Introduction
The major objective of all national policies in the sphere of healthcare is the provision of accessible, high-quality, universal medical service. However, despite the similarity in goals, distinct countries are characterized by significant organizational differences in healthcare systems. The character of public healthcare in a particular state is primarily affected by the social and economic models adopted there, as well as the level of the political situation in the country. Based on this, the given paper aims to identify and outline the main differences in healthcare models adopted in such countries as Cuba, Russia, Sweden, Canada, etc. The analysis of the differences in such aspects of international healthcare organization as managerial patterns, cultural values, financial issues, and others is provided below.
Legal and Political Considerations
According to BuÅŸoi (2010), there are three major political approaches in the global community: conservative, liberal, and radical. The first one is rooted in the principle of “equality in front of the law” (BuÅŸoi, 2010, p. 4). In conservative states, government interference is associated with policy enforcement activities while, in liberal states, government involvement is only accepted if its purpose is the improvement of citizens’ health. Finally, the radical political approach is characterized by a centralized planning and the use of federal funds as the only source of financing (BuÅŸoi, 2010).
A political and ideological situation in the country largely affects policy making and, in this way, indirectly impacts the social and economic systems. When speaking of healthcare, political context affects the selection of sources and methods of financing; the style of organization, medical practice, etc.
Managerial Patterns, Consumer Behavior, and Financing
As it was mentioned above, political factors affect social and economic characteristics of healthcare systems. In their turn, these system properties, impact the patterns of consumer behavior, managerial styles and activities, ownership policies, and the mechanisms of financing. According to the general classification, two basic types of health systems are distinguished: the governmental or the Beveridge model, and the health insurance or the Bismarck model. The governmental budgeting and ownership of healthcare are adopted in Sweden, Brazil, and Cuba, while the Bismarck system is actualized in such countries as Canada, and Russia.
The Beveridge model is associated with free medical services, financing from the governmental budgets and taxes, a governmental monopoly on the healthcare resources, and the centralized management. For instance, 80% of healthcare expenditures are funded from taxes in Sweden (Anell, Glenngård, & Merkur, 2012). The health insurance there is voluntary there, and patient charges constitute approximately 15% of the overall health expenditures and are limited to the purchase of medicines, hospitalization, or visits to specialists. The responsibility for service provision and funding in the Swedish health system is performed by the regional government and county councils that also own most of the primary care medical settings, while the state authorities are accountable for health policies in general (Anell et al., 2012).
The similar situation can be observed in Cuba with the functioning the National Healthcare System (NHS) for universal access to medical service. As mentioned by Keck and Reed (2012), the majority of medical facilities in the country are owned by the government, and most of the Cuban health practitioners are government employees. At the same time, hospitals’ operations are supervised primarily by the community and municipal authorities. In this way, it is possible to say that Cuba’s NHS is characterized by the centralized policy development but does not exclude a flexible approach to patients in particular local environments.
In 1990, Brazil also created the publicly funded Unified Health System (UHS) to increase the availability of medical service to citizens from diverse ethnic and socio-economic backgrounds. The programs included in the UHS cover over 97 million Brazilians; moreover, the system employs more than 30 thousand professional teams which focus on rendering services in isolated and unprivileged communities in the country (World Health Organization [WHO], 2010). Brazil is characterized by the decentralized funding and management patterns. Nowadays, a substantial part of managerial and financing responsibilities is performed by local authorities in 26 states. They are required to provide at least 12% of budgets for the maintenance and development of health in their regions, and the federal government provides the general support to the system by investing the money raised from taxes (WHO, 2010).
The Bismarck model is based on the principles of mixed economy and combines the principles of private service market with government regulations and social guarantees. In comparison to completely privatized systems, the given model is characterized by a relatively high level of service accessibility because it includes mandatory medical insurance policies. The government plays a key role in financing national insurance funds which, in their turn, attempt to meet healthcare needs of the diverse population groups, while the role of the market is reduced to the fulfillment of the medical needs which exceed the guaranteed level of healthcare.
This type of organization can be observed in the Russian health system. A constitutional right to receive a qualified medical aid is recognized in the country, and the government thus attempts to develop free medical services. However, the principles of private healthcare are included in the modern Russian system as well to allow patients to select medical facilities and practitioners according to their preferences. In this way, the healthcare system in Russia has potential to combine advantages associated with both national and private models. In Russia, public health financing and management systems are highly decentralized and based on the activities of specialized non-governmental organizations such as insurance companies, and the control over the quality of medical service and volumes of expenditures is conducted by sponsoring organizations. However, the lack of universal administrative control at both federal and regional levels is regarded as one of the major flaws in the modern Russian healthcare systems which interfere with the achievement of greater safety, quality, and cost effectiveness of service (Vertakova & Vlasova, 2014).
