Universal healthcare (also called universal health coverage, universal coverage, or universal care) is a health care system that provides health care and financial protection to all citizens of a particular country. It is organized around providing a specified package of benefits to all members of a society with the end goal of providing financial risk protection, improved access to health services, and improved health outcomes.
Universal healthcare does not imply coverage for all people for everything, only that all people have access to healthcare. Some universal healthcare systems are government funded, while others are based on a requirement that all citizens purchase private health insurance. Universal healthcare can be determined by three critical dimensions: who is covered, what services are covered, and how much of the cost is covered. It is described by the World Health Organization as a situation where citizens can access health services without incurring financial hardship. The Director General of WHO describes universal health coverage as the “single most powerful concept that public health has to offer” since it unifies “services and delivers them in a comprehensive and integrated way”. One of the goals with universal healthcare is to create a system of protection which provides equality of opportunity for people to enjoy the highest possible level of health.
As part of Sustainable Development Goals, United Nations member states have agreed to work toward worldwide universal health coverage by 2030.
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. 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 Soviet Union established a fully public and centralized health care system in 1920. However, it was not a truly universal system at that point, as rural residents were not covered.
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 then introduced in Japan (1961), and in Canada through stages, starting with the province of Saskatchewan in 1962, followed by the rest of Canada from 1968 to 1972. The Soviet Union extended universal health care to its rural residents in 1969. Italy introduced its Servizio Sanitario Nazionale (National Health Service) in 1978. Universal health insurance was implemented in Australia beginning with the Medibank system which led to universal coverage under the Medicare system.
From the 1970s to the 2000s, Southern and 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. In addition, universal health coverage was introduced in some Asian countries, including South Korea (1989), Taiwan (1995), Israel (1995), and Thailand (2001).
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 which has the largest universal health care system in the world and Brazil's SUS which improved coverage up to 80% of the population. A 2012 study examined progress being made by these countries, focusing on nine in particular: Ghana, Rwanda, Nigeria, Mali, Kenya, India, Indonesia, the Philippines, and Vietnam.
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 levies (which may be charged to the individual and/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 (like in Portugal, Spain, Denmark, and Sweden). Some nations, such as Germany, France, and Japan, employ a multipayer system in which health care is funded by private and public contributions. However, much of the non-government funding is by contributions by 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, 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. A paper by Sherry A. Glied from Columbia University found that universal health care systems are modestly redistributive, and that the progressivity of health care financing has limited implications for overall income inequality.
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 (as in Canada). Healthcare in Switzerland is based on compulsory insurance.
In some European countries, in which 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 to eliminate 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 cheap 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 you are obliged to pay a percentage of the average monthly wage to the state if you are not employed. 
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 limiting the ability of insurance companies to deny insurance to individuals or vary price between individuals.
Single-payer health care is a system in which the government, rather than private insurers, pays for all health care costs. Single-payer systems may contract for healthcare services from private organizations (as is the case in Canada) or own and employ healthcare resources and personnel (as was the case in England before the introduction of the Health and Social Care Act). "Single-payer" thus describes only the funding mechanism and refers to health care financed by a single public body from a single fund and does not specify the type of delivery or for whom doctors work. Although the fund holder is usually the state, some forms of single-payer use a mixed public-private system.
In tax-based financing, individuals contribute to the provision of health services through various taxes. These are typically pooled across the whole population, unless local governments raise and retain tax revenues. Some countries (notably the United Kingdom, Canada, Ireland, New Zealand, Italy, Spain, Portugal, and the Nordic countries) choose to fund health care directly from taxation alone. Other countries with insurance-based systems effectively meet the cost of insuring those unable to insure themselves via social security arrangements funded from taxation, either by directly paying their medical bills or by paying for insurance premiums for those affected.
In a social health insurance system, contributions from workers, the self-employed, enterprises, and governments are pooled into a single or multiple funds on a compulsory basis. It is based on risk pooling. The social health insurance model is also referred to as the 'Bismarck Model,' after Prussian Chancellor Otto von Bismarck, who introduced the first universal health care system in Germany in the 19th century. The funds typically contract with a mix of public and private providers for the provision of a specified benefit package. Preventive and public health care may be provided by these funds or responsibility kept solely by the Ministry of Health. Within social health insurance, a number of functions may be executed by parastatal or non-governmental sickness funds or in a few cases, by private health insurance companies. Social health insurance is used in a number of Western European countries and increasingly in Eastern Europe as well as in Israel and Japan.
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.
