National health insurance is health insurance that is provided to all members of a nation. Varied examples abound around the globe. In every instance government legislation has been required to establish national health insurance. A national insurance may be administered by the government, by the private sector or through some combination of private and government administration. The nature and extent of government involvement in funding, fee setting, determination of what health care services will be covered, eligibility for services, which providers will be covered, and administration of payment, funding and delivery of services varies across national health plans.
Funding
National health insurance is not the same as socialized medicine or government-funded insurance. National health insurance may be funded privately through insurance fees, employee and employer contributions, may be funded by the government or may be funded by some combination of private and public sources.
Payers and Providers
Payers are the institutional entities who pay health care providers for medical services. In countries with national health insurance the payers may be the government, as in the British system, or entities such as Medicare in the United States. On the other hand, payers may be private insurance companies. Providers are the medical practitioners who deliver the medical services. National health insurance may or may not require that providers work for the government.
In England there is true socialized medicine. Providers work for the government, which funds and administers the delivery of health care. British hospital doctors are paid a salary by the government, and general practitioners are paid by the government according to how many people they see. In most countries with national health insurance, however, providers work for private or nonprofit organizations. For example, in Japan and Taiwan most hospitals and medical care facilities are privately owned.
Single-Payer Systems
Canada, England and France all have single-payer health care programs. The sources of funding vary. In Canada money to pay for health care is collected solely through taxation by the government. In England the government assesses taxes and also collects fees from employees and employers based on salary levels. In France, a nonprofit organization administers health care, using income from taxes and employee/employer fees to pay for costs. Despite the differences in funding sources across these programs, the providers all bill a single payer. Advocates of single-payer systems argue that it enhances the bargaining power of the single payer for negotiating prices on health supplies and medicines, minimizes the high profits associated with privatized insurance and reduces overhead by standardizing and reducing administration costs.
Social Insurance
Germany, Japan and Switzerland have "social insurance" programs wherein everybody is required to have insurance. The health care costs are chiefly paid for through fees that are collected from employers and employees. These moneys are placed into general funds that are used to pay for health care benefits. The government provides subsidies to the poor or unemployed. Social insurance programs have a set fee per person regardless of their age, gender or health status. In Germany people can choose from among more than 200 private, nonprofit "sickness" funds that vary in their terms and benefits. Fund administrators will act as gatekeepers to set certain limits on use of health care providers and services. In Japan, on the other hand, there are no gatekeepers. People can go to any specialist, as often as they like.
Taiwan's National Health Insurance
Taiwan developed a national health insurance program in 1995 after evaluating other countries' health care systems. Insurance is mandated of everyone. There is only one government-administered insurance. People with jobs pay premiums that their employers also contribute to. Others pay flat rates but receive government subsidies, while veterans and the poor are fully subsidized. Taiwan's national insurance is similar to Canada's and to the U.S. Medicare program.
Advantages of National Health Insurance
Advocates for national health insurance suggest that when compared to the United State's privatized health insurance system, First World nations with national health insurance programs consistently spend less on health care and have better health care outcomes. For example, the second-most expensive health care system in the world, Switzerland, spends 11.6 percent of its gross domestic product (GDP) on health care compared to the U.S., which spends 15.3 percent of GDP on health care. The United States ranks behind all First World nations with national health insurance programs in terms of objective outcomes such as percentage of population covered by insurance, infant mortality and life expectancy.
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