Universal health care
Universal health care is health care coverage which is extended to all eligible residents of a governmental region. Universal health care programs vary widely in their structure and funding mechanisms, particularly the degree to which they are publicly funded. Typically, most health care costs are met by the population via compulsory
health insuranceor taxation, or a combination of both. According to the Institute of Medicineof the National Academy of Sciences and others, the United Statesis the only wealthy, industrialized nation that does not provide universal health care. [http://www.iom.edu/?id=17848 Insuring America's Health: Principles and Recommendations] , Institute of Medicine at the National Academies of Science, 2004-01-14] [ [http://cthealth.server101.com/the_case_for_universal_health_care_in_the_united_states.htm The Case For Single Payer, Universal Health Care For The United States] ]
Universal health care systems require government involvement, typically in the forms of enacting legislation, mandates and regulation. 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.
In the 1880s, most citizens in
Germanybecame covered under the mandatory health care system championed by Otto von Bismarck. The National Health Service(NHS), established in the United Kingdomin 1948, is considered the world's first universal health care system provided by government. Universal health care is provided in most developed countries and in many developing countries.
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. Most countries 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 but are subsidized by taxation and compensated to the patient by the government. Many programs utilize some form of compulsory
insuranceto accomplish this goal. Other programs are paid for entirely out of tax revenues and provide automatic coverage for every citizen or resident. [ For an international comparison of ten different health care systems in ten developed countries - nine universal systems and one non-universal system (the U.S.) - and their relative costs and key health outcomes, see http://www.nao.org.uk/publications/Int_Health_Comp.pdf. For a wider international comparison of 16 countries, each with universal health care, see the World Health Organisationpublication at http://www.euro.who.int/document/e85400.pdf.]
Virtually all of Europe has publicly sponsored and regulated health care. The public plans in many countries provide basic or "sick" coverage only; their citizens can purchase supplemental insurance for additional coverage. Countries include Austria, Belgium, Bosnia-Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark, Finland, Estonia, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Italy, Malta, the Netherlands, Norway, Latvia, Liechtenstein, Luxembourg, Poland, Portugal, [Portugal: Bentes M, Dias CM, Sakellarides C, Bankauskaite V. [http://www.euro.who.int/document/e82937.pdf#search=%22Portugal%2C%20health%20care%22 "Health Care Systems in Transition: Portugal."] WHO are Regional Offices for Europe on behalf of the European Observatory on Health Systems and Policies, 2004.] Romania, Russia, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland and the United Kingdom.
Finland, public medical services at clinics and hospitals are run by the municipalities (local government) and are funded 76% by taxation, 20% by patients through access charges, and 4% by others. Private provision is mainly in the primary care sector. There are very few private hospitals [ [http://www.kela.fi/in/internet/english.nsf/NET/210806144050AK KELA - Use of European Health Insurance Card in Finland ] ] . The main hospitals are either municipally owned (funded from local taxes) or run by the medical teaching universities (funded jointly by the municipalities and the national government). According to a survey published by the European Commission in 2000, Finland's is in the top 4 of EU countries in terms of satisfaction with their hospital care system: 88% of Finnish respondents were satisfied compared with the EU average of 41.3%. [http://ec.europa.eu/public_opinion/archives/ebs/ebs_283_en.pdf European Commission: Health and long-term care in the European Union] Finnish health care expenditures are below the European average. The private medical sector accounts for about 14 percent of total health care spending. Only 8% of doctors choose to work in private practice, and some of these also choose to do some work in the public sector.
Taxation funding is partly local and partly nationally based. The national social insurance institution KELA reimburses part of patients prescription costs and makes a contribution towards private medical costs (including
dentistry) if they choose to be treated in the private sector rather than the public sector. Patient access charges are subject to annual caps. For example GP visits are (11€ per visit with annual 33€ cap), hospital outpatient treatment (22€ per visit), a hospital stay, including food, medical care and medicines (26€ per 24 hours, or 12€ if in a psychiatric hospital). After a patient has spent 590€ per year on public medical services, all treatment and medications thereafter are free.
Germany has the world's oldest universal health care system, with origins dating back to Otto von Bismarck's Health Insurance Act of 1883. As mandatory health insurance, it originally applied only to low-income workers and certain government employees, but has gradually expanded to cover virtually the entire population. [ [http://www.photius.com/countries/germany/society/germany_society_development_of_the_h~1372.html History of German Health Care System] ] Currently 85% of the population is covered by a basic 'Statutory Health Insurance' plan, which provides the standard level of coverage. The remainder opt for private health insurance, which frequently offers additional benefits. According to the
World Health Organization, Germany's health care system was 77% government-funded and 23% privately funded as of 2004. [http://www.who.int/whosis/database/core/core_select.cfm World Health Organization Statistical Information System: Core Health Indicators] ]
The government's role is chiefly regulatory.Fact|date=February 2008 It convenes representatives of consumers, employers, health care professionals, workers unions, and the insurance industry annually to set national standards and reimbursement levels for particular services.Fact|date=February 2008 Although the government regulates the process, it is administered by myriad health insurance providers and is financed chiefly by a combination of employer and employee contributions.Fact|date=February 2008 The government also subsidizes the cost of Statutory Health Insurance for the unemployed.Fact|date=February 2008 It partially reimburses the costs for low-wage workers, whose premiums are capped at a predetermined value. Higher wage workers pay a premium based on their salary. They may also opt for private insurance, which is generally more expensive, but whose price may vary based on the individual's health status. [http://www.finanztip.de/web/abc-der-krankenkassen/ Gesetzliche Krankenversicherungen im Vergleich] [http://translate.google.com/translate?hl=en&sl=de&u=http://www.finanztip.de/web/abc-der-krankenkassen/&sa=X&oi=translate&resnum=5&ct=result&prev=/search%3Fq%3Dgesetzliche%2Bkrankenversicherung%2Bin%2Bdeutschland%26hl%3Den%26client%3Dsafari%26rls%3Den%26sa%3DX (English Translation)] ]
In Germany, most hospital care is provided by salaried physicians and nurses in public non-profit hospitals.Fact|date=February 2008 A smaller number of private non-profit (e.g., church-owned) hospitals exist, but private hospitals are rare.Fact|date=February 2008 Ambulatory care is generally provided by physicians in individual or small-group practices.Fact|date=February 2008 Ambulatory care physicians may not be simultaneously employed by hospitals.Fact|date=February 2008 Reimbursement is on a fee-for-service basis, but the number of physicians allowed to accept Statutory Health Insurance in a given locale is regulated by the government and professional societies.
