Julio-Diciembre 2015

Vol. 5 No. 2

Julio-septiembre 2024

Vol. 14 No. 2

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de atención médica

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Interacción y Perspectiva Dep. Legal pp 201002Z43506

Revista de Trabajo Social ISSN 2244-808X

Vol. 14 N

Julio-septiembre

ARTÍCULO DE INVESTIGACIÓN

Problemas y soluciones en los sistemas modernos de atención médica: una

revisión exhaustiva

DOI: https://doi.org/10.5281/zenodo.10909824

Liliia Zhyvotovska *, Yrii Kozar**, Maksym Mirzebasov***, Vlada Bilohur****

y Vadym Zozuliak*****

Resumen

La atención de la salud de la población es una de las direcciones más importantes del

desarrollo del Estado, ya que garantiza el funcionamiento eficaz del propio Estado, su

desarrollo económico, su capacidad de defensa, el nivel adecuado de servicios y la

productividad laboral. El propósito del artículo es esbozar un análisis integral de los

problemas que enfrentan los tres principales sistemas de atención de salud (público,

seguro y privado) junto con posibles soluciones a estos problemas. El autor utilizó

métodos científicos generales de análisis, síntesis, generalización, abstracción, así como

métodos sistemáticos y funcionales para investigar este problema. Se analizan los

desafíos únicos de cada sistema, como el costo y la asequibilidad, el acceso a la atención,

las diferencias en calidad y los avances tecnológicos. En busca de soluciones, el artículo

enfatiza la importancia de la colaboración interdisciplinaria, las reformas regulatorias y

los enfoques innovadores para mejorar la eficiencia, la asequibilidad y la accesibilidad

de la atención médica. Al analizar y comprender las fortalezas y limitaciones de cada

sistema, aquellos interesados en estudiar el campo pueden obtener información sobre

el desarrollo de políticas efectivas para mejorar la prestación de atención médica y

promover el bienestar general de la población.

Palabras clave: sistemas de salud, medicina pública, medicina de seguros, medicina

privada, desafíos y soluciones.

Abstract

Problems and Solutions in Modern Healthcare Systems: A Comprehensive

Review

Public health care is one of the most important areas of state development, as it ensures

the effective functioning of the state itself, its economic development, defense capability,

and an adequate level of service and labor productivity. The purpose of the article is to

outline a comprehensive analysis of the challenges faced by the three main healthcare

systems - public, insurance and private - along with potential solutions to address these

challenges. The author used general scientific methods of analysis, synthesis,

generalization, abstraction, as well as systemic and functional methods of researching

this problem. The unique challenges of each system are discussed, such as cost and

accessibility, access to care, quality differences, and technological progress. In searching

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for solutions, the article emphasizes the importance of interdisciplinary collaboration,

regulatory reforms, and innovative approaches to improve the efficiency, accessibility,

and affordability of health care. By analyzing and understanding the strengths and

limitations of each system, those interested in studying this area can gain comprehensive

information on developing effective policies to improve health care delivery and promote

the overall well-being of the population.

Keywords: health care systems, public health care, insurance medicine, private

medicine, challenges and solutions.

Recibido: 26/12/2023 Aceptado: 12/02/2024

** Poltava State Medical University, Poltava, Ukraine. ORCID: https://orcid.org/0000-0002-1469-060X E-mail:

lzhyvotovska@gmail.com

** Luhunsk State Medical University, Rivne, Ukraine. ORCID: https://orcid.org/0000-0002-6424-6419 E-mail:

kozar.yurii@ukr.net

*** Luhunsk State Medical University, Rivne, Ukraine. ORCID: https://orcid.org/0000-0002-4287-8829 E-

mail: mirzebasovmaksym@gmail.com

**** Uzhhorod National University, Uzhhorod, Ukraine. ORCID iD: http://orcid.org/0000-0003-1053-2716 E-

mail: bilovlada@gmail.com

***** Luhunsk State Medical University, Rivne, Ukraine. ORCID: https://orcid.org/0009-0006-2973-1546 E-

mail: v.o.zozulyak@lsmu.ukr.education

1. Introduction

Health care systems play a vital role in ensuring the well-being of the population

throughout the modern world. However, they face numerous challenges that impede

their ability to provide equitable, accessible, and high-quality care to all people. This

article takes a closer look at the challenges faced by the three primary health care

systems: public, insurance, and private. By exploring these challenges, we aim to shed

light on the intricacies that underlie the global healthcare landscape and identify

potential solutions to address these pressing issues.

