The Bismarck model, which is also called the Social Insurance system, is adopted in Germany, France, Switzerland, Belgium, Japan, and countries of Latin America. This system assumes that the majority of patients are treated by private health care providers, whose services are financed from non-profit insurance funds (Zaman & Hossain, 2017). The main advantage of this model is the provision of fair and equitable health care. However, often such systems cannot meet the needs of patients due to overload.
This model was formed in Germany and later spread to European countries, where it practically did not change. Primarily in Germany and other European countries, the system is used for strengthening accountability to ensure the fulfillment of promises made between citizens, governments, and healthcare. In order to achieve this, the states, the federal government, and civil society organizations participate in the health care system (Tulchinsky, 2018). Health insurance is mandatory and is paid in part from the residents’ income as taxes which goes to funds. In contrast, in Japan, the patient and his family pay 12% of healthcare costs directly, and the rest is covered by insurance funds and taxes (“Social security in Japan,” n. d.). Japan also has various forms of insurance for workers, self-employed people, and older people, which imply different direct fees. In all countries using the Bismarck model, workers and employers make monthly social security payments.
In European and Latin American countries, hospital payments are made by diagnostic category, not hospital length of stay as in Japan. This aspect is a limiting factor for Japan, as it reduces the effectiveness of the assistance provided due to too long hospitalization (“Social security in Japan,” n. d.). However, the government is developing strategic purchasing policies to encourage physicians to work more efficiently. Thus, compared with the countries of Europe and Latin America, Japan has a more expensive and less efficient system. Still, it contributes to the provision of universal assistance to all members of society. European countries have been most successful in providing affordable care, both in terms of patient benefit and government. Countries using the Bismarck model are extending health insurance coverage to almost the entire population, as all workers are required to pay for it. However, the provision of services is not always possible due to the overload of the system or, as in the case of Japan, the low speed of medical providers activities.
Social security in Japan. (n. d.). Ministry of Foreign Affairs of Japan.
Tulchinsky, T. H. (2018). Bismarck and the long road to universal health coverage. In T. Tulchinsky, Case studies in public health (pp. 131-179). Elsevier.
Zaman, S. B., & Hossain, N. (2017). Universal health coverage: A burning need for developing countries. Journal of Medical Research and Innovation, 1(1), 18-20.