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American healthcare costs are driven primarily by societal factors and demands on treatment in concert with the rapid growth of expensive new technology and treatment.America is the most obese and sedentary country in the world and we are getting worse by the year. That is not a healthcare system problem. It’s a societal problem.Being sedentary and obese give us the highest rates of cancer, diabetes and heart disease. Once the horses are out of the barn, it’s a very expensive catch up of very expensive cancer surgery, radiation, chemotherapy, immunotherapy, diabetic related heart attacks and strokes, dialysis, infections, amputations, knee and hip replacements, back surgeries and the like.Whatever healthcare costs are in the EU, double or triple it to account for the extra diseases caused by American obesity and inactivity and the rapid approval and incorporation of new treatment in the US.But, dissenters argue, that the US spends much more and has lower life expectancies (by a couple of years) compared to other industrialized countries.This lower life expectancy has been explained by healthcare economists who note that in the US, any birth is counted. Many other countries discount premature births in their statistics. Thus, it’s a comparison of apples and oranges given the high death rate in premature births and that as a society, the US has the higher teen pregnancy rate in the industrialized world which is commonly associated with premies.Add to that, the very high death rates of young Americans due to motor vehicle accidents (large country, limited public transportation outside of a few urban areas), incredible drug overdose numbers due to the opioid epidemic which is now topping 60,000 early deaths a year, and deaths and grievous injuries from gang violence.I’m not sure that an entirely government run healthcare system will fix any of this. How could it? Generally and perhaps without exception, huge government programs cost far more than initial estimates, not less.But progressives point to Medicare and how efficient a system it is. But their calculations exclude the cost of collecting premiums (the IRS) and the cost of administration (Department of Health and Human Services) and absolutely ignore the fraud and abuse to the point that the Russian mafia is now participating as well. The $272 billion swindle/ Health Care Goodfellas: Mafia Turns to Medicare FraudThe societal issues impacting US healthcare costs and life expectancy have been commented upon by noted Harvard economist, Professor Mankiw in the New York Times before the ACA was passed:WITH the health care system at the center of the political debate, a lot of scary claims are being thrown around. The dangerous ones are not those that are false; watchdogs in the news media are quick to debunk them. Rather, the dangerous ones are those that are true but don’t mean what people think they mean.Here are three of the true but misleading statements about health care that politicians and pundits love to use to frighten the public:STATEMENT 1 The United States has lower life expectancy and higher infant mortality than Canada, which has national health insurance.The differences between the neighbors are indeed significant. Life expectancy at birth is 2.6 years greater for Canadian men than for American men, and 2.3 years greater for Canadian women than American women. Infant mortality in the United States is 6.8 per 1,000 live births, versus 5.3 in Canada.These facts are often taken as evidence for the inadequacy of the American health system. But a recent study by June and Dave O’Neill, economists at Baruch College, from which these numbers come, shows that the difference in health outcomes has more to do with broader social forces.For example, Americans are more likely than Canadians to die by accident or by homicide. For men in their 20s, mortality rates are more than 50 percent higher in the United States than in Canada, but the O’Neills show that accidents and homicides account for most of that gap. Maybe these differences have lessons for traffic laws and gun control, but they teach us nothing about our system of health care.Americans are also more likely to be obese, leading to heart disease and other medical problems. Among Americans, 31 percent of men and 33 percent of women have a body mass index of at least 30, a definition of obesity, versus 17 percent of men and 19 percent of women in Canada. Japan, which has the longest life expectancy among major nations, has obesity rates of about 3 percent.The causes of American obesity are not fully understood, but they involve lifestyle choices we make every day, as well as our system of food delivery. Research by the Harvard economists David Cutler, Ed Glaeser and Jesse Shapiro concludes that America’s growing obesity problem is largely attributable to our economy’s ability to supply high-calorie foods cheaply. Lower prices increase food consumption, sometimes beyond the point of optimal health.Infant mortality rates also reflect broader social trends, including the prevalence of infants with low birth weight. The health system in the United States gives low birth-weight babies slightly better survival chances than does Canada’s, but the more pronounced difference is the frequency of these cases. In the United States, 7.5 percent of babies are born weighing less than 2,500 grams (about 5.5 pounds), compared with 5.7 percent in Canada. In both nations, these infants have more than 10 times the mortality rate of larger babies. Low birth weights are in turn correlated with teenage motherhood. (One theory is that a teenage mother is still growing and thus competing with the fetus for nutrients.) The rate of teenage motherhood, according to the O’Neill study, is almost three times higher in the United States than it is in Canada.Whatever its merits, a Canadian-style system of national health insurance is unlikely to change the sexual mores of American youthThe bottom line is that many statistics on health outcomes say little about our system of health care.STATEMENT 2 Some 47 million Americans do not have health insurance.This number from the Census Bureau is often cited as evidence that the health system is failing for many American families. Yet by masking tremendous heterogeneity in personal circumstances, the figure exaggerates the magnitude of the problem.To start with, the 47 million includes about 10 million residents who are not American citizens. Many are illegal immigrants. Even if we had national health insurance, they would probably not be covered.The number also fails to take full account of Medicaid, the government’s health program for the poor. For instance, it counts millions of the poor who are eligible for Medicaid but have not yet applied. These individuals, who are healthier, on average, than those who are enrolled, could always apply if they ever needed significant medical care. They are uninsured in name only.The 47 million also includes many who could buy insurance but haven’t. The Census Bureau reports that 18 million of the uninsured have annual household income of more than $50,000, which puts them in the top half of the income distribution. About a quarter of the uninsured have been offered employer-provided insurance but declined coverage.Of course, millions of Americans have trouble getting health insurance. But they number far less than 47 million, and they make up only a few percent of the population of 300 million.Any reform should carefully focus on this group to avoid disrupting the vast majority for whom the system is working. We do not nationalize an industry simply because a small percentage of the work force is unemployed. Similarly, we should be wary of sweeping reforms of our health system if they are motivated by the fact that a small percentage of the population is uninsured.STATEMENT 3 Health costs are eating up an ever increasing share of American incomes.In 1950, about 5 percent of United States national income was spent on health care, including both private and public health spending. Today the share is about 16 percent. Many pundits regard the increasing cost as evidence that the system is too expensive.But increasing expenditures could just as well be a symptom of success. The reason that we spend more than our grandparents did is not waste, fraud and abuse, but advances in medical technology and growth in incomes. Science has consistently found new ways to extend and improve our lives. Wonderful as they are, they do not come cheap.Fortunately, our incomes are growing, and it makes sense to spend this growing prosperity on better health. The rationality of this phenomenon is stressed in a recent article by the economists Charles I. Jones of the University of California, Berkeley, and Robert E. Hall of Stanford. They ask, “As we grow older and richer, which is more valuable: a third car, yet another television, more clothing — or an extra year of life?”Mr. Hall and Mr. Jones forecast that the share of income devoted to health care will top 30 percent by 2050. But in their model, this is not a problem: It is the modern form of progress.Even if the rise in health care spending turns out to be less than they forecast, it is important to get reform right. Our health care system is not perfect, but it has been a major source of advances in our standard of living, and it will be a large share of the economy we bequeath to our children.As we look at reform plans, we should be careful not to be fooled by statistics into thinking that the problems we face are worse than they really are.N. Gregory Mankiw is a professor of economics at Harvard. He was an adviser to President Bush and is advising Mitt Romney, the former governor of Massachusetts, in the campaign for the Republican presidential nomination.Beyond Those Health Care Numbers

I'm more of a technocrat, but of late, I tend to vote with the Democrats.To preface, I'm reasonably successful, and I think that well regulated capitalism is the best engine for growth and mobility within our democracy. I also think that not every part of our lives is best handled by private industry, especially in cases where shareholder obligations are in direct conflict with the service being provided (such as health insurance).On to the 'why', which is fairly straight forward. From my perspective, the modern GOP has taken a dramatic, and irresponsible shift, toward ignorance, fear, and religious extremism.Ideology Trumps RealityHowever skeptical the individual, to entirely reject the concept that the Human species can affect the climate, a position entirely unsupported by fact or scientific consensus, is unacceptable. There is plenty of room to discuss how solutions to things like climate change will impact the economy and how those disruptions can be mitigated, I don't advocate immediately transitioning from oil/coal/etc..., but to completely ignore the issue because it doesn't coincide with your ideology is dangerous and foolish.On the extreme end of this spectrum, are people like Jim Inhofe, who claims that Humans quite literally cannot affect the environment. While he is free to believe whatever nonsense he likes, it is entirely unacceptable to have someone in a decision making capacity who is unable to differentiate his beliefs from reality. Not only that, but the fact that we do not hear significant criticism of this absurd and irresponsible position from other members of the GOP is truly disturbing, and hints that many of them may agree with him.While I think that climate change is currently the most significant issue along these lines, this problem extends to many other areas.Examples include:Stem cell researchBaseless support for vaccine deniersAttempting to control a women's choice when it comes to their own bodies.Pushing for failed 'abstinence only' sexual education programs.Discrimination against homosexuals.Attempts to redirect tax dollars to religious organizations.I also find the polarized 'black and white' view of the world and government to be dis-functional.Fiscal responsibilityPersonally, I subscribe the concept of financial responsibility. I think that deficit spending, as a standard practice, should be entirely avoided, so that during economic downturns, we're able to keep social safety-nets afloat, and prevent a downward spiral. To this end, I would be perfectly willing to accept either tax increases to support additional government spending, or cuts to both social programs and taxes, depending on which party was in control. What I do not accept as legitimate, are tax cuts without corresponding budget cuts, or spending increases without corresponding tax increases.There is zero evidence that Conservatives are financially responsible; in fact, they tend to advocate cutting taxes, while never having the support, or perhaps guts, to make legitimate cuts to existing social programs in order to balance the budget. This type of behavior is exceedingly childish, myopic, ideologically driven, and serves only to damage the government, at which point conservatives claim the government is broken and needs more tax cuts.Funding moonshot / next-gen research.Many organizations can't/won't do research on technology that is 10+ years out, even if there may be a significant pay off. I fully believe that government has a role to play here, as it did with DARPA, the space program, etc...Too many times, I see conservative members of congress scrambling to keep farm and oil subsidies in place, while at the same time slashing funding to the NSF. I consider this incredibly stupid and irresponsible. Its also enraging when you find out that many of the people involved directly benefit from the specific subsidies.Health careAs mentioned at the start, I don't think that private industry is always the best provider of every service. In that respect, I am a supporter of single payer health insurance via the government; however, since that is likely not achievable within our system, I think the ACA is a step in the right direction.There is significant empirical evidence, that despite conservative rhetoric that we are the 'best' in the world in terms of health care, we are actually paying significantly more, for more or less average outcomes. We are not significantly better in many quantifiable measures than other countries who practice some form of socialized, subsidized, or socialized with additional private insurance.When it comes to health care, the GOP doesn't seem to have any ideas past deregulating, and selling across state lines. More absurdly, many times when they speak about the issues now, they talk about keeping some of the 'nice' parts of the ACA, such as not being dropped for getting sick, but have no answers when it comes to how they would make up the costs.Economic policyHere my problem is very direct. I see conservative policies as supporting consolidation of wealth, inequality, and an inexorable march toward oligarchy. So far as I can tell, most data supports this, and I see it as being destabilizing and inefficient. I'm reasonably in sync with Nick Hanauer on this and many related issues. The economy needs a solid mix of supply and high enough wages to create sustained demand. Too much or too little of either is unbalanced and leads to destabilization.Conservative policies that support someone like Mitt Romney paying 14% taxes on his gains while a doctor, engineer, etc.. is paying 32%+, is not equitable from a social perspective. Some may argue that it is 'fair' because of corporate revenue being taxed 'twice', but I see that as a red herring. If anything its a sign that corporate tax rates should be reformed, not that we should maintain soft barriers that give undue advantage to the wealthy.

