ABSTRACT
This chapter discusses the experiences of health systems since the 1980s with specific focus on the role played by financing mechanisms over time. In the mid-1980s, health systems at national level could largely be characterised along a public–private spectrum. A number of poorer countries modelled their health systems on either the Bevanite or Semashko model. Taking Uganda as an example, the health system was designed to be dominated by public finance and provision. Social insurance dominated the health systems of most of the remaining industrialised countries. The Bismarck model of social insurance, developed in Germany, has often been considered the standard model of social insurance. The countries in the following table are ‘segmented’, meaning that they all have public, social insurance and private subsystems. Health expenditure expressed as a share of GDP increased in all of the countries in the sample between 1975 and 2015 but this hides interesting trends in the data.
