National health insurance

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National health insurance (NHI), sometimes called statutory health insurance (SHI), is a system of health insurance that insures a national population against the costs of health care. It may be administered by the public sector, the private sector, or a combination of both. Funding mechanisms vary with the particular program and country. National or statutory health insurance does not equate to government-run or government-financed health care, but is usually established by national legislation. In some countries, such as Australia's Medicare system, the UK's National Health Service and South Korea's National Health Insurance Service, contributions to the system are made via general taxation and therefore are not optional even though use of the health system it finances is. In practice, most people paying for NHI will join it. Where an NHI involves a choice of multiple insurance funds, the rates of contributions may vary and the person has to choose which insurance fund to belong to.

Contents

History

Germany has the world's oldest national social health insurance system, [1] with origins dating back to Otto von Bismarck's Sickness Insurance Law of 1883. [2] [3] In Britain, the National Insurance Act 1911 included national social health insurance for primary care (not specialist or hospital care), initially for about one-third of the population—employed working class wage earners, but not their dependents. [4] This system of health insurance continued in force until the creation of the National Health Service in 1948 which created a universal service, funded out of general taxation rather than on an insurance basis, and providing health services to all legal residents.

Types of programs

National healthcare insurance programs differ both in how the contributions are collected, and in how the services are provided. In countries such as Canada, payment is made by the government directly from tax revenue and this is known as single-payer health care. [5] The provision of services may be through either publicly or privately owned health care providers. In France, a similar system of compulsory contributions is made, but the collection is administered by non-profit organisations set up for the purpose.

An alternative funding approach is where countries implement national health insurance by legislation requiring compulsory contributions to competing insurance funds. These funds (which may be run by public bodies, private for-profit companies, or private non-profit companies), must provide a minimum standard of coverage and are not allowed to discriminate between patients by charging different rates according to age, occupation, or previous health status (pre-existing medical conditions). To protect the interest of both patients and insurance companies, the government establishes an equalization pool to spread risks between the various funds. The government may also contribute to the equalization pool as a form of health care subsidy. This is the model used in the Netherlands.

Other countries are largely funded by contributions by employers and employees to sickness funds. With these programs, funds come from neither the government nor direct private payments. This system operates in countries such as Germany and Belgium. These funds are usually non-profit institutions run solely for the benefit of their members. These systems are characterized by a mixture of three sources of funds in varying degrees: private, employer-employee contributions, and national/subnational taxes.

In addition to direct medical costs, some national insurance plans also provide compensation for loss of work due to ill-health, or may be part of wider social insurance plans covering things such as pensions, unemployment, occupational retraining, and financial support for students.

National schemes have the advantage that the pool or pools of contributors tend to be vast and reflective of the national population. Health care costs tend to be high at the extremes of age and other specific events in life, such as during pregnancy and childbirth. In a national healthcare scheme, these costs are covered by contributions made to the pool over an individual's lifetime (i.e., higher when earning capacity is greatest to meet costs incurred at times when earning capacity is low or non-existent). This differs from the private insurance schemes with contribution rates that vary year by year, according to health risks such as age, family history, previous illnesses, and height/weight ratios. Consequently, some people tend to have to pay more for their health insurance when they are sick or are least able to afford it. These problems do not exist in national health insurance schemes.

Programs

See also

Related Research Articles

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<span class="mw-page-title-main">Social services</span> Range of public services

Social services are a range of public services intended to provide support and assistance towards particular groups, which commonly include the disadvantaged. They may be provided by individuals, private and independent organisations, or administered by a government agency. Social services are connected with the concept of welfare and the welfare state, as countries with large welfare programs often provide a wide range of social services. Social services are employed to address the wide range of needs of a society. Prior to industrialisation, the provision of social services was largely confined to private organisations and charities, with the extent of its coverage also limited. Social services are now generally regarded globally as a 'necessary function' of society and a mechanism through which governments may address societal issues.

Health insurance or medical insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among many individuals. By estimating the overall risk of health risk and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization, such as a government agency, private business, or not-for-profit entity.