In some countries with universal coverage, private insurance often excludes many health conditions that are expensive and the state health care system can provide. For example, in the United Kingdom, one of the largest private health care providers is BUPA, which has a long list of general exclusions even in its highest coverage policy, most of which are routinely provided by the National Health Service. In the United States, dialysis treatment for end stage renal failure is generally paid for by government, not by the insurance industry. Those with privatized Medicare (Medicare Advantage) are the exception and must get their dialysis paid through their insurance company, but with end stage renal failure generally cannot buy Medicare Advantage plans. In the Netherlands, which has regulated competition for its main insurance system (but subject to a budget cap), insurers must cover a basic package for all enrollees, but may choose which additional services they cover in other, supplementary plans (which most people possess - citation needed).
The Planning Commission of India has also suggested that the country should embrace insurance to achieve universal health coverage. General tax revenue is currently used to meet the essential health requirements of all people.
A particular form of private health insurance that has often emerged if financial risk protection mechanisms have only a limited impact is community-based health insurance. Individual members of a specific community pay to a collective health fund, which they can draw from when they need of medical care. Contributions are not risk-related, and there is generally a high level of community involvement in the running of these plans.
Universal health care systems vary according to the degree of government involvement in providing care and/or health insurance. In some countries, such as the UK, Spain, Italy, Australia, and the Nordic countries, the government has a high degree of involvement in the commissioning or delivery of health care services and access is based on residence rights, not on the purchase of insurance. Others have a much more pluralistic delivery system, based on obligatory health with contributory insurance rates related to salaries or income and usually funded by employers and beneficiaries jointly.
Sometimes, the health funds are derived from a mixture of insurance premiums, salary related mandatory contributions by employees and/or employers to regulated sickness funds, and by government taxes. These insurance based systems tend to reimburse private or public medical providers, often at heavily regulated rates, through mutual or publicly owned medical insurers. A few countries, such as the Netherlands and Switzerland, operate via privately owned but heavily regulated private insurers, which are not allowed to make a profit from the mandatory element of insurance but can profit by selling supplemental insurance.
Universal health care is a broad concept that has been implemented in several ways. The common denominator for all such programs is some form of government action aimed at extending access to health care as widely as possible and setting minimum standards. Most implement universal health care through legislation, regulation, and taxation. Legislation and regulation direct what care must be provided, to whom, and on what basis. Usually, some costs are borne by the patient at the time of consumption, but the bulk of costs come from a combination of compulsory insurance and tax revenues. Some programs are paid for entirely out of tax revenues. In others, tax revenues are used either to fund insurance for the very poor or for those needing long-term chronic care.
A critical concept in the delivery of universal healthcare is that of population healthcare. This is a way of organising the delivery, and allocating resources, of healthcare (and potentially social care) based on populations in a given geography with a common need (such as asthma, end of life, urgent care). Rather than focus on institutions such as hospitals, primary care, community care etc. the system focuses on the population with a common as a whole. This includes people currently being treated, and those that are not being treated but should be (i.e. where there is health inequity). This approach encourages integrated care and a more effective use of resources.
The United Kingdom National Audit Office in 2003 published an international comparison of ten different health care systems in ten developed countries, nine universal systems against one non-universal system (the United States), and their relative costs and key health outcomes. A wider international comparison of 16 countries, each with universal health care, was published by the World Health Organization in 2004. In some cases, government involvement also includes directly managing the health care system, but many countries use mixed public-private systems to deliver universal health care.
Universal and comprehensive health insurance was debated at intervals all through the Second World War, and in 1946 such a bill was voted in Parliament. For financial and other reasons, its promulgation was delayed until 1955, at which time coverage was extended to include drugs and sickness compensation, as well.
Since 2 July 1956 the entire population of Norway has been included under the obligatory health national insurance program.
Spain employs a universal health care system. The system is essentially "free" except for small, often symbolic co-payments in some products and services.