The answer requires quite a bit of education, information and foresight as every other 1st world country has had a proven Universal health care system for decades that is lower cost with better outcomes than the USA health care system.US Spends More on Health Care Than Other High-Income Nations But Has Lower Life Expectancy, Worse HealthPeople such as myself fight for the ACA because it is the only form of Universal health care available to USA citizens under age 65. All citizens including yourself are winners because of this as the Biggest Cause of Personal Bankruptcies? Medical Bills.You are a winner under this system in the long run because when the tax-exempt health sharing program kicks you out or when the tax-exempt health sharing program you are in becomes bankrupt you will have access to Universal health care.Your tax-exempt health sharing program is not large enough to be financially stable and is likely not available to all citizens especially those with pre existing conditions. we need to take care of all citizens.Universal health care is described by the World Health Organization as a situation where citizens can access health services without incurring financial hardship.[3]We need all healthcare model that covers all citizens not just the ones that happen to be fortunate and well off.The ACA (Patient Protection and Affordable Care Act - Wikipedia) is not the optimal solution as the best solution is likely a Single-payer healthcare which is a proven economic model practiced in many 1st world countries. It is probably the best proven method of providing economically efficient Universal health care.Here are the wikipages describing how Universal health care - Wikipedia works in all countries around the world. The ACA is a decent start although it is time to improve it not throw it out going back to the 3rd world stone ages.Even Trump may now realize this inescapable fact as Here’s why Trump is already waffling on Obamacare.Universal health care - WikipediaUniversal health care, sometimes referred to as universal health coverage, universal coverage, or universal care, usually refers to a health care system which provides health care and financial protection to all citizens of a particular country. It is organized around providing a specified package of benefits to all members of a society with the end goal of providing financial risk protection, improved access to health services, and improved health outcomes.[2]Universal health care is not one-size-fits-all and does not imply coverage for all people for everything. Universal health care can be determined by three critical dimensions: who is covered, what services are covered, and how much of the cost is covered.[2]It is described by the World Health Organization as a situation where citizens can access health services without incurring financial hardship.[3]The health policy framework is of central importance. Thus, in the development of universal health systems, it is appropriate to recognize "healthy public policy" (Health in All Policies) as the overarching policy framework, with public health, primary health care, and community services as the cross-cutting framework for all health and health-related services operating across the spectrum from primary prevention to long term care and end-stage conditions. Although that perspective is both logical and well grounded in the social ecological model, the reality is different in most settings, and there is room for improvement everywhere.[4]History[edit]The first move towards a national health insurance system was launched in Germany in 1883, with the Sickness Insurance Law. Industrial employers were mandated to provide injury and illness insurance for their low-wage workers, and the system was funded and administered by employees and employers through "sick funds", which were drawn from deductions in workers' wages and from employers' contributions. Other countries soon began to follow suit. In the United Kingdom, the National Insurance Act 1911 provided coverage for primary care (but not specialist or hospital care) for wage earners, covering about one third of the population. The Russian Empire established a similar system in 1912, and other industrialized countries began following suit. By the 1930s, similar systems existed in virtually all of Western and Central Europe. Japan introduced an employee health insurance law in 1927, expanding further upon it in 1935 and 1940. Following the Russian Revolution of 1917, the Soviet Union came close to a universal health care system. It established a fully public and centralized health care system in 1920.[5][6]However, it was not a truly universal system at that point, as rural residents were not http://covered.In New Zealand, a universal health care system was created in a series of steps, from 1939 to 1941.[7][8]In Australia, the state of Queensland introduced a free public hospital system in the 1940s.Following World War II, universal health care systems began to be set up around the world. On July 5, 1948, the United Kingdom launched its universal National Health Service. Universal health care was next introduced in the Nordic countries of Sweden (1955),[9]Iceland (1956),[10] Norway (1956),[11] Denmark (1961),[12] and Finland (1964).[13]Universal health insurance was then introduced in Japan (1961), and in Canada through stages, starting with the province of Saskatchewan in 1962, followed by the rest of Canada from 1968 to 1972.[7][14]The Soviet Union extended universal health care to its rural residents in 1969.[7][15]Italy introduced its Servizio Sanitario Nazionale (National Health Service) in 1978. Universal health insurance was implemented in Australia beginning with the Medibank system in 1975, which led to universal coverage under the Medicare system, established in 1984.From the 1970s to the 2000s, Southern and Western European countries began introducing universal coverage, most of them building upon previous health insurance programs to cover the whole population. For example, France built upon its 1928 national health insurance system, with subsequent legislation covering a larger and larger percentage of the population, until the remaining 1% of the population that was uninsured received coverage in 2000.[16][17]In addition, universal health coverage was introduced in some Asian countries, including South Korea (1989), Taiwan (1995), Israel (1995), and Thailand (2001).Following the collapse of the Soviet Union, Russia retained and reformed its universal health care system,[18] as did other former Soviet nations and Eastern bloc countries.Beyond the 1990s, many countries in Latin America, the Caribbean, Africa, and the Asia-Pacific region, including developing countries, took steps to bring their populations under universal health coverage, including China which has the largest universal health care system in the world.[19]A 2012 study examined progress being made by these countries, focusing on nine in particular: Ghana, Rwanda, Nigeria, Mali, Kenya, India, Indonesia, the Philippines, and Vietnam.[20][21]Funding models[edit]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 (by direct or optional insurance) for services beyond those covered by the public system.Almost all European systems are financed through a mix of public and private contributions.[22]Most universal health care systems are funded primarily by tax revenue (like in Portugal[22] Spain, Denmark, and Sweden). Some nations, such as Germany and France[23] and Japan[24] employ a multipayer system in which health care is funded by private and public contributions. However, much of the non-government funding is by contributions by employers and employees to regulated non-profit sickness funds. Contributions are compulsory and defined according to law.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. The progressivity of health care financing has limited implications for overall income inequality.[25]Compulsory insurance[edit]This is usually enforced via legislation requiring residents to purchase insurance, but sometimes the government provides the insurance. Sometimes, there may be a choice of multiple public and private funds providing a standard service (as in Germany) or sometimes just a single public fund (as in Canada). Healthcare in Switzerland and the US Patient Protection and Affordable Care Act are based on compulsory insurance.[26][27]In some European countries in which private insurance and universal health care coexist, such as Germany, Belgium, and the Netherlands, the problem of adverse selection is overcome by 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 they compete mainly on price and service. In some countries, the basic coverage level is set by the government and cannot be modified.[28]The Republic of Ireland at one time had a "community rating" system by VHI, effectively a single-payer or common risk pool. The government later opened VHI to competition but without a compensation pool. That resulted in foreign insurance companies entering the Irish market and offering cheap health insurance to relatively healthy segments of the market, which then made higher profits at VHI's expense. The government later reintroduced community rating by a pooling arrangement and at least one main major insurance company, BUPA, then withdrew from the Irish market.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 or limiting the ability of insurance companies to deny insurance to individuals or vary price between individuals.[29][30]Single payer[edit]Single-payer health care is a system in which the government, rather than private insurers, pays for all health care costs.[31]Single-payer systems may contract for healthcare services from private organizations (as is the case in Canada) or own and employ healthcare resources and personnel (as was the case in England before of the Health and Social Care Act). "Single-payer" thus describes only the funding mechanism and refers to health care financed by a single public body from a single fund and does not specify the type of delivery or for whom doctors work. Although the fund holder is usually the state, some forms of single-payer use a mixed public-private system.Tax-based financing[edit]In tax-based financing, individuals contribute to the provision of health services through various taxes. These are typically pooled across the whole population, unless local governments raise and retain tax revenues. Some countries (notably the United Kingdom, Canada, Ireland, Australia, New Zealand, Italy, Spain, Portugal, Greece and the Nordic countries) choose to fund health care directly from taxation alone. Other countries with insurance-based systems effectively meet the cost of insuring those unable to insure themselves via social security arrangements funded from taxation, either by directly paying their medical bills or by paying for insurance premiums for those affected.Social health insurance[edit]In social health insurance, contributions from workers, the self-employed, enterprises and government are pooled into a single or multiple funds on a compulsory basis. The funds typically contract with a mix of public and private providers for the provision of a specified benefit package. Preventive and public health care may be provided by these funds or responsibility kept solely by the Ministry of Health. Within social health insurance, a number of functions may be executed by parastatal or non-governmental sickness funds or in a few cases by private health insurance companies.Private insurance[edit]In private health insurance, premiums are paid directly from employers, associations, individuals and families to insurance companies, which pool risks across their membership base. Private insurance includes policies sold by commercial for profit firms, non-profit companies, and community health insurers. Generally, private insurance is voluntary in contrast to social insurance programs, which tend to be compulsory.[32]In some countries with universal coverage, private insurance often excludes many health conditions that are expensive and the state health care system can provide. For example, in the United Kingdom, one of the largest private health care providers is BUPA, which has a long list of general exclusions even in its highest coverage policy,[33] most of which are routinely provided by the National Health Service. In the United States, dialysis treatment for end stage renal failure is generally paid for by government, not by the insurance industry. Those with privatized Medicare (Medicare Advantage) are the exception and must get their dialysis paid through their insurance company, but those with end stage renal failure generally cannot buy Medicare Advantage plans.[34]The Planning Commission of India has also suggested that the country should embrace insurance to achieve universal health coverage.