The current models that shape the centers of public health policy are derived from

the goals of a nation's socioeconomic progress. These goals include sustaining economic

progress, increasing social well-being, strengthening human capital, improving the

quality of health care services, and addressing current demographic challenges.

Evaluation of practical medical effectiveness emphasizes that almost half of the increase

in life expectancy can be attributed to clinical preventive and curative interventions.

In order to fulfill the public role of health care, it is necessary to pay attention to

taking advantage of the factors that influence premature death. This task is largely

influenced by the effectiveness of the country's health care system, including its key

elements such as primary health care. The main focus is on overcoming the permanent

factors contributing to the increase in mortality, which is confirmed by statistical data.

Improving the well-being of the population requires a government strategy

focused on strengthening and increasing health care resources. This involves creating

an appropriate legal and regulatory framework, improving the efficiency of the

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organizational and operational structure of health care, shifting health care facilities from

mainly curative to preventive care, and ensuring cooperation between different agencies

and sectors (Novikov, Nykoniuk, 2012), 2) a significant role in this direction is played by

the main health care systems (forms), which are responsible for promoting the physical

health of society. That is why the study of the main systems (forms) of health care and

the identification of their features aims to identify their main shortcomings and improve

their functioning.

The purpose of the article is to provide a comprehensive overview of the problems

faced by the three main health care systems - public, insurance and private - in the

modern world. By exploring the problems specific to each system, the article aims to

highlight the complexities and differences in the delivery of health care. Furthermore,

the article aims to identify potential solutions and innovative approaches to address

these challenges and improve the overall efficiency and accessibility of healthcare

systems.

2. Summary of the main material

Public health care is one of the most important areas of state development, as it

ensures the effective functioning of the state itself, its economic development, defense

capability, and an adequate level of service and labor productivity. The study of issues

related to state regulation of public health, maintaining it at the proper level, and

promoting scientific research in this area is an urgent issue of today.

The healthcare sector is a vital industry responsible for the effective functioning

of the country's economy, strengthening its defense capabilities, maintaining optimal

human potential and ensuring its continuous growth. Health care research is closely

related and interdependent on the definition of this concept. A clear understanding of

this concept allows government agencies to focus their efforts on a range of legal,

political, socioeconomic, financial, medical and other measures. These efforts, in turn,

contribute to the realization of goals and objectives in this defined area (Terezi, 2018,

46).

Currently, there is no universally standardized health care system that would

adequately meet the health needs of the majority of the nation's population. Instead,

different countries have different and often numerous coexisting health care structures,

each characterized by its own unique national features.

There are three main systems (forms) of health care: public; insurance; and

private. The difference between them is based on the source of funding.

The state health care system is recognized as the most optimal. Its organizational

principles were recommended by the World Health Organization in 1980 to all countries

of the world for the development of national health care systems.

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Let us consider the provisions of the national health care system. The

comprehensive principle means that the state assumes full responsibility for financing

health care, developing medical research, carrying out all types of planning, building

health care facilities, and improving the level of education and training of medical

personnel. The government creates and structures the healthcare system within the legal

framework through its authorities and relevant administrative bodies. At the same time,

certain regulations clearly regulate the following aspects: constitutional guarantee of the

right to healthcare to all citizens; state ownership of all healthcare institutions; allocation

of funds from the state budget for healthcare; planned development of the material and

technical base, personnel and financial support for healthcare.

