Health Systems: Type, Coverage and Financing Mechanisms
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1 Health Systems: Type, Coverage and Mechanisms Austria Belgium Bulgaria (2007) Czech Republic Denmark (2007) Estonia (2008). Supplementary private health Complementary voluntary and private health Public health scheme Complementary voluntary health Social health and public funds Private sources All employed, self-employed and unemployed people, pensioners, and their family members. All employed, self-employed and unemployed people, pensioners, and their family members. All employed, unemployed, poor, pensioners, students, soldiers, civil servants. Universal membership: permanent residents; employees by an employer whose registered base is in the country. 98% According to their social or occupational situations people are insured in one of the: 1) provincial funds 2) large companies' funds or 3) funds for specific categories. 33% 3.6% - 4.1% 3.5% % 99% Insurance funds % 24.77% 92% Funded through contributions by employees and employer. For unemployed, poor, pensioners, students, soldiers, civil servants the contributions covered by central or local budgets. 100% Funded through contributions by individuals, employers and the State (on behalf of the unemployed, pensioners, children etc). Whole population. 99% Financed through general and local taxes. Entitlement to is based on residence in Estonia and entitlement rules of specific groups are defined by law. 33% Non-profit-making or private profitmaking companies. 95.2% 62.5%: earmarked payroll by Estonian Health Insurance Fund, 11.2% general tax revenue by the state and the municipalities. Mainly through co-payments. 3.0% 3.0% 4.5% 9.0% 0% 0% 13.0% a) 0% Page 1 of 7
2 Health Systems: Type, Coverage and Mechanisms Finland (2008) France Germany (2004) Greece Hungary (2004) Statutory health Whole population. 100% Mainly funded out of national and local taxes. Also out of employers and employees payroll contributions. Private sources Statutory health Complementary sources: Voluntary health Statutory health Private health Mix of tax-based and -based statutory financing (supplemented by a high proportion of private expenses). Social Insurance Whole population (all those legitimately resident in France). All employed (up to specified income limit), self-employed and unemployed people, pensioners, and their family members. High-income earners, who's income is higher than specified income limit; civil servants. Membership in the funds is compulsory and is based on occupation. Therefore there is no freedom in choice of fund, nor is there any competition among funds. is virtually universal with less than 1% of the population not covered. Out-of-pocket accounts for 22% of health care financing in almost 100% The health is funded by contributions of employers and employees. Accompanied by a general social contribution (CSG) based on total income. 88% Coverage under National health system can be complemented by: mutual associations, private companies, provident institutions. 1.24% (sickness ) 0.67% (income ) 0.85% (+ 3.8% - 9.5% CSG) 1.97% (income ) 13.10% 88% Sickness funds. 8.0% 7.1% 10% Sickness and funds. 100% Insurance funds. Significant differences among funds. 99% Health fund (HIF) with its revenue mainly from the health contribution, a proportional payroll tax; and from the hypothecated health care tax consisting of a lump sum tax and a proportional tax. Also general and local taxation, co-payments. Significant differences among funds 3.0% 11.0% Page 2 of 7
3 Health Systems: Type, Coverage and Mechanisms Ireland Italy Luxembourg (1999) Netherlands National health service Category I (people whose income fall below a certain threshold). Category II (rest of population). 30% Taxes. 70% Voluntary health 50% Voluntary Health Insurance Board. Contributions. National health service Whole population. 100% A mix of hypothecated taxes applied both at the regional and national levels. Statutory health All employed, self-employed and unemployed people, pensioners, and their family members. Voluntary health 75% 1st Compartment: Compulsory national scheme for long-term care or high-cost treatment. 2nd Compartment: Compulsory Basic health 99% 9 sickness funds for various categories of occupation. Contributions from the state finance 40% of health expenditures. Payroll taxes with a regressive structure: starts with 10.6%/6.6% (employees/ selfemployed) for lesser income and decreasing to 4.6% for higher income % depends on continuation of salary. Regional tax on the value added of companies: 4.25%. Tax on public sector salaries: 9.6% on the first EUR 20, 660 and 3.8% on the following EUR 56,820. Vary from sector to sector. Whole population. 99% National scheme % n.a. Whole population almost 100% Sickness funds. Health insurers are free to set the nominal premium level. The insured persons pay these premiums directly to their health insurer. Page 3 of 7