[35] General tax revenue is currently used to meet the essential health requirements of all people.Community-based health insurance[edit]A particular form of private health insurance that has often emerged if financial risk protection mechanisms have only a limited impact is community-based health insurance. Individual members of a specific community pay to a collective health fund, which they can draw from when they need of medical care. Contributions are not risk-related, and there is generally a high level of community involvement in the running of these plans.Implementation and comparisons[edit]Main article: Universal health coverage by countrySee also: Health care system and Health systems by countryHealth spending per capita, in US$ purchasing power parity-adjusted, among various OECD countriesUniversal health care systems vary according to the degree of government involvement in providing care and/or health insurance. In some countries, such as the UK, Spain, Italy, Australia and the Nordic countries, the government has a high degree of involvement in the commissioning or delivery of health care services and access is based on residence rights, not on the purchase of insurance. Others have a much more pluralistic delivery system, based on obligatory health with contributory insurance rates related to salaries or income and usually funded by employers and beneficiaries jointly.Sometimes, the health funds are derived from a mixture of insurance premiums, salary related mandatory contributions by employees and/or employers to regulated sickness funds, and by government taxes. These insurance based systems tend to reimburse private or public medical providers, often at heavily regulated rates, through mutual or publicly owned medical insurers. A few countries, such as the Netherlands and Switzerland, operate via privately owned but heavily regulated private insurers, which are not allowed to make a profit from the mandatory element of insurance but can profit by selling supplemental insurance.Universal health care is a broad concept that has been implemented in several ways. The common denominator for all such programs is some form of government action aimed at extending access to health care as widely as possible and setting minimum standards. Most implement universal health care through legislation, regulation and taxation. Legislation and regulation direct what care must be provided, to whom, and on what basis. Usually, some costs are borne by the patient at the time of consumption, but the bulk of costs come from a combination of compulsory insurance and tax revenues. Some programs are paid for entirely out of tax revenues. In others, tax revenues are used either to fund insurance for the very poor or for those needing long-term chronic care.The United Kingdom National Audit Office in 2003 published an international comparison of ten different health care systems in ten developed countries, nine universal systems against one non-universal system (the United States), and their relative costs and key health outcomes.[36]A wider international comparison of 16 countries, each with universal health care, was published by the World Health Organization in 2004.[37]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.Single-payer healthcareSingle-payer healthcare is a system in which the state, rather than private insurers, pays for all healthcare costs.[1]Single-payer systems may contract for healthcare services from private organizations (as is the case in Canada) or may own and employ healthcare resources and personnel (as is the case in the United Kingdom).The term "single-payer" thus describes the funding mechanism, referring to healthcare financed by a single public body from a single fund, not the type of delivery or for whom physicians work. The British system is technically not single payer, as it consists of a number of financially and legally autonomous trusts.The actual funding of a "single payer" system comes from all or a portion of the covered population. Although the fund holder is usually the state, some forms of single-payer use a mixed public-private system.Description[edit]Single-payer health insurance collects all medical fees and then pays for all services, by a single government (or government-related) source.[2]In wealthy nations, that kind of publicly managed insurance is typically extended to all citizens and legal residents. Examples include the United Kingdom's National Health Service, Australia's Medicare, Canada's Medicare, and Taiwan's National Health Insurance.The standard usage of the term "single-payer healthcare" refers to health insurance, as opposed to healthcare delivery, operating as a public service and offered to citizens and legal residents towards providing nearly universal or universal healthcare. The fund can be managed by the government directly or as a publicly owned and regulated agency.[2]Some writers describe publicly administered systems as "single-payer plans". Some writers have described any system of healthcare which intends to cover the entire population, such as voucher plans, as "single-payer plans",[3] but that is uncommon.Countries and regions[edit]Many nations worldwide have single-payer health insurance programs. These programs generally provide some form of universal healthcare, which are implemented in a variety of ways. In some cases doctors are employed, and hospitals run by, the government such as in the United Kingdom[4] or Spain.[5]Alternatively the government may purchase healthcare services from outside organizations, such as the approach taken in Canada.Australia[edit]Healthcare in Australia is provided by both private and government institutions. Medicare is the publicly funded universal health care venture in Australia. It was instituted in 1984 and coexists with a private health system. Medicare is funded partly by a 2% income taxlevy[6](with exceptions for low-income earners), but mostly out of general revenue. An additional levy of 1% is imposed on high-income earners without private health insurance. As well as Medicare, there is a separate Pharmaceutical Benefits Scheme that considerably subsidises a range of prescription medications. The Minister for Health, currently Sussan Ley, administers national health policy, elements of which (such as the operation of hospitals) are overseen by individual states.Canada[edit]See also: Canadian and American health care systems compared and Medicare (Canada)Healthcare in Canada is delivered through a publicly funded healthcare system, which is mostly free at the point of use and has most services provided by private entities.[7]It is guided by the provisions of the Canada Health Act of 1984.[8]The government assures the quality of care through federal standards. The government does not participate in day-to-day care or collect any information about an individual's health, which remains confidential between a person and his or her physician. Canada's provincially based Medicare systems are cost-effective partly because of their administrative simplicity. In each province each doctor handles the insurance claim against the provincial insurer. There is no need for the person who accesses healthcare to be involved in billing and reclaim. Private insurance represents a minimal part of the overall system.Competitive practices such as advertising are kept to a minimum, thus maximizing the percentage of revenues that go directly towards care. In general, costs are paid through funding from income taxes, except in British Columbia, the only province to impose a fixed monthly premium which is waived or reduced for those on low incomes.[9]There are no deductibles on basic health care and co-pays are extremely low or non-existent (supplemental insurance such as Fair Pharmacare may have deductibles, depending on income). A health card is issued by the Provincial Ministry of Health to each individual who enrolls for the program and everyone receives the same level of care.[10]There is no need for a variety of plans because virtually all essential basic care is covered, including maternity and infertility problems. Depending on the province, dental and vision care may not be covered but are often insured by employers through private companies. In some provinces, private supplemental plans are available for those who desire private rooms if they are hospitalized. Cosmetic surgery and some forms of elective surgery are not considered essential care and are generally not covered. These can be paid out-of-pocket or through private insurers. Health coverage is not affected by loss or change of jobs, as long as premiums are up to date, and there are no lifetime limits or exclusions for pre-existing conditions.Pharmaceutical medications are covered by public funds for the elderly or indigent,[11]or through employment-based private insurance. Drug prices are negotiated with suppliers by the federal government to control costs. Family physicians (often known as general practitioners or GPs in Canada) are chosen by individuals. If a patient wishes to see a specialist or is counseled to see a specialist, a referral can be made by a GP. Canadians do wait for some treatments and diagnostic services. Survey data shows that the median wait time to see a special physician is a little over four weeks with 89.5% waiting less than three months. The median wait time for diagnostic services such as MRI and CAT scans[12] is two weeks, with 86.4% waiting less than three months.[13]The median wait time for surgery is four weeks, with 82.2% waiting less than three months.[14]Spain[edit]Building upon less structured foundations, in 1963 the existence of a single-payer healthcare system in Spain was established by the Spanish government.[15]The system was sustained by contributions from workers, and covered them and their dependents.[16]The universality of the system was established later in 1986. At the same time, management of public healthcare was delegated to the different autonomous communities in the country.[17]While previously this was not the case, in 1997 it was established that public authorities can delegate management of publicly funded healthcare to private companies.[18]Additionally, in parallel to the single-payer healthcare system there are private insurers, which provide coverage for some private doctors and hospitals. Employers will sometimes offer private health insurance as a benefit,[19] with 14.8% of the Spanish population being covered under private health insurance in 2013.[20]In 2000, the Spanish healthcare system was rated by the World Health Organization as the 7th best in the world.Taiwan[edit]Healthcare in Taiwan is administrated by the Department of Health 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.[21]In 2002 Taiwan had nearly 1.6 physicians and 5.9 hospital beds per 1,000 population.[21]In 2002, there were a total of 36 hospitals and 2,601 clinics in the country. Per capita health expenditures totaled US$752 in 2000.[21]Health expenditures constituted 5.8 percent of the gross domestic product (GDP) in 2001 (or $951 US in 2009[22]); 64.9 percent of the expenditures were from public funds.[21]Overall life expectancy in 2009 was 78 years.[23]The current healthcare system in Taiwan, known as National Health Insurance (NHI), was instituted in 1995. NHI is a single-payer compulsory social insurance plan which centralizes the disbursement of health-care funds. The system promises equal access to health care for all citizens, and the population coverage had reached 99% by the end of 2004.[24]NHI is mainly financed through premiums, which are based on the payroll tax, and is supplemented with out-of-pocket payments and direct government funding. In the initial stage, fee-for-service predominated for both public and private providers. Most health providers operate in the private sector and form a competitive market on the health delivery side. However, many healthcare providers took advantage of the system by offering unnecessary services to a larger number of patients and then billing the government. In the face of increasing loss and the need for cost containment, NHI changed the payment system from fee-for-service to a global budget, a kind of prospective payment system, in 2002.United Kingdom[edit]Healthcare in the United Kingdom is a devolved matter, meaning England, Northern Ireland, Scotland and Wales each have their own systems of private and publicly funded healthcare, generally referred to as the National Health Service (NHS). Each country having different policies and priorities has resulted in a variety of differences existing between the systems.[25][26]That said, each country provides public healthcare to all UK permanent residents that is free at the point of use, being paid for from general taxation. In addition, each also has a private sector which is considerably smaller than its public equivalent, with provision of private healthcare acquired by means of private health insurance, funded as part of an employer funded healthcare scheme or paid directly by the customer, though provision can be restricted for those with conditions such as AIDS/HIV.[27]The individual systems are:England: National Health ServiceNorthern Ireland: Health and Social Care in Northern Ireland (HSCNI)Scotland: NHS ScotlandWales: NHS WalesIn England, funding from general taxation is channeled through NHS England, which is responsible for commissioning mainly specialist services and primary care, and Clinical Commissioning Groups (CCGs), which hold 60% of the budget and are responsible for commissioning health services for their local populations.[28]These commissioning bodies do not provide services themselves directly, but procure these from NHS Trusts and Foundation Trusts, as well as private, voluntary and social enterprise sector providers.[29]United States[edit]A number of proposals have been made for a universal single-payer healthcare system in the United States, most recently the United States National Health Care Act, (popularly known as H.R. 676 or "Medicare for All") but none has achieved more than 20% congressional co-sponsorship.Advocates argue that preventive healthcare expenditures can save several hundreds of billions of dollars per year because publicly funded universal healthcare would benefit employers and consumers, that employers would benefit from a bigger pool of potential customers and that employers would likely pay less, would be spared administrative costs, and inequities between employers would be reduced. Advocates also argue that single payer could benefit from a more fluid economy with increasing economic growth, aggregate demand, corporate profit, and quality of life.