What Are the Different Primary Health Care Models?

Florence J. Tipton

There are several primary health care models with distinct features in different countries. Some countries have primary health care models that place the sole responsibility for medical costs on citizens. Other countries might have government sponsored primary health care models that cover all or part of medical costs. Within some developed countries, the primary health care model is insurance provider plans paid for by employers and employees. Additionally, a combination of government sponsored and insurance provider models may exist for some countries.

In the United States, patients may owe a co-pay or co-insurance fee to the clinic when they visit the doctor.
In the United States, patients may owe a co-pay or co-insurance fee to the clinic when they visit the doctor.

Out-of-pocket health care usually refers to primary health care models that require citizens to carry the full financial responsibility for receiving medical aid. Typically, no formal system exists from the private or public sector for citizens to receive medical care. In these cases, those who can afford treatments simply pay the bill when services are rendered. Anyone who cannot afford to receive medical care might go without services.

Costs for prescription drugs are typically lower in areas where there is not a competitive health insurance market.
Costs for prescription drugs are typically lower in areas where there is not a competitive health insurance market.

Government sponsored primary health care models subsidize medical care costs through taxes paid into a fund from local citizens. With this model, citizens are not expected to pay out-of-pocket when they receive medical care. Instead, health care facilities and medical professionals are paid through this fund based on a government-controlled fee structure.

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Government-sponsored primary health care models subsidize the costs associated with medical care through taxes paid into a fund from local citizens.
Government-sponsored primary health care models subsidize the costs associated with medical care through taxes paid into a fund from local citizens.

Community health care is another model that might provide a coordination of medical care for citizens, regardless of payment ability. This model may exist in countries where access to medical care is limited. Besides providing medical care, this model may examine risk factors to common health issues and implement programs to reduce those risks.

Nationalized care models often have the lowest costs for both routine care and prescription medications.
Nationalized care models often have the lowest costs for both routine care and prescription medications.

Two distinct features are typically related to the model where insurance providers offer medical care plans funded by employers and employees. One feature is that every citizen must receive coverage, even if they are unemployed. The other feature is insurance providers do not expect to profit on premiums charged to employers and employees.

Nationalized care is a combination of government-sponsored and insurance provider primary health care models. In this model, health care providers are usually controlled by private insurance companies, but may receive payment for services from the government. Moreover, medical services receive a set fee structure for all providers under this model.

The premise is that medical service costs are typically lower without a competitive market for health insurance coverage. For example, citizens do not expect to have insurance claims denied, resulting in out-of-pocket expenses for care. Also, costs for prescription drugs and routine medical care are generally lower because insurance providers are not competing for customers.

With a few exceptions, a similar model exists in the insurance provider model where employers and employees fund medical care. Insurance providers offer medical care plans, but are not required to cover every citizen, whether or not they are employed. Additionally, these insurance providers can earn profits on the payments received from employers and employees.

Some countries have primary health care models that place the sole responsibility for medical costs on citizens.
Some countries have primary health care models that place the sole responsibility for medical costs on citizens.

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