Nicola Giannelli

The health systems of the United States, Germany, UK: market, redistribution and reciprocity

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This article compares three health care systems in the light of social regulation models proposed by Karl Polanyi: market, redistribution and reciprocity. According to the writer of these three categories they are useful to understand what is the relationship between health care systems and society regardless of the public or private nature of service providers. A market model is in fact geared to efficiency and individualization of services at the expense of fairness, a redistributive model aims to equity but with some problems of economic efficiency and sustainability, a model based on reciprocity promotes social integration, but when it is favored by incentives it can enable opportunistic behavior. The paper analyzes the cases of United States, Germany and the United Kingdom because in each of them you can observe the prevalence of one of the models of social regulation at the time of foundation of heath care: market in the USA, reciprocity in Germany and redistribution in Britain. British National Health Care has been a welfare model for many other countries, Italy included, and its reforms are often taken as example. The subsequent evolution shows how each model has required the presence of the other models to mitigate the negative effects of the first.


  • Market
  • Health Care Systems
  • Welfare


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