[30][31][32]Also, for example, cancer patients are more likely to be diagnosed at Stage I where curative treatment is typically a few outpatient visits, instead of at Stage III or later in an emergency room where treatment can involve years of hospitalization and is often terminal.[33][34]Others have estimated a long-term savings amounting to 40% of all national health expenditures due to preventive health care,[35] although estimates from the Congressional Budget Office and The New England Journal of Medicine have found that preventive care is more expensive due to increased utilization.[36]Any national system would be paid for in part through taxes replacing insurance premiums, but advocates also believe savings would be realized through preventive care and the elimination of insurance company overhead and hospital billing costs.[37]An analysis of a single-payer bill by Physicians for a National Health Program estimated the immediate savings at $350 billion per year.[38]The Commonwealth Fund believes that, if the United States adopted a universal health care system, the mortality rate would improve and the country would save approximately $570 billion a year.[39]Recent enactments of single-payer systems within individual states, such as in Vermont in 2011, are seen as possible routes to enacting single-payer on the federal level.[40][41]In December 2014, Vermont cancelled its plan for single payer healthcare.[42]National policies and proposals[edit]Medicare in the United States is a single-payer healthcare system, but is restricted to only senior citizens over the age of 65, people under 65 who have specific disabilities, and anyone with End-Stage Renal Disease.[43]Government is increasingly involved in U.S. health care spending, paying about 45% of the $2.2 trillion the nation spent on individuals' medical care in 2004.[44]However, studies have shown that the publicly administered share of health spending in the U.S. may be closer to 60% as of 2002.[45]According to Princeton University health economist Uwe Reinhardt, U.S. Medicare, Medicaid, and State Children's Health Insurance Program (SCHIP) represent "forms of 'social insurance' coupled with a largely private health-care delivery system" rather than forms of "socialized medicine." In contrast, he describes the Veterans Administration healthcare system as a pure form of socialized medicine because it is "owned, operated and financed by government."[46]In a peer-reviewed paper published in the Annals of Internal Medicine, researchers of the RAND Corporation reported that the quality of care received by Veterans Administration patients scored significantly higher overall than did comparable metrics for patients currently using United States Medicare.[47]The United States National Health Care Act, is a perennial piece of legislation introduced in the United States House of Representatives by Representative John Conyers (D-MI) every year since 2002.[48]The act would establish a universal single-payer health care system in the United States, the rough equivalent of Canada's Medicare, the United Kingdom's National Health Service, and Taiwan's Bureau of National Health Insurance, among other examples. Under a single payer system, all medical care would be paid for by the Government of the United States, ending the need for private health insurance and premiums, and probably recasting private insurance companies as providing purely supplemental coverage, to be used when non-essential care is sought. The bill was first introduced in 2002,[48] and has been reintroduced in each Congress since. During the 2009 health care debates over the bill that became the Patient Protection and Affordable Care Act, H.R. 676 was expected to be debated and voted upon by the House in September 2009,[49] but was never debated.[50]The Congressional Budget Office and related government agencies scored the cost of a single payer health care system several times since 1991. The General Accounting Office published a report in 1991 noting that "[I]f the US were to shift to a system of universal coverage and a single payer, as in Canada, the savings in administrative costs [10 percent of health spending] would be more than enough to offset the expense of universal coverage.”[51]The CBO scored the cost in 1991, noting that "the population that is currently uninsured could be covered without dramatically increasing national spending on health" and that "all US residents might be covered by health insurance for roughly the current level of spending or even somewhat less, because of savings in administrative costs and lower payment rates for services used by the privately insured.[52]A CBO report in 1993 stated that "[t]he net cost of achieving universal insurance coverage under this single payer system would be negative" in part because "consumer payments for health would fall by $1,118 per capita, but taxes would have to increase by $1,261 per capita" in order to pay for the plan.[53]A July 1993 scoring also resulted in positive outcomes, with the CBO stating that, "[a]s the program was phased in, the administrative savings from switching to a single-payer system would offset much of the increased demand for health care services. Later, the cap on the growth of the national health budget would hold the rate of growth of spending below the baseline."[54]The CBO also scored Sen. Paul Wellstone's American Health and Security Act of 1993 in December 1993, finding that "by year five (and in subsequent years) the new system would cost less than baseline."[55]A 2014 study published in the journal BMC Medical Services Research by James Kahn, etal, found that the actual administrative burden of health care in the United States was 27.4% of all national health expenditures. The study examined both direct costs charged by insurers for profit, administration and marketing but also the indirect burden placed on health care providers like hospitals, nursing homes and doctors for costs they incurred in working with private health insurers including contract negotiations, financial and clinical record-keeping (variable and idiosyncratic for each payer). Kahn, et al. estimate that the added cost for the private insurer health system in the US was about $471 billion in 2012 compared to a single payer system like Canada's. This represents just over 20% of the total national healthcare expenditure in 2012. Kahn asserts that this excess administrative cost will increase under the Affordable Care Act with its reliance on the provision of health coverage through a multi-payer system.[56]State proposals[edit]Several single-payer state referendums and bills from state legislatures have been proposed, but, with the exception of Vermont,[57] all have failed. In December 2014, Vermont canceled its plan for single payer health care.[42]California[edit]California attempted passage of a single-payer bill as early as 1994,[58]and the first successful passages of legislation through the California State Legislature, SB 840 or "The California Universal Healthcare Act" (authored by Sheila Kuehl), occurred in 2006 and again in 2008.[59]Both times, Governor Arnold Schwarzenegger vetoed the bill.[60]State Senator Mark Leno has reintroduced the bill in each legislative session since.[61]Colorado[edit]Colorado Amendment 69, will have a ballot proposal in November 2016 to vote on a single payer healthcare system funded by a 10% payroll tax split 2:1 between employers and employees. This would replace the private health insurance premiums currently paid by employees and companies.[62]Hawaii[edit]In 2009, the Hawaii state legislature passed a single-payer healthcare bill that was vetoed by Republican Governor Linda Lingle. While the veto was overridden by the legislature, the bill was not implemented.[63]Illinois[edit]In 2007, the Health Care for All Illinois Act was introduced and the Illinois House of Representatives' Health Availability Access Committee passed the single-payer bill favorably out of committee by an 8–4 vote. The legislation was eventually referred back to the House rules committee and not taken up again during that session.[64]Massachusetts[edit]Massachusetts had passed a universal healthcare program in 1986, but budget constraints and partisan control of the legislature resulted in its repeal before the legislation could be enacted.[65]Question 4, a nonbinding referendum, was on the ballot in 14 state districts in November 2010, asking voters, "[S]hall the representative from this district be instructed to support legislation that would establish healthcare as a human right regardless of age, state of health or employment status, by creating a single payer health insurance system like Medicare that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts?" The ballot question passed in all 14 districts that offered the question.[66][67]Minnesota[edit]The Minnesota Health Act, which would establish a statewide single payer health plan, has been presented to the Minnesota legislature regularly since 2009. The bill was passed out of both the Senate Health Housing and Family Security Committee[68] and the Senate Commerce and Consumer Protection Committee[69] in 2009, but the House version was ultimately tabled.[70]In 2010, the bill passed the Senate Judiciary Committee on a voice vote[71] as well as the House Health Care & Human Services Policy and Oversight Committee.[72]In 2011, the bill was introduced as a two-year bill in both the Senate[73] and House,[74] but did not progress. It has been introduced again in the 2013 session in both chambers.[75][76]Montana[edit]In September 2011, Governor Brian Schweitzer announced his intention to seek a waiver from the federal government allowing Montana to set up a single payer healthcare system.[77]Governor Schweitzer was unable to implement single-payer health care in Montana, but did make moves to open government-run clinics[78] and, in his final budget as governor, increased coverage for lower-income Montana residents.[79]New York[edit]New York State has been attempting passage of the New York Health Act, which would establish a statewide single-payer health plan, since 1992. The New York Health Act has passed the Assembly twice, once in 1992 and again in 2015, but has failed to advance through the Senate after referrals to the Health Committee. On both occasions, the legislation passed the Assembly by an almost two-to-one ratio of support.[80]Oregon[edit]The state of Oregon attempted to pass single payer healthcare via Oregon Ballot Measure 23 in 2002, and the measure was rejected by a significant majority.[81]Previous bills, including the Affordable Health Care for All Oregon Act, have been introduced in the legislature but have never left committee. The Affordable Health Care Act may be reintroduced in the 2013 session.[82]Pennsylvania[edit]The Family Business and Healthcare Security Act has been introduced in the Pennsylvania legislature numerous times, but has never been able to pass.[83][84][85]Vermont[edit]In December 2014, Vermont canceled its plan for single payer healthcare.[42]Vermont passed legislation in 2011 creating Green Mountain Care.[86]When Governor Peter Shumlin signed the bill into law, Vermont became the first state to functionally have a single payer health care system.[87]While the bill is considered a single-payer bill, private insurers can continue to operate in the state indefinitely, meaning it does not fit the strict definition of single-payer. Representative Mark Larson, the initial sponsor of the bill, has described Green Mountain Care's provisions "as close as we can get [to single-payer] at the state level."[88][89]Vermont abandoned the plan in 2014, citing costs and tax increases as too high to implement.[90]Public opinion[edit]Advocates for single payer point to support in polls, although the polling is mixed depending on how the question is asked.[91]Polls from Harvard University in 1988,[92] the Los Angeles Times in 1990,[93] and the Wall Street Journal in 1991[94] all showed strong support for a health care system comparable to the system in Canada. More recently, however, polling support has declined.[91][95]A 2007 Yahoo/AP poll showed a majority of respondents considered themselves supporters of "single-payer health care,"[96] and a plurality of respondents in a 2009 poll for Time Magazine showed support for "a national single-payer plan similar to Medicare for all."[97]Polls by Rasmussen Reports in 2011[98] and 2012[99] showed pluralities opposed to single payer health care.A 2001 article in the public health journal Health Affairs studied fifty years of American public opinion of various health care plans and concluded that, while there appears to be general support of a "national health care plan," poll respondents "remain satisfied with their current medical arrangements, do not trust the federal government to do what is right, and do not favor a single-payer type of national health plan."[95]Politifact rated a statement by Michael Moore "false" when he stated that "[t]he majority actually want single-payer health care." According to Politifact, responses on these polls largely depend on the wording. For example, people respond more favorably when they are asked if they want a system "like Medicare."[91]Advocacy groups[edit]This section needs to be updated. Please update this article to reflect recent events or newly available information. (February 2014)Physicians for a National Health Program[100] the American Medical Student Association[101] and the California Nurses Association[102] are among advocacy groups that have called for the introduction of a single payer healthcare program in the United States. A study published in the Annals of Internal Medicine found that 59% of physicians "supported legislation to establish national health insurance" while 9% were neutral on the topic, and 32% opposed it.[103]Universal health coverage by countryFrom Wikipedia, the free encyclopediaSee also: Health systems by country 58 countries with universal health care in 2009.