Publicly-funded health care
Overview
 
Publicly funded health care is a form of health care financing designed to meet the cost of all or most health care needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population contributing to the fund or receiving benefits from it. The fund may be a not-for-profit trust which pays out for health care according to common rules established by the members or by some other democratic form.
Encyclopedia
Publicly funded health care is a form of health care financing designed to meet the cost of all or most health care needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population contributing to the fund or receiving benefits from it. The fund may be a not-for-profit trust which pays out for health care according to common rules established by the members or by some other democratic form. In some countries the fund is controlled directly by the government or by an agency of the government for the benefit of the entire population. This distinguishes it from other forms of private medical insurance, the rights of access to which are subject to contractual obligations between an insurer (or his sponsor) and an insurance company which seeks to make a profit by managing the flow of funds between funders and providers of health care services.

Financing

Publicly funded health care systems are usually financed in one of two ways: through taxation or via compulsory national health insurance
National health insurance
National 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...

. In compulsory insurance models, healthcare is financed from some combination of employees' salary deductions, employers' contributions, and possibly additional state funds. Insurance may cover other benefits as well as health.

When taxation is the primary means of financing health care, and sometimes with compulsory insurance, all eligible people receive the same level of cover regardless of their financial circumstances or risk factors.

Increasing costs

As medical science advances more treatments, many increasingly expensive, become available, which increases health costs both for public and private systems. Advances in medicine, amongst other factors, increase life expectancy
Life expectancy
Life expectancy is the expected number of years of life remaining at a given age. It is denoted by ex, which means the average number of subsequent years of life for someone now aged x, according to a particular mortality experience...

, leading to population aging; the proportion of the population who are working and pay tax or compulsory insurance, rather than retired, decreases at the same time as healthcare per capita becomes more expensive to provide.

Varieties of public systems

Most developed countries, with the exception of the United States, have partially or fully publicly-funded health systems. For example, the United Kingdom has a National Health Service
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...

 (NHS). Other examples would be the Medicare systems in Canada
Medicare (Canada)
Medicare is the unofficial name for Canada's publicly funded universal health insurance system. The formal terminology for the insurance system is provided by the Canada Health Act and the health insurance legislation of the individual provinces and territories.Under the terms of the Canada Health...

 and in Australia
Medicare (Australia)
Medicare is Australia's publicly funded universal health care system, operated by the government authority Medicare Australia. Medicare is intended to provide affordable treatment by doctors and in public hospitals for all resident citizens and permanent residents except for those on Norfolk Island...

. In Europe, a system of social insurance
Social insurance
Social insurance is any government-sponsored program with the following four characteristics:* the benefits, eligibility requirements and other aspects of the program are defined by statute;...

 based on the principle of social solidarity covers eligible people from bearing the direct burden of most health care expenditure, funded by taxation during their working life.

Among countries with significant public funding of health care there are many different approaches to the funding and provision of medical services. Systems may be funded from general government revenues (as in Canada), or through a government social security system (as in France, Belgium, Japan and Germany) with a separate budget and hypothecated
Hypothecation (taxation)
The hypothecation of a tax is the dedication of the revenue from a specific tax for a particular expenditure purpose. Hypothecation is the pledging of assets....

 taxes or contributions. The proportion of the cost of care covered also differs: in Canada, all hospital care is paid for by the government, while in Japan patients must pay 10 to 30% of the cost of a hospital stay. Services provided by public systems vary. For example, the Belgian government pays the bulk of the fees for dental and eye care, while the Australian government covers eye care, but not dental care.

Publicly funded medicine may be administered and provided by the government, as in the United Kingdom ; in some systems, though, medicine is publicly funded but most hospital providers are private entities, as in Canada. The organization providing public health insurance is not necessarily a public administration, and its budget may be isolated from the main state budget. Some systems do not provide universal healthcare, or restrict coverage to public health facilities. Some countries, such as Germany, have multiple public insurance organizations linked by a common legal framework. Some, such as Holland, allow private for-profit insurers to participate.

Two-tier health care

Almost every major country that has a publicly funded health care system also has a parallel private system for patients who hold private medical insurance or themselves pay for treatment. In these states those able to pay have access to treatment and comforts that may not be available to those dependent upon the state system.

From the inception of the NHS model (1948), public hospitals in the United Kingdom have included "amenity beds" which would typically be siderooms fitted more comfortably, and private wards in some hospitals where for a fee more amenities are provided. Patients using these beds are in an NHS hospital for surgical treatment, and operations are generally carried out in the same operating theatres as NHS work and by the same personnel but the hospital and the physician will receive funding from an insurance company or the patient. These amenity beds do not exist in all publicly funded systems, such as in Spain. From time to time the NHS pays for private hospitals (arranged hospitals) to take on surgical cases under contract.

Policy discussion

Many countries are seeking the right balance of public and private insurance, public subsidies, and out-of-pocket payments.

Many OECD countries have implemented reforms to achieve policy goals of ensuring access to health-care, improving the quality of health care and health outcomes, allocating an
appropriate level of public sector other resources to health care, whilst at the same time ensuring that services are provided in a cost-efficient and cost-effective manner (microeconomic
efficiency). A range of measures, such as better payment methods, have improved the microeconomic incentives facing providers. However, introducing improved incentives through a more competitive environment among providers and insurers has proved difficult.

A 2009 Harvard study published in the American Journal of Public Health found more than 44,800 excess deaths annually in the United States due to Americans' lacking health insurance, equivalent to one excess death every 12 minutes. More broadly, the total number of people in the United States, whether insured or uninsured, who die because of lack of medical care was estimated in a 1997 analysis to be nearly 100,000 per year.

See also

  • Health care compared for varying degrees of public funding
  • National health insurance
    National health insurance
    National 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...

  • Public opinion on health care reform in the United States
    Public opinion on health care reform in the United States
    Public opinion on health care reform in the United States is mixed. Many Americans express a desire for health care reform because they see health care as too expensive and because they perceive that insurance companies avoid meeting health costs through coverage exclusions, caps, and co-pays...

  • Single-payer health care
    Single-payer health care
    Single-payer health care is medical care funded from a single insurance pool, run by the state. Under a single-payer system, universal health care for an entire population can be financed from a pool to which many parties employees, employers, and the state have contributed...

  • Socialized medicine
    Socialized medicine
    Socialized medicine is a term used to describe a system for providing medical and hospital care for all at a nominal cost by means of government regulation of health services and subsidies derived from taxation. It is used primarily and usually pejoratively in United States political debates...

  • Social insurance
    Social insurance
    Social insurance is any government-sponsored program with the following four characteristics:* the benefits, eligibility requirements and other aspects of the program are defined by statute;...

  • Universal health care
    Universal health care
    Universal health care is a term referring to organized health care systems built around the principle of universal coverage for all members of society, combining mechanisms for health financing and service provision.-History:...


Further reading

The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
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