Universal health care is health care coverage that is extended to all eligible residents of a governmental region and often covers medical, dental, and mental health care. These programs vary in their structure and funding mechanisms. Typically, most costs are met via single-payer health care system or national health insurance, or else by compulsory regulated pluralist insurance (public, private or mutual) meeting certain regulated standards. Universal health care is implemented in most wealthy, industrialized countries, with the exception of the United States.[1][2] It is also provided in many developing countries and is the trend worldwide.
[edit] Implementation
Universal health care is a broad concept that has been implemented in several ways. The common denominator for all such programs is some form of government action aimed at extending access to health care as widely as possible and setting minimum standards. Most implement universal health care through legislation, regulation and taxation. Legislation and regulation direct what care must be provided, to whom, and on what basis. Usually some costs are borne by the patient at the time of consumption but the bulk of costs come from a combination of compulsory insurance and tax revenues. Some programs are paid for entirely out of tax revenues.[3] In some cases, government involvement also includes directly managing the health care system, but many countries use mixed public-private systems to deliver universal health care.
[edit] Africa
[edit] Americas
Argentina[citation needed], Brazil (see below), Canada (see below), Chile[citation needed], Costa Rica[citation needed], Cuba, Panama[citation needed], Peru[citation needed], Uruguay[citation needed]], and Venezuela[citation needed] all have public universal health care provided. Mexico plans to accomplish public universal health care by 2011.[4][5]
[edit] Brazil
The universal health care system was adopted in Brazil in 1988 after the end of the military regime's rule.[citation needed]
[edit] Canada
In 1984, the Canada Health Act was passed, which prohibited extra billing by doctors on patients while at the same time billing the public insurance system. In 1999, the prime minister and most premiers reaffirmed in the Social Union Framework Agreement that they are committed to health care that has "comprehensiveness, universality, portability, public administration and accessibility."[6]
The system is for the most part publicly funded, yet most of the services are provided by private enterprises or private corporations, although most hospitals are public. Most doctors do not receive an annual salary, but receive a fee per visit or service.[7] About 30% of Canadians' health care is paid for by the private sector or individuals.[8] This mostly goes towards services not covered or only partially covered by Medicare such as prescription drugs, dentistry and vision care.[9] Many Canadians have private health insurance, often through their employers, that cover these expenses.[10]
The Canada Health Act of 1984 "does not directly bar private delivery or private insurance for publicly insured services," but provides financial disincentives for doing so. "Although there are laws prohibiting or curtailing private health care in some provinces, they can be changed," according to a report in the New England Journal of Medicine.[11][12] The legality of the ban was considered in a decision of the Supreme Court of Canada which ruled in Chaoulli v. Quebec that "the prohibition on obtaining private health insurance, while it might be constitutional in circumstances where health care services are reasonable as to both quality and timeliness, is not constitutional where the public system fails to deliver reasonable services." The appellant contended that waiting times in Quebec violated a right to life and security in the Quebec Charter of Human Rights and Freedoms. The Court agreed, but acknowledged the importance and validity of the Canada Health Act, and at least four of the seven judges explicitly recognized the right of governments to enact laws and policies which favour the public over the private system and preserve the integrity of the public system. But not if the public system fails to deliver reasonable service as to quality or timeliness, as the court found in this case.[13]
[edit] United States
The United States is the only wealthy, industrialized nation that does not have a universal health care system.[1][2] The government directly covers 27.8% of the population[14] through health care programs for the elderly, disabled, military service families and veterans, children, and some of the poor, through Medicare, Medicaid, SCHIP, and TRICARE.[15][16] Federal law ensures public access to emergency services regardless of ability to pay.[17] However, this unfunded mandate has contributed to a health care safety net that some analyses say is increasingly strained.[18] Certain types of medical spending and particularly health insurance benefit from significant tax subsidies; in particular, employer-sponsored health insurance is a non-taxable benefit. In all, government spending accounted for 45.1% of total health spending in the U.S. in 2005.[19] Current estimates put U.S. health care spending at more than 15% of GDP, a greater portion than in any other United Nations member state except for the Marshall Islands.[20]
Whether a government-mandated system of universal health care should be implemented in the US remains a hotly debated political topic, with Americans divided along party lines in their views of the US health system and what should be done to improve it. Those in favor of government-guaranteed universal health care argue that the large number of uninsured Americans creates direct and hidden costs shared by all, and that extending coverage to all would lower costs and improve quality.[21] Opponents of government mandates or programs for universal health care argue that people should be free to opt out of health insurance.[22] Both sides of the political spectrum have also looked to more philosophical arguments, debating whether people have a fundamental right to have health care provided to them by their government.
