International Profiles of Health Care Systems

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International Profiles of Health Care Systems EDITED BY Elias Mossialos and Ana Djordjevic London School of Economics and Political Science MAY 2017 MAY Robin Osborn and Dana Sarnak The Commonwealth Fund International Profiles of Health Care Systems Australia, Canada, China, Denmark, England, France, Germany, India, Israel, Italy, Japan, the Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, Taiwan, and the United States THE COMMONWEALTH FUND is a private foundation that promotes a high performance health care system providing better access, improved quality, and greater efficiency. The Fund’s work focuses particularly on society’s most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults. The Fund carries out this mandate by supporting independent research on health care issues and making grants to improve health care practice and policy. An international program in health policy is designed to stimulate innovative policies and practices in the United States and other industrialized countries. MAY 2017 International Profiles of Health Care Systems Australia EDITED BY Canada Elias Mossialos and Ana Djordjevic London School of Economics and Political Science China Denmark Robin Osborn and Dana Sarnak The Commonwealth Fund England France To learn more about new publications when they become available, Germany visit the Fund’s website and register to receive email alerts. India Israel Italy Japan The Netherlands New Zealand Norway Singapore Sweden Switzerland Taiwan United States CONTENTS Table 1. Health Care System Financing and Coverage in 19 Countries . 6 Table 2. Selected Health Care System Indicators for 18 Countries . 7 Table 3. Selected Health System Performance Indicators for 17 Countries. 8 Table 4. Provider Organization and Payment in 19 Countries . 9 The Australian Health Care System . .11 The Canadian Health Care System. 21 The Chinese Health Care System . .31 The Danish Health Care System . .39 The English Health Care System . 49 The French Health Care System . 59 The German Health Care System. 69 The Indian Health Care System. 77 The Israeli Health Care System . 85 The Italian Health Care System . 95 The Japanese Health Care System . 105 The Dutch Health Care System . 113 The New Zealand Health Care System. 121 The Norwegian Health Care System . 129 The Singaporean Health Care System. 139 The Swedish Health Care System . 147 The Swiss Health Care System . 155 The Taiwanese Health Care System . 163 The U.S. Health Care System. 173 Table 1. Health Care System Financing and Coverage in 19 Countries Health System and Public/Private Insurance Role Benefit Design Private insurance role (core benefits; cost-sharing; noncovered ben- Government role Public system financing efits; private facilities or amenities; substitute for public insurance) Caps on cost-sharinga Exemptions and low-income protectiona Australia Regionally administered, joint (national & state) public hospital funding; universal General tax revenue; earmarked income tax ~47% buy complementary (e.g., private hospital and dental care, optom- Caps for pharmaceutical out-of-pocket expenditure Low-income and older people: Lower cost-sharing; lower public medical insurance program (Medicare) etry) and supplementary coverage (increased choice, faster access for only, dependent on income and total out-of-pocket pharmaceutical out-of-pocket cap and lower out-of-pocket nonemergency services, rebates for selected services) expenditure in the same year maximum for 80% Medicare services rebate Canada Regionally administered universal public insurance program that plans and funds Provincial/federal general tax revenue ~67% buy complementary coverage for noncovered benefits (e.g., private No There is no cost-sharing for publicly covered services; protec- (mainly private) provision rooms in hospitals, drugs, dental care, optometry) tion for low-income people from cost of prescription drugs varies by region China Supervision by health authorities (Health and Family Planning Commissions) There are three main publicly financed health insurance types Complementary to cover cost-sharing and gaps, as well as better health No Government subsidies to low-income families for insurance at the national, provincial and local levels; some direct provision through public with local-area risk pooling: urban employer-based (mainly pay- care quality and/or higher reimbursements; no data on coverage, but contributions and out-of-pocket costs; emergency assistance ownership of hospitals roll taxes, for formally employed urban residents), urban resident growth has been rapid by local governments for specific diseases and unpaid emer- basic (mainly government-funded, for urban nonemployed gency department or other expenses residents), and