National health insurance

National health insurance (NHI) – sometimes called statutory health insurance (SHI) – is a system of health insurance that insures a national population against the costs of health care. It may be administered by the public sector, the private sector, or a combination of both. Funding mechanisms vary with the particular program and country. National or Statutory health insurance does not equate to government-run or government-financed health care, but is usually established by national legislation. In some countries, such as Australia's Medicare system, the UK's National Health Service, and the South Korea’s National Health Insurance Corporation contributions to the system are made via general taxation and therefore are not optional even though use of the health system it finances is. In practice, most people paying for NHI will join it. Where the NHI involves a choice of multiple insurance funds, the rates of contributions may vary and the person has to choose which insurance fund to belong to.


Germany has the world's oldest national social health insurance system,[1] with origins dating back to Otto von Bismarck's Sickness Insurance Law of 1883.[2][3] In Britain, the National Insurance Act 1911 included national social health insurance for primary care (not specialist or hospital care), initially for about one third of the population—employed working class wage earners, but not their dependents.[4] This system of health insurance continued in force until the creation of the National Health Service in 1948 which created a universal service, funded out of general taxation rather than on an insurance basis, and providing health services to all legal residents.

Types of programs

National healthcare insurance programs differ both in how the money is collected, and in how the services are provided. In countries such as Canada, payment is made by the government directly from tax revenue. The collection is administered by government. This is known in the United States as single-payer health care. The provision of services may be through either publicly or privately owned health care providers. In France a similar system of compulsory contributions is made, but the collection is administered by non-profit organisations set up for the purpose.

An alternative funding approach is where countries implement national health insurance by legislation requiring compulsory contributions to competing insurance funds. These funds (which may be run by public bodies, private for-profit companies, or private non-profit companies), must provide a minimum standard of coverage and are not allowed to discriminate between patients by charging different rates according to age, occupation, or previous health status. To protect the interest of both patients and insurance companies, the government establishes an equalization pool to spread risks between the various funds. The government may also contribute to the equalization pool as a form of health care subsidy. This is the model used in the Netherlands.

Other countries are largely funded by contributions by employers and employees to sickness funds. With these programs, funds come from neither the government nor direct private payments. This system operates in countries such as Germany and Belgium. These funds are usually not for profit institutions run solely for the benefit of their members. Usually characterization is a matter of degree: systems are mixes of these three sources of funds (private, employer-employee contributions, and national/sub-national taxes).

In addition to direct medical costs, some national insurance plans also provide compensation for loss of work due to ill-health, or may be part of wider social insurance plans covering things such as pensions, unemployment, occupational retraining, and financial support for students.

National schemes have the advantage that the pool or pools tend to be very very large and reflective of the national population. Health care costs, which tend to be high at certain stages in life such as during pregnancy and childbirth and especially in the last few years of life can be paid into the pool over a lifetime and be higher when earnings capacity is greatest to meet costs incurred at times when earnings capacity is low or non existent. This differs from the private insurance schemes that operate in some countries which tend to price insurance year on year according to health risks such as age, family history, previous illnesses, and height/weight ratios. Thus some people tend to have to pay more for their health insurance when they are sick and/or are least able to afford it. These factors are not taken into consideration in NHI schemes. In private schemes in competitive insurance markets, these activities by insurance companies tend to act against the basic principles of insurance which is group solidarity.