In lieu of a national program, supporters of universal health care have sought implementation of such programs at the state and municipal level. The Commonwealth of Massachusetts implemented a near-universal health care system by mandating that residents purchase health insurance by July 1, 2007.[23] The City of San Francisco is also undertaking a universal health care system for uninsured residents.[24][25] Hawaii has, since 1974, required employers to provide employees working more than 20 hours per week with a comprehensive health insurance plan.[26] California, Connecticut, Maine and Vermont are also considering or seeking to implement universal or near-universal systems.[27]
Brunei, China,[28] Hong Kong SAR, India[citation needed], Kuwait[citation needed], Qatar[citation needed], UAE[citation needed], Saudi Arabia[citation needed], Israel,[29] Japan, Malaysia[citation needed], South Korea, Seychelles[citation needed], Sri Lanka,[30] Taiwan,[31] and Thailand have universal health care.
Since the founding of the People's Republic of China, the goal of health care programs has been to provide care to every member of the population and to make maximum use of limited health-care personnel, equipment, and financial resources.[citation needed]
China is undertaking a reform on its universal health care system.[citation needed] The New Rural Co-operative Medical Care System (NRCMCS), is a new 2005 initiative to overhaul the healthcare system, particularly intended to make it more affordable for the rural poor. Under the NRCMCS, the annual cost of medical cover is 50 yuan (US$7) per person. Of that, 20 yuan is paid in by the central government, 20 yuan by the provincial government and a contribution of 10 yuan is made by the patient. As of September 2007, around 80% of the whole rural population of China had signed up (about 685 million people). The system is tiered, depending on the location. If patients go to a small hospital or clinic in their local town, the scheme will cover from 70-80% of their bill. If they go to a county one, the percentage of the cost being covered falls to about 60%. And if they need specialist help in a large modern city hospital, they have to bear most of the cost themselves, the scheme would cover about 30% of the bill.[32]
On 21 January 2009, the Chinese government announced that a total of 850 billion yuan will be provided between 2009 and 2011 in order to improve the existing health care system.[33]
India has a universal health care system run by the local (state or territorial), governments. The government hospitals, some of which are among the best hospitals in India,[34] provide treatment at taxpayer expense. Most drugs are offered free of charge in these hospitals.
Most government hospitals do not require payment from people below the poverty line, proof of citizenship or residency. Government hospitals in some parts of the country and some private non-profit (including teaching) hospitals charge a nominal fee to prevent abuse of the system. Most hospitals are operated on an annual budget allocated by the government, and do not rely on individual billing. These hospitals also provide better amenities (such as private air-conditioned rooms) if the patient can afford to pay. However, they charge less than comparable private hospitals.[citation needed]
Primary health care is provided by city and district hospitals and rural primary health centres. These hospitals provide treatment free of cost. Primary care is focused on immunization, prevention of malnutrition, pregnancy, child birth, postnatal care, and treatment of common illnesses. The primary health centres are staffed by general practitioners (primary care physicians), nurses and midwives trained in labour and delivery. Patients who receive specialized care or have complicated illnesses are referred to secondary (often located in district and taluk headquarters) and tertiary care hospitals (located in district and state headquarters or those that are teaching hospitals).
Now organizations like Hindustan Latex Family Planning Promotional Trust and other private organizations have started creating hospitals and clinics in India, which also provide free or subsidized health care and subsidized insurance plans.
