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Table 2.1
Key indicators of studied countries

Population GNI per Tax Current CHE per Government OOP health
(million) capita, revenue health capita health expenditure
(USD) (% GDP) expenditure (USD) expenditure (% CHE)
(CHE) (% govt.
exp.)
Jurisdictions with tax-based financing system
United 66.5 41,740 25.6 10.0 4,315.4 19.2 16.7
Kingdom
Canada 37.1 44,950 13.1 10.8 4,994.9 19.6 14.7
Jurisdictions with social health insurance
China 1,392.7 9,600 9.1 5.4 501.1 8.6 35.8
Japan 126.5 41,150 N/A 11.0 4,266.6 23.6 12.8
Jurisdictions with private health insurance
United States 326.8 63,510 9.9 16.9 10,623.9 22.5 10.8
Jurisdictions with public-private mixed system
Australia 25.0 53,190 23.1 9.3 5,425.3 17.9 17.7
Malaysia 31.5 10,650 12.0 3.8 427.2 8.5 35.1
Singapore 5.6 56,900 13.1 4.5 2,823.6 15.3 31.0
Source: The World Bank, 2018

2.2.2.1 DESCRIPTIONS OF HEALTH FINANCING SYSTEMS AND
PURCHASING PROGRAMMES

Tax-based systems
United Kingdom: The NHS Diabetes Prevention Programme

National Health Service (NHS) England has been at the forefront of strategic purchasing in
healthcare financing, with the United Kingdom’s NHS having been actively involved in
purchasing, termed commissioning, since 1991 when the internal market was introduced.
Clinical Commissioning Groups (CCGs) were established in 2013 and are clinically-led groups
of hospital and community care groups in local areas that are responsible for deciding on the
most appropriate healthcare services for local or regional populations (NHS England, n.d.-a).
NHS has a statutory duty to conduct annual assessments of every CCG to identify their
support needs.

Commissioning for PHC is implemented by primary care networks (PCNs). Primary care
networks are large local groups of General Practitioner (GP) practices, hospitals,
pharmacists, mental health and social care practitioners, and other healthcare professionals
who can provide more accessible PHC to a wider population within a locality using shared
resources, including medical technology, medications, and patient health records. The NHS
provides guidelines to CCGs for encouraging practices to be part of local primary care
networks that provide targeted chronic disease care and management (NHS England, 2019).

In recent years, the NHS Long Term Plan endorsed programmes for disease prevention and
health promotion. Numerous policy and financing initiatives have been implemented in the
United Kingdom to improve chronic disease management care, particularly within PHC
through focusing on prevention of chronic diseases. The NHS Diabetes Prevention
Programme (NHS DPP) is one such initiative aimed at providing a systemic approach to
preventing diabetes at a population level (NHS England, n.d.-b). The NHS DPP advises CCGs
on evidence-based diabetes measures to take heed of in order to successfully manage
patients’ conditions, including outlines for achieving the National Institute for Health and Care
Excellence (NICE) recommended treatment targets, reducing waiting times, and reducing
inpatient days. The NHS DPP promotes identifying high risk patients and referring them to
programmes that focus on behavioural and lifestyle changes.
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