National health insurance (NHI) is a legally enforced scheme of health insurance that insures a national population against the cost 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 healt insurance does not equate to government-run or goernment-health financed health care, but is usually established by national legislation. In some countries, such as Australia's Medicare system or the UK's National Health Service, contributions to the system are made via general taxation and therefore are not optional even through use of the health scheme it finances is. In practice, of course, most people paying for NHI will joint the insurance scheme. where the NHI scheme 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.
History
History
Germany has the world's oldest national social health
insurance system, with origins dating back to Otto von Bismarck's Sickness
Insurance Law of 1883. 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.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.
Programs
See also: Health care systems, Single-payer health care and
Universal health care
National healthcare insurance programs differ both in how
the money is collected, and in how the services are provided. In countries such
as Canada, payment is made by the government directly from tax revenue. The
collection is administered by government. In France a similar system of
compulsory contributions is made, but the collection is administered by
non-profit organisations set up for the purpose. This is known in the United
States as single-payer health care. The provision of services may be through
either publicly or privately owned health care providers.
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. 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 not for profit
institutions run solely for the benefit of their members. 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.
National schemes have the advantage that the pool or pools
tend to be very very large and reflective of the national population. Health
care costs, which tend to be high at certain stages in life such as during
pregnancy and childbirth and especially in the last few years of life can be
paid into the pool over a lifetime and be higher when earnings capacity is
greatest to meet costs incurred at times when earnings capacity is low or non
existent. This differs from the private insurance schemes that operate in some
countries which tend to price insurance year on year according to health risks
such as age, family history, previous illnesses, and height/weight ratios. Thus
some people tend to have to pay more for their health insurance when they are
sick and/or are least able to afford it. These factors are not taken into
consideration in NHI schemes. In private schemes in competitive insurance
markets, these activities by insurance companies tend to act against the basic
principles of insurance which is group solidarity.
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