rural cooperative medical scheme (government- funded, for rural residents) Denmark National health care system; regulation, central planning, and funding by Earmarked income tax ~39% have complementary coverage (cost-sharing, noncovered benefits No; decreasing copayments with higher drug out-of- Drug out-of-pocket cap for chronically ill (DKK3,775 [USD498]); national government; provision by regional and municipal authorities such as physiotherapy), ~26% have supplementary coverage (access to pocket spending financial assistance for low-income and terminally ill private providers) England National Health Service (NHS) General tax revenue (includes employment-related insurance ~11% buy supplementary coverage for more rapid and convenient access No general cap, but out-of-pocket payments almost Drug cost-sharing exemption for low-income, older people, contributions) (including to elective treatment in private hospitals) exclusively apply to prescription drugs and medical children, pregnant women and new mothers, and some appliances only; for drugs, prepayment certificate with disabled/chronically ill; financial assistance with transport GBP29.10 [USD41.10] per three months or GBP104 costs available to people with low incomes; vision tests free for [USD147] per year ceiling for those needing young people, older people, and low-income people a large number of prescription drugs France Statutory health insurance system, with all SHI insurers incorporated into Employer/employee earmarked income and payroll tax; general ~95% buy or receive government vouchers for complementary No; EUR50 [USD60] cap on deductibles for Exemption for low income, chronically ill and disabled, a single national exchange tax revenue, earmarked taxes coverage (mainly cost-sharing, some noncovered benefits); limited consultations and services and children supplementary insurance Germany Statutory health insurance system, with 118 competing SHI insurers (“sickness Employer/employee earmarked payroll tax; general tax revenue ~11% opt out from statutory insurance and buy substitutive coverage; Yes; 2% of household income; 1% of income for Children and adolescents <18 years of age exempt funds” in a national exchange); high income can opt out for private coverage some complementary (minor benefit exclusions from statutory scheme, chronically ill copayments) and supplementary coverage (improved amenities) India Financing, legislation, and regulation by central government; financing, General tax revenue Limited role (<4% of total expenditure) providing substitutive coverage for No; significant reliance on out-of-pocket payments Various government-financed health insurance schemes for regulation, and direct provision of services by state governments the upper-class urban population (~70% of total health expenditure) poor and vulnerable population groups to improve access to hospitalization and reduce out-of-pocket payments Israel National health insurance (NHI) system with four competing, nonprofit health Earmarked income-related tax and general government revenues Complementary (for benefits such as dental care, drugs, or long-term care) Not overall; caps on out-of-pocket costs for drugs Quarterly out-of-pocket caps for drugs for the chronically plans; government distributes the NHI budget among the health plans primarily and supplementary coverage (for quicker access and superior service) pro- (chronically ill only) and specialist visits (at house- ill and age-, income-, and health status-related discounts; through capitation vided by two types of voluntary health insurance: VHI offered by statutory hold level) copayment exemptions for holocaust survivors; age-, income-, health plans (HP-VHI) (~87% of adult population coverage); commercial disability-, and health status-related exemptions on copay- VHI (C-VHI) (~53% coverage); C-VHI tend to be more comprehensive and ments for specialist consultations; reduced health tax more expensive (3% instead of 5%) for people on low incomes Italy National health care system; funding and definition of minimum benefit pack- National earmarked corporate and value-added taxes; general tax Patients buy complementary (services excluded from statutory benefits) No; max EUR46.15 [USD61] copayment per outpa- Exemptions for low-income older people/children, pregnant age by national government; planning, regulation, and provision by regional revenue and regional tax revenue or supplementary coverage (more amenities in hospitals, wider provider tient specialist consultation or diagnostic procedure; women, chronic conditions/disabilities, rare diseases governments choice); around 5.5% buy individual VHI coverage (1.33 million families), limited copayment (regional rates) on drugs while around 2.5 million people have group coverage Japan
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