Information about Universal Health Care

Universal health care is a situation in which all residents of a geographic or political region have access to most types of health care regardless of ability to pay.

Universal health care is provided in most developed countries, and many developing countries across the globe. In the 1880s, most Germans became covered under the mandatory health care system championed by Bismarck. The National Health Service in the United Kingdom was the world's first universal health care system provided by government. It was established in 1948. The most comprehensive today is in France, and the second most is in Italy. Other examples are Medicare in Australia, established in the 1970s, and by the same name Medicare in Canada, established between 1966 and 1984. Universal health care contrasts to the systems like health care in the United States or South Africa, though South Africa is one of the many countries attempting health care reform.^[1]

Some government health care systems allow private practitioners to provide services, and some do not. In the U.K., doctors are allowed to provide services outside the government system; in Canada, some services are permitted and some are not.

Implementation

Main article: Health care systems

Universal health care is a broad concept and has been implemented in several ways. The common denominator for them all is that every resident of a geographic area — such as a country — is mandated to have guaranteed health care access at reasonable cost.

Most countries implement universal health care through legislation and taxation. Legislation directs what care must be provided, to whom, and on what basis. Usually some costs are borne by the patient but are heavily subsidised by direct taxation and compensated to the patient to some extent either directly by the government or by some form of compulsory insurance.^[2]

Europe

Most of Europe has publicly sponsored and regulated health care. Countries include Austria, Belgium, Bosnia, Bulgaria, Croatia, Czech Republic, Denmark, Finland, Estonia, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Malta, the Netherlands, Norway, Lichtenstein, Luxembourg, Poland, Portugal,^[3] Romania, Russia, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland and the United Kingdom.^[4]

United Kingdom

Main article: National Health Service

The NHS is the world's largest centralized health service, and the world's third largest employer after the Chinese army and the Indian railways. It provides a very wide range of health services to virtually the entire population. Unlike most health systems, it does not bill its services to either its patients, an insurance fund or to the government. Even in-patient medicines, hospital supplies such as bandages and hip joints, as well hospital supplied meals and refreshments all are free to in-patients, and even outpatients receive free loans of medical aids such as crutches. This is a factor which reduces administration costs considerably over insurance based systems. It is entirely funded from general taxation. It was created in the aftermath of World War II, by Clement Attlee's Labour government, based on the proposals of the Beveridge Report, prepared in 1942.^[5] The structure of the NHS in England and Wales was established by the National Health Service Act 1946 (1946 Act). Governments since 1997 have spent more money on the NHS and UK spending on health is now closer to (but still below) the European average. The new money has reduced waiting times and modernised the infrastructure, and has improved the salaries of medical staff. The outsourcing of medical services and support to the private sector is a recent innovation. Hospitals may have both medical services (such as "surgicentres"),^[6] and non-medical services (such as catering) provided under long-term contracts by the private sector. Capital projects such as new hospitals have been privatized through the Private Finance Initiative, enabling the public sector borrowing requirement to be reduced.

See also Health care in the United Kingdom.

Americas

Argentina, Brazil, Costa Rica, Canada, Chile, Cuba and Uruguay all have public health care provided. Mexico is planning to launch its own universal health care network.^[7]

The United States is one of the few industrialized nations lacking universal health care. In the absence of a national program, more localized efforts are under way. Both Massachusetts^[8] and San Francisco^[9] have recently undertaken programs to achieve universal health care coverage within their jurisdictions.

Canada

In 1984, the Canada Health Act was passed, which prohibited user fees and extra billing by doctors. In 1999, the prime minister and most premiers reaffirmed in the Social Union Framework Agreement that they are committed to health care that has "comprehensiveness, universality, portability, public administration and accessibility."^[10]

The Canadian system is for the most part publicly funded, yet most of the services are provided by private enterprises or private corporations. Most doctors do not receive an annual salary, but receive a fee per visit or service. About 30% of Canadians' health care is paid for by the private sector or individuals. This mostly goes towards services not covered or only partially covered by Medicare such as prescription drugs, dentistry and optometry. Many Canadians have private health insurance, often through their employers, that cover these expenses.