According to the Organisation for Economic Co-operation and Development, total health spending accounted for 9.4% of GDP in Spain in 2011, slightly above the OECD average of 9.3%. The Spanish health care system is considered one of the best in the world, in 7th position in the ranking calculated by the World Health Organization. Spain is ranked 1st in the world in organ transplants. The public sector is the main source of health funding. In Spain, 73% of health spending was funded by public sources in 2011, very close to the average of 72% in OECD countries. Since 2010, real term spending on healthcare has declined in Spain.Healthcare in Croatia
Croatia has a universal health care system, whose roots can be traced back to the Hungarian-Croatian Parliament Act of 1891, providing a form of mandatory insurance of all factory workers and craftsmen. The population is covered by a basic health insurance plan provided by statute and optional insurance and administered by the Croatian Health Insurance Fund. In 2012, annual compulsory healthcare related expenditures reached 21.0 billion kuna (approximately 2.8 billion euro).Healthcare in Europe
Healthcare in Europe is provided through a wide range of different systems run at the national level. The systems are primarily publicly funded through taxation (universal health care). Private funding may represent personal contributions towards meeting the non-taxpayer refunded portion of costs or may reflect totally private (non-subsidized) healthcare either paid out of pocket or met by some form of personal or employer funded insurance. Many European countries (and all European Union countries) offer their citizens a European Health Insurance Card which, on a reciprocal basis, provides insurance for emergency medical treatment insurance when visiting other participating European countries.Healthcare in Georgia (country)
Healthcare in Georgia is provided by a universal health care system under which the state funds medical treatment in a mainly privatized system of medical facilities. In 2013, the enactment of a universal health care program triggered universal coverage of government-sponsored medical care of the population and improving access to health care services. Responsibility for purchasing publicly financed health services lies with the Social Service Agency (SSA).Healthcare in Liechtenstein
The nation of Liechtenstein has a universal health care system with decentralized, free market elements through mandated health insurance coverage for every person residing in the country (not necessarily just every citizen).Healthcare in San Marino
Healthcare in San Marino is provided through a universal health care system, as well as private healthcare to compliment it. San Marino's healthcare system is consistently rated as one of the top three in Europe.Healthcare in Serbia
Healthcare in Serbia is delivered by means of a universal health care system, although corruption, inefficiency, and a physician shortage are major problems.Healthy San Francisco
Healthy San Francisco is a health access program launched in 2007 to subsidize medical care for uninsured residents of San Francisco, California. The program's stated objective is to bring universal health care to the city. Healthy San Francisco is not a true insurance program, as it does not cover services such as dental and vision care, and only covers services received in the city and county of San Francisco. The program itself acknowledges its limitations, and has stated that "insurance is always a better choice." Healthy San Francisco represents the first time a local government has attempted to provide health insurance for all of its constituents. The program is open to low-income city residents over the age of 18 who do not qualify for other public coverage, and who have had no insurance for at least 90 days. Eligibility is not conditional on citizenship, immigration, employment or health status. The program covers a range of services, but only pays providers within San Francisco. By July 2010, almost 90% of the uninsured adults in San Francisco — over 50,000 people — had enrolled in Healthy San Francisco.Juan Figueroa
Juan Figueroa is president of Universal Health Care Foundation of Connecticut and former president and general counsel of the Puerto Rican Legal Defense and Education Fund. In 2010, he pursued the Democratic Party nomination for governor of Connecticut.List of companies of Estonia
Estonia is a country in the Baltic region of Northern Europe. It is a developed country with an advanced, high-income economy that as of 2011 is among the fastest growing in the EU. Its Human Development Index ranks very highly, and it performs favourably in measurements of economic freedom, civil liberties and press freedom (3rd in the world in 2012 and 2007). The 2015 PISA test places Estonian high school students 3rd in the world, behind Singapore and Japan. Citizens of Estonia are provided with universal health care, free education and the longest paid maternity leave in the OECD. Since independence the country has rapidly developed its IT sector, becoming one of the world's most digitally advanced societies. In 2005 Estonia became the first nation to hold elections over the Internet, and in 2014 the first nation to provide E-residency.
For further information on the types of business entities in this country and their abbreviations, see "Business entities in Estonia".List of countries with universal health care
Universal health coverage is a broad concept that has been implemented in several ways. The common denominator for all such programs is some form of government action aimed at extending access to health care as widely as possible and setting minimum standards. Most implement universal health care through legislation, regulation and taxation. Legislation and regulation direct what care must be provided, to whom, and on what basis.
Usually some costs are borne by the patient at the time of consumption but the bulk of costs come from a combination of compulsory insurance and tax revenues. Some programs are paid for entirely out of tax revenues. In others tax revenues are used either to fund insurance for the very poor or for those needing long term chronic care. In some cases, government involvement also includes directly managing the health care system, but many countries use mixed public-private systems to deliver universal health care.