[1]58 countries with legislation mandating universal health care, along with >90% health insurance coverage, and >90% skilled birth attendance.Main article: Universal health careUniversal health coverage is a broad concept that has been implemented in several ways. The common denominator for all such programs is some form of government action aimed at extending access to health care as widely as possible and setting minimum standards. Most implement universal health care through legislation, regulation and taxation. Legislation and regulation direct what care must be provided, to whom, and on what basis. Usually some costs are borne by the patient at the time of consumption but the bulk of costs come from a combination of compulsory insurance and tax revenues. Some programs are paid for entirely out of tax revenues. In others tax revenues are used either to fund insurance for the very poor or for those needing long term chronic care. The UK government's National Audit Office in 2003 published an international comparison of ten different health care systems in ten developed countries, nine universal systems against one non-universal system (the U.S.), and their relative costs and key health outcomes.[2]A wider international comparison of 16 countries, each with universal health care, was published by the World Health Organization in 2004[3]In some cases, government involvement also includes directly managing the health care system, but many countries use mixed public-private systems to deliver universal health care.The UN has adopted a resolution on universal health care. It may be the next stage after the Millennium Development Goals.[4]Africa[edit]Algeria[edit]Algeria operates a public healthcare system. A network of hospitals, clinics, and dispensaries provide treatment to the population, with the Social Security system funding health services, although many people must still cover part of their costs due to the rates paid by the Social Security system unchanged since 1987. The poor are generally entitled to health services free of charge, while the wealthy pay for treatment according to a sliding scale.[5][6]Botswana[edit]Botswana operates a system of public medical centers, with 98% of health facilities in the country run by the government. All citizens are entitled to be treated in public facilities free of charge, though a nominal fee of $70 is typically charged for public health services except for sexual reproductive health services and antiretroviral therapy services, which are free.[7]Burkina Faso[edit]Burkina Faso operates a scheme called Universal Health Insurance (AMU) which provides universal healthcare to citizens. It is administered by two separate bodies, one for civilians and the other for the armed forces.[8]Egypt[edit]Egypt operates a system of public hospitals and clinics through the Ministry of Health. Egyptian citizens can receive treatment at these facilities free of charge. However, those Egyptians who can afford it prefer to pay out of pocket for private healthcare.[9]Ghana[edit]Ghana operates the National Health Insurance Scheme to provide citizens with health insurance. The level of premiums citizens must pay varies according to their level of income. Most medical facilities are run directly by the Ministry of Health or Ghana Health Service.[10]Mauritius[edit]The Government of Mauritius operates a system of medical facilities that provide treatment to citizens free of charge.[11]Morocco[edit]Morocco operates a public health sector run by the government that operates 85% of the country's hospital beds. It deals mainly with the poor and rural populations, who cannot afford private healthcare. In addition, there is a non-profit health sector operated by the National Social Security Fund which covers 16% of the population. There is also a private sector for those who can afford it.[12]Rwanda[edit]Rwanda operates a system of universal health insurance through the Ministry of Health called Mutuelle de Santé (Mutual Health), a system of community-based insurance where people pay premiums based on their income level into local health insurance funds, with the wealthiest paying the highest premiums and required to cover a small percentage of their medical expenses, while those at the lowest income levels are exempt from paying premiums and can still utilize the services of their local health fund. In 2012, this system insured all but 4% of the population.[13]South Africa[edit]South Africa has a public healthcare system that provides services to the vast majority of the population, though it is chronically underfunded and understaffed, and a private system that is far better equipped, which covers the wealthier sectors of society.[14]Tunisia[edit]Tunisia operates a public healthcare system under the National Health Insurance Fund (Caisse Nationale d'Assurance Maladie). All Tunisian citizens and residents can receive treatment in state-run hospitals and clinics free of charge.[15]Asia[edit]Countries that provide public healthcare in Asia include Bhutan,[16]Bahrain,[17]China, Hong Kong, India, Iran,[18]Israel[19](see below), Jordan,[20]Kazakhstan,[21]Macau (see below), Malaysia,[22]Mongolia,[23]Oman,[24][25]Singapore, Sri Lanka,[26]Syria,[27]Taiwan (R.O.C.)[28](see below), Tajikistan,[29]Thailand (see below), Turkey,[30]and Turkmenistan[31]have universal health care.Bhutan[edit]The Royal Government of Bhutan maintains a policy of free and universal access to primary health care. As hospital facilities in the country are limited, patients with diseases that cannot be treated in Bhutan, such as cancer, are normally referred to hospitals in India for treatment. Such referral treatment is also carried out at the cost of the Royal Government.[32]Hong Kong[edit]Hong Kong has early health education, professional health services, and well-developed health care and medication system. The life expectancy is 84 for females and 78 for males,[33]which is the second highest in the world, and 2.94 infant mortality rate, the fourth lowest in the world.[34][35]There are two medical schools in Hong Kong, and several schools offering courses in traditional Chinese medicine. The Hospital Authority is a statutory body that operates and manages all public hospitals. Hong Kong has high standards of medical practice. It has contributed to the development of liver transplantation, being the first in the world to carry out an adult to adult live donor liver transplant in 1993.[36]India[edit]India's healthcare system is dominated by the private sector, although there are various public healthcare systems like Rajiv Gandhi Jeevandayee Arogya Yojana in Maharashtra that provides free healthcare to those below the poverty line.[37][38]Currently, the majority of Indian citizens do not have health insurance, and must pay out of pocket for treatment. There are government hospitals that provide treatment at taxpayer expense. Some essential drugs are offered free of charge in these hospitals.An outpatient card at AIIMS costs a one-time fee of 10 rupees (around 20 cents U.S.) and thereafter outpatient medical advice is free. In-hospital treatment costs depend on the financial condition of the patient and the facilities utilized, but are usually much less than the private sector. For instance, a patient is waived treatment costs if their income is below the poverty line. However, getting treatment at high quality government hospitals is very tough due to the high number of people needing healthcare and the lack of sufficient facilities.Primary health care is provided by city and district hospitals and rural primary health centres (PHCs). These hospitals provide treatment free of cost, but only if they are functional. Primary care is focused on immunization, prevention of malnutrition, pregnancy, child birth, postnatal care, and treatment of common illnesses.Patients who receive specialized care or have complicated illnesses are referred to secondary (often located in district and taluk headquarters) and tertiary care hospitals (located in district and state headquarters or those that are teaching hospitals).Now organizations like Hindustan Latex Family Planning Promotional Trust and other private organizations have started creating hospitals and clinics in India, which also provide free or subsidized health care and subsidized insurance plans.The government-run healthcare suffers from a lack of hygiene; the rich avoid the government hospitals and go to private hospitals. With the advent of privatized healthcare, this situation has changed. India now has medical tourism for people from other countries while its own poor find high-quality healthcare either inaccessible or unaffordable.The current Indian government is planning to unveil a national universal healthcare system called the National Health Assurance Mission, which will provide all Indian citizens with insurance coverage for serious illnesses, and free drugs and diagnostic treatments.[39]Israel[edit]Health care in Israel as a percentage of GDPIsrael has a system of universal healthcare as set out by the 1995 National Health Insurance Law. The state is responsible for providing health services to all residents of the country, who can register with one of the four national health service funds. To be eligible, a citizen must pay a health insurance tax. Coverage includes medical diagnosis and treatment, preventive medicine, hospitalization (general, maternity, psychiatric and chronic), surgery and transplants, preventive dental care for children, first aid and transportation to a hospital or clinic, medical services at the workplace, treatment for drug abuse and alcoholism, medical equipment and appliances, obstetrics and fertility treatment, medication, treatment of chronic diseases and paramedical services such as physiotherapy and occupational therapy.[40]In Israel, the National Health Insurance Law (or National Health Insurance Act) is the legal framework which enables and facilitates basic, compulsory universal health care. The Law was put into effect by the Knesset on January 1, 1995, and was based on recommendations put forward by a National Committee of Inquiry headed by Shoshana Netanyahu which examined restructuring the health care system in Israel in the late 1980s. Prior to the law's passage over 90% of the population was already covered by voluntarily belonging to one of four nationwide, not-for-profit sickness funds which operated some of their own medical facilities and were funded in part by employers and the government and in part by the insured by levies which varied according to income. However, there were three problems associated with this arrangement. First, membership in the largest fund, Clalit, required one to belong to the Histadrut labor organization, even if a person did not wish to (or could not) have such an affiliation while other funds restricted entry to new members based on age, pre-existing conditions or other factors. Second, different funds provided different levels of benefit coverage or services to their members and lastly was the issue mentioned above whereby a certain percentage of the population, albeit a small one, did not have health insurance coverage at all.Before the law went into effect, all the funds collected premiums directly from members. However, upon passage of the law, a new progressive national health insurance tax was levied through Israel's social security agency which then re-distributes the proceeds to the sickness funds based on their membership and its demographic makeup. This ensured that all citizens would now have health coverage. While membership in one of the funds now became compulsory for all, free choice was introduced into movement of members between funds (a change is allowed once every six months), effectively making the various sickness funds compete equally for members among the populace. Annually, a committee appointed by the ministry of health publishes a "basket" or uniform package of medical services and prescription formulary which all funds must provide as a minimum service to all their members. Achieving this level of equality ensured that all citizens are guaranteed to receive basic healthcare regardless of their fund affiliation which was one of the principal aims of the law. An appeals process was put in place to handle rejection of treatments and procedures by the funds and evaluating cases falling outside the "basket" of services or prescription formulary.While the law is generally considered a success and Israeli citizens enjoy a high standard of medical care comparatively, with more competition having been introduced into the field of health care in the country, and order having been brought into what was once a somewhat disorganized system, the law nevertheless does have its critics. First and foremost among the criticisms raised is that the "basket" may not provide enough coverage. To partly address this issue, the HMOs and insurance companies began offering additional "supplementary" insurance to cover certain additional services not included in the basket. However, since this insurance is optional (though usually very modestly priced, costing the equivalent of about US$10 to $20 a month), critics argue that it goes against the spirit of the new law which stressed equality among all citizens with respect to healthcare. Another criticism is that in order to provide universal coverage to all, the tax income base amount (the maximum amount of yearly earnings that are subject to the tax) was set rather high, causing many high-income taxpayers to see the amount they pay for their health premiums (now health tax) skyrocket. Finally, some complain about the constantly rising costs of copayments for certain services.Macau[edit]Macau offers universally accessible single-payer system funded by taxes. Health care is provided by the Bureau for Health.People's Republic of China[edit]Since the founding of the People's Republic of China, the goal of health care programs has been to provide care to every member of the population and to make maximum use of limited health-care personnel, equipment, and financial resources.China is undertaking a reform on its health care system, which was largely privatized in the 1990s. 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 coverage 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.[41]On January 21, 2009, the Chinese government announced that a total of 850 billion yuan (US$127.5 billion) will be provided between 2009 and 2011 in order to improve the existing health care system.