Universal health care is a health care system in which all residents of a particular country or region are assured access to health care. It is generally organized around providing either all residents or only those who cannot afford on their own, with either health services or the means to acquire them, with the end goal of improving health outcomes.

<span class="mw-page-title-main">Two-tier healthcare</span> Unequal access to higher quality healthcare

Two-tier healthcare is a situation in which a basic government-provided healthcare system provides basic care, and a secondary tier of care exists for those who can pay for additional, better quality or faster access. Most countries have both publicly and privately funded healthcare, but the degree to which it creates a quality differential depends on the way the two systems are managed, funded, and regulated.

Single-payer healthcare is a type of universal healthcare in which the costs of essential healthcare for all residents are covered by a single public system.

<span class="mw-page-title-main">Healthcare in Switzerland</span> Overview of the health care system in Switzerland

The healthcare in Switzerland is universal and is regulated by the Swiss Federal Law on Health Insurance. There are no free state-provided health services, but private health insurance is compulsory for all persons residing in Switzerland.

<span class="mw-page-title-main">Healthcare in Israel</span> Overview of the health care system in Israel

Healthcare in Israel is universal and participation in a medical insurance plan is compulsory. All Israeli residents are entitled to basic health care as a fundamental right. The Israeli healthcare system is based on the National Health Insurance Law of 1995, which mandates all citizens resident in the country to join one of four official health insurance organizations, known as Kupat Holim which are run as not-for-profit organizations and are prohibited by law from denying any Israeli resident membership. Israelis can increase their medical coverage and improve their options by purchasing private health insurance. In a survey of 48 countries in 2013, Israel's health system was ranked fourth in the world in terms of efficiency, and in 2014 it ranked seventh out of 51. In 2020, Israel's health system was ranked third most efficient in the world. In 2015, Israel was ranked sixth-healthiest country in the world by Bloomberg rankings and ranked eighth in terms of life expectancy.

<span class="mw-page-title-main">Healthcare in Germany</span> Overview of healthcare in the Federal Republic of Germany

Germany has a universal multi-payer health care system paid for by a combination of statutory health insurance and private health insurance.

Healthcare in Finland consists of a highly decentralized three-level publicly funded healthcare system and a much smaller private sector. Although the Ministry of Social Affairs and Health has the highest decision-making authority, specific healthcare precincts are responsible for providing healthcare to their residents as of 2023.

The French health care system is one of universal health care largely financed by government national health insurance. In its 2000 assessment of world health care systems, the World Health Organization found that France provided the "best overall health care" in the world. In 2017, France spent 11.3% of GDP on health care, or US$5,370 per capita, a figure higher than the average spent by rich countries, though similar to Germany (10.6%) and Canada (10%), but much less than in the US. Approximately 77% of health expenditures are covered by government funded agencies.

A health insurance mandate is either an employer or individual mandate to obtain private health insurance instead of a national health insurance plan.

<span class="mw-page-title-main">National Health Insurance Scheme (Ghana)</span> National Health Insurance of Ghana

The National Health Insurance Scheme (NHIS) is the publicly funded healthcare systems established by the Government of Ghana in 2003. The program was a form of national health insurance established to provide equitable access and financial coverage for basic health care services to Ghanaian citizens. Ghana's universal healthcare system has been described as the most successful healthcare system on the African continent by business magnate Bill Gates. The system has been found to have made Ghana's rate of health insurance one of the highest in Africa, though funding problems may complicate its future.

<span class="mw-page-title-main">Healthcare in Austria</span> Overview of the health care system in Austria

The nation of Austria has a two-tier health care system in which virtually all individuals receive publicly funded care, but they also have the option to purchase supplementary private health insurance. Care involving private insurance plans can include more flexible visiting hours and private rooms and doctors. Some individuals choose to completely pay for their care privately.

Social security in Germany is codified on the Sozialgesetzbuch (SGB), or the "Social Code", contains 12 main parts, including the following,

Examples of health care systems of the world, sorted by continent, are as follows.

