Health systems encompass all activities that function principally to improve health (World Health Organization (WHO), 2000). The organization of a health system is crucial to achieving its three basic goals of accessible, high quality and efficient healthcare, so as to attain its primary goal of improving health. Each country adopts a specific organizational model that caters to its individual healthcare needs, which are dependent on its history, economy and sociopolitical status (Reid, 2010). This has sparked comparison of different health system models, which this paper serves to partake in. This paper will begin by establishing the different levels of care in health systems, before comparing the different models of patient flow through these levels in New Zealand, the United Kingdom (U.K.) and the United States (U.S.). Finally, this paper will discuss how different organization and focus of health systems facilitates and/or impedes the attainment of accessible healthcare, by comparing the New Zealand, UK and U.S. systems.
Each health system comprises of the following three levels of care: primary, secondary and tertiary care.
The Declaration of Alma Ata (1978) defines primary care as the first level of contact of patients with the healthcare system. This level of care comprises treatment of common illnesses (such as sore throats, diabetes, or hypertension), and preventive measures including vaccinations and mammograms (Bodenheimer & Grumbach, 2008). Primary care providers (PCPs) include general practitioners (GPs), nurses, pharmacists, dentists and physiotherapists (King, 2001).
Distinctively, only primary care is outpatient-focused and office setting-based. Secondary and tertiary levels, on the contrary, are both inpatient-focused and hospital setting-based (Haneline & Meeker, 2011). Secondary and tertiary care can be distinguished on the basis of the complexity of disorders managed. Secondary care involves general surgery, specialist consultation and rehabilitation while tertiary care provides the most complex and specialized level of care, including trauma care, neonatal intensive care and open heart surgery (Shi & Singh, 2004).
There are two contradictory methods of organizing a health system around these levels – the Dawson model of regionalized healthcare and the dispersed model.
The Dawson model is adopted by both New Zealand and the U.K. Bodenheimer and Grumbach (2009) describe this model as the regionalization of the organization and coordination of all health resources and services within distinct tiers in the primary, secondary and tertiary levels. Primary care is limited to office-based services, and secondary and tertiary care to inpatient services (Bodenheimer & Grumbach, 2008). Secondary and tertiary care have defined boundaries of specialties; secondary care involves pediatricians, neurologists, and general surgeons located at hospital-based clinics; tertiary care specialists include cardiac surgeons and...