National health insurance programs

See also


  1. ^ Bump, Jesse B. (October 19, 2010). "The long road to universal health coverage. A century of lessons for development strategy" (PDF). Seattle: PATH. Retrieved March 10, 2013. Carrin and James have identified 1988—105 years after Bismarck’s first sickness fund laws—as the date Germany achieved universal health coverage through this series of extensions to minimum benefit packages and expansions of the enrolled population. Bärnighausen and Sauerborn have quantified this long-term progressive increase in the proportion of the German population covered by public and private insurance. Their graph is reproduced below as Figure 1: German Population Enrolled in Health Insurance (%) 1885–1995.
    Carrin, Guy; James, Chris (January 2005). "Social health insurance: Key factors affecting the transition towards universal coverage" (PDF). International Social Security Review. 58 (1): 45–64. doi:10.1111/j.1468-246x.2005.00209.x. Retrieved March 10, 2013. Initially the health insurance law of 1883 covered blue-collar workers in selected industries, craftspeople and other selected professionals.6 It is estimated that this law brought health insurance coverage up from 5 to 10 per cent of the total population.
    Bärnighausen, Till; Sauerborn (May 2002). "One hundred and eighteen years of the German health insurance system: are there any lessons for middle- and low income countries?" (PDF). Social Science & Medicine. 54 (10): 1559–1587. doi:10.1016/S0277-9536(01)00137-X. PMID 12061488. Retrieved March 10, 2013. As Germany has the world’s oldest SHI [social health insurance] system, it naturally lends itself to historical analyses. |first3= missing |last3= in Authors list (help)
  2. ^ Leichter, Howard M. (1979). A comparative approach to policy analysis: health care policy in four nations. Cambridge: Cambridge University Press. p. 121. ISBN 0-521-22648-1. The Sickness Insurance Law (1883). Eligibility. The Sickness Insurance Law came into effect in December 1884. It provided for compulsory participation by all industrial wage earners (i.e., manual laborers) in factories, ironworks, mines, shipbuilding yards, and similar workplaces.
  3. ^ Hennock, Ernest Peter (2007). The origin of the welfare state in England and Germany, 1850–1914: social policies compared. Cambridge: Cambridge University Press. p. 157. ISBN 978-0-521-59212-3.
  4. ^ Leathard, Audrey (2000). "Health care in Britain: pre-war provision, 1900–1939". Health care provision: past, present, and into the 21st century (2nd ed.). Cheltenham: Stanley Thornes. pp. 3–4. ISBN 9780748733545.

Further reading

  • Nicholas Laham: Why the United States lacks a national health insurance program, Westport, Conn. [u.a.] : Greenwood Press, 1993
  • Barona, B., Plaza, B., and Hearst, N. (2001) Managed Competition for the poor or poorly managed: Lessons from the Colombian health reform experience. Oxford University Press [1]
  • Ronald L. Numbers (ed.): Compulsory Health Insurance: The Continuing American Debate, Westport, Conn. : Greenwood Press, 1982.
  • Saltman, R.B., Busse, R. and Figueras, J. (2004) Social health insurance systems in western Europe, Berkshire/New York: Open University Press/McGraw-Hill. ISBN 0-335-21363-4
  • Saltman, R.B. and Dubois, H.F.W. (2004) Individual incentive schemes in social health insurance systems, 10(2): 21-25. Full text
  • Van de Ven, W.P.M.M., Beck, K., Buchner, F. et al. (2003) Risk adjustment and risk selection on the sickness fund market in five European countries, Health Policy, 65(1=: 75-98.
  • Saltman, R.B. and Dubois, H.F.W. (2005) Current reform proposals in social health insurance countries, Eurohealth, 11(1): 10-14. Full text

External links

Health in Ghana

Health in Ghana includes the healthcare systems on prevention, care and treatment of diseases and other maladies.

Health in Nigeria

Health standards as measured by life expectancy in Nigeria have increased since 1950, although progress has not been steady and maternal mortality rate appears to have increased between 1990 and 2010. Among factors affecting health, access to safe water supply has become more common although not universal, and there is little sewerage infrastructure.

Preventable diseases that occur in Nigeria include HIV/AIDS, malaria and yellow fever. Among other threats to health are malnutrition, pollution and road traffic accidents.

Healthcare in Greece

Healthcare in Greece consists of a universal health care system provided through national health insurance, and private health care. According to the 2011 budget, the Greek healthcare system was allocated 6.1 billion euro, or 2.8% of GDP. In a 2000 report by the World Health Organization, the Greek healthcare system was ranked 14th worldwide in the overall assessment, above other countries such as Germany (25) and the United Kingdom (18), while ranking 11th at level of service.Healthcare in Greece is provided by the National Healthcare Service, or ESY (Greek: Εθνικό Σύστημα Υγείας, ΕΣΥ).