<span class="mw-page-title-main">Healthcare in Luxembourg</span>

Healthcare in Luxembourg is based on three fundamental principles: compulsory health insurance, free choice of healthcare provider for patients and compulsory compliance of providers in the set fixed costs for the services rendered. Citizens are covered by a healthcare system that provides medical, maternity and illness benefits and, for the elderly, attendance benefits. The extent of the coverage varies depending on the occupation of the individual. Those employed or receiving social security have full insurance coverage, and the self-employed and tradesmen are provided with both medical benefits and attendance benefits. That is all funded by taxes on citizens' incomes, payrolls and wages. However, the government covers the funding for maternity benefits as well as any other sector that needs additional funding. About 75% of the population purchases a complementary healthcare plan. About 99% of the people are covered under the state healthcare system.

<span class="mw-page-title-main">Healthcare in Liechtenstein</span> Overview of healthcare in Liechtenstein

The nation of Liechtenstein has a universal health care system with decentralized, free market elements through mandated health insurance coverage for every person residing in the country.

<span class="mw-page-title-main">National Health Insurance (British Virgin Islands)</span>

The National Health Insurance scheme is a form of national health insurance established by the Government of the British Virgin Islands through the Ministry of Health, with a goal to provide access to and financial coverage for health care services to British Virgin Islands residents. A National Health Insurance scheme was first considered in 2006, but it took over a decade to come to fruition. It eventually came into effect on 1 January 2016.

References

  1. ↑ Bump, Jesse B. (October 19, 2010). "The long road to universal health coverage. A century of lessons for development strategy" (PDF). Seattle: PATH . Retrieved March 10, 2013. Carrin and James have identified 1988—105 years after Bismarck's first sickness fund laws—as the date Germany achieved universal health coverage through this series of extensions to minimum benefit packages and expansions of the enrolled population. Bärnighausen and Sauerborn have quantified this long-term progressive increase in the proportion of the German population covered by public and private insurance. Their graph is reproduced below as Figure 1: German Population Enrolled in Health Insurance (%) 1885–1995.
    Carrin, Guy; James, Chris (January 2005). "Social health insurance: Key factors affecting the transition towards universal coverage" (PDF). International Social Security Review. 58 (1): 45–64. doi:10.1111/j.1468-246x.2005.00209.x . Retrieved March 10, 2013. Initially the health insurance law of 1883 covered blue-collar workers in selected industries, craftspeople and other selected professionals.6 It is estimated that this law brought health insurance coverage up from 5 to 10 per cent of the total population.
    Bärnighausen, Till; Sauerborn, Rainer (May 2002). "One hundred and eighteen years of the German health insurance system: are there any lessons for middle- and low income countries?" (PDF). Social Science & Medicine. 54 (10): 1559–1587. doi:10.1016/S0277-9536(01)00137-X. PMID   12061488 . Retrieved March 10, 2013. As Germany has the world's oldest SHI [social health insurance] system, it naturally lends itself to historical analyses.
  2. ↑ Leichter, Howard M. (1979). A comparative approach to policy analysis: health care policy in four nations. Cambridge: Cambridge University Press. p.  121 . ISBN   0-521-22648-1. The Sickness Insurance Law (1883). Eligibility. The Sickness Insurance Law came into effect in December 1884. It provided for compulsory participation by all industrial wage earners (i.e., manual laborers) in factories, ironworks, mines, shipbuilding yards, and similar workplaces.
  3. ↑ Hennock, Ernest Peter (2007). The origin of the welfare state in England and Germany, 1850–1914: social policies compared. Cambridge: Cambridge University Press. p.  157 . ISBN   978-0-521-59212-3.
  4. ↑ Leathard, Audrey (2000). "Health care in Britain: pre-war provision, 1900–1939". Health care provision: past, present, and into the 21st century (2nd ed.). Cheltenham: Stanley Thornes. pp. 3–4. ISBN   9780748733545.
  5. ↑ Marmor, Theodore R.; Hoffman, Wayne L.; Heagy, Thomas C. (1975). "National Health Insurance: Some Lessons from the Canadian Experience". Policy Sciences. 6 (4): 447–466. doi:10.1007/BF00142384. ISSN   0032-2687. JSTOR   4531619.

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