[42]At the end of 2008, the government published its reform plan clarifying government's responsibility by saying that it would play a dominant role in providing public health and basic medical service. It declared "Both central and local governments should increase health funding. The percentage of government's input in total health expenditure should be increased gradually so that the financial burden of individuals can be reduced," The plan listed public health, rural areas, city community health services and basic medical insurance as four key areas for government investment. It also promised to tighten government control over medical fees in public hospitals and to set up a "basic medicine system" to quell public complaints of rising drug costs.[43]The plan was passed by the Chinese Cabinet in January 2009. The long-awaited medical reform plan promised to spend 850 billion yuan by 2011 to provide universal medical service and that measures would be taken to provide basic medical security to all Chinese.[44]Singapore[edit]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.[45]Singapore currently has the second lowest infant mortality rate in the world and among the highest life expectancies from birth, according to the World Health Organization.[46]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.[47]Singapore's system uses a combination of compulsory savings from payroll deductions (funded by both employers and workers) a nationalized health insurance plan, and government subsidies, as well as "actively regulating the supply and prices of healthcare services in the country" to keep costs in check; the specific features have been described as potentially a "very difficult system to replicate in many other countries." Many Singaporeans also have supplemental private health insurance (often provided by employers) for services not covered by the government's programs.[47]Taiwan[edit]The current health care system in Taiwan, known as National Health Insurance (NHI), was instituted in 1995. NHI is a single-payer compulsory social insurance plan which centralizes the disbursement of health care dollars. The system promises equal access to health care for all citizens, and the population coverage had reached 99% by the end of 2004.[48]NHI is mainly financed through premiums, which are based on the payroll tax, and is supplemented with out-of-pocket payments and direct government funding. In the initial stage, fee-for-service predominated for both public and private providers.NHI delivers universal coverage offered by a government-run insurer. The working population pays premiums split with their employers, others pay a flat rate with government help and the poor or veterans are fully subsidized.[49]Under this model, citizens have free range to choose hospitals and physicians without using a gatekeeper and do not have to worry about waiting lists. NHI offers a comprehensive benefit package that covers preventive medical services, prescription drugs, dentalservices, Chinese medicine, home nurse visits and many more. Since NHI, the previously uninsured have increased their usage of medical services. Most preventive services are free such as annual checkups and maternal and child care. Regular office visits have co-payments as low as US $5 per visit. Co-payments are fixed and unvaried by the person's income.[50]Thailand[edit]Thailand introduced universal coverage reforms in 2001, becoming one of only a handful of lower-middle income countries to do so at the time. 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.[45]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.[51][52][53]Europe[edit]Virtually all of Europe has either publicly sponsored and regulated universal health care or publicly provided universal healthcare. The public plans in some countries provide basic or "sick" coverage only, with their citizens being able to purchase supplemental insurance for additional coverage. Countries with universal health care include Austria, Belarus,[54]Croatia, Czech Republic, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, Malta, Moldova,[55]the Netherlands, Norway, Portugal,[56]Romania, Russia, Serbia, Spain, Sweden, Switzerland, Ukraine,[57]and the United Kingdom.[58]Austria[edit]Healthcare in Austria is universal for residents of Austria as well as those from other EU countries.[59]Austria has a two-tier health care system in which many individuals receive publicly funded care; they also have the option to purchase supplementary private health insurance.Croatia[edit]Croatia has a universal health care system that provides high quality medical services and is coordinated by the Ministry of Health. The population is covered by a basic health insurance plan provided by statute and optional insurance and administered by the Croatian Health Insurance Fund. In 2012, annual compulsory healthcare related expenditures reached 21.0 billion kunas (c. 2.8 billion euro). There are hundreds of healthcare institutions in Croatia, including 79 hospitals and clinics with 25,285 beds, caring for more than 760 thousand patients per year, 5,792 private practice offices and 79 emergency medical service units.Czech Republic[edit]Czech Republic has a universal public health system paid largely from taxation. Private health care systems do co-exist freely alongside public ones, sometimes offering better quality or faster service. Almost all medical services are covered by health insurance and insurance companies, though certain services such as prescription drugs or vision and dental care are only covered partially.Denmark[edit]Denmark has a universal public health system paid largely from taxation with local municipalities delivering health care services in the same way as other Scandinavian countries. Primary care is provided by a general practitioner service run by private doctors contracting with the local municipalities with payment on a mixed per capita and fee for service basis. Most hospitals are run by the municipalities (only 1% of hospital beds are in the private sector).Finland[edit]In 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 a few private hospitals.[60]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%.[61]Finnish health care expenditures are below the European average.[62]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 cost €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 (including prescription drugs), all treatment and medications thereafter in that year are free.Finland has a highly decentralized three-level public system of health care and alongside this, a much smaller private health-care system.[63]Overall, the municipalities (funded by taxation, local and national) meet about two thirds of all medical-care costs, with the remaining one third paid by the national insurance system (nationally funded), and by private finance (either employer-funded or met by patients themselves).[63]Private inpatient care forms about 3–4% of all inpatient care.[63]In 1999 only 17 per cent of total funding for health care came from insurance, comprising 14.9% statutory (government) insurance and 2.1% private health insurance. Spectacles are not publicly subsidized at all, although dentistry is available as a municipal service or can be obtained privately with partial reimbursement from the state.[63]The government announced in 2009 that Kela would re-imburse the cost of private dental-hygiene work, starting in 2010.[64]The percentage of total health expenditure financed by taxation in Finland (78%)[65]is above the OECD average and similar to the levels seen in Germany (77%) and France (80%) but below the level seen in the UK (87%). The quality of service in Finnish health care, as measured by patient satisfaction, is excellent. According to a survey published by the European Commission in 2000, Finland has one of the highest ratings of patient satisfaction with their hospital care system in the EU: 88% of Finnish respondents were satisfied compared with the EU average of 41.3%.[66]There are caps on total medical expenses that are met out-of-pocket for drugs and hospital treatments. The National Insurance system pays all necessary costs over these caps. Public spending on health care in 2006 was 13.6 billion euros (equivalent to US$338 per person per month). The increase over 2005 at 8.2 per cent was below the OECD average of 9 percent. Household budgets directly met 18.7 per cent of all health-care costs.[67]France[edit]France has a system of universal health care largely financed by government through a system of national health insurance. It is consistently ranked as one of the best in the world.[68]Germany[edit]Germany has the world's oldest national social health insurance system,[69][70][71]with origins dating back to Otto von Bismarck's Sickness Insurance Law of 1883.[72][73]The system is decentralized with private practice physicians providing ambulatory care, and independent, mostly non-profit hospitals providing the majority of inpatient care. Approximately 92% of the population is covered by a 'Statutory Health Insurance' plan, which provides a standardized level of coverage through any one of approximately 1100 public or private sickness funds. Standard insurance is funded by a combination of employee contributions, employer contributions and government subsidies on a scale determined by income level. Higher income workers sometimes choose to pay a tax and opt out of the standard plan, in favor of 'private' insurance. The latter's premiums are not linked to income level but instead to health status.[74]Historically, the level of provider reimbursement for specific services is determined through negotiations between regional physician's associations and sickness funds. Since 1976 the government has convened an annual commission, composed of representatives of business, labor, physicians, hospitals, and insurance and pharmaceutical industries.[75]The commission takes into account government policies and makes recommendations to regional associations with respect to overall expenditure targets. In 1986 expenditure caps were implemented and were tied to the age of the local population as well as the overall wage increases. Although reimbursement of providers is on a fee-for-service basis the amount to be reimbursed for each service is determined retrospectively to ensure that spending targets are not exceeded. Capitated care, such as that provided by U.S. health maintenance organizations, has been considered as a cost containment mechanism but would require consent of regional medical associations, and has not materialized.[76]Copayments were introduced in the 1980s in an attempt to prevent overutilization and control costs. 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).[77][78]The difference is partly driven by the fact that hospital reimbursement is chiefly a function of the number of hospital days as opposed to procedures or the patient's diagnosis. Drug costs have increased substantially, rising nearly 60% from 1991 through 2005. 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).[79]Greece[edit]The Greek healthcare system provides high quality medical services to insured citizens and is coordinated by the Ministry for Health and Social Solidarity. Public health services are provided by the National Healthcare Service, or ESY (Greek: Εθνικό Σύστημα Υγείας, ΕΣΥ). In 2010 there were 35,000 hospital beds and 131 hospitals in the country.The Greek healthcare system has received high rankings by the World Health Organization, ranked 14th in the overall assessment and 11th in quality of service in a 2000 report by the WHO.Guernsey / Jersey[edit]The medical care system in the Channel Islands is very similar to that of the UK in that many of the doctors and nurses have been trained from the UK health perspective. There is universal health care for residents of the islands.[80]Iceland[edit]Iceland has a universal public health system paid largely from taxation with local municipalities delivering health care services in the same way as other Scandinavian countries. Iceland's entire population has equal access to health care services.Ireland[edit]The public health care system of the Republic of Ireland is governed by the Health Act 2004,[81]which established a new body to be responsible for providing health and personal social services to everyone living in Ireland – the Health Service Executive. The new national health service came into being officially on January 1, 2005; however the new structures are currently in the process of being established as the reform program continues. In addition to the public-sector, there is also a large private health care market.Isle of Man[edit]The Isle of Man provides universal public health coverage to its residents.[82]Italy[edit]Italy has a public health care service for all the residents called "Servizio Sanitario Nazionale" or SSN (National Health Service) which is similar to the UK National Health Service. It is publicly run and funded mostly from taxation: some services requires small co-pays, while other services (like the emergency medicine and the general doctor) are completely free of charge. Like the UK, there is a small parallel private health care system, especially in the field of Dental Medicine.Luxembourg[edit]Luxembourg provides universal health care coverage to all residents (Luxembourgers and foreigners) by the National Health Insurance (CNS - Caisse nationale de santé (French) or National Gesondheetskeess (Luxembourgish)) which is funded by mandatory contributions of employers and the workforce and by government subsidies for insuring jobseekers, the poor and for financing medical infrastructure. It exists as well a mandatory public long-term care insurance.[83][84]Netherlands[edit]The Netherlands has 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 insurance funded from taxation. According to the WHO, the health care system in the Netherlands was 62% government funded and 38% privately funded as of 2004.