The state nature of health care ensures the implementation of another principle

- free and public accessibility. These concepts are interrelated, as public accessibility to

some extent implies free access. Conversely, this approach brings healthcare services

closer to the population. The very fact of seeking care follows a purposeful and constant

trajectory. When it comes to free of charge, it is very important to define free of charge

for whom? Government spending on health care translates into a significant financial

investment of billions of dollars (Meiners, McKay, Mahoney, 2002). The changing

demands on health policy are also intertwined with the current global phenomenon of

globalization. In today's context, health issues are increasingly globalized and at the

same time subject to active politicization (Spivak, 2015, 272).

The cornerstone of the national health care system is its focus on preventive

measures. Until the 1960s and 1970s, when infectious diseases were the main cause of

morbidity, the main goal was to eradicate them. In the second half of the twentieth

century, the non-epidemic type of pathology came to the fore. Nowadays, the well-being

of the population (including morbidity, mortality, disability, etc.) is mainly affected by

cardiovascular diseases, neoplasms (e.g., tumors), and accidents. Healthcare

professionals, together with government and public institutions, face a major mission:

to stop the progression of these and other common forms of disease.

With regard to the health care system's emphasis on prevention, it is important

to emphasize the growing intensity of environmental problems. Of all the factors that

affect human health, 20% can be attributed to environmental factors. In addition, the

role of genetic predisposition is growing, with one in five diseases being associated with

it. Targeted and effective efforts are needed to address these aspects.

Timely and thorough prevention means protection against diseases, preservation

of health and life. The cost of treating patients far exceeds the cost of preventing disease

(Poullier, 1992).

National programs make it possible to: approach prevention problems using not

only health care resources, but also the means and capabilities of other agencies and

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ministries; organize the interaction of specialists at the international level; and involve

NGOs and the general population in the program.

With regard to the health care system itself, the focus on prevention can be

manifested in the following ways: organization of socio-economic and medical measures

to prevent diseases and eliminate their causes; monitoring compliance with hygiene

standards and rules, implementation of sanitary legislation; development of healthy

lifestyle skills among the population; and wide coverage of the population with

dispensary monitoring. A number of researchers link national health programs to the

national security of the country (Borshch, 2019).

Another important principle underlying the public health system is integration

within health care: integration of treatment and prevention, combination of scientific

knowledge with practical application, etc.

One of the leading places in the public healthcare system is occupied by planning

its development. Planning is the main principle, and the lack of its precise

implementation hinders the smooth construction of the future healthcare system. Almost

every nation is actively involved in finding ways to improve healthcare. Accordingly,

ensuring this direction is possible only through an appropriate public administration

mechanism (Krynychko, 2019, 181).

However, real and effective health care planning should be based on the

possibility of providing it with economic resources.

Numerous health care issues are addressed through the involvement of public

associations and the population itself. Within health care, this progress can be described

as an autonomous principle that emphasizes its public character. Currently, this can be

illustrated by the following fundamental manifestations: both at the local level and in

the higher echelons of power, such as parliament, there are parliamentary committees

dedicated to addressing health issues; the activities of the Red Cross Society are

gradually expanding; and numerous issues related to health and social welfare are

addressed by trade unions and similar organizations.

Over the past 25-30 years, global health cooperation has become increasingly

evident. This principle is based on bringing together experts from around the world to

jointly address important health issues.

Currently, this form of health care is most fully represented in the UK, Slovakia,

Bulgaria, Sweden, and some other countries (Wild, Gibis, 2003).

The main principles of health care in Ukraine are: recognition of health care as a

priority of society and the state; observance of human and civil rights and freedoms in

the field of health care, backed by state guarantees; promotion of a human-centered

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approach that prioritizes universal values over individual, group or national interests,

while strengthening medical and social support for the most vulnerable segments of the

population; ensuring equality, democracy and universal access to medical care and

related services; and ensuring the right to health care.