As in many countries, rising health care costs have been a cause of concern and have led to a number of changes or reforms in the health care system.Fact|date=February 2008 Capitated care, such as that provided by health maintenance organizations, has been prohibited since the 1930s, but has been recently reconsidered as a cost containment mechanism. [ [http://www.ncbi.nlm.nih.gov/pubmed/17497087?dopt=Abstract Capitation in Germany] ] Copayments were introduced in the 1980s in an attempt to prevent overutilization. The average length of hospital stay in Germany has decreased in recent years from 14 days to 9 days, still considerably longer than average stays in the U.S. (5 to 6 days). [ [http://www.group-economics.allianz.com/en/publications/working_papers/social_security/news3.html Length of hospital stay, Germany] ] [ [http://www.cdc.gov/MMWR/preview/mmwrhtml/mm5427a6.htm Length of hospital stay, U.S.] ] Part of the difference is that the chief consideration for hospital reimbursement is the number of hospital days as opposed to procedures or diagnosis. Drug costs have increased substantially, rising nearly 60% from 1991 through 2005. However, because of the relative simplicity and universality of the reimbursement mechanisms the administrative costs are low, at 160 euro per capita.Fact|date=February 2008 Despite attempts to contain costs, overall health care expenditures rose to 10.7% of GDP in 2005, comparable to other western European nations, but substantially less than that spent in the U.S. (nearly 16% of GDP). [Borger C, et al. [http://www.ncbi.nlm.nih.gov/pubmed/16495287?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum "Health spending projections through 2015: changes on the horizon."] Health Affairs (2006)]
Netherlandshas a dual-level system. All primary and curative care (i.e. the family doctor service and hospitals and clinics) is financed from private compulsory insurance. Long term care for the elderly, the dying, the long term mentally ill etc. is covered by social insurancefunded from taxation. According to the WHO, the health care system in the Netherlands was 62% government funded and 38% privately funded as of 2004.
Insurance companies must offer a core universal insurance package for the universal primary, curative care which includes the cost of all prescription medicines. They must do this at a fixed price for all. The same premium is paid whether young or old, healthy or sick. It is illegal in The Netherlands for insurers to refuse an application for health insurance, to impose special conditions (e.g. exclusions, deductables, co-pays etc or refuse to fund treatments which a doctor has determined to be medically necessary). The system is 50% financed from payroll taxes paid by employers to a fund controlled by the Health regulator. The government contributes an additional 5% to the regulator's fund. The remaining 45% is collected as premiums paid by the insured directly to the insurance company. Some employers negotiate bulk deals with health insurers and some even pay the employees' premiums as an employment benefit). All insurance companies receive additional funding from the regulator's fund. The regulator has sight of the claims made by policyholders and therefore can redistribute the funds its holds on the basis of relative claims made by policy holders. Thus insurers with high payouts will receive more from the regulator than those with low payouts. Thus insurance companies have no incentive to deter high cost individuals from taking insurance and are compensated if they have to pay out more than might be expected. Insurance companies compete with each other on price for the 45% direct premium part of the funding and try to do negotiate deals with hospitals to keep costs low and quality high. The competition regulator is charged with checking for abuse of dominant market positions and the creation of cartels that act against the consumer interests. An insurance regulator ensures that all basic policies have identical coverage rules so that no person is medicially disadvantaged by his or her choice of insurer.
Hospitals in the Netherlands are also regulated and inspected but are mostly privately run and for profit, as are many of the insurance companies. Patients can choose where they want to be treated and have access to information on the internet about the performance and wait times at each hospital. Patients dissatisfied with their insurer and choice of hospital can cancel at any time but must make a new agreement with another insurer.
Insurance companies can offer additional services at extra cost over and above the universal system laid down by the regulator, e.g. for dental care. The standard monthly premium for health care paid by individual adults is about 100€ per month. Persons on low incomes can get assistance from the government if they cannot afford these payments. Children under 18 are insured by the system at no additional cost to them or their families because the insurance company receives the cost of this from the regulator's fund.
Each of the countries of the
United Kingdomhas a public health service that provides healthcare to all UK permanent residents that is free at the point of need and paid for from general taxation. However, since Health is a devolved matter, considerable differences are developing between the systems in the different countries. [ [http://news.bbc.co.uk/1/hi/health/7149423.stm NHS now four different systems] BBC January 2 2008] Though commonly referred to as the NHS across the UK, in fact the National Health Servicejust covers England with separate 'National Health Services' in the other parts of the UK. For details of public healthcare in each country, see:
The NHS provides the majority of healthcare in England, including
primary care, in-patient care, long-term healthcare, ophthalmologyand dentistry. The National Health Service Act 1946came into effect on 5 July 1948, and is considered the world's first universal health care system provided by government.Fact|date=July 2008 With the exception of small subsidised charges for prescriptions, dentistry and ophthalmology (which themselves are free to children, the elderly, the unemployed and those on low incomes), all treatment is free. Private health care has continued parallel to the NHS, paid for largely by private insurance, but it is used by less than 8% of the population, and generally as a top-up to NHS services.
The outsourcing of medical services and support to the private sector is a recent innovation. Hospitals may have both medical services (such as "surgicentres"), [cite web | title = New generation surgery-centers to carry out thousands more NHS operations every year | publisher = Department of Health | date= 2002-12-03 | url = http://www.dh.gov.uk/PublicationsAndStatistics/PressReleases/PressReleasesNotices/fs/en?CONTENT_ID=4026000&chk=0NNhMe | accessdate = 2006-09-15] and non-medical services (such as catering) provided under long-term contracts by the private sector. Capital projects such as new hospitals have been privatized through the
Private Finance Initiative, enabling the public sector borrowing requirementto be circumvented, at least in the short term.
Health and Social Care in Northern Ireland
NHS Scotland was founded by the
National Health Service (Scotland) Act 1947(since repealed by the National Health Service (Scotland) Act 1978) which came into effect on the same day as the NHS in England and Wales but has always been a separate organisation.
NHS Waleswas originally formed as part of the same NHS structure created by the National Health Service Act 1946but powers over the NHS in Wales came under the Secretary of State for Wales in 1969 [ [http://www.wales.nhs.uk/sites3/page.cfm?pid=11595&orgid=452 Introduction to NHS Wales 1960's] www.wales.nhs.uk ] .
Argentina, Brazil, Canada(see below), Chile, Costa Rica, Cuba, Peru, Uruguay, and Venezuelaall have public universal health care provided. Mexicois planning to launch its own universal health care network.G20 Health Care: "Health Care Systems and Health Market Reform in the G20 Countries." Prepared for the World Economic Forum by Ernst & Young. January 3, 2006.]
