Expenditure and Outcomes.
  6. Ani Turner, George Miller, and Elise Lowry, High U.S. Health Care Spending: Where Is It All Going? (Commonwealth Fund, Oct. 2023). https://doi.org/10.26099/r6j5-6e66.
  7. Reid, T.R. The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. Penguin Books, 2010.

Conclusion 

Dr. Susan Rashid:
As we bring this two-part exploration of global healthcare delivery models to a close, I invite you to reflect on the intricate systems that sustain the health of billions around the world. These models—whether grounded in universal accessibility, employer contributions, single-payer efficiency, or direct payments—each tell a story of human resilience, innovation, and the enduring quest for equity in healthcare.

In Part 1, we delved into the foundational frameworks of the Beveridge and Bismarck model and in Part 2, we explored the foundational frameworks of the National Health Insurance, and Out-of-Pocket models. We examined how these systems serve as blueprints, shaping how care is delivered, financed, and experienced across nations.

In Part 2, we also turned our gaze to the United States, a nation where all four models intersect in a unique and complex hybrid system. We explored the remarkable diversity in access, the challenges posed by geography and socio-economic disparities, and the pressing need for reform to ensure no one is left behind.

Through this journey, one truth becomes clear: the way we deliver healthcare reflects not only our priorities but also our values as a society. Every model, every decision, carries with it the potential to transform lives, reduce suffering, and inspire progress.

Thank you for joining me here on the Secrets of Survival (SOS) podcast and on this thought-provoking journey. Until next time, stay curious, stay compassionate, and above all, stay committed to the survival and well-being of all.

[Outro Music: Graceful and uplifting tone]

Conclusion 

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3. Harassment and Stalking: Unwelcome, repeated contact, threats or intimidation directed at Dr. Susan Rashid, or her media entities constitutes harassment or stalking and may result in criminal charges. 

4. Invasion of Privacy Sharing: Private information or images of Dr. Susan Rashid or her family or business associates without consent infringes upon privacy rights and may lead to civil or criminal action. Any attempt to seek professional and or personal information, especially through inquiries directed toward Dr. Susan Rashid's family members, employers or close associates, is regarded as both intrusive and inappropriate. Such actions constitute stalking, harassment and or invasion of privacy, each subject to serious legal recourse. 

5. Cyberbullying and Doxing: Harassment through online posts or comments as well as Doxing, publishing personal details with malicious intent is a severe violation and punishable by law. 

6. False Associations and Misrepresentation: Claiming affiliation with Dr. Susan Rashid or her media companies without authorization, including creating fake accounts, pages, websites, or profiles to imply a connection is misleading, illegal, and subject to litigation. 

Dr. Susan Rashid, Rashid Media Productions, and Rashid Publications welcome expressions of appreciation and respectful dialogue. However, any official endorsement, affiliation or partnership with Dr. Susan Rashid, Rashid Media Productions, or Rashid Publications requires express written authorization from our leadership team. Unauthorized statements of support or implied associations are strictly prohibited. 

We extend our sincere gratitude for adhering to these standards which uphold a respectful and dignified exchange as we pursue this journey together. Your positive engagement and thoughtful presence are invaluable to us as we explore profound insights and meaningful connections. Together, we are building a legacy of insight, empathy and inspiration. This journey has only just begun, and we warmly invite you with us. Thank you for being a part of this legacy. Until we meet again, we extend our deepest gratitude for your commitment to this shared path.