[45]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, deductibles, 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 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 medically disadvantaged by his or her choice of insurer.Hospitals in the Netherlands are also regulated and inspected but are mostly privately run and not 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 waiting 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. There is a fixed yearly threshold of €375 for each adult person, excluding first visits for diagnosis to general physicians.Norway[edit]Norway has a universal public health system paid largely from taxation in the same way as other Scandinavian countries. Norway's entire population has equal access to health care services. The Norwegian health care system is government-funded and heavily decentralized. The health care system in Norway is financed primarily through taxes levied by county councils and municipalities. Dental care is included for children until 18 years old, and is covered for adults for some ailments.[85]Norway regularly comes top or close to the top of worldwide healthcare rankings.Portugal[edit]Portugal's National Healthcare Service, known nationally as Serviço Nacional de Saúde (SNS), is a universal and free healthcare service, provided nationwide since 1979, and is available to both Portuguese and foreigner residents. In 2014, Portugal SNS ranked 13th best healthcare service in Europe.[86]The National Medical Emergency Institute (INEM) is the main emergency medical serviced and can be activated by calling 112.Romania[edit]According to Article 34 of the Constitution of Romania, the state is obliged "to guarantee the protection of healthcare". Romania has a fully universal health care system, which covers up medical check-ups, any surgical interventions, and any post-operator medical care, as well as free or subsidized medicine for a range of diseases. The state is also obliged to fund public hospitals and clinics. Dental care is not funded by the state, although there are public dental clinics in some hospitals, which treat patients free of charge. However, due to inadequate funding and corruption, it is estimated that a third of medical expenses are, in some cases, supported by the patient.[87][clarification needed]Furthermore, Romania spends, per capita, less than any other EU state on medical care.Russia and Soviet Union[edit]In the Soviet Union, the preferred term was "socialist medicine"; the Russian language has no term to distinguish between "socialist" and "socialized" (other than "public", Rus: obshchestvenniy/общественный, sometimes "collectivized" or "nationalized", Rus: obobshchestvlenniy/обобществленный).[88][89]Russia in Soviet times (between 1917 and the early 1990s) had a totally socialist model of health care with a centralised, integrated, hierarchically organised with the government providing free health care to all citizens. Initially successful at combating infectious diseases, the effectiveness of the socialized model declined with underinvestment. Despite a doubling in the number of hospital beds and doctors per capita between 1950 and 1980, the quality of care began to decline by the early 1980s and medical care and health outcomes were below western standards.The new mixed economy Russia has switched to a mixed model of health care with private financing and provision running alongside state financing and provision. The OECD reported that unfortunately, none of this has worked out as planned and the reforms have in many respects made the system worse.[90]The population's health has deteriorated on virtually every measure. The resulting system is overly complex and very inefficient. It has little in common with the model envisaged by the reformers. Although there are more than 300 private insurers and numerous public ones in the market, real competition for patients is rare leaving most patients with little or no effective choice of insurer, and in many places, no choice of health care provider either. The insurance companies have failed to develop as active, informed purchasers of health care services. Most are passive intermediaries, making money by simply channelling funds from regional OMS funds to healthcare providers.Article 41 of the Constitution of the Russian Federation confirms a citizen's right to state healthcare and medical assistance free of charge.[91]This is achieved through state compulsory medical insurance (OMS) which is free to Russian citizens, funded by obligatory medical insurance payments made by companies and government subsidies.[92][93]Introduction in 1993 reform of new free market providers in addition to the state-run institutions intended to promote both efficiency and patient choice. A purchaser-provider split help facilitate the restructuring of care, as resources would migrate to where there was greatest demand, reduce the excess capacity in the hospital sector and stimulate the development of primary care. Russian Prime Minister Vladimir Putin announced a new large-scale health care reform in 2011 and pledged to allocate more than 300 billion rubles ($10 billion) in the next few years to improve health care in the country.[94]He also said that obligatory medical insurance tax paid by companies will increase from current 3.1% to 5.1% starting from 2011.[94]Serbia[edit]The Constitution of the Republic of Serbia states that it is a right of every citizen to seek medical assistance free of charge.[95]This is achieved by mutual contribution to the Compulsory Social Healthcare Fund of RZZO (Republički Zavod za Zdravstveno Osiguranje or National Health Insurance Institution). The amount of contribution depends on the amount of money the person is making. During the 1990s, Serbia's healthcare system has been of a poor quality due to severe underfunding. In the recent years, however, that has changed and the Serbian government has invested heavily in new medical infrastructure, completely remodeling existing hospitals and building two new hospitals in Novi Sad and Kragujevac.Sweden[edit]Sweden has a universal public health system paid largely from taxation in the same way as other Scandinavian countries. Sweden's entire population has equal access to health care services. The Swedish public health system is funded through taxes levied by the county councils, but partly run by private companies. Government-paid dental care for children under 21 years old is included in the system, and dental care for adults is somewhat subsidised by it.Sweden also has a smaller private health care sector, mainly in larger cities or as centers for preventive health care financed by employers.Sweden regularly comes in top in worldwide healthcare rankings.[96]Switzerland[edit]Healthcare in Switzerland is universal and is regulated by the Federal Health Insurance Act of 1994. Basic health insurance is mandatory for all persons residing in Switzerland (within three months of taking up residence or being born in the country). Insurers are required to offer insurance to everyone, regardless of age or medical condition. They are not allowed to make a profit off this basic insurance, but can on supplemental plans.[97]United Kingdom[edit]Each of the Countries of the United Kingdom has a National Health Service that provides public healthcare to all UK permanent residents that was originally designed to be free at the point of need and paid for from general taxation; but changes included introducing charging for prescription medicines and dentistry (those below 16 and those on certain benefits may still get free treatment). However, since Health is now a devolved matter, considerable differences are developing between the systems in each of the countries as for example Scotland abolished prescription charges.[98]Private healthcare companies are free to operate alongside the public one.England[edit]Norfolk and Norwich University Hospital, a National Health Service hospital.The National Health Service (NHS), created by the National Health Service Act 1946, has provided the majority of healthcare in England since its launch on 5 July 1948.The NHS Constitution for England documents, at high level, the objectives of the NHS, the legal rights and responsibilities of the various parties (patients, staff, NHS trust boards), and the guiding principles which govern the service.[99]The NHS constitution makes it clear that it provides a comprehensive service, available to all irrespective of age, gender, disability, race, sexual orientation, religion, or belief; that access to NHS services is based on clinical need and not an individual's ability to pay; and that care is never refused on unreasonable grounds. Patient choice in terms of doctor, care, treatments, and place of treatment is an important aspect of the NHS's ambition, and in some cases patients can elect for treatment in other European countries at the NHS's expense. Waiting times are low, with most people able to see their primary care doctor on the same day or the following day.[100]Only 36.1% of hospital admissions are from a waiting list, with the remainder being either emergencies admitted immediately or else pre-booked admissions or the like (e.g., child birth).[101]One of the main goals of care management is to ensure that patients do not experience a delay of more than 18 weeks from initial hospital referral to final treatment, inclusive of time for all associated investigative tests and consultations.102]At present, two-thirds of patients are treated in under 12 weeks.[103]Although centrally funded, the NHS is not managed by a large central bureaucracy. Responsibility is highly devolved to geographical areas through Strategic Health Authorities and even more locally through NHS primary care trusts, NHS hospital trusts and increasingly to NHS foundation trusts which are providing even more decentralized services within the NHS framework, with more decision making taken by local people, patients, and staff. The central government office, the Department of Health, is not involved in day-to-day decision making in either the Strategic Health Authorities or the individual local trusts (primarily health, hospital, or ambulance) or the national specialist trusts such as NHS Blood and Transplant, but it does lay down general guidelines for them to follow. Local trusts are accountable to their local populations, whilst government ministers are accountable to Parliament for the service overall.The NHS provides, among other things, primary care, in-patient care, long-term healthcare, psychiatric care and treatments, ophthalmology, and dentistry. All treatment is free with the exception of certain charges for prescriptions, dentistry and ophthalmology (which themselves are free to children, certain students in full-time education, the elderly, the unemployed and those on low incomes). Around 89 pc of NHS prescriptions are obtained free of charge, mostly for children, pensioners, and pregnant women. Others pay a flat rate of £8.20,[104]and others may cap their annual charges by purchasing an NHS Prescription Prepayment Certificate. Private health care has continued parallel to the NHS, paid for largely by private insurance. Private insurance accounts for only 4 percent of health expenditure and covers little more than a tenth of the population.[105]Private insurers in the UK only cover acute care from specialists. They do not cover generalist consultations, pre-existing conditions, medical emergencies, organ transplants, chronic conditions such as diabetes, or conditions such as pregnancy or HIV.[106]Most NHS general practitioners are private doctors who contract to provide NHS services, but most hospitals are publicly owned and run through NHS Trusts. A few NHS medical services (such as "surgicentres") are sub-contracted to private providers[107]as are some non-medical services (such as catering). Some capital projects such as new hospitals have been funded through the Private Finance Initiative, enabling investment without (in the short term) increasing the public sector borrowing requirement, because long-term contractually obligated PFI spending commitments are not counted as government liabilities.Northern Ireland[edit]Health and Social Care in Northern Ireland is the designation of the national public health service in Northern Ireland.Scotland[edit]The Royal Aberdeen Children's Hospitalis a specialist children's hospital within NHS Scotland.NHS Scotland, created by the National Health Service (Scotland) Act 1947, was also launched on 5 July 1948, although it has always been a separate organization. Since devolution, NHS Scotland has followed the policies and priorities of the Scottish Government, including the phasing out of all prescription charges by 2011.[citation needed]Wales[edit]NHS Wales was originally formed as part of the same NHS structure created by the National Health Service Act 1946 but powers over the NHS in Wales came under the Secretary of State for Wales in 1969,[108]in turn being transferred under devolution to what is now the Welsh Government.North America[edit]The Bahamas,Barbados, Canada, Costa Rica, Cuba, Mexico, Panama, and Trinidad and Tobago all provide some level of universal health coverage.The Bahamas[edit]The Bahamas approved the National Health Insurance Act in August 2016. The legislation allows for the establishment of a universal health coverage system that will begin with universal coverage of primary health care services and later expand to include a wide set of benefits including all specialized care. The system will all for universal coverage of a basic benefit package and for voluntary insurance to be purchased as a top up policy to cover services or amenities that are not included in the government plan.[109]Canada[edit]In 1984, the Canada Health Act was passed, which prohibited extra billing by doctors on patients while at the same time billing the public insurance system. In 1999, the prime minister and most premiers reaffirmed in the Social Union Framework Agreement that they are committed to health care that has "comprehensiveness, universality, portability, public administration and accessibility."[110]The system is for the most part publicly funded, yet most of the services are provided by private enterprises or private corporations, although most hospitals are public. Most doctors do not receive an annual salary, but receive a fee per visit or service.[111]About 29% of Canadians' health care is paid for by the private sector or individuals.[112]This mostly goes towards services not covered or only partially covered by Medicare such as prescription drugs, dentistry and vision care.[113]Many Canadians have private health insurance, often through their employers, that cover these expenses.