Health Administration

Family Medicine and Comparisons

Wali Omer
Department of Community Medicine
College of Medicine
Hawler Medical University
www.hmu.edu.iq
 Planning

“Failure to plan is planning for failure”

Winston Churchill

(British Statesman, Orator, 

Historian, Writer, Artist, 

and Nobel Laureate. 

1874-1965)
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Outline

• Family Medicine
• Elements of Family Medicine
• Advantage of Family Medicine
• Comparison of Health Systems
• How can we improve our health system?
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Family Medicine

• Medical specialty devoted to comprehensive health

care for people of all ages.
• It is a division of primary care that provides continuing
and comprehensive health care for the individual and
family across all ages, sexes, diseases, and parts of
the body.
• It is based on knowledge of the patient in the context
of the family and the community, emphasizing disease
prevention and health promotion.
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Family Medicine

Basic elements of family medicine:

• Personalization
• Continuity
• Integration
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Advantages Family Medicine

• Responsiveness
• Trust
• Satisfaction
• Better diagnosis
• Less misuse and overuse of medications
• Better compliance
•…
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How we can improve our System?

• Family medicine
• Community-based (engagement)
• Health system insurance.
• Making maximum use of the existing
resources.
• Separating public and private sectors.
• The use of technology e.g. HIS.
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Comparison of Health Systems

Life Infant Physicians Nurses Expenditure Expenditure

Country
Expectancy Mortality /1000 /1000 (Per Capita $) (% of GDP)

USA 78.1 6.7 2.4 10.6 7,290 16.0

UK 79.1 4.8 2.5 10.0 2,992 8.4

Germany 79.8 3.8 3.5 9.9 3,588 10.4

France 81.0 4.0 3.4 7.7 3,601 11.0

Sweden 81.0 2.5 3.6 10.8 3,323 9.2

Canada 81.3 5.0 2.2 9.0 3,895 10.1

Japan 82.6 2.6 2.1 9.4 2,581 8.1

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Health Systems Models

These are basic health systems models:

• Beveridge Model
• Bismarck Model
• National Health Insurance Model
• Out-of-Pocket Model
• Mix Model
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Beveridge Model

• Named after William Beveridge, social reformer who

designed Britain’s National Health Service.
• Health care is provided and financed by the
government from tax revenues.
• Many hospitals and clinics are owned by the
government.
• Doctors are government employees, but there are
also private doctors.
• Examples: Britain, Spain, Scandinavia. Cuba is an
extreme example; it is the world’s purest example of
total government control.
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Bismarck Model

• Named for the German Chancellor Bismarck.

• It uses an insurance system (called “sickness
funds” ) funded by both employers and
employees (about 14% of wages).
• Universal is coverage.
• Doctors and hospitals tend to be private.
• Examples: Germany, France, Belgium,
Netherlands, Japan and Switzerland.
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National Health Insurance Model

• This system has elements of both Beveridge and

Bismarck.
• It uses private-sector providers, but payment comes
from a government-run insurance program that every
citizen pays.
• The single payer tends to have considerable market
power to negotiate for lower prices.
• Examples: Canada, Taiwan and South Korea.
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Out-of-Pocket Model

• Many poor countries do not have a system

that can provide quality care for all of its
people.
• In such countries only those can get medical
care who can afford it.
• Example: rural regions of Africa, India, China
and South America, millions of people do not
see a doctor in their entire life.
• “Wallet-biopsy”
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Mix Model

• USA Health System has elements of all of these

systems.
• For Veterans it is similar to Britain or Cuba.
• For old ages > 65 on Medicare, it is like Canada.
• For working Americans who get insurance from their
the job, it is similar to Germany.
• For the 15-20% who have no health insurance, It is
like Africa or rural India, with access to a doctor
available as out-of-pocket or emergency hospital.