Healthcare in Israel

Healthcare in Israel is universal and participation in a medical insurance plan is compulsory. All Israeli residents are entitled to basic health care as a fundamental right. The Israeli healthcare system is based on the National Health Insurance Law of 1995, which mandates all citizens resident in the country to join one of four official health insurance organizations, known as Kupat Holim (קופת חולים - "Sick Funds") which are run as not-for-profit organizations and are prohibited by law from denying any Israeli resident membership. Israelis can increase their medical coverage and improve their options by purchasing private health insurance. In a survey of 48 countries in 2013, Israel's health system was ranked fourth in the world in terms of efficiency, and in 2014 it ranked seventh out of 51.

In 2015, Israel was ranked sixth-healthiest country in the world by Bloomberg rankings and ranked eighth in terms of life expectancy.

Healthcare in Slovenia

Health care in Slovenia is organised primarily through the Health Insurance Institute of Slovenia.

In 2008 around 3 billion Euros, 8.10% of the Gross domestic product was allocated to health expenditures. It was ranked 15th in the Euro health consumer index 2015 and second in the 2012 Euro Hepatitis Index,The Slovenian healthcare system is a conservative-health care model paid for through a mandatory insurance program called the Health Insurance Institute of Slovenia, HIIS (Zavod za zdravstveno zavarovanje Slovenije) that is paid by employers and employees. However, not all medical costs are covered from this insurance, with the exception of children's healthcare which is fully covered. Almost all Slovenes thus pay voluntary insurance fees for additional coverage that also help support the system. Due to the amount of funds that is put into the system, Slovenian healthcare is comparable to many other advanced European nations'. The National Health Insurance Institute oversees all healthcare services. It is a right for all citizens to have equal access to healthcare, so long as they are Slovenian citizens or registered long-term residents. In 2015, 8.10% of the gross domestic product went to healthcare expenditures.

Healthcare in Taiwan

Healthcare in Taiwan is administered by the Ministry of Health and Welfare of the Executive Yuan. As with other developed economies, Taiwanese people are well-nourished but face such health problems as chronic obesity and heart disease. In 2002 Taiwan had nearly 1.6 physicians and 5.9 hospital beds per 1,000 population. In 2002, there were 36 hospitals and 2,601 clinics in the country. Per capita health expenditures totaled US$752 in 2000. Health expenditures constituted 5.8 percent of the gross domestic product (GDP) in 2001 (or US$951 in 2009); 64.9 percent of the expenditures were from public funds. Overall life expectancy in 2009 was 78 years.Recent major health issues include the SARS crisis in 2003, though the island was later declared safe by the World Health Organization (WHO).The current healthcare system in Taiwan, known as National Health Insurance (NHI, Chinese: 全民健康保險), was instituted in 1995. NHI is a single-payer compulsory social insurance plan that centralizes the disbursement of healthcare funds. The system promises equal access to healthcare for all citizens, and the population coverage had reached 99% by the end of 2004. NHI is mainly financed through premiums, which are based on the payroll tax, and is supplemented with out-of-pocket payments and direct government funding. In the initial stage, fee-for-service predominated for public and private providers. Most health providers operate in the private sector and form a competitive market on the health delivery side. However, many healthcare providers took advantage of the system by offering unnecessary services to a larger number of patients and then billing the government. In the face of increasing loss and the need for cost containment, NHI changed the payment system from fee-for-service to a global budget, a kind of prospective payment system, in 2002.

The implementation of universal healthcare created fewer health disparities for lower-income citizens in Taiwan. Additionally, life expectancy increased more in health class groups that had higher mortality rates before national health insurance was introduced. Life expectancy in Taiwan is about 80 years old as of 2018. Infant mortality rate is low and only 4 deaths for 1,000 live births as well as fertility rates are very high and stable. Healthcare is much more thorough and supported than it is in America, as a modern-day country Taiwan has shifted its approach to allow its country to set structures and functions for other countries to follow. Although there are many different people to tend to including the disabled, Taiwan has catered to its best ability and also supported more than 23.4 million citizens to provide this universal healthcare. This nation has focused more on the medical aspect of health care instead of administrative or economy which is why everyone is succeeding, especially the disabled who need guidance and support because of sensitive circumstances.