See|Health care in the United States|Health care reform in the United StatesHealthcareThe
United Statesis the only wealthy, industrialized nation that does not have a universal health care system. [http://www.iom.edu/?id=17848 Insuring America's Health: Principles and Recommendations] , Institute of Medicine at the National Academies of Science, 2004-01-14, accessed 2007-10-22] [ [http://cthealth.server101.com/the_case_for_universal_health_care_in_the_united_states.htm The Case For Single Payer, Universal Health Care For The United States] ] The government directly covers 27.8% of the population 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. [ [http://www.cms.hhs.gov/MedicaidGenInfo/ Overview - What is Not Covered] , U.S. Department of Health & Human Services] [Centers for Medicare & Medicaid Services. [http://www.cms.hhs.gov/ CMS Programs & Information.] Retrieved August 30, 2006.] Federal law ensures public access to emergency services regardless of ability to pay. [Centers for Medicare & Medicaid Services. [http://www.cms.hhs.gov/EMTALA/ Emergency Medical Treatment & Labor Act.] Retrieved August 30, 2006.] However, this unfunded mandate has contributed to a health care safety net that some analyses say is increasingly strained.cite web |url=http://www.iom.edu/CMS/3800/5502/4118.aspx |title=Report Brief: America's Health Care Safety Net: Intact but Endangered |accessdate=2007-10-22 |date=2000-01-01 |format=PDF |publisher=Institute of Medicine, National Academies of Science | quote=In the absence of universal health insurance, a health care “safety net” is the default system of care for many of the 44 million low-income Americans with no or limited health insurance as well as many Medicaid beneficiaries and people who need special services. This safety net system is neither uniformly available throughout the country nor financially secure.] 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. [ [http://www.oecd.org/dataoecd/46/2/38980580.pdf Briefing note for OECD Health Data 2007: How Does the United States Compare] , OECD Health Data 2007, accessed 2007-10-28]
Current estimates put U.S. health care spending at approximately 15% of
GDP, the highest in the world. [ [http://www.who.int/whr/2006/whr06_en.pdf "The World Health Report 2006 - Working together for health."] ] An estimated 84.7% of citizens have some form of health insurancecoverage, either through their employer, purchased individually, or through government sources. The number of uninsured, at 45.7 million in 2007, decreased slightly from 2006, because government programs covered nearly 3 million more people. [http://www.census.gov/prod/2008pubs/p60-235.pdf "Income, Poverty, and Health Insurance Coverage in the United States: 2007."] U.S. Census Bureau. Issued August 2008.] One study estimates that about 25% of the country's uninsured, or roughly another 11 million people, are eligible for government health care programs but unenrolled. However, assuring adequate financing to cover those who are eligible remains a challenge.cite web |url=http://www.kff.org/uninsured/upload/7613.pdf |title=Characteristics of the Uninsured: Who is Eligible for Public Coverage and Who Needs Help Affording Coverage? |accessdate=2007-07-19 |format=PDF |work=Kaiser Commission on Medicaid and the Uninsured ]
In 2003, approximately 61 million adults, or 35 percent of individuals ages 19 to 64, had either no insurance, sporadic coverage, or insurance coverage that exposed them to high health care costs. [cite web | title= Insured But Not Protected: How Many Adults Are Underinsured | publisher = The Commonwealth Fund | url= http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=280812 | accessdate= 2007-07-27] Employers that do provide insurance, on average, spend between 4.6 and 8.7% of their payroll in health insurance premiums. The cost of health care premiums is rising much faster than the general rate of inflation or employee wages. Since 2001, premiums for family coverage have increased 78%, while inflation has risen 17% and wages have risen 19%, according to a 2007 study by the Kaiser Family Foundation. [cite press release |title=Health Insurance Premiums Rise 6.1 Percent In 2007, Less Rapidly Than In Recent Years But Still Faster Than Wages And Inflation |publisher=Kaiser Family Foundation |date=2007-09-11 |url=http://www.kff.org/insurance/ehbs091107nr.cfm |accessdate=2007-09-13]
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 is implementing a near-universal health care system by mandating that residents purchase health insurance by July 1, 2007. [Fahrenthold DA. [http://www.washingtonpost.com/wp-dyn/content/article/2006/04/04/AR2006040401937.html "Mass. Bill Requires Health Coverage."] "
Washington Post"; Wednesday, April 5, 2006; Page A01.] The City of San Francisco is also undertaking a universal health care system for uninsured residents. [cite web |url=http://www.healthysanfrancisco.org/about_us/ |title=Healthy San Francisco: About Us |accessdate=2007-10-27 |work=City of San Francisco ] [Meredith, Adams. " [http://www.chicagotribune.com/news/nationworld/chi-070918health,1,888898.story San Francisco launches universal health care] ". " Chicago Tribune". 2007-09-18. Retrieved on 2007-10-09] California, Maine, Vermontand Hawaiiare also considering or seeking to implement universal or near-universal systems. [cite news |first=Jennifer |last=Steinhauer |title=California Plan for Health Care Would Cover All |url=http://www.nytimes.com/2007/01/09/us/09calif.html?th&emc=thn |work= |publisher=New York times |date=2007-01-09 |accessdate=2007-10-27 ] Recently, a California State Senatecommittee voted on a bi-partisan basis against a plan to help establish a $14 billion fund to subsidize medical insurance for 5 million uninsured Californians. [http://www.reuters.com/article/domesticNews/idUSN2953792420080129]
There have been numerous proposals to stimulate the current system into extending coverage more universally, rather than through a more comprehensive restructuring. For example, since most Americans with private coverage receive it through employer-sponsored plans, many have suggested employer "pay or play" requirements as a way to increase coverage levels. However, one study suggests that current pay or play proposals are limited in their ability to increase coverage among the "working poor". [Richard Burkhauser and Kosali Simon, [http://epionline.org/downloads/BurkhauserSimon.pdf "Who Gets What From Employer “Pay or Play” Mandates"] , Employment Policies Institute, Cornell University, November 2007] The study's criticisms of these proposals included the observations that they generally exclude small firms, do not distinguish between individuals who have access to other forms of coverage and those who do not, and increase the overall compensation costs to employers. One study that examined several such market-based reform packages concluded that if market-oriented reforms are not implemented on a systematic basis with appropriate safeguards, they have the potential to cause more problems than they solve. [Blumberg, Linda J. and Nichols, Len (1995-11-01). "Health Insurance Market Reforms: What They Can and Cannot Do".
Urban Institute, November 1, 1995. Retrieved from http://www.urban.org/publications/306448.html.]
