Health insurance is a mechanism responsible for an individual facing financial risk of care for illness, and a minimum income when the disease robs the person of work.
In most Western countries, a large share of health insurance is paid by the State. This is one of the fundamental components of social security, and a duty of the State under the Universal Declaration of Human Rights of 1948.
A health insurance system state can be managed by a state agency, delegated to private organizations, or be mixed.
The operation, like all insurance, is based on the pooling of risk: each person contributes in exchange for which it is reimbursed on a fixed schedule.
On a state health insurance, the premium paid by the insured is not necessarily the rules of pure insurance, ie based solely on risk. Indeed, the state system satisfies both the pure insurance function and distribution function in which the wealthy pay more insurance for the most disadvantaged.
Models of Health Insurance
Health insurance can take two forms:
* Or it is simply a financial assurance: the individual is insured for a risk (accident, disease), and care (remuneration of practitioners, products and cost of drugs, prosthetics, orthotics ...) are paid according to the scale;
* Either the insurer is a care network: it contacts practitioners, insurance providers ... buys a subscription to this network of care and resells to the user;
in its most extreme form, the insured has no choice but to its practitioners, at least if he wants to benefit from free health care or reimbursement.
There may be coexistence of these two models.
Health insurance may be a pure state, it can only be private insurers or we can have a mixed system: the user has a state insurance and can take out private insurance with a company or mutual d insurance who completes the repayment or provides access to a network of complementary care.
It finds that countries that have adopted a purely private and competitive, are those for which expenses are higher. Thus, while developed countries spend on average 10% of their GDP into their system of care, the United States spend 14% and Switzerland 13%. However, in a system of competing insurance, policyholders choose the level of spending they want from the level of health coverage they want. The level of expenditure in a system in competition revealed the desired level of spending by consumers. In a state system, the State sets the level of spending and rationing the use of health services to the limit. A comparison of expenditure levels between state systems and systems competition is biased because it is non-comparable in their use.
Founded on the principles of professional insurance in the context of enterprise and social welfare, the German system is in a process of reform since the late 1980s including a financial and organizational.
In 1883, the Health Insurance Act stipulates the establishment of compulsory insurance for workers in industry. Entered into force in 1914, this system remains the main legal basis for legislation on health insurance until the adoption in 1988 of the first law on the reform of the health system.
- The public: 88% of the population are members. Health insurance is mandatory below a certain income threshold.
- Private: 12% of the population are members. Beyond a certain threshold of income, people can opt for the statutory scheme or private insurance. This insurance covers 10% of the population has the right not to choose the system of compulsory membership beyond a threshold of income but can also combine the two types of public and private protection.
The characteristics of the German system are:
* Social contributions (and employer) fund the majority of disease risk
* Health insurance in which sit representatives of funding
(trade unions and employer organizations) have a role manager
* A very wide range (nearly three hundred different public funds) and a great
autonomy of health insurance (they set free all their rates, which are different from one fund to another),
* The generalized third-party payer,
* The role of collective bargaining between the funds and representatives of doctors and
* The federal system that gives an important role for the Lander.
The health insurance system is close to the German model in french philosophy and faced comparable.
Health Insurance Disability Insurance is a "health care" mandatory managed by the National Institute of Invalidity Insurance (INAMI). This is one of the foundations of the Belgian social security.
This insurance is in deficit of 634 million euros in 2004, partly because of aging and degradation of "number of contributors" / "number of beneficiaries."
The Belgian federal government in agreement with the players in the medical field looking for different solutions to this problem. The increased use of generic drugs, the effectiveness of drugs equivalent to major brand but much cheaper, for instance, to reduce drug costs (the costs of the pharmaceutical industry). The reduction of unnecessary medical examinations is another track. Others argue for regionalization of health insurance, arguing that the Flemish Walloon over-subsidize health care.
In Education and Health, it is for Canadian provinces to administer the policies and budgetary allocations in these sectors, following the division of authorities and responsibilities federal, provincial, regional and municipal levels.
In the United States, health insurance is primarily private insurers. The public authorities guarantee the care of older people (Medicare) or poor (Medicaid). According to OECD data, public spending on health per capita is $ 2364.
The number of uninsured is high, 45 million, which represents a minority (15.6%) compared to the total population of 288 million. This rate should be reconsidered: half of uninsured individuals under 35 years and the distribution of uninsured persons by age groups is that 95% of health problems affecting insured populations. In addition, two thirds of the uninsured have incomes above $ 25,000 and households with income below the poverty line represents only a fifth of the uninsured. According Bundorf and Pauly in the Journal of Health Economics, "up to three fourths of uninsured Americans could afford health insurance without breaking their budget. It is thus more non-insurance voluntary.
On the other hand, contrary to popular belief, even the uninsured have access to free health care offered by public hospitals, community health centers, hospitals, etc.
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