Healthcare industry

The healthcare industry (also called the medical industry or health economy) is an aggregation and integration of sectors within the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, and palliative care. It includes the generation and commercialization of goods and services lending themselves to maintaining and re-establishing health. The modern healthcare industry is divided into many sectors and depends on interdisciplinary teams of trained professionals and paraprofessionals to meet health needs of individuals and populations.The healthcare industry is one of the world's largest and fastest-growing industries. Consuming over 10 percent of gross domestic product (GDP) of most developed nations, health care can form an enormous part of a country's economy.


A jūminhyō (住民票) is a registry of current residential addresses maintained by local governments in Japan. Japanese law requires each citizen to report his or her current address to the local authorities who compile the information for tax, national health insurance and census purposes.

Once a jūminhyō has been registered with the local government, one can register for various social services including the national health insurance plan. When proof of residence is required, such as for opening a bank account or registering children at a local school district, one needs to obtain a copy of this record from the local government office. Jūminhyō registration is also required in order to officially register a name seal (inkan), which functions as one's official signature. The jūminhyō is different from a koseki, which is the formal record of a family's history.

Medicare (Canada)

Medicare (French: assurance-maladie) is an unofficial designation used to refer to the publicly funded, single-payer health care system of Canada. Canada does not have a unified national health care system; instead, the system consists of 13 provincial and territorial health insurance plans that provides universal health care coverage to Canadian citizens, permanent residents, and certain temporary residents. These systems are individually administered on a provincial or territorial basis, within guidelines set by the federal government. 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.

The name is a contraction of medical and care, and was used in the United States for health care programs since at least 1953.Under the terms of the Canada Health Act, all "insured persons" are entitled to receive "insured services" without copayment. Such services are defined as medically necessary services if provided in hospital, or by 'practitioners' (usually physicians). Approximately 70% of expenditures for health care in Canada come from public sources, with the rest paid privately (both through private insurance, and through out-of-pocket payments). The extent of public financing varies considerably across services. For example, approximately 99% of physician services, and 90% of hospital care, are paid by publicly funded sources, whereas almost all dental care is paid for privately. Most physicians are self-employed private entities which enjoy coverage under each province's respective healthcare plans.

Services of non-physicians working within hospitals are covered; conversely, provinces can, but are not forced to, cover services by non-physicians if provided outside hospitals. Changing the site of treatment may thus change coverage. For example, pharmaceuticals, nursing care, and physical therapy must be covered for inpatients, but there is considerable variation from province to province in the extent to which they are covered for patients discharged to the community (e.g., after day surgery). The need to modernize coverage was pointed out in 2002 by both the Romanow Commission and by the Kirby committee of the Canadian Senate (see External links below). Similarly, the extent to which non-physician providers of primary care are funded varies; Quebec offers primary health care teams through its CLSC system.

Mike Waters (politician)

Mike Waters (born 30 June 1967) is a South African politician, and Member of Parliament for the opposition Democratic Alliance (DA), where he serves as the Opposition's Deputy Chief Whip. He has served as the Shadow Minister of Health and as the Shadow Minister of Social Development.

National Health Insurance (British Virgin Islands)

The National Health Insurance scheme (or NHI) is a form of national health insurance established by the Government of the British Virgin Islands through the Ministry of Health, with a goal to provide access to and financial coverage for health care services to British Virgin Islands residents. It came into effect on 1 January 2016.The scheme is based on two fundamental principles:

payments are shared based on ability to pay, without worrying about health risks such as age, occupation or pre-existing health conditions; and

healthcare benefits are equally available to everyone.The scheme is administered by the Social Security Board of the British Virgin Islands. The Deputy Director with responsibility for the scheme is Mr Roy Barry. The primary legislation relating to the scheme was implemented by amendments to the Social Security Act (Cap 266), and the subsidiary implementing legislation is the Social Security (National Health Insurance) Regulations, 2015.

From a relatively early stage of the scheme's life, doubts were expressed about its long term sustainability. In the year 2017 it ran at a deficit of nearly US$650,000, with greater losses predicted in 2018.

National Health Insurance (Japan)

National Health Insurance (国民健康保険, Kokumin-Kenkō-Hoken) is one of the two major types of insurance programs available in Japan. The other is

Employees' Health Insurance (健康保険, Kenkō-Hoken). National Health insurance is designed for people who are not eligible to be members of any employment-based health insurance program. Although private insurance is also available, all Japanese citizens, permanent residents, and any non-Japanese residing in Japan with a visa lasting three months or longer are required to be enrolled in either National Health Insurance or Employees' Health Insurance.

