Cooperative health report 2018: Assessing the worldwide contribution of cooperatives to healthcare
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The transformation of health care systems: Main trends and challenges
To address people’s health needs, many nations have developed diverse types of health care systems. Country variations largely depend upon the level of public regulation of the related health activities, the financing mechanism and the degree of coverage for sickness and health problems. Furthermore, the nature and governance of the organizations managing the delivery of health services also impact the shaping of health care systems.
The nations covered by this stage of our research exclude low-income countries, i.e. most African and some Asian countries, which lack health care systems altogether. Although the present research explores different types of well-structured health care systems, organizations supplying health services are significantly diverse; they include public, private non-profit, mutual, cooperative or private for-profit organizations.
When considering the roles played by the different service providers, four typologies of health care systems have been identified. This way of classifying health care systems is meant to shed light on the complexity of the health care supply, particularly on the role played by health cooperatives and mutual aid societies.
The systems identified are the following:
Almost exclusively public health care systems with private actors, for-profits, non-profits and cooperatives covering a marginal function;
Universal health care systems where public actors have integrated the pre-existing private mutual and non-profit organizations;
Health care systems conceived to ensure public universal coverage, which have, however, failed to ensure access to health services to all population groups; and
Mixed health care systems where only basic health services are ensured by public policies targeting low-income groups.
In each health care system identified, the role of mutual aid societies and cooperatives tends to increase in importance over time. There is nonetheless a progressive shift from the first towards the fourth type, which can be interpreted as a reaction to the mounting difficulties all these systems are facing