[114]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.[115][116]The legality of the ban was considered in a decision of the Supreme Court of Canada which ruled in Chaoulli v. Quebec that "the prohibition on obtaining private health insurance, while it might be constitutional in circumstances where health care services are reasonable as to both quality and timeliness, is not constitutional where the public system fails to deliver reasonable services." The appellant contended that waiting times in Quebec violated a right to life and security in the Quebec Charter of Human Rights and Freedoms. The Court agreed, but acknowledged the importance and validity of the Canada Health Act, and at least four of the seven judges explicitly recognized the right of governments to enact laws and policies which favour the public over the private system and preserve the integrity of the public system.Costa Rica[edit]Universal healthcare and pensions are run by the Caja Costarricense de Seguro Social (CCSS). In 1941, Costa Rica established Caja Costarricense de Seguro Social (CCSS), a social security insurance system for wage-earning workers. In 1961, coverage was expanded to include workers’ dependents and from 1961 to 1975, a series of expansions extended coverage for primary care and outpatient and inpatient specialized services to people in rural areas, the low-income population, and certain vulnerable populations. Further expansions during the late 1970s extended insurance coverage to farmers, peasants, and independent contract workers. Additionally, CCSS mandates free health service provision to mothers, children, indigenous people, the elderly, and people living with disabilities, regardless of insurance coverage. By 2000, 82 percent of the population was eligible for CCSS, which has continued to expand in the ensuing period. By covering all population groups through the same system, Costa Rica has avoided social insurance stratification and inequity common in many other countries in the region.[117]CCSS is funded by a 15 percent payroll tax, as well as payments from retiree pensions [6]. Taxes on luxury goods, alcohol, soda, and imported products also help to cover poor households who do otherwise pay into the system. All CCSS funds are merged into a single pool, which is managed by the central financial administration of CCSS. In 1973, the Ministry of Health decided to move away from direct service provision and adopt a steering role. Responsibility for the provision of most care was transferred to the CCSS, although the Ministry retained responsibility for disease control, food and drug regulation, environmental sanitation, child nutrition, and primary care for the poor. Through the CCSS, health care is now essentially free to nearly all Costa Ricans. Private health care is also widely available and INS offers private health insurance plans to supplement CCSS insurance.[118]Cuba[edit]The Cuban government operates a national health system and assumes fiscal and administrative responsibility for the health care of all its citizens. There are no private hospitals or clinics as all health services are government-run. The present Minister for Public Health is Roberto Morales Ojeda. However, although the coverage is wide, the system is underfunded and recently also understaffed. The government organized medical missions in other countries has taken a very significant amount of doctors and other personal. In 2005 there were 25000 Cuban doctors only in Venezuela.Mexico[edit]Public health care delivery is accomplished via an elaborate provisioning and delivery system instituted by the Mexican Federal Government. Public health care is provided to all Mexican citizens as guaranteed via Article 4 of the Constitution. Public care is either fully or partially subsidized by the federal government, depending on the person's (Spanish: derechohabiente's) employment status. All Mexican citizens are eligible for subsidized health care regardless of their work status via a system of health care facilities operating under the federal Secretariat of Health (formerly the Secretaria de Salubridad y Asistencia, or SSA) agency. Employed citizens and their dependents, however, are further eligible to use the health care program administered and operated by the Instituto Mexicano del Seguro Social (IMSS) (English: Mexican Social Security Institute). The IMSS health care program is a tripartite system funded equally by the employee, its private employer, and the federal government. The IMSS does not provide service to employees of the public sector. Employees in the public sector are serviced by the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) (English: Institute for Social Security and Services for State Workers), which attends to the health and social care needs of government employees. This includes local, state, and federal government employees. The government of the states in Mexico also provide health services independently of those services provided by the federal government programs. In most states, the state government has established free or subsidized healthcare to all their citizens.On December 1, 2006, the Mexican government created the Health Insurance for a New Generation also known as "life insurance for babies".[119][120][121]On May 16, 2009, Mexico to Achieve Universal Health Coverage by 2011.[122]On May 28, 2009, Mexico announced Universal Care Coverage for Pregnant Women.[123]On August 2012 Mexico installed a universal healthcare system.[124]Trinidad and Tobago[edit]Main article: Healthcare in Trinidad and TobagoA universal health care system is used in Trinidad and Tobago and is the primary form of health-care available in the country. It is used by the majority of the population seeking medical assistance, as it is free for all citizens.United States[edit]Main article: Patient Protection and Affordable Care ActSee also: Health care reform in the United States and Health care in the United StatesThe United States does not have a universal health care system. However, the Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care and Education Reconciliation Act of 2010, seeks to have expanded insurance coverage to legal residents by 2014. It provides for federally mandated health insurance to be implemented in the United States during the 2010–2019 decade with the Federal government subsidizing legal resident households with income up to 400% of the Federal poverty level.[125]This threshold varies according to State and household size, but for an average family of four, subsidies would be available for families whose income was about $88,000 or lower.[126]In June 2010 adults with pre-existing conditions became eligible to join a temporary high-risk pool.[127]In 2014, applicants of the same age began to be able to obtain health insurance at the same published rate regardless of health status — the first time in U.S. history that insurers no longer had the right to load the premium or deny coverage prior to contract, or cancel a policy after contractdue to an adverse health condition, or test result indicating that one may be imminent. The law prohibits insurers from capping their liability for a person's health care needs, a move which is expected to rectify medically induced bankruptcy. As of April 13, 2015, the U.S. uninsured rate fell to 11.9% from the 17.1% recorded at the end of the fourth quarter of 2013. This is the lowest quarterly average recorded since Gallup and Healthwaysbegan tracking the percentage of uninsured Americans in 2008. Gallup attributed this sharp decline to the Affordable Care Act's requirements for most Americans to have healthcare in the beginning of the first quarter of 2014.[128]The Congressional Budget Office and related government agencies scored the cost of a universal health care system several times since 1991, and have uniformly predicted cost savings,[129]partly from the elimination of insurance company overhead costs.[130]In 2009, a universal health care proposal was pending in Congress, the United States National Health Care Act (H.R. 676, formerly the "Medicare for All Act").The Congressional Budget Office (CBO) estimated that the bill would reduce the number of nonelderly people who are uninsured by about 32 million, leaving about 23 million nonelderly residents uninsured (about one-third of whom would be illegal immigrants). Under the legislation, the share of legal nonelderly residents with insurance coverage would rise from about 83 percent in 2010 to about 94 percent by 2019.[131]In May 2011, the state of Vermont became the first state to pass legislation establishing a single-payer health care system. The legislation, known as Act 48, establishes health care in the state as a "human right" and lays the responsibility on the state to provide a health care system which best meets the needs of the citizens of Vermont. The proposal was shelved not long after the main provisions of the law took effect in 2014.[132]A revised estimate in July 2012 by the CBO stated 30 million people would gain access to health insurance under the law.[133]Discussion in the United States commonly uses the term socialized medicine to impart a pejorative meaning to the idea of universal health care.South America[edit]Argentina, Brazil, Chile, Colombia, Peru, Uruguay, and Venezuela all have public universal health care provided.Argentina[edit]Health care is provided through a combination of employer and labor union-sponsored plans (Obras Sociales), government insurance plans, public hospitals and clinics and through private health insurance plans. It costs almost 10% of GDP and is available to anyone regardless of ideology, beliefs, race or nationality.Brazil[edit]The universal health care system was adopted in Brazil in 1988 after the end of the military regime's rule. However, universalized/socialized health care was available many years before, in some cities, once the 27th amendment to the 1969 Constitution imposed the duty of applying 6% of their income in healthcare on the municipalities.[134]Chile[edit]Health care in Chile is provided by the government (via Fonasa) and by private insurers (via Isapre). All workers and pensioners are mandated to pay 7% of their income for health care insurance (the poorest pensioners are exempt from this payment). Workers who choose not to join an Isapre, are automatically covered by Fonasa. Fonasa also covers unemployed people receiving unemployment benefits, uninsured pregnant women, insured worker's dependant family, people with mental or physical disabilities and people who are considered poor or indigent.Fonasa costs vary depending on income, disability or age. Attention at public health facilities via Fonasa is free for low-income earners, people with mental or physical disabilities and people over the age of 60. Others pay 10% or 20% of the costs, depending on income and number of dependants. Fonasa beneficiaries may also seek attention in the private sector, for a designated fee.Additionally, there are a number of high-mortality illnesses (currently 69) that have special attention guarantees for both Isapre and Fonasa affiliates, in relation to access to treatment, waiting times, maximum costs and quality of service.Colombia[edit]In 1993 a reform transformed the health care system in Colombia, trying to provide a better, sustainable, health care system and to reach every Colombian citizen.Peru[edit]On April 10, 2009, the Government of Peru published the Law on Health Insurance to enable all Peruvians to access quality health services, and contribute to regulate the financing and supervision of these services. The law enables all population to access diverse health services to prevent illnesses, and promote and rehabilitate people, under a Health Basic Plan (PEAS).[135][136]On April 2, 2010, President Alan Garcia Perez on Friday signed a supreme ordinance approving the regulations for the framework law on the Universal Health Insurance, which seeks to provide access to quality health care for all Peruvian citizens.Peru's Universal Health Insurance law aims to increase access to timely and quality health care services, emphasizes maternal and child health promotion, and provides the poor with protection from financial ruin due to illness.[137]The regulation states that membership of the Universal Health Insurance (AUS for its Spanish acronym) is compulsory for the entire population living in the country. To that end, the Ministry of Health will approve, by supreme ordinance, the mechanisms leading to compulsory membership, as well as escalation and implementation.[138]Oceania[edit]Australia and New Zealand have universal health care.Australia[edit]In Australia, Medibank — as it was then known — was introduced, by the Whitlam Labor government on July 1, 1975, through the Health Insurance Act 1973. The Australian Senate rejected the changes multiple times and they were passed only after a joint sitting after the 1974 double dissolution election. However, Medibank was supported by the subsequent Fraser Coalition (Australia) government and became a key feature of Australia's public policy landscape. The exact structure of Medibank/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 Medibank program proposed a 1.35% levy (with low income exemptions) but these bills were rejected by the Senate, and so Medibank was funded from general taxation. In 1976, the Fraser Government introduced a 2.5% levy and split Medibank in two: a universal scheme called Medibank Public and a government-owned private health insurance company, Medibank Private.During the 1980s, Medibank Public was renamed Medicare by the Hawke Labor government, which also changed the funding model, to an income tax surcharge, known as the Medicare Levy, which was set at 1.5%, with exemptions for low income earners.[139]The Howard Coalition government introduced an additional levy of 1.0%, known as the Medicare Levy Surcharge, for those on high annual incomes ($70,000) and do not have adequate levels of private hospital coverage.[140]This was part of an effort by the Coalition to encourage take-up of private health insurance. According to WHO, government funding covered 67.5% of Australia's health care expenditures in 2004; private sources covered the remaining 32.5% of expenditures.[45]New Zealand[edit]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%.[45]