02August2014

ar1

SRCC

Health Insurance System in Future Syria

Publication Date: 12 September 2012
  • Author: Safwan Kassas MD

Syria lacks a fair and equitable access to health care with decreasing government spending on health care and a lack of a health insurance system.

The transitional and post-transitional governments should launch a full feasibility assessment project to initiate deep-rooted changes in the health sector. Reforms should be implemented on a new platform of good governance measures and a political will to resolve the stagnant problems within the health care system in Syria.

The intent of a health insurance system is multidimensional and includes providing universal coverage, coordination of care, prioritization of prevention and wellness programs, effective care for better health outcome, efficient use of resources and responsiveness to patients' concerns.

When designing health insurance systems we need to emphasize on a few pillars. The creation of a value in the system recognizes that spending more on health care does not necessarily correlate with achieving the objectives of the health insurance system. Coordination of care is another important component of building a health insurance system. There is ample evidence to suggest that only through the coordination of care will the insurance system be able to reduce waste and thus decrease cost. This Care coordination must be based on an improved electronic medical record infrastructure and be a fundamental part of administering health care.

Prioritizing prevention and wellness programs should also be a corner stone on any legislation that governs the design of a health insurance system. A great return and cost control can be expected by implementing preventions programs.

Providing universal coverage is a noble cause and probably the most important pillar of the health sector; how a country becomes able to provide universal coverage is tightly linked to how the country will finance its health system and health insurance coverage. There are about 200 countries registered with United Nations today, and each country devises its own set of arrangements for providing coverage to its citizens. However, most of these systems have their own variations of four specific patterns.

In the British national health system (the Beveridge model, named after its designer) health care is provided and financed by the government through tax payments, just like the police force for example. In Britain, you never get a doctor bill. These systems tend to have low costs per capita, because the government, as the sole payer, controls what doctors can do and what they can charge.

The Bismarck model (Bismarck invented the welfare state as part of the unification of Germany in the 19th century). This system uses an insurance system that utilizes a fund which is financed jointly by employers and employees through payroll deduction. This model has some similarities to the United States model except that in the Bismarck-type health insurance plans everybody is covered and these plans don't make a profit. In this system the country ends up in a multi-payer model with multiple funds. The Bismarck model is found in Germany, France, Belgium, the Netherlands, Japan, Switzerland, and, to a degree, in Latin America.

The national health insurance model has elements of both Beveridge and Bismarck. It uses private-sector providers just like the Bismarck model, but payment comes from a single payer (the government) through a government-run insurance program that every citizen pays into (the Beveridge model). The single payer tends to have considerable market power to negotiate for lower prices; Canada's system, for example, has negotiated very low prices from pharmaceutical companies. National health insurance plans also control costs by limiting the medical services they will pay for, or by making patients wait to be treated.

Only the developed, industrialized countries (perhaps 40 of the world's 200 countries) have established health care systems and health insurance plans to provide coverage to their citizens. Most of the nations on the planet are too poor and too disorganized to provide any kind of mass medical care. The basic rule in such countries is that the rich get medical care; the poor stay sick or die.

One might add a fifth model of insurance coverage which is a combination and mixture of all the above resulting in a health care system similar to what is in the United States today or in a reality multiple systems in one country.

Syria is yet to appreciate the benefits of health insurance, where a good segment of the population struggles with out of pocket coverage for its health needs. A large number of people prefer free health services at government-run hospitals and less than 5 per cent of total patients in the country pay through insurance.

In 2010, the government introduced a number of initiatives to improve the quality and access to public health services. These initiatives divide patients into three segments. One segment offers free treatment to the poor people. Another segment is based on a commission system where patients pay less than the actual cost and finally there is a class for people who can afford to pay the full cost of the treatment. On a different initiative the government launched a national health insurance scheme to cover all government servants and public sector employees.

In examining these reform initiatives we can see that they don't follow a particular recognized pattern of insurance system but rather they divide the society into classes and provide different kinds of coverage to each class. How will the government be certain in its accuracy classifying the large non-government sector among the different classes is a big challenge. The social and financial divisions in any society are a very dynamic and constantly changing phenomenon in any society that no government is able to track and monitor. One advantage of this system, however, will be to offload the tremendous financial burden on the public health sector and another advantage will be giving an opportunity to public hospitals to make a profit that theoretically can be re-invested in a better quality health care.

A further examination of reform initiatives on can recognize that different initiatives apply to different sectors. Government employees, for example, will be covered under a national health insurance system while the non-government population will not. It is also not clear if the national health insurance system that provides coverage to government employees will allow these employees and their families to seek health care in the non-government private health care facilities or not.


* Published in collaboration with Hivos



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