The distinctive features of the national health care system include: general

taxation; public allocation of pooled resources; centralized management through a single

ministry; compliance with state laws; a unified training system and consistent policies;

and mandatory compliance with Ministry of Health orders for all health care facilities.

The unique features of the country's healthcare system include: general taxation;

public allocation of pooled resources; centralized management through a single ministry;

compliance with state regulations; a unified training structure and consistent principles;

and mandatory compliance with Ministry of Health instructions for all healthcare

facilities.

Public health system: Public health systems are usually financed and managed

by the state, providing universal coverage to all citizens. In this model, the state acts as

a single insurer, collecting taxes or contributions to finance health care services for the

entire population.

The challenges faced by public healthcare systems are: 1) problems in financing.

Financing a comprehensive public healthcare system can be a significant burden on

government budgets, leading to potential deficits or tax increases; 2) Bureaucracy and

struggle for efficiency: public systems can suffer from bureaucratic inefficiencies, leading

to longer waiting times and administrative complexity; 3) Limited choice and lack of

innovation: in some cases, patients may have limited choice of healthcare providers,

and the system may be slow to introduce new medical technologies. Changes in

government and political priorities may affect funding and policy decisions, potentially

affecting the stability and continuity of the healthcare system.

3. Insurance-based healthcare. An insurance-based healthcare system in which

medical expenses are primarily covered by insurance premiums is called an insurance-

based system. In some countries, this system exists alongside the public healthcare

model, operating independently but coordinating efforts. Health care financing (through

insurance premiums) can come from three main sources: government, business, and

individuals. There are two types of health insurance: mandatory and optional.

Compulsory health insurance - one of the types of social insurance, general,

mass. The insurers of compulsory health insurance are: for the non-working population

- executive authorities; and for the working population - employers (enterprises,

institutions, organizations, etc.).

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Mandatory health insurance is provided by state-owned or state-controlled

organizations. Insurance rules are determined by the state. It is funded by employer

contributions and the state budget. The program (guaranteed minimum services) is

approved by the state authorities. The quality control system is established by the state

authorities. Earnings are used exclusively for the development of the core business,

which is compulsory health insurance.

Positive features of compulsory health insurance include a high level of health

insurance coverage, guarantees of free medical care; separation of the functions of

financing and providing medical services ensures a high level of quality of medical care

guaranteed by the state.

Problems of compulsory health insurance: high cost of medical services;

ineffective measures to curb prices.

Voluntary health insurance is commercial. It falls under the category of individual

insurance and is managed by insurance companies with different ownership structures.

The regulations governing insurance procedures are set by these insurance

organizations. It is paid for by the individual income of insured individuals and

employers' profits. The program (guaranteed minimum services) is determined by an

agreement between the insurer and the insured. Tariffs are set by an agreement

between the insurer and the insured. Revenues can be used in any commercial or non-

commercial activity.

In the context of a market-oriented environment, health insurance (in the

broadest sense) represents a new aspect of economic interaction. Its main goal is to

create a system of health care and social protection that provides affordable, qualified

care for all residents, regardless of their social status or income. The main form of health

insurance is compulsory medical insurance. Through this targeted, guaranteed and

predetermined contribution of the state, the economic basis of health care is laid.

Principles of the insurance system: 1) health insurance covers the entire

population, both working and non-working. It should be comprehensive and cover

prevention, treatment and rehabilitation. All persons covered by this initiative receive

fair health care of the highest standard. This means that each category of health care is

provided in accordance with pre-determined medical and financial standards covering a

certain quantity and quality of medical services. Any services provided outside the

program require additional payment by the patient with prior notice. The insurance

company has the right to use only a certain amount of financial resources, i.e. it can

spend only the funds allocated under the program; 2) health insurance uses well-proven

and highly effective medical techniques. The better the equipment, the higher the quality

of treatment, which means shorter hospital stays, higher bed turnover, and higher

efficiency.