[edit] Israel
In Israel, the National Health Insurance Law (or National Health Insurance Act) is the legal framework which enables and facilitates basic, compulsory universal health care. The Law was put into effect by the Knesset on January 1, 1995, and was based on recommendations put forward by a National Committee of Inquiry which examined restructuring the health care system in Israel in the late 1980s. Prior to the law's passage approximately 85% of the population was already covered by voluntarily belonging to one of four nation-wide, not-for-profit health maintenance organizations (HMOs/sick funds). However, there were three problems associated with this arrangement. First, membership in the largest HMO, Clalit, required one to belong to the Histadrut labor organization, even if a person did not wish to (or could) have such an affiliation while other HMOs restricted entry to new members based on age, pre-existing conditions or other factors. Second, different HMOs provided different levels of benefit coverage or services to their members and lastly was the issue mentioned above whereby a certain percentage of the population, albeit a small one, did not have health insurance coverage at all.
Before the law went into effect, all the HMOs collected premiums directly from members. However, upon passage of the law, a new progressive national health insurance tax was levied through Israel's social security agency which then re-distributes the proceeds to the HMOs based on their membership and its demographic makeup. This ensured that all citizens would now have health coverage. While membership in one of the HMOs now became compulsory for all, free choice was introduced into movement of members between HMOs (a change is allowed once per year), effectively making the various HMOs compete equally for members among the populace. Annually, a committee appointed by the ministry of health publishes a "basket" or uniform package of medical services and prescription formulary which all HMOs must provide as a minimum service to all their members. Achieving this level of equality ensured that all citizens are guaranteed to receive basic healthcare regardless of their HMO affiliation which was one of the principal aims of the law. An appeals process was put in place to handle rejection of treatments and procedures by the HMOs and evaluating cases falling outside the "basket" of services or prescription formulary.
While the law is generally considered a success and Israeli citizens enjoy a high standard of medical care comparatively, with more competition having been introduced into the field of health care in the country, and order having been brought into what was once a somewhat disorganized system, the law nevertheless does have its critics. First and foremost among the criticisms raised is that the "basket" may not provide enough coverage. To partly address this issue, the HMOs and insurance companies (often in conjunction with employers) began offering additional "supplementary" insurance to cover certain additional services not included in the basket. However, since this insurance is optional, critics argue that it goes against the spirit of the new law which stressed equality among all citizens with respect to healthcare. Another criticism is that in order to provide universal coverage to all, the tax income base amount (the maximum amount of yearly earnings that are subject to the tax) was set rather high, causing many high-income taxpayers to see the amount they pay for their health premiums (now health tax) skyrocket. Finally, some complain about the constantly rising costs of copayments for certain services.
[edit] Singapore
Singapore has a universal health care system where government ensures affordability, largely through compulsory savings and price controls, while the private sector provides most care. Overall spending on health care amounts to only 3% of annual GDP. Of that, 66% comes from private sources.[35] Singapore currently has the lowest infant mortality rate in the world (equaled only by Iceland) and among the highest life expectancies from birth, according to the World Health Organization.[36] Singapore has "one of the most successful healthcare systems in the world, in terms of both efficiency in financing and the results achieved in community health outcomes," according to an analysis by global consulting firm Watson Wyatt.[37] Singapore's system uses a combination of compulsory savings from payroll deductions (funded by both employers and workers) a nationalized catastrophic health insurance plan, and government subsidies, as well as "actively regulating the supply and prices of healthcare services in the country" to keep costs in check; the specific features have been described as potentially a "very difficult system to replicate in many other countries." Many Singaporeans also have supplemental private health insurance (often provided by employers) for services not covered by the government's programs.[37]
[edit] Thailand
Thailand introduced universal coverage reforms in 2001, becoming one of only a handful of lower-middle income countries to do so. Means-tested health care for low income households was replaced by a new and more comprehensive insurance scheme, originally known as the 30 baht project, in line with the small co-payment charged for treatment. People joining the scheme receive a gold card which allows them to access services in their health district, and, if necessary, be referred for specialist treatment elsewhere. The bulk of finance comes from public revenues, with funding allocated to Contracting Units for Primary Care annually on a population basis. According to the WHO, 65% of Thailand's health care expenditure in 2004 came from the government, 35% was from private sources.[35] Although the reforms have received a good deal of critical comment, they have proved popular with poorer Thais, especially in rural areas, and survived the change of government after the 2006 military coup. The then Public Health Minister, Mongkol Na Songkhla, abolished the 30 baht co-payment and made the UC scheme free. It is not yet clear whether the scheme will be modified further under the coalition government that came to power in January 2008.[38][4][39]
