Classification of healthcare systems: Can we go further?

- A new framework to classify healthcare systems is presented.
- A distinction can be made between integrated and separated provision systems.
- There are no pure systems: all national healthcare systems are hybrids.
- Healthcare systems are segmented according to various criteria.

This article addresses the issue of the classification of healthcare systems, with the intent to take a step further than the previously analysed models of healthcare organisation.As concerns the financing of healthcare services, the standard tripartite classification (according to which healthcare systems are divided into three groups: voluntary insurance, social health insurance and universal coverage) is enriched with two additional types: compulsory national health insurance and residual programs.With respect to the provision of services and the relationship between insurers and providers, it is important to distinguish between vertically integrated and separated systems.What differentiates this analysis from the majority of previous studies is its underlying logic. Assuming that all systems are hybrid, the article proposes to put aside the classic logic for classifying healthcare systems (according to which individual countries are pigeonholed into different classes depending on the prevailing system) in favour of the identikit logic. The concept of segmentation (of healthcare services or population) proves to be remarkably useful to this purpose.