3 The Bismarck Model The Bismarck mode of healthcare takes the form of health insurance covers, mainly financed jointly by the employee and the employers. The fund is collected through routine payroll deductions each time the employee receives salary or payments from the employer. The Out-of-Pocket Model The Out-of-Pocket Model is a health system in which citizens pay health bills with their own money because they have no health insurance cover or government-sponsored healthcare. The model is synonymous with unequal access to health services and poor public health because one's economic status determines the quality of healthcare service he or she can access. The system is common in the third-world and some developing countries.