Others have proposed premium subsidies to help individuals purchase their own health insurance as a way to increase coverage rates. Research confirms that consumers in the individual health insurance market are sensitive to price. Estimates of the demand elasticity in this market vary, but generally fall in the range of -0.3 to -0.1. It appears that price sensitivity varies among population subgroups, and is generally higher for those at younger ages and lower incomes. However, research also suggests that subsidies alone are unlikely to provide sufficient incentive to encourage more people to get coverage. [ [http://www.cbo.gov/ftpdocs/66xx/doc6620/08-24-HealthInsurance.pdf "The Price Sensitivity of Demand for Nongroup Health Insurance,"]
Congressional Budget Office, 2005 ] [M. Susan Marquis, Melinda Beeuwkes Buntin, Jose J. Escarce, Kanika Kapur, and Jill M. Yegian, [http://findarticles.com/p/articles/mi_m4149/is_5_39/ai_n6228864/print "Subsidies and the Demand for Individual Health Insurance in California,"] Health Services Research 39:5 (October 2004)]
In 1984, the
Canada Health Actwas 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 Agreementthat they are committed to health care that has "comprehensiveness, universality, portability, public administration and accessibility." [Government of Canada, Social Union, News Release, " [http://socialunion.gc.ca/news/020499_e.html A Framework to Improve the Social Union for Canadians: An Agreement between the Government of Canada and the Governments of the Provinces and Territories, February 4, 1999] ," URL accessed 20 December 2006.]
The Canadian 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. [ [http://www.cbc.ca/news/background/healthcare/public_vs_private.html Public vs. private health care.] "CBC", December 1, 2006.] About 30% of Canadians' health care is paid for by the private sector or individuals. [Press release, [http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=media_13nov2007_e "Health care spending to reach $160 billion this year"] , Canadian Institute for Health Information, November 13, 2007, accessed November 19, 2007] This mostly goes towards services not covered or only partially covered by Medicare such as
prescription drugs, dentistryand vision care. [ [http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=PG_876_E&cw_topic=876&cw_rel=AR_31_E National Health Expenditure Trends, 1975-2007] , Canadian Institute for Health Information, November 13, 2007, accessed November 19, 2007] Many Canadians have private health insurance, often through their employers, that cover these expenses. [ [http://books.google.com/books?id=oUM39nDp2s4C&dq=employer+provided+private+health+insurance+in+canada Private Health Insurance in OECD Countries] OECDHealth Project, 2004, accessed November 19, 2007]
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. [ [http://content.nejm.org/cgi/content/full/354/16/1661 Private Health Care in Canada, Robert Steinbrook, N Engl J Med, 354:1661-1664, April 20, 2006] ] cite news |first=Clifford |last=Kraus |title=As Canada's Slow-Motion Public Health System Falters, Private Medical Care Is Surging |url=http://www.nytimes.com/2006/02/26/international/americas/26canada.html?ex=1184644800&en=44cca772dc339429&ei=5070 |publisher=New York Times |date=2006-02-26 |accessdate=2007-07-16] The legality of the ban was considered in a decision of the
Supreme Court of Canadawhich ruled in Chaoulli v. Quebecthat "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. [http://www.sgmlaw.com/PageFactory.aspx?PageID=488]
Asia and Africa
Brunei, China [ [http://www.gadling.com/2007/07/05/what-countries-have-universal-health-care/"Gadling" Gadling ] ] , Hong Kong SAR, India, Kuwait, Qatar, UAE, Saudi Arabia, Israel [ [http://www.mfa.gov.il/MFA/History/Modern%20History/Israel%20at%2050/The%20Health%20Care%20System%20in%20Israel-%20An%20Historical%20Pe "The Health Care System in Israel- An Historical Perspective"] Israel Ministry of Foreign Affairs. Retrieved June 7, 2006.] Japan, Malaysia, South Korea, Seychelles, Sri Lanka, [ [http://www.health.gov.lk/ "Ministry of Health and Nutrition, Sri Lanka"] ] Taiwan [ [http://www.nhi.gov.tw/english/index.asp "Bureau of National Health Insurance, Taiwan"] ] and Thailand have universal health care.
Since the founding of the
People's Republic of China, the goal of healthcareprograms 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.
China is undertaking a reform on its universal health care system. 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. [The reform of the rural cooperative medical system in the People's Republic of China: interim experience in 14 pilot counties. Authors: Carrin G.1; Ron A.; Hui Y.; Hong W.; Tuohong Z.; Licheng Z.; Shuo Z.; Yide Y.; Jiaying C.; Qicheng J.; Zhaoyang Z.; Jun Y.; Xuesheng L. Source: Social Science and Medicine, Volume 48, Number 7, April 1999, pp.961-972(12) [http://www.ingentaconnect.com/content/els/02779536/1999/00000048/00000007/art00396] ]
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. 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. [World Health Organization, [http://www.who.int/entity/whosis/whostat2007_1mortality.pdf "World Health Statistics 2007: Mortality"] , based on 2005 data.] 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. 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 national programs.John Tucci, [http://www.watsonwyatt.com/europe/pubs/healthcare/render2.asp?ID=13850 "The Singapore health system – achieving positive health outcomes with low expenditure"] , Watson Wyatt Healthcare Market Review, October 2004.]
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. 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. [ [http://www.unescap.org/aphen/thailand_universal_coverage.htm "The Universal Coverage Policy of Thailand: An Introduction"] ] [Hughes, D. and Leethongdee, S. Universal coverage in the land of smiles: lessons from Thailand's 30 baht health reforms, Health Affairs 26(4):999-1008, 2007.] "'
India has partial universal health care system run by the local governments. The "government hospitals", some of which are among the best hospitals in India, [ [http://medical-treatment-in-india.com/Top_Hospitals_By_Specialty.asp "A list of the top rated hospitals in India. Several hospitals among these are government hospitals, Including AIIMS"] ] provide treatment at taxpayer cost. Selected drugs are offered free of charge in some hospitals. In 1946 a Health Survey and Development Committee in India put forward a plan for a universal health care system. According to India today, the country has not lived up to their outlined plan. As of 2007, the hospitals contain only a tenth of the recommended ratio of hospital beds; there are only 70 beds for every 100,000 people. [ [http://www.indiatogether.org/2006/oct/hlt-nocare.htm "Universal care - still miles to go "] ] According to the WHO, India's health care system is 83% privately funded, with 17% of health care expenditure coming from the government as of 2004.
