The origins of social protection in healthcare: classifying healthcare systems at introduction in 165 countries

While the emergence of welfare states, and the origins of social protection in healthcare, have been examined extensively for Global North countries, there is much less research with a global perspective. Addressing this gap, this study provides a descriptive and analytical account of the characteristics of healthcare systems as they were introduced worldwide. Using original and unpublished data, the study classifies healthcare systems according to the main actor type in regulation, financing, and service provision. We find two worlds of healthcare regulation – a state-regulated and a societally-regulated. Adding the financing dimension yields six clusters of healthcare regulation and financing. Based on regulation, financing, and service provision the classification reveals the existence of 12 healthcare system types. While systems that rely on societal actors mainly emerged prior to the mid-twentieth century, state-based systems have characterized system introductions since then. The classification of healthcare systems in 165 countries shows that only a limited number of actor combinations can be found empirically. However, it still presents greater variety than previous studies focusing on the Global North. The notable historical and regional patterns in the choice of healthcare system types can serve as a starting point for further research on healthcare system development.