World Library  
Flag as Inappropriate
Email this Article

National health insurance

National health insurance (sometimes called statutory health insurance) is health insurance that insures a national population for the costs of health care and usually is instituted as a program of healthcare reform. It is enforced by law. It may be administered by the public sector, the private sector, or a combination of both. Funding mechanisms vary with the particular program and country. National or Statutory health insurance does not equate to government run or government financed health care, but is usually established by national legislation. In some countries, such as Australia's Medicare system or the UK's NHS, contributions to the NHI or SHI system are made via taxation and therefore are not optional even though use of the health scheme it finances is. In practice of course, most people paying for NHI will join the insurance scheme. Where the NHI scheme involves a choice of multiple insurance funds, the rates of contributions may vary and the person has to choose which insurance fund to belong to. In the United States, the Patient Protection and Affordable Care Act includes a "health insurance mandate" that produces a similar effect as NHI or SHI, though relies more heavily on the private market than their public sector (Medicare, Medicaid, and S-CHIP) than most countries. The US Federal government will be involved in sponsoring several multi-state insurance plans.[1]


  • History 1
  • Types of programs 2
  • National health insurance schemes 3
  • See also 4
  • References 5
  • Further reading 6
  • External links 7


Germany has the world's oldest national social health insurance system,[2] with origins dating back to Otto von Bismarck's Sickness Insurance Law of 1883.[3][4] In Britain, the National Insurance Act 1911 included national social health insurance for primary care (not specialist or hospital care), initially for about one third of the population—employed working class wage earners, but not their dependents.[5] This system of health insurance continued in force until the creation of the National Health Service in 1948 which created a universal service, funded out of general taxation rather than on an insurance basis, and providing health services to all legal residents.

Types of programs

National healthcare insurance programs differ both in how the money is collected, and in how the services are provided. In countries such as Canada, payment is made by the government directly from tax revenue. The collection is administered by government. In France a similar system of compulsory contributions is made, but the collection is administered by non-profit organisations set up for the purpose. This is known in the United States as single-payer health care. The provision of services may be through either publicly or privately owned health care providers.

An alternative funding approach is where countries implement national health insurance by legislation requiring compulsory contributions to competing insurance funds. These funds (which may be run by public bodies, private for-profit companies, or private non-profit companies), must provide a minimum standard of coverage and are not allowed to discriminate between patients by charging different rates according to age, occupation, or previous health status. To protect the interest of both patients and insurance companies, the government establishes an equalization pool to spread risks between the various funds. The government may also contribute to the equalization pool as a form of health care subsidy. This is the model used in the Netherlands.

Other countries are largely funded by contributions by employers and employees to sickness funds. With these programs, funds come from neither the government nor direct private payments. This system operates in countries such as Germany and Belgium. These funds are usually not for profit institutions run solely for the benefit of their members. Usually characterization is a matter of degree: systems are mixes of these three sources of funds (private, employer-employee contributions, and national/sub-national taxes).

In addition to direct medical costs, some national insurance plans also provide compensation for loss of work due to ill-health, or may be part of wider social insurance plans covering things such as pensions, unemployment, occupational retraining, and financial support for students.

National schemes have the advantage that the pool or pools tend to be very very large and reflective of the national population. Health care costs, which tend to be high at certain stages in life such as during pregnancy and childbirth and especially in the last few years of life can be paid into the pool over a lifetime and be higher when earnings capacity is greatest to meet costs incurred at times when earnings capacity is low or non existent. This differs from the private insurance schemes that operate in some countries which tend to price insurance year on year according to health risks such as age, family history, previous illnesses, and height/weight ratios. Thus some people tend to have to pay more for their health insurance when they are sick and/or are least able to afford it. These factors are not taken into consideration in NHI schemes. In private schemes in competitive insurance markets, these activities by insurance companies tend to act against the basic principles of insurance which is group solidarity.

National health insurance schemes

See also


  1. ^
  2. ^ Bump, Jesse B. (October 19, 2010). "The long road to universal health coverage. A century of lessons for development strategy". Seattle:  
    Carrin, Guy; James, Chris (January 2005). "Social health insurance: Key factors affecting the transition towards universal coverage". International Social Security Review 58 (1): 45–64.  
    Bärnighausen, Till; Sauerborn (May 2002). "One hundred and eighteen years of the German health insurance system: are there any lessons for middle- and low income countries?". Social Science & Medicine 54 (10): 1559–1587.  
  3. ^ Leichter, Howard M. (1979). A comparative approach to policy analysis: health care policy in four nations. Cambridge: Cambridge University Press. p. .  
  4. ^ Hennock, Ernest Peter (2007). The origin of the welfare state in England and Germany, 1850–1914: social policies compared. Cambridge: Cambridge University Press. p. .  
  5. ^ Leathard, Audrey (2000). "Health care in Britain: pre-war provision, 1900–1939". Health care provision: past, present, and into the 21st century (2nd ed.). Cheltenham: Stanley Thornes. pp. 3–4.  

Further reading

  • Nicholas Laham: Why the United States lacks a national health insurance program, Westport, Conn. [u.a.] : Greenwood Press, 1993
  • Barona, B., Plaza, B., and Hearst, N. (2001) Managed Competition for the poor or poorly managed: Lessons from the Colombian health reform experience. Oxford University Press [1]
  • Ronald L. Numbers (ed.): Compulsory Health Insurance: The Continuing American Debate, Westport, Conn. : Greenwood Press, 1982.
  • Saltman, R.B., Busse, R. and Figueras, J. (2004) Social health insurance systems in western Europe, Berkshire/New York: Open University Press/McGraw-Hill. ISBN 0-335-21363-4
  • Saltman, R.B. and Dubois, H.F.W. (2004) Individual incentive schemes in social health insurance systems, 10(2): 21-25. Full text
  • Van de Ven, W.P.M.M., Beck, K., Buchner, F. et al. (2003) Risk adjustment and risk selection on the sickness fund market in five European countries, Health Policy, 65(1=: 75-98.
  • Saltman, R.B. and Dubois, H.F.W. (2005) Current reform proposals in social health insurance countries, Eurohealth, 11(1): 10-14. Full text

External links

  • Health Care for America NOW!. An advocacy group that supports a public health insurance option for universal health care.
  • Health Care Issues & Resources Barack Obama Website
  • Health Debate Pros and Cons Family Doctor Magazine Website
This article was sourced from Creative Commons Attribution-ShareAlike License; additional terms may apply. World Heritage Encyclopedia content is assembled from numerous content providers, Open Access Publishing, and in compliance with The Fair Access to Science and Technology Research Act (FASTR), Wikimedia Foundation, Inc., Public Library of Science, The Encyclopedia of Life, Open Book Publishers (OBP), PubMed, U.S. National Library of Medicine, National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health (NIH), U.S. Department of Health & Human Services, and, which sources content from all federal, state, local, tribal, and territorial government publication portals (.gov, .mil, .edu). Funding for and content contributors is made possible from the U.S. Congress, E-Government Act of 2002.
Crowd sourced content that is contributed to World Heritage Encyclopedia is peer reviewed and edited by our editorial staff to ensure quality scholarly research articles.
By using this site, you agree to the Terms of Use and Privacy Policy. World Heritage Encyclopedia™ is a registered trademark of the World Public Library Association, a non-profit organization.

Copyright © World Library Foundation. All rights reserved. eBooks from Project Gutenberg are sponsored by the World Library Foundation,
a 501c(4) Member's Support Non-Profit Organization, and is NOT affiliated with any governmental agency or department.