Medicare was introduced by the Whitlam Labor Government on
1 July 1975through the Health Insurance Act 1973. The Australian Senaterejected the changes multiple times and they were passed only after a joint sitting after the 1974 double dissolution election. Yet Medicare has been supported by subsequent governments and became a key feature of Australia’s public policy landscape. The exact structure of Medicare, in terms of the size of the rebate to doctors and hospitals and the way it has administered, has varied over the years. The original Medicare program proposed a 1.35% levy (with low income exemptions) but these bills were rejected by the Senate, and so Medicare was originally funded from general taxation. In October 1976, the Fraser Government introduced a 2.5% levy. The program is now nominally funded by an income tax surcharge known as the "Medicare levy", which is currently set at 1.5% with exemptions for low income earners. [cite web |url=http://www.ato.gov.au/individuals/content.asp?doc=/content/17482.htm&pc=001/002/030/003/001&mnu=&mfp=&st=&cy=1 |title=What is the Medicare levy? |accessdate=2008-02-15 |author=Australian Taxation Office |date= 19 June 2007] In practice the levy raises only a fraction of the money required to pay for the scheme. If the levy was to fully pay for the services provided under the medicare banner then it would need to be set at about 8%.Fact|date=May 2008 There is an additional levy of 1.0%, known as the Medicare Levy Surcharge, for those on high annual incomes ($50,000) who do not have adequate levels of private hospital coverage. This was part of an effort by the previous Coalition Federal Government to encourage takeup of private health insurance. According to the WHO, government funding covered 67.5% of Australia's health care expenditures in 2004; private sources covered the remaining 32.5% of expenditures.
As with Australia,
New Zealand's healthcare system is funded through general taxation. According to the WHO, government sources covered 77.4% of New Zealand's health care costs in 2004; private expenditures covered the remaining 22.6%.
Universal health care in most countries has been achieved by a mixed model of funding. General taxation revenue is the primary source of funding, but in many countries it is supplemented by specific levies (which may be charged to the individual and/or an employer) or with the option of private payments (either direct or via optional insurance) for services beyond that covered by the public system.
Most all European systems are financed through a mix of public and private contributions.Bentes M, Dias CM, Sakellarides C, Bankauskaite V. [http://www.euro.who.int/document/e82937.pdf#search=%22Portugal%2C%20health%20care%22 "Health Care Systems in Transition: Portuagal."] WHO are Regional Offices for Europe on behalf of the European Observatory on Health Systems and Policies, 2004.] The majority of universal health care systems are funded primarily by
tax revenue(e.g. Portugal). Some nations, such as Germany, FrancePhysicians for a National Health Program [http://www.pnhp.org/facts/international_health_systems.php?page=all "International Health Systems".] ] and JapanChua, Kao-Ping. [http://www.amsa.org/uhc/SinglePayer101.pdf "Single Payer 101".] February 10, 2006.] employ a multi-payer system in which health care is funded by private and public contributions.
A distinction is also made between municipal and national healthcare funding. For example, one model is that the bulk of the healthcare is funded by the municipality, speciality healthcare is provided and possibly funded by a larger entity, such as a municipal co-operation board or the state, and the medications are paid by a state agency.
Universal health care systems are modestly redistributive. Progressivity of health care financing has limited implications for overall income inequality. [Sherry A. Glied, [http://www.nber.org/papers/w13881.pdf "Health Care Financing, Efficiency, and Equity,"]
National Bureau of Economic ResearchWorking Paper No. 13881, March 2008]
This is usually enforced via legislation. Sometimes there may be a choice of several funds providing a basic service (e.g. as in Germany) or sometimes just a single fund (as in Canada).
In some European countries where there is private insurance and universal health care, such as Germany, Belgium and Holland, the problem of adverse selection (see Private Insurance below) is overcome using a risk compensation pool to equalize, as far as possible, the risks between funds. Thus a fund with a predominantly healthy, younger population has to pay into a compensation pool and a fund with an older and predominantly less healthy population would receive funds from the pool. In this way, sickness funds compete on price and there is no advantage to eliminate people with higher risks because they are compensated for by means of risk-adjusted capitation payments. Funds are not allowed to pick and choose their policyholders or deny coverage, but then mainly compete on price and service. In some countries the basic coverage level is set by the government and cannot be modified. [ [http://goliath.ecnext.com/coms2/browse_R_R016 Goliath - Research in Healthcare Financial Management - Industry & Business News Articles - Article, News, Research, Information ] ]
Ireland at one time had a "community rating" system through
VHI, effectively a single payer or common risk pool. The government later opened VHI to competition but without a compensation pool. This resulted in foreign insurance companies entering the Irish market and offering cheap health insurance to relatively healthy segments of the market which then made super profits at VHI's expense. The government later re-introduced community rating through a pooling arrangement and at least one main major insurance company BUPAthen withdrew from the Irish market.
Some countries (notably the United Kingom, Italy and Spain) have eliminated insurance entirely and choose to fund health care directly from taxation. Other countries with insurance-based systems effectively meet the cost of insuring those unable to insure themselves via
social securityarrangements funded from taxation, either by directly paying their medical bills or by paying for insurance premiums for those affected.
This term is used in the U.S. debate to describe a funding mechanism meeting the costs of medical care from a single fund. Although the fund holder is sometimes assumed to be the government allocating funding from taxation, its proponents do not rule out the possibility of some other mechanism. It is therefore as yet undetermined whether a future U.S. single-payer universal health care system would be funded from taxation, from compulsory insurance or a mixture of both.
In countries with universal coverage, private insurance is most often used as a supplement, covering what the core safety net service does not provide, Examples include elective
cosmetic surgeryand special comforts like private rooms. In some countries, people can use private insurance to obtain treatment more quickly than would otherwise be possible.
