How health care system works

• The health care system
• What is Medicaid
• What is Medicare
• Health care systems models

The health care system here are generally five primary methods standardised and mandatory health of funding health care systems insurance is in place, meant to 1. direct or out-of-pocket payments, encourage competition between healthcare 2. general taxation, providers and insurers. The insurance 3. social health insurance, policies are paid for through a system 4. voluntary or private health of levies and subsidies as well as a insurance, and premium paid by the insured, from which 5. donations or community health children under 18 are exempt. insurance. In New Zealand hospitals are public and Although some view health care from an treat citizens or permanent residents economic perspective as being no free of charge and are managed by different from other products or District Health Boards. Under the services, others believe it has many current Labour coalition governments, characteristics that encourage 1999 - present, there are plans to make government intervention or regulation: primary health care available free of The provision of critical health care charge. At present government subsidies treatment is often regarded as a basic exist in health care. This system is human right, regardless of whether the funded by taxes. The New Zealand individual has the means to pay—some government agency PHARMAC subsides treatments cost more than a typical certain pharmaceuticals depending upon family's life savings. their category. Co-payments exist Health care professionals are bound by however these are ignored if the user law and their oaths of service to has a community health services card or provide lifesaving treatment. high user health card. People often lack the information or In South Africa, parallel private and understanding to be able to choose public systems exist. The public system rationally between competing health care serves the vast majority of the providers when they need treatment, population, but is chronically particularly in the event of the need of underfunded and understaffed. The urgent or emergency treatment. wealthiest 20% of the population uses Health care systems models the private system and are far better Purely private enterprise health care served. systems are comparatively rare. Where In Sweden, the publicly funded medical they exist, it is usually for a system is comprehensive and compulsory. comparatively well-off subpopulation in Physician and hospital services take a a poorer country with a poorer standard small patient fee, but their services of health care–for instance, private are funded through the taxation scheme clinics for a small, wealthy expatriate of the County Councils of Sweden. population in an otherwise poor country. In 1948, the United Kingdom passed the But there are countries with a National Health Service Act that majority-private health care system with provided free physician and hospital residual public service services to all people resident in the The other major models are public United Kingdom. Hospital staff are insurance systems: salaried employees according to Social security health care model, where nationally agreed contracts, whilst workers and their families are insured primary care is largely provided by by the State. independent practices, who are paid, Publicly funded health care model, where again via a nationally agreed contract, the residents of the country are insured according to the number of patients by the State. registered with them and the range of Social health insurance, where the whole additional services offered. The population or most of the population is National Health Service has been amended a member of a sickness insurance from time to time, but is largely company. intact. Around 86% of prescriptions are In almost every country with a provided free. Prescriptions are government health care system a parallel provided free to people who satisfy private system is allowed to operate. certain criteria such as low income or This is sometimes referred to as permanent disabilities. People that pay two-tier health care. The scale, extent, for prescriptions do not pay the full and funding of these private systems is cost. For example, in 2004 most people very variable. in will pay a flat fee of £6.40 Examples (€9.64, US$11.76) for a single drug In Australia the current system, known prescription regardless of the cost as Medicare, was instituted in 1984. It (average cost to the health service was coexists with a private health system. £11.10--about €16.70, US$20.40--in Medicare is funded partly by a 1.5% 2002). (Charges are lower in Wales, and income tax levy (with exceptions for the administration there is committed to low-income earners), but mostly out of their eventual elimination.) Funding general revenue. An additional levy of comes from a hypothecated health 1% is imposed on high-income earners insurance tax and from general taxation. without private health insurance. As Private health services are also well as Medicare, there is a separate available. Private health care continued Pharmaceutical Benefits Scheme that parallel to the NHS, paid for largely by heavily subsidises prescription private insurance, but it is used only medications. by a small percentage of the population, Canada has a federally sponsored, and generally as a top-up to NHS publicly funded Medicare system. Each services. province may opt out, though none The United States is alone among currently do. Canada's system is known developed nations with the absence of a as a single payer system, where basic universal healthcare system. The U.S. services are provided by private health system does, however, have doctors, with the entire fee paid for by significant publicly funded components. the government at the same rate. These Medicare for the elderly and disabled rates