Almost every healthcare system in the developed world has evolved from the same basic model: the affluent or powerful accessed the services of paid health professionals (of varying types and qualities) for acute and chronic healthcare services and the poor were provided with charity-based healthcare (of varying types and qualities) when it could be made available. Galen, writing between about 160 and 200 A.D., explicitly and implicitly acknowledges the existence of this basic model across the Roman and Greek spheres of influence at that time.
In the ensuing 1,900+ years, we have seen three basic strands in the evolution of healthcare delivery.
- Strand A has seen a simple expansion of the basic model described above. This gradual expansion of the differential provision of healthcare for the “haves” and the “have nots” was dominant all over the world until the development of Strands B and C described below. It was still going strong in America in the late 1800s, and it is still the dominant model in much of the world even now. Look at how healthcare works today in the two most populous nations on Earth (China and India). In both countries, access to even decent quality healthcare is largely dependent on the ability of the patient to pay for it — even though there are extensive charitable care systems for the less fortunate.
- Strand B, which has been predominant in many European nations since the middle of the 20th Century, is premised on the concept that developed nations need to be able to assure equal access to good (if not always the highest) quality healthcare for their entire populations. And this has been engineered by the development of sophisticated, not-for-profit, national health systems commonly paid for through taxation. The Nordic nations of Sweden, Norway, and Denmark may offer the most sophisticated examples of this type of healthcare evolution.
- Strand C, which has been predominant in the USA since the mid 20th Century, is premised on private/public insurance systems with a high for-profit element. There is little doubt that such a system is capable of providing some of the very best healthcare in the world (for those with the right insurance or the personal capability to pay for it); it is also capable of failing to provide even the most basic healthcare for a large proportion of its population who — for a variety of reasons — may not have appropriate access to the system when they most need it.
And of course there are “mixed” models that allow for elements of all three evolutionary strands described above.
Depending on one’s point of view, all of these models can be seen as being flawed as mechanisms to provide healthcare services for defined populations with multiple millions of members.
With > 7 billion people now needing healthcare services on Planet Earth (as opposed to the mere 2 billion in about 1930), might it be time for us to start seriously re-thinking what an efficient and effective set of healthcare systems and services should look like for the future? The rich and powerful will always find a way to get what they want (whether they need it or not), but even if you are one of the 100 million relatively rich and powerful, do you really want to be living in an environment where you are constantly being exposed to the effects of the less good health of the other 6.9 billion? And what about the rest of us? Current projections suggest that the number needing healthcare services may reach 9 billion by 2050. That’s a 28.6 growth in the need for global healthcare services over the next 35 years.
Of course your correspondent isn’t planning to be around by 2050, so maybe he shouldn’t give a dang (but for some odd reason he does).