HCM 3530 Module 3 European Systems Written Assignment Example

Bismarck, Beveridge and the American Mix: Germany's Sickness Funds, Britain's NHS and What the United States Could Borrow

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B.S. in Healthcare Management, Thomas Edison State University

HCM-3530: Comparative Healthcare Systems

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Month Day, Year

Bismarck, Beveridge and the American Mix: Germany's Sickness Funds, Britain's NHS and What the United States Could Borrow

European health systems are usually described through two founding models. The Bismarck model, named for the German chancellor whose 1883 law created the world's first social health insurance, finances care through mandatory contributions to nonprofit insurers. The Beveridge model, named for the British report behind the 1948 National Health Service, finances care through general taxation, with government owning many facilities. Johnson et al. (2018) use these models to organize comparison across the region. This assignment examines Germany and the United Kingdom as examples of each and compares both with the United States.

Germany: Solidarity Through Sickness Funds

Most Germans belong to one of roughly a hundred competing, nonprofit sickness funds, which they may choose freely; people above an income threshold and some groups such as civil servants may buy private insurance instead. Contributions are set as a share of earnings and shared between employers and employees, then pooled and redistributed among funds according to the health risks of their members, so funds compete on service rather than by avoiding sick people. Busse et al. (2017) describe the system as shaped by three principles over 135 years: solidarity, in which contributions follow income and benefits follow need; self-governance, in which payers and providers negotiate within a legal framework; and, since the 1990s, regulated competition.

A distinctive feature is the Federal Joint Committee, created in 2004, in which representatives of sickness funds, physicians, dentists and hospitals decide which services the statutory system covers, with patient representatives taking part without a vote (Busse et al., 2017). Germany offers a generous benefits package, free choice of physicians and hospitals, and short waiting times, at the cost of high spending by European standards and a large number of hospital beds. Busse et al. (2017) also note a persistent divide between ambulatory and hospital care, which are planned and paid separately, so coordination for patients with chronic disease remains weaker than the system's resources would suggest.

The United Kingdom: A National Health Service

The NHS is funded mainly from general taxation and provides care that is largely free at the point of use to all residents. General practitioners control referral to specialists and hospitals, and most hospitals are publicly owned trusts. In England, NICE, the national body for health and care excellence, appraises new drugs and technologies for clinical and cost-effectiveness, which gives the system an explicit, published method for deciding what it will pay for.

The NHS achieves strong financial protection and equity of access at lower cost than Germany, but it has struggled with capacity. The LSE-Lancet Commission found that years of constrained funding, workforce shortages and underinvestment in buildings and equipment left the service poorly placed when COVID-19 arrived, and that long waits for elective care had become a defining problem (Anderson et al., 2021).

Comparing the Three Systems

Table 1 places Germany and the United Kingdom beside the United States, using World Bank (2026) indicators for the latest year available.

Both European countries cover everyone, spend between 43 and 51 percent of the U.S. amount per person and achieve longer life expectancy and lower infant mortality. Their differences mirror their models. Germany's insurance model, with many funds and free choice of provider, delivers more physicians and fast access at higher cost; Britain's tax-funded model, with a single budget and gatekeeping, controls cost more tightly but rations through waiting. The United States shares features with both, such as multiple insurers like Germany and a public program for older adults that resembles a single payer, but without either country's universal mandate or a central body that decides coverage for everyone.

What the United States Could Borrow

Germany's experience suggests that the United States does not need a single government payer to achieve universal coverage. Mandatory membership, income-related contributions, risk adjustment among insurers and regulated benefits allow private nonprofit insurers to coexist with universal coverage. The Affordable Care Act's marketplaces use some of these tools, such as risk adjustment, but without a universal requirement to belong.

Britain's NICE offers a second lesson. American coverage decisions are made separately by hundreds of insurers and Medicare, often without public reasoning about cost-effectiveness. A transparent national body that assessed the comparative value of new treatments, even if its findings were advisory, could inform those decisions. Britain's waiting lists show the limit of the lesson: cost control without enough capacity transfers the burden from budgets to patients' time. A value assessment body would also face political resistance in the United States, where proposals to compare treatments' cost-effectiveness have often been attacked as rationing, so any American version would need to begin by informing decisions rather than making them.

Conclusion

Germany and the United Kingdom reach universal coverage through different routes, insurance funds bound by solidarity and a tax-funded national service, and both outperform the United States on cost and outcomes. Each also has a weakness, high spending in Germany and long waits in Britain, that tempers any simple prescription. The most transferable ideas for the United States are Germany's regulated competition among insurers and Britain's transparent assessment of value.

References

Anderson, M., Pitchforth, E., Asaria, M., Brayne, C., Casadei, B., Charlesworth, A., Coulter, A., Franklin, B. D., Donaldson, C., Drummond, M., Dunnell, K., Foster, M., Hussey, R., Johnson, P., Johnston-Webber, C., Knapp, M., Lavery, G., Longley, M., Clark, J. M., . . . Mossialos, E. (2021). LSE-Lancet Commission on the future of the NHS: Re-laying the foundations for an equitable and efficient health and care service after COVID-19. The Lancet, 397(10288), 1915-1978. https://doi.org/10.1016/S0140-6736(21)00232-4

Busse, R., Blümel, M., Knieps, F., & Bärnighausen, T. (2017). Statutory health insurance in Germany: A health system shaped by 135 years of solidarity, self-governance, and competition. The Lancet, 390(10097), 882-897. https://doi.org/10.1016/S0140-6736(17)31280-1

Johnson, J. A., Stoskopf, C., & Shi, L. (2018). Comparative health systems: A global perspective (2nd ed.). Jones & Bartlett Learning.

World Bank. (2026). World development indicators [Data set]. https://databank.worldbank.org/source/world-development-indicators