• January 24, 2022


Overview of health insurance systems in developed countries

Overview of health insurance systems in developed countries

To present an overview of the health insurance systems of the major developed countries to the best of my personal knowledge, it can be said that there are two extremes.

One pole is the UK and Japan, whose social health insurance system has achieved universal coverage and is compulsory, and the Japanese social health insurance is financed by workers’ and employers’ contributions and government subsidies (i.e., premiums and taxes), while the UK’s NHS (National Health Service) is composed entirely of tax money, emphasizing government control over the input and allocation of health resources, and community health care Community health care is the focus of its health services. Of course, people who join the NHS can also purchase commercial health insurance, which does not conflict with the NHS, but this is usually an option for people with higher incomes or an attraction for good employer benefit plans.

The other pole is the United States, as the only developed country without a universal health care system, its public health care system only covers the following categories of people: senior, disabled, low-income, military, etc., and the rest of the population’s health care coverage to commercial health insurance solutions. Therefore, the U.S. is the most developed country in the world in terms of commercial health insurance, and at the same time, private non-profit medical institutions in the U.S. account for more than 80% of the total. Compared to Europe, he places more emphasis on the role of the market.

In between are France and Germany, whose social health insurance system covers 90% of their citizens and is also mandatory, with a funding model based on social insurance contributions from employers and employees, supplemented by government tax subsidies. In Germany, the government is not involved in the implementation and management of statutory health insurance, and the statutory health insurance companies are not subordinate to the government (as a member of the Chinese social security system, is not very uncomfortable?) They are non-profit organizations with the status of a legal person and are managed according to the company law, not pursuing profits, but only pursuing the balance of funds.

After understanding the above, it can be seen that medical treatment in the UK is indeed free or nearly free (nationals are required to be compelled to join the NHS after the mandatory deduction through taxation already). But precisely because all the people can be free medical treatment, making the hospital operation inefficient, the quality of health care is not high mentioned is the proof); medical costs are growing too fast, the financial burden increased; these problems have been revealed as early as the 1980s, the criticism of the NHS and other health care system has been a long time. Of course, problems exist in Germany and France as well, and everyone has been pushing forward almost continuously with reforms in health care (e.g., raising the minimum wage required to join commercial insurance to retain high-income people in the social health care system to reduce financial pressure, developing a supplemental commercial insurance market, etc.), but until now, the problems have not completely disappeared.

Looking at the U.S., which relies on the market, the problem of soaring medical costs is also the biggest challenge faced by their commercial health insurance companies. Their commercial health insurance companies’ choice is to conduct managed care attempts, i.e., insurers participate in the management of health care providers, and form a community of interest with hospitals, doctors, etc. by making health care providers share operational benefits with insurers while also sharing the risks of health insurance operations, with relatively obvious results.
Country specific practices and reform programs should be available online, the above is just a general description. Therefore, China’s health insurance system is now also very torn, learning from Europe, learning from the United States, learning from Japan, always want to learn the good part alone, is very difficult, the coin has two sides. Need to consider the fairness and efficiency, the need to consider the financial resources of the government and the income level of the people. Learn Europe our contribution level is not enough, the health insurance program is too incomprehensive; learn the United States our hospitals are mainly public, commercial health insurance is seriously inadequate.

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