By Mohamad Badr MD WCSP and Jeanine Maguire PhD MPT FCPP CWS
DOI: 10.56885/012720hqwcaz
Abstract: Limb preservation has emerged as a critical benchmark, and a suggested metric, of health-care system performance, reflecting the interplay of early detection, multidisciplinary coordination, and reimbursement alignment. Despite advances in vascular and wound care, profound global disparities persist in lower-extremity amputation (LEA) rates. This comparative narrative review examines how the four dominant global health-care financing models—Beveridge, Bismarck, National Health Insurance (NHI), and Out-of-Pocket—influence access to limb salvage services and long-term clinical outcomes. Two contrasting regional paradigms anchor this analysis. The first is the Middle East and North Africa (MENA) region, which faces a dual burden: the world's highest proportional diabetes prevalence and a 1.39% annual increase in LEA incidence driven by political instability and armed conflict. Within MENA, marked heterogeneity exists. The second is the United States, which presents a contrasting picture of structural complexity: a system that achieved documented declines in major amputation rates through the early 2010s (Goodney et al., 2013) before experiencing a subsequent reversal, with current combined amputation rates approximately two to three times those of peer nations (Weaver et al., 2024). Universal drivers of limb loss identified across all systems include delayed patient presentation, socioeconomic disparities, deficient wound education, and misaligned reimbursement. Emerging best practices—including standardized preventive pathways.