Where voluntary insurance (often private) is predominant, such as in the U.S., medical (health) insurance is subject to the well-known economic problem of
adverse selectionwhich may also be referred to as a market failure. Adverse selection in insurance markets occurs because those providing insurance have limited information with which to estimate the health risks on which they may need to pay future claims. In simple terms, those with poor health are more likely to apply for insurance and more likely to need treatments requiring high insurance company payouts. Those with good health may find the cost of insurance too high for the perceived benefit, and some will remove themselves from the risk pool. This adverse selection concentrates the risk pool, thereby further raising costs. In practical terms, the potential for adverse selection means that private insurers have an economic incentive to use medical underwritingto 'weed out' high cost applicants in order to avoid adverse selection. Among the potential solutions posited by economists are single payer systems as well as other methods of ensuring that health insurance is universal, such as by requiring all citizens to purchase insurance and limiting the ability of insurance companies to deny insurance to individuals or vary price between individuals. [Michael Rothschild and Joseph Stiglitz, "Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information," Quarterly Journal of Economics, November 1976 (90:629-649) (known as the Rothschild-Stiglitz Model)] [Paulo Belli, [http://www-wds.worldbank.org/servlet/WDSContentServer/WDSP/IB/2001/04/13/000094946_01040505331570/Rendered/PDF/multi0page.pdf "How Adverse Selection Affects the Health Insurance Market"] ]
Health care systems throughout the world face sustainability challenges that may require far-reaching changes in national policy. Over the last decade, health spending has been accelerating as a percent of Gross Domestic Product (GDP) among
Organisation for Economic Co-operation and Development(OECD) countries.cite web |url=http://www.pwc.com/extweb/pwcpublications.nsf/docid/0A43A30BC3DE09B6852572C100541487 |title=HealthCast 2020: Creating a sustainable future | date=|accessdate=2007-10-27 |format=PDF |work=PriceWaterhouseCoopers (requires registration ] Many industrialized countries have aging populations, with resulting increases in health care utilization, while others face rapid population growth. One recent study, by global consulting firm PriceWaterhouseCoopers, projected that global health care spending would triple in real dollars by 2020, consuming 21% of GDP in the U.S. and 16% of GDP in other OECD countries.
Whether a government mandated system of universal health care should be implemented in the U.S. remains a hotly debated political topic. Those in favor of universal health care, such as the non-partisan
Institute of Medicineof the National Academies, which has called for the U.S. to implement universal health care by 2010, argue that the current rate of uninsurance creates direct and hidden costs shared by all, and that extending coverage to all would lower costs and improve quality. [cite web |url=http://www.iom.edu/CMS/3809/4660/17632.aspx |title=Insuring America's Health: Principles and Recommendations |accessdate=2007-10-27 |work=Institute of Medicine of the National Academies ] Americans have a lower average life expectancy than those in other industrialized nations with universal health care, such as Australia, the United Kingdom, Canada, and Sweden. [ [https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html CIA World Factbook table of life expectancies by country] ] Infant mortality rates also remain higher in the U.S., despite declines in recent decades, and are higher than the average of the European Union. [ [https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html -see table] ] [" CIA World Factbook"; Guide to Rank Order Pages [https://www.cia.gov/library/publications/the-world-factbook/docs/rankorderguide.html] and the complete article on the United States [https://www.cia.gov/library/publications/the-world-factbook/geos/us.html] ]
Critics of this argument note that there is very little correlation between life expectancy and infant mortality with the quality of health care, due to such factors as alternate causality and variations in the way countries collect their statistical data. [National Center for Public Policy Analysis. [http://www.nationalcenter.org/NPA547ComparativeHealth.html] Retrieved August 8, 2007.] In fact, the U.S. led the world in life expectancy twenty years ago with virtually the same health system. Rather, many analysts attribute the lower life expectancy to a great surge in obesity rates. [New England Journal of Medicine. [http://content.nejm.org/cgi/content/full/352/11/1138] Retrieved August 8, 2007.] [Journal of the American Medical Association. [http://jama.ama-assn.org/cgi/content/full/289/2/187?ijkey=3991555087b9d389bcf6f7a36f314334d7e6d394] Retrieved August 8, 2007.] [Center for Disease Control and Prevention. [http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/obesity_trends_2006.pdf] Retrieved August 8, 2007.]
Opponents of government mandates or programs for universal health care, including libertarian think tanks such as
The Cato Institute, argue that people should be free to opt out of health insurance [cite web |url=http://www.cato.org/research/articles/reynolds-021003.html |title=No Health Insurance? So What? |accessdate=2007-10-27 | date=2002-10-03 | work=The Cato Institute ] and that government programs would require higher taxes, increase utilization, and reduce health care quality. Opponents also claim that the absence of a market mechanism may slow innovation in treatment and research, and lead to rationing of care through waiting lists. [ [http://www.pacificresearch.org/pub/sab/health/single_payer/sphealth.html Pacific Research Institute • Search ] ] Both sides of the political spectrumhave also looked to more philosophical arguments, debating whether people have a fundamental rightto have health care provided to them by their government.
Survey research from a liberal perspective shows that Americans see expanding coverage as a top national priority, and a majority express support for universal health care.Thomas Bodenheimer, [http://content.healthaffairs.org/cgi/reprint/24/6/1426?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=National+health+care+oppose&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT "The Political Divide In Health Care: A Liberal Perspective,"] Health Affairs, November/December 2005] There is, however, much more limited support for tax increases to support health care reform.Robert J. Blendon and John M. Benson, [http://content.healthaffairs.org/cgi/reprint/20/2/33?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=National+health+care+oppose&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT "Americans’ Views On Health Policy: A Fifty-Year Historical Perspective,"] Health Affairs, March/April 2001] Most Americans report satisfaction with their own personal health care. Confidence in government, and the willingness to support large expansions of government, have declined significantly since the 1960s. Support for a single-payer system is less than the level of dissatisfaction with the current system and desire for increased coverage might suggest.
Debate in the United States
Common arguments forwarded by supporters of universal health care systems include:
*Health care is a basic human rightUnited Nations, [http://www.un.org/Overview/rights.html Universal Declaration of Human Rights] , Adopted and proclaimed by General Assembly resolution 217 A (III) of 10 December 1948. Article 25 states: "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control."] Center for Economic and Social Rights. [http://cesr.org/ushealthright?PHPSESSID=91...a78f9969da61bd9 "The Right to Health in the United States of America: What Does it Mean?"] October 29, 2004.] National Health Care for the Homeless Council. [http://www.nhchc.org/humanright.html "Human Rights, Homelessness and Health Care".] ] or entitlement. [Kereiakes DJ, Willerson JT. [http://circ.ahajournals.org/cgi/content/full/109/12/1460 "US health care: entitlement or privilege?."] "Circulation." 2004 March 30;109(12):1460-2.]
*Ensuring the health of all citizens benefits a nation economically. [Wilhelmine Miller, Elizabeth Richardson Vigdor, and Willard G.Manning, [http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.157v1 "Covering The Uninsured: What Is It Worth?"] , Health Affairs Web Exclusive, 2004-03-31, accessed 2008-05-09. This study estimated that the value of health forgone each year because of uninsurance in the U.S. was $65–$130 billion and concluded that this figure constituted "a lower-bound estimate of economic losses resulting from the present level of uninsurance nationally."]
