Essay Series: Healthcare Systems

Colombia: A Healthcare System in Crisis

According to Francisco Jose Yepes Lujan, MD, PhD, from the Pontificia Universidad Javeriana in Bogota, Colombia, the Colombian healthcare system is in crisis. In his essay, he discusses the reasons and suggests solutions to transform it.

By Francisco Jose Yepes Lujan, MD, PhD, Director, Graduate Studies in Health and Social Security Administration, Pontificia Universidad Javeriana, Bogota, Colombia
The Colombian Healthcare System

In spite of the 20 years that have elapsed since first transformations, reform of Poland’s healthcare system has yet to be completed. The Polish healthcare system is nominally an insurance-based system, in reality, however, a para-insurance system evolving around a governing budget system.

By Janusz Michalak, President of Termedia Publishing House  

The Portuguese healthcare system is characterized by three coexisting, overlapping systems: the NHS, a universal, tax-financed system; public and private insurance schemes for certain professions; and private voluntary health insurance.

By Jorge Simões, President of the Portuguese Health Regulation Authority (Entidade Reguladora da Saúde)

Healthcare reform initiatives in Turkey date back to the beginning of the 1990s. Recent reforms have put special emphasis on the reorganization of primary care services. The major drawback of the system is the lack of a referral system between primary, secondary, and tertiary care.
By Kamil Adalet, MD, Professor of Cardiology and Vice-Chancellor at the University of Istanbul, Head of the Department of Cardiology at the Istanbul Faculty of Medicine, University of Istanbul, Turkey

The reform of South Africa’s healthcare system is challenged by the historically state-generated inequalities, inadequate financing of the public healthcare system, the existence of a two-tiered healthcare system, human resource gaps, poor quality of healthcare, and a high burden of diseases.
By Olive Shisana, ScD, Chief Executive Officer, Human Sciences Research Council, Cape Town, South Africa

Since 1948, The National Health Service (NHS) of England has organized health services for residents through taxation, but the needs of patients and the limited resources available pose challenges for the NHS and its sustainability. Private care and the NHS are now forced to actively collaborate with one another to establish a mixed and functioning healthcare economy that supports England’s 50 million patients.
By Chris Ham, Executive Chief Officer of the King’s Fund; Professor of Health Policy and Management at the University of Birmingham, England; Honorary Fellow of the Royal College of Physicians of London and the Royal College of General Practitioners.

"Reform is dead. Long live reform." It is a sentiment heard time and again throughout the German healthcare sector. After all, the past 35 years have seen the country enact six sweeping reform packages and an array of smaller ones.
By Jürgen Wasem, Alfred Krupp von Bohlen und Halbach Foundation Endowed Chair for Medicine Management, University of Duisburg-Essen, Germany
 

The Brazilian healthcare system, Sistema Único de Saúde (SUS), was created to provide the entire Brazilian population with equal opportunity for access to health services as a human right, independently of social class. Nevertheless, SUS is still an ongoing process of healthcare reform. This essay helps better understand the importance of this healthcare reform and the challenges that came with it.
By Marcos Kisil, MD, Professor, University of São Paulo, School of Public Health; President, Institute for Development of Social Investment (IDIS)
 

In the Russian Federation, provision for healthcare is one of the primary social functions of the state; covering delivery of medical care, prevention of disease, and improvement of the population’s health.
By Mikhail I. Davydov, Member of the Russian Academy of Sciences and President of the Russian Academy of Medical Science, and Oleg P. Shepin, Member of the Russian Academy of Medical Science and Director of the Russian National Public Health Institute

In the current economic situation, the voices pushing for budget cuts in healthcare are louder than ever. It is simply something we cannot escape: Everyone must contribute and search for savings potential. But other voices claim that the current economic conditions require investment more than ever. Keynesian economics teaches us in simple terms that investment and belief in the future help to relaunch economies. Hence, according to these voices, governments – and in particular, health authorities – should invest even more in healthcare.
By Lieven Annemans, PhD, Professor of Health Economics, Medical Faculties of Ghent University and Brussels University, Belgium

The essential problem in providing healthcare services for the masses lies in lack of purchasing power, lack of access, and lack of knowledge regarding modern medicine.”
By N. Ravichandran, PhD, ASIA Fellow, Health Unit Ateneo School of Business, Ateneo De Manila University, Philippines

“With rapid pharmaceutical and technological development, it is nevertheless increasingly clear that universal access to (almost) free healthcare no longer can imply access to any healthcare.”

By Jon Magnussen, PhD, Professor of Health Economics at the Norwegian University of Science and Technology in Trondheim and at the University of Oslo
 

"We have a shortage of funds because we have not infused enough money into our health insurance system to care for the growing population of the elderly."
By Seiritsu Ogura, Professor of Economics at Hosei University in Tokyo, Japan, and Editor of the Japanese Journal of Health Economics and Policy
 

“Rationalizing the system means figuring out how to save money while delivering better care to more people.”

By David M. Cutler, Otto Eckstein Professor of Applied Economics at Harvard University and Member of the Institute of Medicine