The Supreme Court of Quebec ruled, in Chaoulli v. Quebec, that private services must be allowed to compete with the public program.^[11]

Asia and Africa

Australia, Brunei, India, Israel ^[12] Japan, Malaysia, New Zealand, Saudi Arabia, South Korea, Seychelles, Sri Lanka^[13], Taiwan^[14] and Thailand have universal health care.

Thailand

Thailand introduced universal coverage reforms in 2001, becoming one of only a handful of lower-middle income countries to achieve this. Means-tested health care for the poor was replaced by a new more comprehensive insurance scheme - originally known as the 30 baht project, in line with the small co-payment charged for treatment. People joining the scheme receive a gold card which allows them to access services in their health district, and - if necessary - to be referred for specialist treatment elsewhere. The Thai system is relatively unusual in having a single, central purchasing agency - the National Health Security Office - which channels funds to a large number of contracting units for primary care (CUPs) that co-ordinate services in local districts. The bulk of finance comes from public revenues, with funding allocated to CUPs annually on a population basis. All public hospitals and some private hospitals participate in the scheme. Although the reforms have received a good deal of critical comment, they have proved popular with poorer Thais, especially in rural areas, and appear likely to survive even after the 2006 military coup. The current Public Health Minister, Mongkol Na Songkhla, recently announced his intention to abolish the 30 baht co-payment and make the UC scheme free. ^[15][16][17]

India

India has partial universal health care system run by the local governments. The "government hospitals", some of which are among the best hospitals in India^[18], provide treatment free of cost, or at a nominal cost. Selected drugs are offered free of charge in some hospitals.

Oceania

Australia

Main article: Medicare (Australia)

Medicare was introduced by the Whitlam Labor Government on 1 July 1975 through the Health Insurance Act 1973. The Australian Senate rejected the changes multiple times and they were passed only after a joint sitting after the 1974 double dissolution election. Yet Medicare has been supported by subsequent governments and became a key feature of Australia’s public policy landscape. The exact structure of Medicare, in terms of the size of the rebate to doctors and hospitals and the way it has administered, has varied over the years. The original Medicare program proposed a 1.35% levy (with low income exemptions) but these bills were rejected by the Senate, and so Medicare was originally funded from general taxation. In October 1976, the Fraser Government introduced a 2.5% levy. The program is now nominally funded by an income tax surcharge known as the Medicare levy, which is currently set at 1.5% with exemptions for low income earners. In practice the levy raises only a fraction of the money required to pay for the scheme. If the levy was to fully pay for the services provided under the medicare banner then it would need to be set at about 8%. There is an additional levy of 1.0%, known as the Medicare Levy Surcharge, for those on high annual incomes ($50,000) who do not have adequate levels of private hospital coverage. This is part of an effort by the current Coalition Federal Government to encourage people towards private health insurance.

New Zealand

As with Australia, New Zealand's healthcare system is funded through general taxation.

Economics

Main article: Health care economics

Funding models

Universal health care in most countries has been achieved by a mixed model of funding, based on elements of compulsory safety net insurance for all (which may be levied on the individual and/or an employer), with special protections for the poor and disadvantaged (funded by taxation) with the option of private payments (either direct or via optional insurance) for services beyond that covered by the safety net.

Compulsory insurance

This is usually enforced via legislation. Sometimes there may be a choice of several funds providing a basic service (e.g. as in Germany) or sometimes just a single fund (as in Canada).

Taxation

Some countries (notably the UK) effectively have stripped away the pretence that there is insurance for the safety net and choose to fund health care directly from taxation.

Other countries with insurance-based systems effectively meet the cost of insuring those unable to insure themselves via social security arrangements funded from taxation.

Single-payer

This term is used in the U.S. debate to describe a funding mechanism meeting the costs of medical care from a single fund. Although the fund holder is sometimes assumed to be the government allocating funding from taxation, its proponents do not rule out the possibility of some other mechanism. It is therefore as yet undetermined whether a future U.S. single-payer universal health care system would be funded from taxation, from compulsory insurance or a mixture of both.

Private insurance

Private insurance is most often used to meet what the core safety net services do not provide. E.g. cosmetic surgery for reasons of vanity, for special comforts like private rooms, or to obtain service more quickly than is otherwise possible.

