Table 1 Characteristics of the different health care systems

National Health Services (NHS)

A NHS is funded by means of general taxation. Responsibility for the budget is in hands of the Ministry of Health and as such the NHS is associated with a strong influence of the state. The organisation is often part of a pyramid shaped hierarchical bureaucracy with primary health care at the bottom and high tech hospitals at the top and goes together with a strict geographic subdivision. Access to specialized care is dependent on a referral from a GP: the so-called gate-keeping system. Hospitals are state owned and individual GPs have contracts with the NHS. A major weakness of the NHS is the risk for under-funding. Health care has to compete for public funding with other social segments like education and traffic.

Social Security Health care system

A SSH is funded by means of earmarked premiums, mainly from salaried employees. The system is more loosely organised, with less state influence and more pluralistic, with a strong influence of health care providers and (social) insurers. There is often parallel access to primary and specialised care and no strict geographic subdivision. Care is provided by non-profit hospitals and individual practitioners. Major weakness of the system is the lack of a power centre, cost control is difficult.