On July 9, 2012, the alien registration system was abolished and foreigners are now able to apply as part of the Basic Resident Registration System. Foreigners who reside in Japan for more than three months need to register for national health insurance.REGISTRO CIVIL - 16KokuminKenkouHokenEn.pdf

It is defined by the National Health Care Act of 1958.

National Health Insurance Scheme (Ghana)

The National Health Insurance Scheme is a form of National health insurance established by the Government of Ghana, with a goal to provide equitable access and financial coverage for basic health care services to Ghanaian citizens.

National Insurance

National Insurance (NI) is a tax system in the United Kingdom paid by workers and employers for funding state benefits. Initially, it was a contributory form of insurance against illness and unemployment, and eventually provided retirement pensions and other benefits. Citizens pay National Insurance contributions to become eligible for State Pension and other benefits. Anyone 16 years old and above are mandated to pay National Insurance provided the employee earns more than £162 a week or the individual is self-employed and makes a profit of £6,205 or more annually. It is necessary to obtain a National Insurance number before starting to pay contributions.NI was first introduced by the National Insurance Act 1911 and expanded by the Labour government in 1948. The system was subjected to numerous amendments in succeeding years.

Employees and employers pay for National Insurance contributions on certain benefits provided to employees. Self-employed persons contribute partly through a fixed weekly or monthly payment, and partly on a percentage of net profits above a certain threshold. Individuals may also make voluntary contributions to fill a gap in their contributions record and thus protect their entitlement to benefits. Contributions from employees are collected by HM Revenue and Customs (HMRC) through the PAYE system, along with Income Tax, repayments of Student Loans and any Apprenticeship Levy which the employer is liable to pay.

Employers include PAYE in their payroll. it refers to the "HM Revenue and Customs’ (HMRC) system for the collection of Income Tax and National Insurance from employment."The benefit component includes several contributory benefits of availability and amount determined by the claimant's contribution record and circumstances. Weekly income and some lump-sum benefits are provided for participants upon death, retirement, unemployment, maternity and disability.

National Insurance contributes a significant part of the government's revenue (21.5% of the total collected by HMRC). The structure of National Insurance was modified to remove the fixed upper contribution limits, with a much lower rate paid by employees on income above a certain level.

National Medical Association

The National Medical Association (NMA) is the largest and oldest national organization representing African American physicians and their patients in the United States. The NMA is a 501 (c) (3) national professional and scientific organization representing the interests of more than 30,000 African American physicians and the patients they serve, with nearly 112 affiliated societies throughout the nation and U.S. territories. The National Medical Association has been firmly established in a leadership role in medicine. The NMA is committed to improving the quality of health among minorities and disadvantaged people through its membership, professional development, community health education, advocacy, research and partnerships with federal and private agencies. Throughout its history the National Medical Association has focused primarily on health issues related to African Americans and medically underserved populations; however, its principles, goals, initiatives and philosophy encompass all ethnic groups.

“Conceived in no spirit of racial exclusiveness, fostering no ethnic antagonism, but born of the exigencies of the American environment, the National Medical Association has for its object the banding together for mutual cooperation and helpfulness, the men and women of African descent who are legally and honorably engaged in the practice of the cognate professions of medicine, surgery, pharmacy and dentistry.”—C.V. Roman, M.D. NMA Founding Member and First Editor of the JNMA 1908