The UN has adopted a resolution on universal health care. It may be the next stage after the Millennium Development Goals.Minister of Health (Canada)
The Minister of Health (French: Ministre de la Santé) is the Minister of the Crown in the Canadian Cabinet who is responsible for overseeing health-focused government agencies including Health Canada and the Public Health Agency of Canada, as well as enforcing the Canada Health Act (the law governing Canada's universal health care system). The current Minister of Health is Ginette Petitpas Taylor, MP for Moncton—Riverview—Dieppe.
The Minister of Health is responsible for maintaining and improving the health of Canadians. This is supported by the Health Portfolio which comprises:
Canadian Food Inspection Agency
Canadian Institutes of Health Research
Patented Medicine Prices Review Board
Public Health Agency of CanadaThe Health Portfolio consists of approximately 12,000 full-time equivalent employees and an annual budget of over $3.8 billion.Newfoundland and Labrador Federation of Labour
The Newfoundland and Labrador Federation of Labour is the Newfoundland and Labrador provincial trade union federation for the Canadian Labour Congress. It was founded in 1937, and has a membership of 65,000.
The Newfoundland and Labrador Federation of Labour has been representing the interests of union members and workers since 1937. The federation is made up of nearly 30 affiliated unions, 500 locals and six district labour councils. They represent working women and men from every sector of the economy and from every community in the province.
The NLFL is dedicated to advancing the cause of working people and promoting a progressive civil society. They advocate for improved workplace rights and stronger laws including occupational, health and safety laws as well as workers’ compensation and employment insurance programs that are fair. They advocate better labour laws and strong, accessible public services such as universal health care, education, worker training, elderly home care, child care and early learning.Organic Consumers Association
The Organic Consumers Association (OCA) is a non-profit advocacy group for organic agriculture based in Minnesota. It was formed in 1998 by members of the organic industry and consumers of organic products after the U.S. Department of Agriculture's controversial initial version of their proposed regulations for organic food. The organization's members include subscribers to their online newsletters, volunteers, supporters, and 3,000 retail outlets.The OCA's "Organic Agenda" is to encourage the U.S. government to expand organic agriculture, utilize fair trade, eliminate genetically modified food, implement universal health care, and obtain energy independence through renewable energy. The organization hopes to "inspire" consumers to buy organic products, and to "pressure the USDA and organic companies to preserve strict organic standards."Sicko
Sicko (stylized as SiCKO) is a 2007 American documentary film made by filmmaker Michael Moore. The film investigates health care in the United States, focusing on its health insurance and the pharmaceutical industry. The movie compares the profiteering, non-universal U.S. system with the non-profit universal health care systems of Canada, the United Kingdom, France and Cuba.
Sicko was made on a budget of about $9 million, and grossed $25 million theatrically in the United States. This box office take exceeded the official expectation of The Weinstein Company, which had hoped for a gross in line with Bowling for Columbine's $22 million US box office gross.Single-payer healthcare
Single-payer healthcare is a type of universal healthcare financed by taxes that covers the costs of essential healthcare for all residents, with costs covered by a single public system (hence 'single-payer').Single-payer systems may contract for healthcare services from private organizations (as is the case in Canada) or may own and employ healthcare resources and personnel (as is the case in the United Kingdom). "Single-payer" describes the mechanism by which healthcare is paid for by a single public authority, not the type of delivery or for whom physicians work, which may be public, private, or a mix of both.Universal Health Care Foundation of Connecticut
Universal Health Care Foundation of Connecticut is an independent, nonprofit organization with offices in Meriden, Connecticut. The foundation supports the mission of its parent organization, CHART (Connecticut Health Advancement and Research Trust). The foundation has assets of approximately $30 million.Verla C. Insko
Verla Clemens Insko (born February 5, 1936) is a Democratic member of the North Carolina General Assembly representing the state's fifty-sixth House district, including constituents in Orange county. A retired health program administrator from Chapel Hill, North Carolina, Insko is (2016-2017 session) serving in her tenth term in the State House. She sits on several committees including the Appropriations Subcommittee on Health and Human Services, the Standing Committee on Health and Human Services, the Insurance Committee and the Environment Committee. She has been noted for her progressive policy positions, such as her support for publicly funded universal health care, and stated in a candidate questionnaire, "I believe in an activist government that provides for the common good and protects the vulnerable".Vermont health care reform
In 2011, the Vermont state government enacted a law functionally establishing the first state-level single-payer health care system in the United States. Green Mountain Care, established by the passage of H.202, creates a system in the state where Vermonters receive universal health care coverage as well as technological improvements to the existing system.
On December 17, 2014, Vermont abandoned its plan for universal health care, citing the taxes required of smaller businesses within the state.