Different countries have different primary health care models, ranging from direct health care where citizens pay for medical care themselves, to government-sponsored models that cover all or part of medical costs. Community health care can provide medical care regardless of ability to pay, while nationalized care combines government-sponsored models and insurance providers. Insurance providers may offer employer- and employee-funded medical care plans, but may not cover all citizens and can earn profits.
There are different primary health care models with distinct characteristics in different countries. Some countries have primary health care models that place sole responsibility for medical costs on citizens. Other countries may have government-sponsored primary health care models that cover all or part of medical costs. Within some developed countries, the primary health care model consists of insurance plans paid for by employers and employees. Additionally, a combination of government-sponsored models and insurance providers may exist for some countries.
Direct health care usually refers to primary health care models that require citizens to take full financial responsibility for receiving medical care. Typically, there is no formal public or private sector system for enabling citizens to receive medical care. In these cases, those who can afford the care simply foot the bill when the services are rendered. Anyone who cannot afford medical care could be left without services.
Government-sponsored primary health care models subsidize the costs of medical care through fees paid into a fund by local citizens. Under this model, citizens are not required to pay out-of-pocket when receiving medical care. Instead, healthcare facilities and medical professionals are paid through this fund under a government-controlled fee structure.
Community health care is another model that could provide coordination of medical care for citizens, regardless of ability to pay. This model can exist in countries where access to medical care is limited. In addition to providing medical care, this model can examine risk factors for common health problems and implement programs to reduce those risks.
Two distinct characteristics are typically related to the pattern in which insurance providers offer employer- and employee-funded medical care plans. One feature is that every citizen must receive coverage, even if he is unemployed. The other feature is that insurance providers do not expect to profit from the premiums charged to employers and employees.
Nationalized care is a combination of government-sponsored primary health care models and insurance providers. In this model, health care providers are usually controlled by private insurance companies, but may receive payments for services from the government. Additionally, medical services receive a fixed fee structure for all providers under this model.
The premise is that medical service costs are generally lower without a competitive market for health insurance coverage. For example, citizens do not expect to have their claims denied, resulting in out-of-pocket costs for treatment. Additionally, costs for prescription drugs and routine medical care are usually lower because insurance providers aren’t competing for customers.
With few exceptions, a similar model exists in the insurance provider model where employers and employees fund medical care. Insurance providers offer medical assistance plans, but they are not required to cover all citizens, whether they are employed or not. Additionally, these insurance providers can earn profits on payments received from employers and employees.
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