are negotiated between the with a historical work record, and provincial governments and the Medicaid for indigents, provides province's medical associations, usually taxation-financed coverage. This care is on an annual basis. A physician cannot generally provided by privately owned charge a fee for a service that is hospitals or physicians in private higher than the negotiated rate - even practice, but public hospitals are to patients who are not covered by the common in older cities. Medicare is a publicly funded system - unless he opts federal government program providing out of billing the publicly funded coverage to people age 65 or older. system altogether. Other areas of health Medicaid is a federal and state program care, such as dentistry and optometry, providing coverage to low-income and are wholly private. disabled persons. The Department of Cuba has a wholly government-controlled Veterans Affairs directly provides system that consumes a large proportion health care to injured U.S. military of the nation's GDP. The system does veterans and current servicemen and work on a for profit basis in treating women through a nationwide network of patients from abroad. Cuba attracts government hospitals (non-injured patients mostly from Latin America and veterans are often not covered). A Eastern Europe by offering care of significant and growing number of people comparable quality to a developed nation cannot obtain health insurance through but at much lower prices. While the their employer, or are unable to afford government system is free to all, individual coverage. Currently, it is patients frequently pay out-of-pocket estimated that 17% of the U.S. for drugs that are in short supply in population is uninsured. This number is the public system. growing rapidly as increasing numbers of In Finland, the publicly funded medical employers cannot afford the ever-growing system is funded by taxation and every costs of the insurance. For those that citizen has state-funded health continue to provide employer-based insurance. The system is comprehensive programs, the employee percentage share and compulsory, like in Sweden, and a is increasing year by year. The cost of small patient fee is also taken. medicines is frequently not covered by In France, most doctors remain in insurances and it is common for U.S. private practice; there are both private citizens to travel to Canada and Mexico and public hospitals. Social Security for drug purchases at prices far below consists of several public those in their home areas. A few states organizations, distinct from the state have taken serious steps toward government, with separate budgets that universal health care coverage, most refunds patients for care in both notably Minnesota and Massachusetts, private and public facilities. It with a recent example being the generally refunds patients 70% of most Massachusetts 2006 Health Reform health care costs, and 100% in case of Statute. Other states, while not costly or long-term ailments. attempting to insure all of their Supplemental coverage may be bought from residents, cover large numbers of people private insurers, most of them by reimbursing hospitals and other nonprofit, mutual insurers. Until health-care providers using what is recently, social security coverage was generally characterized as a charity restricted to those who contributed to care scheme; New Jersey is perhaps the social security (generally, workers or best example of a state that employs the retirees), excluding some poor segments latter strategy. It is typical for most of the population; the government of forms of general liability insurance Lionel Jospin put into place the sold in the U.S., such as home, "universal health coverage". In some automobile, or business insurance to systems, patients can also take private have a significant premium allocation health insurance, but choose to receive for medical damages. The U. S. legal care at public hospitals, if allowed by system, which has the highest number of the private insurer. attorneys per 100,000 population of any Germany has a universal multi-payer country in the world, is available to system with two main types of health assist in proving liability and insurance: "Compulsory health insurance" collecting the money for medical bills (Gesetzlich) and "Private" (Privat). from such insurances. In Ghana, most health care is provided The Indian Health Service provides by the government, but hospitals and public funded care for indigenous clinics run by religious groups also peoples. Employer benefit based health play an important role. Some for profit insurance remains quite common with clinics exist, but they provide less larger employers. Workers injured on the than 2% of health services. Health care job are covered by government mandated is very variable through the country. worker compensation insurance and wage The major urban centres are well served, replacement benefits. These benefits but rural areas often have no modern vary considerably state-to-state and health care. Patients in these areas employers bear the cost of this either rely on traditional medicine or insurance. Businesses with considerable travel great distances for care. risks, such as bridge-building, mining, In Hong Kong, both private and public or meat processing face far higher clinics are common, while public worker compensation insurance costs than hospitals account for the majority of do office based clerical businesses. the market. In Italy the public system has the In Israel, the publicly funded medical unique feature of paying its doctors a system is universal and compulsory. fee per capita per year, a salary Payment for the services are shared by system, that does not reward repeat labor unions and the government. visits, testing, and referrals In the Netherlands, a system of 1 A B C D 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110