Other Health Care

A health care system is the organization by which health care is provided. more...

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Financing

There are generally five primary methods of funding health care systems:

direct or out-of-pocket payments,; general taxation,; social health insurance,; voluntary or private health insurance, and; donations or community health insurance.;

Although some view health care from an economic perspective as being no different from other products or services, others believe it has many characteristics that encourage government intervention or regulation:

The provision of critical health care treatment is often regarded as a basic human right, regardless of whether the individual has the means to pay—some treatments cost more than a typical family's life savings.; Health care professionals are bound by law and their oaths of service to provide lifesaving treatment.; Health care professionals are monopolists in various respects: surgery, gynecology, prescribing, etc.; People often lack the information or understanding to be able to choose rationally between competing health care providers when they need treatment, particularly in the event of the need of urgent or emergency treatment.;

Health care systems models

Purely private enterprise health care systems are comparatively rare. Where they exist, it is usually for a comparatively well-off subpopulation in a poorer country with a poorer standard of health care–for instance, private clinics for a small, wealthy expatriate population in an otherwise poor country. But there are countries with a majority-private health care system with residual public service (see Medicare, Medicaid).;

The other major models are public insurance systems:

Social security health care model, where workers and their families are insured by the State.; Publicly funded health care model, where the residents of the country are insured by the State.; Social health insurance, where the whole population or most of the population is a member of a sickness insurance company.;

In almost every country with a government health care system a parallel private system is allowed to operate. This is sometimes referred to as two-tier health care. The scale, extent, and funding of these private systems is very variable.

Examples

In Australia the current system, known as Medicare, was instituted in 1984. It coexists with a private health system. Medicare is funded partly by a 1.5% income tax levy (with exceptions for low-income earners), but mostly out of general revenue. An additional levy of 1% is imposed on high-income earners without private health insurance. As well as Medicare, there is a separate Pharmaceutical Benefits Scheme that heavily subsidises prescription medications.; Canada has a federally sponsored, publicly funded Medicare system. Each province may opt out, though none currently do. Canada's system is known as a single payer system, where basic services are provided by private doctors, with the entire fee paid for by the government at the same rate. These rates are negotiated between the provincial governments and the province's medical associations, usually on an annual basis. A physician cannot charge a fee for a service that is higher than the negotiated rate - even to patients who are not covered by the publicly funded system - unless he opts out of billing the publicly funded system altogether. Other areas of health care, such as dentistry and optometry, are wholly private.; Cuba has a wholly government-controlled system that consumes a large proportion of the nation's GDP. The system does work on a for profit basis in treating patients from abroad. Cuba attracts patients mostly from Latin America and Eastern Europe by offering care of comparable quality to a developed nation but at much lower prices. While the government system is free to all, patients frequently pay out-of-pocket for drugs that are in short supply in the public system.; In Finland, the publicly funded medical system is funded by taxation and every citizen has state-funded health insurance. The system is comprehensive and compulsory, like in Sweden, and a small patient fee is also taken.; In France, most doctors remain in private practice; there are both private and public hospitals. Social Security consists of several public organizations, distinct from the state government, with separate budgets that refunds patients for care in both private and public facilities. It generally refunds patients 70% of most health care costs, and 100% in case of costly or long-term ailments. Supplemental coverage may be bought from private insurers, most of them nonprofit, mutual insurers. Until recently, social security coverage was restricted to those who contributed to social security (generally, workers or retirees), excluding some poor segments of the population; the government of Lionel Jospin put into place the \"universal health coverage\". In some systems, patients can also take private health insurance, but choose to receive care at public hospitals, if allowed by the private insurer.; Germany has a universal multi-payer system with two main types of health insurance: \"Compulsory health insurance\" (Gesetzlich) and \"Private\" (Privat).; In Ghana, most health care is provided by the government, but hospitals and clinics run by religious groups also play an important role. Some for profit clinics exist, but they provide less than 2% of health services. Health care is very variable through the country. The major urban centres are well served, but rural areas often have no modern health care. Patients in these areas either rely on traditional medicine or travel great distances for care.; In Hong Kong, both private and public clinics are common, while public hospitals account for the majority of the market.; In Israel, the publicly funded medical system is universal and compulsory. Payment for the services are shared by labor unions and the government.; In the Netherlands, a system of standardised and mandatory health insurance is in place, meant to encourage competition between healthcare providers and insurers. The insurance policies are paid for through a system of levies and subsidies as well as a premium paid by the insured, from which children under 18 are exempt.; In New Zealand hospitals are public and treat citizens or permanent residents free of charge and are managed by District Health Boards. Under the curent Labour coalition governments, 1999 - present, there are plans to make primary health care available free of charge. At present government subsidies exist in health care. This system is funded by taxes. The New Zealand government agency PHARMAC subsides certain pharmaceuticals depending upon their category. Co-payments exist however these are ignored if the user has a community health services card or high user health card.; In South Africa, parallel private and public systems exist. The public system serves the vast majority of the population, but is chronically underfunded and understaffed. The wealthiest 20% of the population uses the private system and are far better served.; In Sweden, the publicly funded medical system is comprehensive and compulsory. Physician and hospital services take a small patient fee, but their services are funded through the taxation scheme of the County Councils of Sweden.; In 1948, the United Kingdom passed the National Health Service Act that provided free physician and hospital services to all people resident in the United Kingdom. Most doctors and nurses are on contracts, and receive salaries, a fixed fee for each patient assigned, and enhanced payments for specialized treatments or skills. The National Health Service has been amended from time to time, but is largely intact. Around 86% of prescriptions are provided free. Prescriptions are provided free to people who satisfy certain criteria such as low income or permanent disabilities. People that pay for prescriptions do not pay the full cost. For example, in 2004 most people in will pay a flat fee of £6.40 (€9.64, US$11.76) for a single drug prescription regardless of the cost (average cost to the health service was £11.10--about €16.70, US$20.40--in 2002). (Charges are lower in Wales, and the administration there is committed to their eventual elimination.) Funding comes from a hypothecated health insurance tax and from general taxation. Private health services are also available. Private health care continued parallel to the NHS, paid for largely by private insurance, but it is used only by a small percentage of the population, and generally as a top-up to NHS services.;

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