Addressing health inequity during the COVID-19 pandemic through primary health care and public health collaboration: a multiple case study analysis in eight high-income countries

Table 2 Health system indicators for each jurisdiction

Jurisdiction	Population size (million)	Regionalization	Type of HC system*	Gini index**	Patient list	PHC payment system	Out-of-pocket payment (% of total CHE***)	PHC practice mode
Belgium	11.5 M	Three regions: Brussels, Flanders, Wallonia	ESHI	27.2	No	Predominantly fee-for-service	18.03	Majority mono-professional group practices.
Ontario, Canada	13.6 M	Ten provinces and three territories	NHI	33.3	No	Mix of PHC payment models: predominantly fee-for-service, blended capitation models, alternate payment models	14.91	Majority group practices
Germany	82.9 M	16 federated states	SHI	31.9	No	Predominantly fee-for-service with quarterly capitation fee	13.12	Majority mono-professional group practices
Italy	60.3 M	107 provinces in 21 regions	NHS	35.9	Yes	Capitation	21.76	Majority mono-professional group practices
Japan	125.6 M	47 prefectures	SHI	32.9	No	Fee-for-service	11.81	Majority mono-professional group practices
The Netherlands	17.2 M	12 provinces	ESHI	28.1	Yes	Combination per practice of fee-for-service, capitation, and pay for performance	11.53	Majority mono-professional group practices
Norway	5.5 M	11 counties	NHS	27.6	Yes	Combination of fee-for-service and capitation	14.59	Majority mono-professional group practices
Spain	46.7 M	17 autonomous regions divided into 50 provinces	NHS	34.7	Yes	Capitation	23.98	Majority multi-professional group practices

*Types of healthcare systems (The definitions underneath are adapted from Böhm et al. [30]):
National Health Service type (NHS): Regulation, financing and provision are governed by the state [30]
National Health Insurance type (NHI): Regulation by the state, financing by taxes, dominantly private service provision [30]
Social Health Insurance type (SHI): A dominant role of societal actors in regulation and financing, whereas private for-profit providers mainly deliver services [30]
Etatist Social Health Insurance (ESHI): Completely mixed healthcare: state responsible for regulating the system, financing is organized by societal actors, and provision has been delegated to private hands [30]
**Gini index (as defined by World Bank [31]: measures the extent to which the distribution of income (or, in some cases, consumption expenditure) among individuals or households within an economy deviates from a perfectly equal distribution. A Lorenz curve plots the cumulative percentages of total income received against the cumulative number of recipients, starting with the poorest individual or household. The Gini index measures the area between the Lorenz curve and a hypothetical line of absolute equality, expressed as a percentage of the maximum area under the line. Thus a Gini index of 0 represents perfect equality, while an index of 100 implies perfect inequality [31]
***CHE: Country Health Expenditure

ISSN: 1475-9276