* About 60% of the U.S. health care system is already publicly financed with federal and state taxes, property taxes, and tax subsidies - a universal healthcare system would merely replace private/employer spending with taxes. Total spending would go down for individuals and employers. [http://www.pnhp.org/facts/singlepayer_faq.php#raise_taxes "Won’t this raise my taxes?"] PHNP.org. ]
*A single payer system could save $286 billion a year in overhead and paperwork.Public Citizen. [http://www.citizen.org/pressroom/release.cfm?ID=1623 "Study Shows National Health Insurance Could Save $286 Billion on Health Care Paperwork:"] http://www.citizen.org. ] Administrative costs in the U.S. health care system are substantially higher than those in other countries and than in the public sector in the US: one estimate put the total administrative costs at 24 percent of U.S. health care spending. [http://content.healthaffairs.org/cgi/content/full/23/3/10 Reinhardt, Hussey and Anderson, "U.S. Health Care Spending In An International Context", Health Affairs, 23, no. 3 (2004): 10-25]
*Several studies have shown a majority of taxpayers and citizens across the political divide would prefer a universal healthcare system over the current U.S. systemTeixeira , Ruy. [http://www.motherjones.com/commentary/columns/2005/09/universal_healthcare.html "Healthcare for All?"] MotherJones September 27, 2005 .] CBSNews. [http://www.cbsnews.com/stories/2007/03/01/opinion/polls/main2528357.shtml "Poll: The Politics Of Health Care"] CBSNews March 1, 2007 .] Blake, Aaron. [http://thehill.com/campaign-2008/poll-shows-many-republicans-favor-universal-healthcare-gays-in-military-2007-06-28.html "Poll shows many Republicans favor universal health care, gays in military"] TheHill.com June 28, 2007.]
*Universal health care would provide for uninsured adults who may forgo treatment needed for chronic health conditions. [http://covertheuninsured.org/media/docs/release050205a.pdf]
*Wastefulness and inefficiency in the delivery of health care would be reduced.Paul Krugman and Robin Wells, [http://www.nybooks.com/articles/18802 The Health Care Crisis and What to Do About It] , New York Review of Books, 2006-03-23, accessed 2007-10-28]
*America spends a far higher percentage of GDP on health care than any other country but has worse ratings on such criteria as quality of care, efficiency of care, access to care, safe care, equity, and wait times, according to the Commonwealth Fund. [ [http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678 "Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care"] by Karen Davis, Ph.D., Cathy Schoen, M.S., Stephen C. Schoenbaum, M.D., M.P.H., Michelle M. Doty, Ph.D., M.P.H., Alyssa L. Holmgren, M.P.A., Jennifer L. Kriss, and Katherine K. Shea Commonwealth Fund, May 15, 2007.]
*A universal system would align incentives for investment in long term health-care productivity, preventive care, and better management of chronic conditions. [ [http://www.washingtonmonthly.com/features/2005/0501.longman.html "The Best Care Anywhere"] by Phillip Longman, Washington Monthly, January 2005.]
*Universal health care could act as a subsidy to business, at no cost thereto. (Indeed, the Big Three of U.S. car manufacturers cite health-care provision as a reason for their ongoing financial travails. The cost of health insurance to U.S. car manufacturers adds between USD 900 and USD 1,400 to each car made in the U.S.A.) [ [http://business.guardian.co.uk/story/0,,1948040,00.html "Detroit's big three seek White House help"] Guardian Unlimited, November 15, 2006]
*The profit motive adversely affects the cost and quality of health care. If
managed careprograms and their concomitant provider networks are abolished, then doctors would no longer be guaranteed patients solely on the basis of their membership in a provider group and regardless of the quality of care they provide. Theoretically, quality of care would increase as true competition for patients is restored. [ [http://news.pajamasmedia.com/2006/05/18/8722240_Book_tells_how_p.shtml Pajamas Media ] ]
*A 2008 opinion poll of 2,000 US doctors found support for a universal healthcare plan at 59%-32%, which is up from the 49%-40% opinion of physicians in 2002. These numbers include 83% of psychiatrists, 69% of emergency medicine specialists, 65% of pediatricians, 64% of internists, 60% of family physicians and 55% of general surgeons. The reasons given are an inability of doctors to decide patient care and patients who are unable to afford care. [ [http://in.reuters.com/article/health/idINN3143203520080331 Doctors support universal health care: survey | Health | Reuters ] ]
*According to an estimate by Dr.
Marcia Angellroughly 50% of healthcare dollars are spent on healthcare, the rest go to various middlemen and intermediaries. A streamlined, non-profit, universal system would increase the efficiency with which money is spent on healthcare. [http://www.pnhp.org/facts/statement_of_dr_marcia_angell_introducing_the_us_national_health_insurance_act.php Statement of Dr. Marcia Angell introducing the U.S. National Health Insurance Act] , Physicians for a National Health Program, February 4, 2003. Accessed March 4, 2008]
* In countries in
Western Europewith public universal health care, private health care is also available, and one may choose to use it if desired. Most of the advantages of private health care continue to be present, see also two-tier health care. [cite web
url = http://www.farmindustria.it/farmindustria/documenti/001/etica.pdf
title = "Uguali e diversi" davanti alla salute
accessdate = 2008-01-22
format = PDF
language = it]
* Universal health care and public doctors would protect the right to privacy between insurance companies and patients. [cite web
url = http://www.omceoto.it/News/31%20agosto%202005/TRIBUNE/MAGGIO%202005.pdf
title = Il segreto professionale nella relazione medico-paziente
accessdate = 2008-01-22
format = PDF
language = it]
* Public health care system can be used as independent third party in disputes between employer and employee. [cite web
url = http://www.lomb.cgil.it/leggi/legge300.htm
title = LEGGE 20 maggio 1970, n. 300 (Statuto dei lavoratori)
accessdate = 2008-01-22
pages = ART. 5. and ART. 6.
language = it]
* Libertarians and conservatives can favor universal health care, because in countries with universal health care, the government spends less tax money per person on health care than the U.S. For example, in France, the government spends $569 less per person on health care than in the United States. This would allow the U.S. to adopt universal health care, while simultaneously cutting government spending and cutting taxes. [ [http://www.americanthinker.com/2007/12/a_conservative_case_for_univer.html A Conservative Case for Universal Health Coverage] , Randall Hoven, December 12, 2007]
Common arguments forwarded by opponents of universal health care systems include:
*Health care is not a right. Sade RM. "Medical care as a right: a refutation." "N Engl J Med." 1971 December 2;285(23):1288-92. PMID 5113728. (Reprinted as [http://www.aapsonline.org/brochures/sademcr.htm "The Political Fallacy that Medical Care is a Right."] )] David E. Kelley, A Life of One's Own:Individual Rights and the Welfare State,
Cato Institute, October 1998, ISBN 1-882577-70-1] As such, it is not the responsibility of government to provide health care. [Michael Tanner, [http://www.cato.org/pubs/pas/pa565.pdf "Individual Mandates for Health Insurance: Slippery Slope to National Health Care,"] Cato Institute, Policy Analysis No. 565, April 5, 2006]
* If universal health care is provided by federally mandated purchase of health insurance, it may be unconstitutional, since the Constitution does not give the federal government this right and reserves all non-mentioned rights to the States or the People.