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Insurance companies take over the payment for home care, as it is less

expensive; 3) the fundamentals of the compulsory health insurance system are

unchanged. An insured person who has an insurance policy has the right to access

medical treatment anywhere in the country, regardless of their place of residence. They

also have the freedom to choose a medical institution and a doctor, provided that the

chosen institution has a contract with the insurance company. Every citizen is given the

opportunity for optional health insurance, which allows them to receive medical services

that exceed the established minimum; 4) insurance medicine operates without

recognizing a deficit. The patient is guaranteed to receive only qualified treatment; 5)

insurance medicine requires a significant level of medical etiquette and experience. Each

employee (doctor, paramedic or nurse) must obtain a license or permit for certain tasks.

Insurance companies will enter into agreements aligned with these licenses. This

encourages medical personnel to improve their professional competence; 6) insurance

medicine makes people prioritize their health, and those who neglect their well-being

face significant insurance fees. This system requires a strong level of public organization;

7) health insurance companies carefully assess the technological and economic viability

of new approaches, adopting them only when the benefits are clear.

In countries such as Canada, France, Germany, Japan, Finland, and others,

insurance-based health care is the dominant model, with various variations (Wild and

Gibis, 2003).

Thus, in terms of insurance-based health care, we note that in an insurance-

based system, health care is provided by private insurance companies. Individuals or

employers purchase insurance coverage plans, and insurers negotiate with health care

providers for services

Challenges faced by insurance-based health care systems include: 1) affordability

and coverage gaps: some insurance plans can be expensive, leaving certain groups or

individuals without coverage due to cost constraints; 2) administrative costs: insurance

companies often have significant administrative costs that can divert resources from

direct patient care; 3) pre-existing conditions and discrimination: insurance companies

may deny coverage or charge higher premiums based on pre-existing conditions. Dealing

with multiple insurance coverage plans and their different coverage policies can be

confusing for patients and providers.

4. Private healthcare. The private healthcare model works on the basis of individual

responsibility for health and is a personal concern of each person. The population

assumes full financial responsibility for access to medical services. This is an expensive

type of medical care. The costs of providing it can often go beyond the financial capacity

of the population, and then they are effectively left without medical care.

The main attributes of the private health care system include: dependence on

personal finances of individuals and revenues from legal entities as the main source of

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funding; wide availability of medical facilities and practitioners; unlimited pricing of

medical services; a significant part of the national income is allocated to health care.

Positive aspects of the private healthcare system include: a wide range of medical

facilities in terms of quality and cost of medical services, which ensure satisfaction of

various individual needs of patients; attention paid to the quality of medical care; high

incomes of doctors and other medical professionals; and no waiting lists for medical care.

In its pure form, the private health care system is not present in any country, as

its functioning is also associated with certain problems, namely: high cost of medical

services, which are unaffordable for some of the poor; insufficient attention to preventive

measures; inefficient use of resources, costly system; performance of a significant

number of procedures and medical interventions without proper medical justification,

overdiagnosis; lack of state regulation and quality control of medical services

(Henderson, Souder, Bergman, Collard, 1988).

Private health care is most fully represented in the USA, South Africa, and

Luxembourg (other forms of health care are also represented in these countries to

varying degrees) (Wild, Gibis, 2003).

Thus, a private health care system includes: In a purely private health care

system, medical services are provided and financed by private organizations, including

hospitals, clinics, and individual health care providers. Patients pay for services out of

pocket or through private insurance.

Challenges faced by private healthcare systems: 1) affordability and inequality:

private healthcare can be expensive, leading to inequalities in access to quality

healthcare depending on the financial resources of individuals; 2) profit-making and

overutilization. The for-profit nature of private healthcare can encourage overuse of

services, unnecessary procedures, and higher costs; 3) lack of universal coverage: a

purely private system can leave vulnerable populations without access to essential

healthcare services; 4) quality control and regulation: without proper oversight and

regulation, there is a risk of variable quality and safety standards in private healthcare

providers.

It is important to note that many countries have hybrid healthcare systems that

combine elements of public, insurance, and private models. Each system has its own

advantages and challenges, and the goal is to strike a balance that ensures affordable,

accessible, and high-quality health care for all citizens.