Medical (health) insurance is subject to the well-known economic problem of adverse selection which may also be referred to as a market failure. Adverse selection in insurance markets occurs because those providing insurance have limited information with which to estimate the risks their clients wish to insure against. In simple terms, those with poor health will apply for insurance, raising the cost of providing insurance; those with good health will find the cost of insurance too expensive, raising costs further. In practical terms, adverse selection means that private insurers are economically incentivized to spend substantial sums on 'weeding out' bad risks in advance by providing medical insurance only to the most healthy. Among the potential solutions posited by economists are forms of universal health insurance, such as requiring all citizens to purchase insurance, limiting the ability of insurance companies to deny insurance to individuals or vary price between individuals. Compulsory universal health insurance is a common thread, be it through single payer systems or by requiring individuals to have private health insurance.^{[19] [20]}

Financial inputs and outcomes compared

The table below gives some indications of financial inputs and medical in a number of different countries, some of which have universal coverage and some of which do not. Interpreting data of this kind can be difficult because of other factors (e.g. genetic differences, diet) that are not controlled for.

Country	Life expectancy	Infant mortality rate	Physicians per 1000 people	Nurses per 1000 people	Per capita expenditure on health (USD)	Healthcare costs as a percent of GDP	% of government revenue spent on health	% of health costs paid by government
Australia	80.5	5.0	2.47	9.71	2,519	9.5	17.7	67.5
Canada	80.5	5.0	2.14	9.95	2,669	9.9	16.7	69.9
France	79.5	4.0	3.37	7.24	2,981	10.1	14.2	76.3
Germany	80.0	4.0	3.37	9.72	3,204	11.1	17.6	78.2
Japan	82.5	3.0	1.98	7.79	2,662	7.9	16.8	81.0
Sweden	80.5	3.0	3.28	10.24	3,149	9.4	13.6	85.2
UK	79.5	5.0	2.30	12.12	2,428	8.0	15.8	85.7
USA	77.5	6.0	2.56	9.37	5,711	15.2	18.5	44.6

Most all European systems are financed through a mix of public and private contributions.^[21] The majority of universal health care systems are funded primarily by tax revenue (e.g. Portugal^[21]). Some nations, such as Germany, France^[1] and Japan^[23] employ a multi-payer system in which health care is funded by private and public contributions. In 2001 Canadians paid $2,163 per capita versus $4,887 U.S., according to the Los Angeles Times (also, see table above). According to Dr. Stephen Bezruchka, a senior lecturer in the School of Public Health at the University of Washington in Seattle, Canadians do better by every health care measure. According to a World Health Organization report published in 2003, life expectancy at birth in Canada is 79.8 years, versus 77.3 in the U.S^[24].

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, speciality healthcare is provided and possibly funded by a larger entity, such as a municipal co-operation board or the state, and the medications are paid by a state agency. One advantage of tying health care to local budgets is that that health care improvements and cost savings can be obtained by cross subsidy. For instance in Finland, type II diabetes patients can get discounted access to municipal owned sports facilities such as gyms and swimming pools, the discounts being rewarded to the community in the longer term because fitter patients will not need more expensive medical or personal care later in life. No entirely private health care system exists, although the reform bill in Massachusetts attempts to make private health care more affordable. Bill Frist argued in the New England Journal of Medicine that the free market will keep costs down, because individuals who have to pay for their own health care will make wiser decisions and not spend money on unneeded or inefficient care. A deregulated free market, Frist argues, will also encourage efficiency and innovation.

Politics

Main article: Health care politics

Because most developed and many developing countries already have systems for universal health care that have been in place for many years, universal health care per se is not a matter of political debate. The exception is the United States, which does not have such a system currently and where health care is currently a hot political issue.

Within the U.S., those in favor of implementing universal health care, such as the advocacy group, Physicians for a National Health Program, argue that it would provide health care to the people who currently do not have it. Opponents of universal health care argue that universal health care will require higher taxes and a great likelihood of poorly performing healthcare facilities and physicians. ^[25] Opponents also claim that the absence of a market mechanism may slow innovation in treatment and research, and lead to rationing of care through waiting lists.^[26] Both sides of the political spectrum have also looked to more philosophical arguments, debating whether people have a fundamental right to have health care provided to them by their government.

