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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 In many states with political systems derived from the Westminster system, a consolidated fund or consolidated revenue fund is the main bank account of the government. General taxation is taxation paid into the consolidated fund (as opposed ...
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.


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 The National Insurance Act 1911 created National Insurance, originally a system of health insurance for industrial workers in Great Britain based on contributions from employers, the government, and the workers themselves. It was one of the foun ...
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 In many states with political systems derived from the Westminster system, a consolidated fund or consolidated revenue fund is the main bank account of the government. General taxation is taxation paid into the consolidated fund (as opposed ...
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. 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 An equalization pool is a fund created to level out differences in financial risk, often across long periods of time, in a process known as risk equalization. Examples include mandatory health insurance and grower co-operatives. Health insurance ...
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

*
Aasandha Aasandha ( Dhivehi: އާސަންދަ) is the universal health insurance scheme of the Maldives. It is a single-payer healthcare system financed solely by the Government of Maldives. The Scheme is designed to provide medical care including hospitaliz ...
– Maldives *
Health care in Argentina Argentina's health care system is composed of a universal health care system and a private system. The government maintains a system of public medical facilities that are universally accessible to everyone in the country, but formal sector worker ...
*
Health care in Australia Health care in Australia operates under a shared public-private model underpinned by the Medicare system, the national single-payer funding model. State and territory governments operate public health facilities where eligible patients rec ...
Medicare (Australia) Medicare is the publicly-funded universal health care insurance scheme in Australia, operated by the nation's social security department, Services Australia. Medicare is the principal way Australian citizens and permanent residents access mos ...
*
Healthcare in Belgium Healthcare in Belgium is composed of three parts. Firstly there is a primarily publicly funded healthcare and social security service run by the federal government, which organises and regulates healthcare; independent private/public practition ...
– Sickness and Invalidity Insurance * Health care in Canada * Health care in Colombia – Law 100 – National Health Insurance Scheme: Contributory Vs. Subsidized coverage (NHIS) * Health care in France *
Healthcare in Germany Germany has a universal multi-payer health care system paid for by a combination of statutory health insurance (') and private health insurance ('). The turnover of the health sector was about US$368.78 billion (€287.3 billion) in 2010, eq ...
* Health care in Ghana – National Health Insurance Scheme (NHIS) *
Health care 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 Insuranc ...
* Health care in Italy – National Health Service (SSN) * Healthcare in India - Employees' State Insurance,
Ayushman Bharat Yojana Ayushman Bharat Pradhan Mantri Jan Arogya Yojana ( or PM-JAY'';'' also referred to as Ayushman Bharat National Health Protection Scheme or NHPS) is a national public health insurance fund of the Government of India that aims to provide free acc ...
, others are provided insurance through their employer. *
Health care in Japan The health care system in Japan provides healthcare services, including screening examinations, prenatal care and infectious disease control, with the patient accepting responsibility for 30% of these costs while the government pays the remain ...
– People without insurance through employers can participate in a national health insurance program administered by local governments. * Healthcare in Nigeria – National Health Insurance Scheme (NHIS) *
Health care in the Netherlands Healthcare in the Netherlands is differentiated into several main categories. Firstly in three different echelons; secondly in physical (somatic) versus mental healthcare; and thirdly in "cure" (short term) versus "care" (long term). ''"Huisarts ...
*
Healthcare in the Philippines Health care in the Philippines varies with private, public and barangay health centers (many in rural municipalities). Most of the national burden of health care is taken up by private health providers. Overview The World Health Organization d ...
– Social Health Insurance Program, a resource pooling, risk sharing health care program that provides quality health care financing not only to the employed but to the sick, elderly, and indigents, as well *
Health care in Poland Health care in Poland is insurance based, delivered through a publicly funded health care system called the Narodowy Fundusz Zdrowia, which is free for all the citizens of Poland provided they fall into the "insured" category (usually meaning tha ...
*
Healthcare in South Korea Healthcare in South Korea is universal, although a significant portion of healthcare is privately funded. South Korea's healthcare system is based on the National Health Insurance Service, a public health insurance program run by the Ministry of H ...
*
Healthcare 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 Switz ...
– A compulsory health insurance covers a range of treatments which are set out in detail in the Federal Act. *
Healthcare in Taiwan Healthcare in Taiwan is administered by the Ministry of Health and Welfare of the Executive Yuan. As with other developed economies, Taiwanese people are well-nourished but face such health problems as chronic obesity and heart disease. In 2002 ...
– National Health Insurance (NHI) * Health care in the United Kingdom – National Insurance


See also

*
Health care compared Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organiz ...
* Health care politics * Publicly funded health care * Single-payer health care *
Universal health care Universal health care (also called universal health coverage, universal coverage, or universal 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 ar ...


References


Further reading

*Nicholas Laham: ''Why the United States lacks a national health insurance program'', Westport, Conn. .a.: Greenwood Press, 1993 *Barona, B., Plaza, B., and Hearst, N. (2001) Managed Competition for the poor or poorly managed: Lessons from the Colombian health reform experience. Oxford University Pres

*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. *Saltman, R.B. and Dubois, H.F.W. (2004) Individual incentive schemes in social health insurance systems, 10(2): 21-25
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*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
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External links


Health Care for America NOW!
An advocacy group that supports a
public health insurance option The public health insurance option, also known as the public insurance option or the public option, is a proposal to create a government-run health insurance agency that would compete with other private health insurance companies within the United ...
for universal health care.
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