Physicians for a National Health Program

Physicians for a National Health Program (PNHP) is an advocacy organization of more than 20,000 American physicians, medical students, and health professionals that supports a universal, comprehensive single-payer national health insurance program. Since being co-founded in 1987 by Dr. David Himmelstein and Dr. Steffie Woolhandler, PNHP has advocated for reform in the U.S. health care system. PNHP is the only national physician organization in the United States dedicated exclusively to implementing a single-payer national health program. The organization works to educate physicians and other health professionals about the benefits of a single-payer system, including fewer administrative costs and affording health insurance for the millions of Americans who have none. Its members and physician activists work toward a single-payer national health program in their communities. Additionally, PNHP performs ground-breaking research on the health crisis and the need for fundamental reform, coordinates speakers and forums, participates in town hall meetings and debates, contributes scholarly articles to peer-reviewed medical journals, and appears regularly on national television and news programs advocating for a single-payer system. The group is best known for its influential proposals for national health insurance, which have been published in the New England Journal of Medicine, JAMA, and the American Journal of Public Health.The group is also known for its members' substantial contributions to scientific research on the uninsured, health system economics and international health systems. Members such as David Himmelstein, Steffie Woolhandler, Marcia Angell and Arnold Relman have contributed articles to major peer-reviewed journals such as the New England Journal of Medicine (of which Angell and Relman are former editors-in-chief), JAMA, Health Affairs, and The American Journal of Medicine. Quentin Young was president of the organization from 1991 to 1993.

Private hospital

A private hospital is a hospital owned by a for-profit company or a non-profit company and privately funded through payment for medical services by patients themselves, by insurers, governments through national health insurance programs, or by foreign embassies. This is normal in the United States of America, Chile, France, Germany, and Australia.

In the United Kingdom, private hospitals are distinguished from the far more prevalent National Health Service institutions. In 1979 there were about 4,000 beds in private hospitals

United States National Health Care Act

The United States National Health Care Act, or the Expanded and Improved Medicare for All Act (H.R. 676), is a bill, first introduced in the United States House of Representatives in 2003 with 25 cosponsors by former Representative John Conyers (D-MI). The bill had 49 cosponsors in 2015. As of October 1, 2017, it had 120 cosponsors, which amounts to a majority of the Democratic caucus in the House of Representatives and is the highest level of support the bill has ever received since Conyers began annually introducing the bill in 2003. The act would establish a universal single-payer health care system in the United States, the rough equivalent of Canada's Medicare and Taiwan's Bureau of National Health Insurance, among other examples. Under a single-payer system, most medical care would be paid for by the federal government, ending the need for private health insurance and premiums, and probably recasting private insurance companies as providing purely supplemental coverage, to be used when non-essential care is sought.

The national system would be paid for in part through taxes replacing insurance premiums, but also by savings realized through the provision of preventative universal healthcare and the elimination of insurance company overhead and hospital billing costs. An analysis of the bill by Physicians for a National Health Program estimated the immediate savings at $350 billion per year. Others have estimated a long-term savings amounting to 40% of all national health expenditures due to preventative health care. Preventative care can save several hundreds of billions of dollars per year in the U.S., because for example cancer patients are more likely to be diagnosed at Stage I where curative treatment is typically a few outpatient visits, instead of at Stage III or later in an emergency room where treatment can involve years of hospitalization and is often terminal.The bill was first introduced in 2003, when it had 25 cosponsors, and has been reintroduced in each Congress since. During the 2009 health care debates over the bill that became the Patient Protection and Affordable Care Act, H.R. 676 was expected to be debated and voted upon by the House in September 2009, but was never debated.On 13 September 2017, Senator Bernie Sanders introduced a parallel bill in the United States Senate with 16 cosponsors. The act would establish a universal single-payer health care system in the United States.On January 22, 2019, the House passed HR 676, however the bill that was passed under that number indicated Congressional support for NATO, unrelated to the subject of health care, necessitating a renumbering of the original 16 year old proposal. In 2019, Pramila Jayapal (D-WA) charged with preparing a revised proposal in its place, introduced such a bill for the consideration of the 116th United States Congress.

Árpád híd (Budapest Metro)

Árpád híd is a station on the Budapest Metro Line 3 (North-South). It was the temporary terminus of Line 3 between 1984 and 1990.The station is located beneath the intersection of Váci Avenue and Róbert Károly Boulevard, near the eponymous bridge Árpád híd. It is also a major public transport hub.The area has several high-rise offices and governmental buildings, including the headquarters of the Hungarian Police, the National Health Insurance Fund (Országos Egészségbiztosítási Pénztár), Hungarian State Treasury (Magyar Államkincstár) and the National Pension Insurance Directorate (Országos Nyugdíjbiztosítási Főigazgatóság).

Types of insurance
Insurance policy and law
Insurance by country

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