4 Health Systems: Type, Coverage and Mechanisms Netherlands (cont.) Poland (2005) Portugal (2007) Slovak Republic (2004) 2nd Compartment: Compulsory Basic health (cont.) 3rd Compartment: complementary voluntary health Sickness funds and private medical. (2009 nominal premium varied between EUR 933 and 1,150 p.a.). The incomedependent contribution amounts to 6.9% of income for employees and social security recipients. s are legally obliged to compensate their employees for their incomerelated contributions. Statutory health Universal. 100% National Health Fund 9.0% of taxable income (2007). National health service Whole population. 100% Mainly financed by general taxes. Health subsystems Special public and private schemes for certain professions. Private health 10% 20-25% and employer contributions. Statutory health Universal. 100% Contributions paid by incomeearners and by the Government (taxes) on behalf of the exempt population. Private sources Out-of-pocket payment. 1.5% n.a. 4.0% 10.0% Page 4 of 7
5 Health Systems: Type, Coverage and Mechanisms Slovenia Spain Sweden (2005) United Kingdom (England) (2011) Statutory health The entire population with permanent residence in Slovenia. Voluntary health Insurance for co-payments. 95% Spanish National Health System (SNS) Private 99% Mainly financed through the contributions towards the statutory. Whole population. 99.5% Almost all public health care expenditure (excluding civil servants mutual funds) is funded through general taxation (94.07%). State Health Service Whole population. 100% National, county and municipal taxes. Voluntary health Supplementary. 2.3% National health service Universal. 99% General taxation (76.2%). Private Insurance National Insurance Contribution scheme (18.4%). 6.36% 6.56% b) 11.0% Croatia Compulsory Health Insurance Universal. Public funds for health care originate from two main sources: contributions for mandatory health and funds collected by general taxation. Macedonia Employed and self-employed individuals, people working in the agricultural sector, temporarily unemployed people, pensioners, disability -related beneficiaries, war veterans, social welfare beneficiaries, etc. more than 90% Funds managed by the Health Insurance Fund. Norway State health service, National Insurance Scheme All persons who are either residents, or working as employees in Norway or on permanent or movable installations on the Norwegian Continental Shelf. 99% Financed mostly through county and municipal taxes, state subsidies for healthcare, and from the National Insurance Scheme through taxes on employers and employees. Page 5 of 7
6 Health Systems: Type, Coverage and Mechanisms Switzerland Switzerland (cont.) Turkey (2002) supplementary health and out-of-pocket payments All permanent residents, except for public employees covered by military. Social health 87% But maybe too high estimated). 100% Contributions are community rated, i.e. all subscribers to a particular company within a canton or sub-region of a canton pay the same rate. Both the Swiss Confederation and the cantons subsidize compulsory health premiums through tax-financed allocations. Health care is financed by the general government budget funded by tax revenue, social security institutions (the Social Insurance Organization (SSK), the Social Insurance Agency of Merchants, Artisans and the Self-employed (Bag-Kur) and the Government s Retirement Fund (GERF)) and out-ofpocket payments. Vary among cantons. Vary among cantons. Australia Japan New Zealand Commonwealth fund (70%) Permanent residents in Australia and New Zealand. Voluntary heath and Out-of-pocket payments Compulsory Complementary Public sector Private sector s of private companies. Public Service s. Self-employed people, agricultural workers, unemployed, etc. Government required most people to meet some or all of the costs of their own primary health care, and have chosen to target benefits to lowincome patients, (using concession cards), rather than offer universal free services paid for through taxation or through statutory. 100% Through general taxation. 1.5% (above certain income) 99.5% Health Insurance under the supervision of the government. Mutual Aid Associations. National Health Insurance. General taxation. Out-of-pocket payments and private. 1.5% - 5% 1.5-5% Page 6 of 7
7 Health Systems: Type, Coverage and Mechanisms United States Voluntary health Predominantly middle-class and higher classes. Medicare Medigap People 65 years of age and older, people with disabilities, people with End-Stage Renal Disease, also middle-class population. Medigap is a Medicare supplemental health policy sold by private. 85% Private schemes financed through employers' and employees' premiums (average split 80:20), but ca. 40% of all employers pays the full premium for their employees. Medicare is a federal health program, financed through taxes (75%) and contributions (25%) paid into Social Security. Medicaid People with low income. 11% Medicaid is a join federal and state program. People with no (grayzone patients). (a) Contribution paid by employers on behalf of employees. (b) Plus an additional 0.53% by employers to cover occupational injuries and diseases. 15% 7.65% Sources: German Ministry of Labour and Social Affairs 2001, Schneider, et al : Gesundheitssysteme im internationalen Vergleich, BASYS, 1997; WHO Europe, Health Care Systems in Transition, (accessed 13 April 2011). Page 7 of 7
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