A statistical comparison shows that it is not universal health care that leads to a doctor shortage, but the payment system to doctors that causes a doctors shortage. A 2001 study showed that doctors in Italy,^[27] are paid a fee per patient per year, a per capita salary, without causing a doctor shortage; even maintaining the highest doctor per patient ratio seen at, 5.8 doctors per 1,000 patients. Canada has a doctor per patient ration of 2.1 doctors per 1,000 patients, compared to the UK with 1.8 and the US with 2.7.

In Canada, the self regulation of the health industry by the doctors union, the Canadian Medical Association, and its self-regulatory wing, College of Physicians and Surgeons of Ontario ^[28] are not required to respond publicly to complaints against doctors unless disciplinary action was given, leading to cases where doctors have been taken to court multiple times for similar actions^[29]

United States

Main article: Health care in the United States

Insert the text of the quote here, without quotation marks.

The United States does not have a universal health care system but does have certain publicly funded health care programs help to provide for the elderly, disabled, military service families and veterans, and the poor^[30] and federal law ensures public access to emergency services regardless of ability to pay.^[31] The Commonwealth of Massachusetts is attempting to implement a near-universal health care system by mandating that residents purchase health insurance by July 1, 2007.^[32] California, Maine, Pennsylvania, and Vermont also are attempting universal systems.^[33] In addition, certain types of medical spending and particularly health insurance benefit from significant tax subsidies; in particular, employer-sponsored health insurance is a non-taxable benefit. In all, government spending (including tax benefits) accounts for more than 44.6% of total health spending in the U.S.^[34]

Proponents of implementing a universal health care system in the United States argue that there are many flaws in the reasoning used against having such a system. Proponents cite the low life expectancy of American citizens compared to other industrialized nations, including those with national healthcare systems, such as Australia, the United Kingdom, Canada, and Sweden.^[35] Infant mortality rates remain higher in the United States, despite declines in recent decades, and are higher than the average of the European Union. [https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html -see table]^[36]

In turn, critics note that there is very little correlation between life expectancy and infant mortality with the quality of health care, due to such factors as alternate causality and variations in the way countries collect their statistical data.^[37] In fact, the United States led the world in life expectancy twenty years ago with virtually the same health system. Rather, many analysts attribute the lower life expectancy to the astronomical surge in obesity rates.^[38][39][40]

Current estimates put U.S. health care spending at approximately 15% of GDP, the highest in the world.^[41] Despite this, only an estimated 84.2% of citizens have some form of health insurance coverage, either through their employer, purchased individually, or through government sources.^[42] In 2003, approximately 61 million adults, or 35 percent of individuals ages 19 to 64, had either no insurance, sporadic coverage, or insurance coverage that exposed them to high health care costs.^[43] Employers that do provide insurance, on average, spend between 4.6 and 8.7% of their payroll in health insurance premiums. The cost of health care premiums is rising much faster than the general rate of inflation or employee wages. Since 2001, premiums for family coverage have increased 78%, while inflation has risen 17% and wages have risen 19%, according to a 2007 study by the Kaiser Family Foundation.^[44]

Debate

See also

(In alphabetical order)

• California Speaks
• Health care
• Health care systems
• Health savings account
• Journal of Health Care for the Poor and Underserved
• Massachusetts 2006 Health Reform Statute
• Medical savings account
• Medicare (United States)
• Physicians for a National Health Program
• Publicly-funded health care
• Sicko (film)
• Socialized medicine
• The Citadel
• Two-tier health care

References

External links

(In alphabetical order)

Support

• American Medical Student Association (AMSA) - Statement supporting universal health care
• California OneCareNow Campaign
• Connecticut Coalition for Universal Health Care
• Health Care for All—California
• Physicians for a National Health Program
• Sicko - Official site
• Universal Health Care Action Network (UHCAN)
• Universal Health Care / National Health Insurance

Oppose

• British, Canadian Experience Shows Folly of Socialized Medicine, Analyst Says. Press release, Heritage Foundation. Sept. 29, 2000.
• Capitalism Magazine
• Dead Meat On The Fence's short film about Canada's socialized healthcare system.
• The Heartland Institutes' Health Care Issue Suite
• The Problems with Socialized Health Care from Mark Valenti's Liberty Page

Neutral

• BalancedPolitics.org - "Should the Government Provide Free Universal Health Care for All Americans?"
• Hidden costs, value lost: uninsurance in America. Institute of Medicine Committee on the Consequences of Uninsurance. Washington, DC: National Academies Press, 2003.