Health System Models under Pressure: A Comparative Assessment of Saturation and Collapse Risks through the SEA Framework

Abstract

Health systems worldwide are increasingly exposed to cumulative pressures, including demographic transitions, workforce shortages, fiscal constraints, technological expansion, and recurrent public health shocks. Although the concept of health system resilience has received growing attention, the processes through which health systems approach saturation and potential systemic collapse remain insufficiently understood. Traditional classifications of health systems such as Beveridge, Bismarck, national health insurance, and market-oriented models have mainly been evaluated through indicators of efficiency, equity, and quality, with less emphasis on structural vulnerability and the accumulation of systemic stress.

This study aims to comparatively assess major health system models from the perspective of saturation dynamics and collapse risk using the Stability–Efficiency–Adaptability (SEA) framework. A conceptual comparative analysis was conducted through an integrative review of literature on health system performance, governance, resilience, and systems thinking. Institutional characteristics of major health system models were examined across the three SEA dimensions: stability, efficiency, and adaptability.

The findings suggest that resilience and collapse risk depend less on institutional typology and more on maintaining balance among these three dimensions. Tax-funded systems tend to offer high stability but may face rigidity, social insurance systems show efficiency and adaptability but encounter governance complexity, while market-oriented systems demonstrate innovation but greater financial vulnerability and inequality. Maintaining equilibrium among SEA dimensions is therefore essential for preventing systemic saturation and strengthening health system resilience.