*Universal health care would result in increased wait times, which could result in unnecessary deaths. [ [http://www.cato-at-liberty.org/2006/05/02/depends-on-what-the-meaning-of-universal-is/ Cato-at-liberty » Depends on What the Meaning of “Universal” Is ] ]
*Unequal access and health disparities still exist in universal health care systems.Victor R. Fuchs and Ezekiel J. Emanuel, [http://content.healthaffairs.org/cgi/reprint/24/6/1399?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=%22health+care+reform%22+oppose&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT "Health Care Reform: Why? What? When?,"] Health Affairs, November/December 2005]
*Universal health care would reduce efficiency because of more bureaucratic oversight and more paperwork, which could lead to fewer doctor-patient visits.Fact|date=February 2008 Advocates of this argument claim that the performance of administrative duties by doctors results from medical
centralizationand over-regulation, and may reduce charitable provision of medical services by doctors.
*Many problems that universal health insurance is meant to solve are presumed caused by limitations on the free market. As such, free market solutions have greater potential to improve care and coverage. [ [http://www.gmu.edu/departments/economics/wew/articles/07/health%20care.htm A Minority View ] ]
Emergency Medical Treatment and Active Labor Actrequires hospitals and ambulanceservices to provide emergency care to anyone regardless of citizenship, legal status or ability to pay. The health care safety net, which includes free medical clinics, charity care, nonprofits and government-run community hospitals, provides necessary care to the uninsured.
*The widely quoted health care system ranking by the
World Health Organization, in which the US system ranked below other countries' universal health care systems, used biased criteria, giving a false sense of those systems' superiority.Glen Whitman, [http://www.cato.org/pub_display.php?pub_id=9236 WHO's Fooling Who? The World Health Organization's Problematic Ranking of Health Care Systems] , Cato Institute Briefing Paper No. 101, 2008-02-08, accessed 2008-05-28]
*Empirical evidence on the Medicare single payer-insurance program demonstrates that the cost exceeds the expectations of advocates.Sue Blevins, [http://www.cato.org/pub_display.php?pub_id=3057 Universal Health Care Won't Work -- Witness Medicare] , The
Cato Institute, 2003-04-11, accessed 2007-10-28] As an open-ended entitlement, Medicare does not weigh the benefits of technologies against their costs. Paying physicians on a fee-for-service basis also leads to spending increases. As a result, it is difficult to predict or control Medicare's spending. Large market-based public program such as the Federal Employees Health Benefits Programand CalPERScan provide better coverage than Medicare while still controlling costs as well. [Michael J. O’Grady, [http://jec.senate.gov/republicans/_files/HealthInsuranceGrowth.pdf "Health Insurance Spending Growth - How Does Medicare Compare?,"] Joint Economic Committee, June 17, 2003] [Jeff Lemieux, [http://www.centrists.org/pages/2003/06/23_lemieux_health.html "Medicare vs. FEHB Spending: A Rare, Reasonable Analysis,"] [http://www.centrists.org/ Centrists.org] , June 2003]
*Universal health care systems, in an effort to control costs by gaining or enforcing
monopsonypower, sometimes outlaw medical care paid for by private, individual funds. [ [http://www.cato-at-liberty.org/2006/08/23/revolt-against-canadian-health-care-system-continues/ Cato-at-liberty » Revolt Against Canadian Health Care System Continues ] ]
Health care systems
Journal of Health Care for the Poor and Underserved
Kaiser Family Foundation
Massachusetts health care reform
Medicare Rights Center
Medicare (United States)
National health insurance
National Physicians Alliance
Physicians for a National Health Program
Publicly-funded health care
United States National Health Insurance Act
* [http://npalliance.org/content/pages/2008_presidential_candidate_health_plan_report_card 2008 Presidential Candidate Health Plan Report Card] issued by the National Physicians Alliance
* [http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=707948 2008 Presidential Candidates' Health Reform Proposals] from The Commonwealth Fund
* [http://www.reuters.com/article/healthNews/idUSN3143203520080331?feedType=RSS&feedName=healthNews&rpc=22&sp=true Doctors support universal health care: survey] , Reuters, March 31, 2008 (first reported in Annals of Internal Medicine).
* [http://www.healthcare4every1.org "healthcare4every1" Campaign]
* [http://www.pnhp.org/ Physicians for a National Health Program]
* [http://www.sicko-themovie.com/ "Sicko" - Official site]
* [http://video.google.com/videoplay?docid=-6298224654181195116 Squeaky Wheel Productions forum on Universal Health Care video]
* [http://www.uhcan.org/ Universal Health Care Action Network (UHCAN)]
* [http://www2.umdnj.edu/omcweb/1999/universalhealthcare.htm Universal Health Care / National Health Insurance]
* [http://www.heritage.org/Press/NewsReleases/NR092900.cfm British, Canadian Experience Shows Folly of Socialized Medicine, Analyst Says.] Press release, Heritage Foundation. September 29, 2000.
* [http://www.heartland.org/Article.cfm?artId=10333 The Heartland Institutes' Health Care Issue Suite]
* [http://www.liberty-page.com/issues/healthcare/socialized.html/ The Problems with Socialized Health Care] from Mark Valenti's Liberty Page
* [http://www.angelfire.com/rnb/y/universal.htm CHARTS. Healthcare costs; by nation, yearly dollars, GDP percent] .
* [http://www.nap.edu/catalog/10719.html Hidden costs, value lost: uninsurance in America.] Institute of Medicine Committee on the Consequences of Uninsurance. Washington, DC: National Academies Press, 2003.
* [http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/ Sick Around the World: Can the U.S. learn anything from the rest of the world about how to run a health care system?] from Frontline, PBS.
* [http://www.kff.org/uninsured/kcmu_statehealthreform.cfm States Moving Towards Comprehensive Health Care Reform in the U.S.] , The Henry J. Kaiser Family Foundation
* [http://www.wilsoncenter.org/index.cfm?topic_id=116811&fuseaction=topics.event_summary&event_id=241825 Universal Health Care in the United States] Video and summary of event held at the Woodrow Wilson Center, October 2007.
* [http://www.who.int/inf-pr-2000/en/pr2000-44.html World Health Organization.] Assesses The World's Health Systems," Press Release, WHO/44, June 21, 2000.
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