A promising avenue for extending this research is the application of crowdfunding

in real life. This is when patients and caregivers use web-based campaigns around the

world to finance their medical expenses, usually locally, using donation-based or even

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reward-based schemes, regardless of the archetype of healthcare system (public,

private, insurance, or hybrid) (Grassi and Fantaccini, 2022).

Big data analysis with the use of artificial intelligence in this area can identify

positive and negative trends based on actual data, which will allow for a reasonable

balance.

5. Conclusions

Solving problems in healthcare systems requires a multifaceted approach that

involves collaboration between different stakeholders, including governments,

healthcare providers, insurance companies, politicians, and communities. Here are

possible solutions to the challenges faced by different health systems:

A public health system ensures: 1) efficient allocation of resources. Governments

can focus on optimizing health care spending and ensuring that funds are allocated

efficiently to deliver high quality health care without wastage; 2) continuous

improvement: Implementing performance indicators and quality improvement programs

can help improve the efficiency and effectiveness of public health systems; 3) public-

private partnerships: Collaborating with private health care providers can help improve

access to care and innovate while leveraging public funds. Investments in health

promotion and disease prevention programs can reduce the burden of chronic diseases

and minimize health care costs in the long run; 5) Transparency and accountability:

governments can ensure transparency of the health care system and be accountable to

the public for the use of health care resources.

Insurance-based health care promotes: 1) regulatory reforms: governments can

introduce and enforce regulations to standardize insurance practices, limit administrative

costs, and protect consumers from discriminatory practices; 2) subsidies and assistance:

providing subsidies or financial assistance to low-income individuals can help improve

insurance coverage and reduce affordability barriers; 3) competition and increased

choice: Encouraging competition among insurers can lead to better plans and pricing

options, giving consumers more choices; 4) expanded coverage: Expanding insurance

coverage to include essential services and preventive care can lead to better health

outcomes and lower health care costs in the long run; 5) expanded health information

technology: Investments in health information technology can optimize the

administration of health care services.

The private health care system has: 1) universal healthcare coverage. Countries

can consider introducing universal health coverage to ensure that all citizens have access

to essential health services, even within the private system; 2) a regulatory and

oversight function: introducing regulations and oversight mechanisms can ensure quality

control, patient safety, and fair pricing in the private health sector; 3) non-profit options:

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encouraging the growth of non-profit health care providers can balance the health care

services provided by the private sector with those provided by the public sector.

Regardless of the form of health care system, interdisciplinary efforts to overcome

these challenges are essential. Public education, research, and data-driven policymaking

play a vital role in identifying and implementing the most effective solutions. In addition,

international collaboration and knowledge sharing can help countries learn from each

other's successes and failures, contributing to positive change in global health.

From the public health system's struggles with underfunding and bureaucracy to

concerns about the insurance system regarding affordability and coverage gaps, to the

private system's challenges related to accessibility and quality control, it is clear that no

system is without its shortcomings.

However, among these challenges are promising opportunities for improvement.

The potential solutions identified offer pathways for progress and transformation.

Efficient resource allocation, regulatory reforms, health promotion, and technology

integration are emerging as powerful tools for improving health systems in all areas.

Collaborative efforts between governments, healthcare providers, insurance

companies, policy makers, and communities are paramount in this endeavor. By

applying interdisciplinary strategies and developing data-driven policies, we can lay the

groundwork for a more physically and financially accessible and equitable health system.

As we navigate the complexity of the modern world, it is imperative that we

remain vigilant in understanding the dynamic health needs of different populations. Only

through collective action, innovation, and compassion can we strive for a healthier future

where healthcare is not a privilege but a basic right for all.

In conclusion, this article is a call to action, urging stakeholders to transcend

traditional boundaries and embrace change. By implementing evidence-based solutions

and fostering a culture of collaboration, we can begin a dramatic journey toward a

brighter and healthier future for all.

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