The Canadian healthcare is sponsored by the government as well, and it is based on the mandatory insurance system (Medicare). The individual insurance programs are developed for each province, and the number of covered services may vary from one region to another. Although it may seem that the medical service in the country is free, it is not so. The Canadian healthcare is mainly tax funded, and the average amount of health tax a family pays annually may equal US $11.400 (Esmail & Palacios, 2012). But contrary to the situation in Russia and some other countries, Canada has one of the highest-quality health services.
Cultural Values and Negotiation Styles
Like any sphere of business, maintenance of service quality and safety in healthcare largely depends on the cultural values and social norms adopted in a particular country. Analyzing the influence of culture on behavior in business and social interactions, Geert Hofstede (2001) distinguished several factors or dimensions including power distance balance, orientation to individualism or collectivism, strategic direction, etc. All of these cultural dimensions apply to the analysis of national healthcare systems.
It is possible to assume that the Beveridge model is adopted primarily in those states that are higher on the collectivism scale. For instance, the value of common good and collective welfare is central to the Cuban national culture. Its influence can be observed in the country’s social and economic structure. And it largely defines the socialized nature of Cuba’s NHS. As stated by Apple (2014), Swedish healthcare system mirrors the broader cultural values of collaboration, consensus-based action and decision making, and equality. Thus, the national culture influences various organizational and managerial activities in the country as the administrators and leaders always strive to find agreement with stakeholders and gain mutual advantages in every situation.
The analysis of the national power distance index reveals that countries with high scores in this cultural dimension are usually deferential to figures of authority and tend to accept unequal distribution of power. The attitude to authority largely affects interpersonal and professional communication patterns. It is possible to say that the given cultural value may influence the manner of professional interactions within a healthcare system, as well as the overall model of medical care. For example, in Canada, the country with a relatively low power distance index, people mainly establish relationships based on the principles of equality. In this cultural context, the adoption of patient-oriented care models is more facilitated than in the states with high power distance indexes, such as Russia. Russian people tend to trust health practitioners’ authority and knowledge and, therefore, the course of communication with patients, as well as the course of treatment, is primarily guided by medical professionals. At the same time, Canadian patients regard doctors as equal, and the trust in patient-practitioner communication can be better developed through non-paternalistic styles of interaction.
Summary
The analysis of political, cultural, and managerial factors influencing designs of healthcare systems in different countries has many practical implications. It helps to identify the causes of deficiency associated with particular practices or structures and systems as a whole and allows the development of effective plans for the improvement. A strategic approach towards transformation and modernization of health models is of particular importance today because of the dynamic global advancement processes. Due to the rapid increase in the quality and level of life, substantial changes in social and demographic structures occurred in many countries. It has affected birth rates, population aging, etc. and, nowadays, these tendencies lead to a drastic increase in the social costs and expenses associated with healthcare services in many regions. It means that the financial burden on the society is rapidly growing while the national budgets become less capable of handling the social costs.
It is the responsibility of every healthcare practitioner to contribute to the improvement of the adverse situation through the research of international experiences and analysis of data. The implementation of derived evidence can help communities and governments to refine policies and medical practices at all levels: individual, organizational, regional, and national.
It is possible to say that the obtainment of MBA degree will complement the achievement of these ambitious goals because the purpose of the course is the training of highly-qualified and competent leaders. The practical orientation of MBA program helps students to develop necessary abilities, build essential knowledge, and increase efficiency and effectiveness of work. The strategic and systematic management skills; enhanced understanding of business environments, organizational behaviors, technologies, systems, operations, etc. can largely facilitate the achievement of formulated professional objectives.
References
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Esmail, N., & Palacios, M. (2012). “The price of public health care insurance.”Fraser Alert. Web.
Hofstede, G. H. (2001). Culture’s consequences: comparing values, behaviors, institutions, and organizations across nations. Thousand Oaks, CA: Sage Publications.
Keck, C. W., & Reed, G. A. (2012). The curious case of Cuba.American Journal of Public Health, 102(8), e13–e22. Web.
Vertakova, J., & Vlasova, O. (2014). Problems and trends of Russian health care development. Procedia Economics and Finance, 16, 34-39. Web.
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