A universal health care or universal health coverage (UHC) system is a healthcare system in which all citizens of a country have some level of health coverage.
While often confused with single-payer healthcare (in which the government provides health coverage for all citizens), universal health coverage can be achieved through many different models, and only 13 of the OECD's 34 countries used single-payer models as of 2013. Countries may achieve coverage through the Beveridge model (as in the United Kingdom), in which the government provides healthcare directly; through a single public insurer contracting with private healthcare providers (as in Canada); through mandatory social insurance provided by non-governmental organizations (as in Germany); or through mandatory private insurance provided by for-profit companies (as in the Netherlands and Switzerland). Systems also differ substantially in which services are covered and what share of costs patients pay.
The World Health Organization describes universal healthcare as a situation where citizens can access health services without incurring financial hardship, and Sustainable Development Goal 3 includes universal health coverage.
History
Universal health care start dateForeign Countries with Universal Health Care. By New York State Department of Health.CountryYear197520231975196719571945197019881958196620091980197319721974194119831993199020141977199519781961195019731980s1966193819561979191820191993197219881986195519941995200319711948
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. This social health insurance model, named the Bismarck Model after Prussian Chancellor Otto von Bismarck, was the first form of universal care in modern times.
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 Bolsheviks established the world's first fully free and universal health care system in Soviet Russia in July 1918. The system was highly centralized, and while nominally any person regardless of his status was covered, the actual coverage, especially in the more remote and impoverished areas was virtually non-existent.
In New Zealand, a universal health care system was created in a series of steps, from 1938 to 1941. In Australia, the state of Queensland introduced a free public hospital system in 1946.
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), Iceland (1956), Norway (1956), Denmark (1961) and Finland (1964). Universal health insurance was introduced in Japan in 1961, and in Canada through stages, starting with the province of Saskatchewan in 1962, followed by the rest of Canada from 1968 to 1972. A public healthcare system was introduced in Egypt following the Egyptian revolution of 1952. Centralized public healthcare systems were set up in the Eastern bloc countries. The Soviet Union extended universal health care to its rural residents in 1969. Kuwait and Bahrain introduced their universal healthcare systems in 1950 and 1957 respectively (prior to independence). Italy introduced its Servizio Sanitario Nazionale (National Health Service) in 1978. Universal health insurance was implemented in Australia in 1975 with the Medibank, which led to universal coverage under the current Medicare system from 1984.
From the 1970s to the 2000s, 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. Single payer healthcare systems were introduced in Finland (1972), Portugal (1979), Cyprus (1980), Spain (1986) and Iceland (1990). Switzerland introduced a universal healthcare system based on an insurance mandate in 1994. In addition, universal health coverage was introduced in some Asian countries, including Malaysia (1980s),Savedoff, W and Smith, A. Achieving Universal Health Coverage: Learning from Chile, Japan, Malaysia and Sweden. Working paper of the Results for Development Institute, 2011. South Korea (1989), Taiwan (1995), Singapore (1993), Israel (1995) and Thailand (2001).
Following the collapse of the Soviet Union, Russia retained and reformed its universal health care system, as did other now-independent former Soviet republics 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 and Brazil's SUS which improved coverage up to 80% of the population. Taiwan implemented its system in 1995. India introduced a tax-payer funded decentralised universal healthcare system as well as comprehensive public and private health insurances that helped reduce mortality rates drastically and improved healthcare infrastructure across the country dramatically. A 2012 study examined progress being made by these countries, focusing on nine in particular: Ghana, Rwanda, Nigeria, Mali, Kenya, Indonesia, the Philippines and Vietnam.
Currently, most industrialized countries and many developing countries operate some form of publicly funded health care with universal coverage as the goal. According to the National Academy of Medicine and others, the United States is the only wealthy, industrialized nation that does not provide universal health care. The only forms of government-provided healthcare available are Medicare (for elderly patients above age 65 as well as people with disabilities), Medicaid (for low-income people),Insuring America's Health: Principles and Recommendations , Institute of Medicine at the National Academies of Science, 2004-01-14, accessed 2007-10-22 the Children's Health Insurance Program (for children in families of modest income, but too high to qualify for Medicaid), the Military Health System (active, reserve, and retired military personnel and dependants), and the Indian Health Service (members of federally recognized Native American tribes).
Funding models
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 charge (which may be charged to the individual 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. Most universal health care systems are funded primarily by tax revenue (as in Portugal, India, Spain, Denmark and Sweden). Some nations, such as Germany, France, and Japan, employ a multi-payer system in which health care is funded by private and public contributions. However, much of the non-government funding comes from contributions from 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, specialty healthcare is provided and possibly funded by a larger entity, such as a municipal co-operation board or the state, and medications are paid for by a state agency. Universal health care financing can range from premiums to taxes and fees which increase with income. Universal health care systems can have redistributive effects.
Compulsory insurance
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. Healthcare in Switzerland is based on compulsory insurance.
In some European countries where 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 in eliminating 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.
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 much less expensive 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, withdrew from the Irish market.
In Poland, people are obliged to pay a percentage of the average monthly wage to the state, even if they are covered by private insurance. People working under a employment contract pay a percentage of their wage, while entrepreneurs pay a fixed rate, based on the average national wage. Unemployed people are insured by the labor office.
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 by limiting the ability of insurance companies to deny insurance to individuals or vary price between individuals.
Private insurance
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.