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National health insurance is health insurance that insures a national population for the costs of health care and usually is instituted as a program of healthcare reform. 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.
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Types of programs
- See also: Single-payer health care and Universal health care
Some countries implement national health insurance through a national insurance fund operated by the government from which medical expenses are paid. These services are provided by private health care providers. This is known in the United States as single-payer health care, and if US Medicare were expanded and covered all Americans, it would be considered national health insurance.1 A 2008 survey shows that a majority of US physicians (by almost 2 to 1), favor national health insurance.2 Two existing examples of this type of program are Australia's Medicare and Canada's health insurance system.
In other programs, the funds can only be spent on health services commissioned by the government. An example of this is the UK's National Health Service.
Some 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. To protect the interest of both patients and insurance companies, the government establishes an equalization pool to spread risks between the various funds. This occurs when younger, healthier people must pay into the pool and older, sicker people receive money from the pool. The government may also contribute to the equalization pool as a form of health care subsidy.
Other countries are largely funded by contributions by employers and employees to sickness funds. With these programs, funds do not come from the government, and neither from direct private payments. This system operates in countries such as Germany and Belgium. These countries have so-called social health insurance systems, characterized by the presence of sickness funds, which can be based on professional, regional, religious, or political affiliation. Usually characterization is a matter of degree: systems are mixes of these three sources of funds (private, employer-employee contributions, and national/sub-national 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.
See also
- Health care reform in the United States
- Health care systems
- Healthcare-NOW!
- List of healthcare reform advocacy groups in the United States
- Medicare Rights Center
- Physicians for a National Health Program
- Publicly-funded health care
- Single-payer health care
- United States National Health Insurance Act
- Universal health care
Notes and references
- ^ Physicians for a National Health Program - Health Care is a Human Right
- ^ Doctors support universal health care: survey, Reuters, March 31, 2008 (first reported in Annals of Internal Medicine).
Further reading
- Nicholas Laham: Why the United States lacks a national health insurance program, Westport, Conn. [u.a.] : Greenwood Press, 1993
- Ronald L. Numbers (ed.): Compulsory Health Insurance: The Continuing American Debate, Westport, Conn. : Greenwood Press, 1982.
- Saltman, R.B., Busse, R. and Figueras, J. (2004) Social health insurance systems in western Europe, Berkshire/New York: Open University Press/McGraw-Hill. ISBN 0-335-21363-4
- Saltman, R.B. and Dubois, H.F.W. (2004) Individual incentive schemes in social health insurance systems, 10(2): 21-25. Full text
- Van de Ven, W.P.M.M., Beck, K., Buchner, F. et al. (2003) Risk adjustment and risk selection on the sickness fund market in five European countries, Health Policy, 65(1=: 75-98.
- Saltman, R.B. and Dubois, H.F.W. (2005) Current reform proposals in social health insurance countries, Eurohealth, 11(1): 10-14. Full text