JANUARY 2016 of Health Care Systems 2015 International ...

JANUARY 2016

2015 International Profiles

of Health Care Systems

EDITED BY Elias Mossialos and Martin Wenzl London School of Economics and Political Science

Robin Osborn and Dana Sarnak The Commonwealth Fund

AUSTRALIA CANADA CHINA

DENMARK ENGLAND

FRANCE GERMANY

INDIA ISRAEL

ITALY JAPAN NETHERLANDS NEW ZEALAND NORWAY SINGAPORE SWEDEN SWITZERLAND 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.

2015 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, and the United States

EDITED BY Elias Mossialos and Martin Wenzl London School of Economics and Political Science Robin Osborn and Dana Sarnak The Commonwealth Fund

JANUARY 2016

Abstract: This publication presents overviews of the health care systems of Australia, Canada, China, Denmark, England, France, Germany, India, Israel, Italy, Japan, the Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization and governance, health care quality and coordination, disparities, efficiency and integration, use of information technology and evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views.

To learn more about new publications when they become available, visit the Fund's website and register to receive email alerts. Commonwealth Fund pub. 1857.

CONTENTS

Table 1. Health Care System Financing and Coverage in 18 Countries . . . 6 Table 2. Selected Health System Indicators for 17 Countries . . . . . . . . . . . . 7 Table 3. Selected Health System Performance Indicators for 11 Countries . . . . . 8 Table 4. Provider Organization and Payment in 18 Countries . . . . . . . . . . . . . . . .9

The Australian Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 The Canadian Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 The Chinese Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 The Danish Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39 The English Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 The French Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 The German Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 The Indian Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 The Israeli Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 The Italian Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 The Japanese Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107 The Dutch Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 The New Zealand Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 The Norwegian Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 The Singaporean Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 The Swedish Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 The Swiss Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 The U.S. Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . 171

Table 1. Health Care System Financing and Coverage in 18 Countries

Australia

HEALTH SYSTEM AND PUBLIC/PRIVATE INSURANCE ROLE

Government role

Public system financing

Private insurance role (core benefits; cost-sharing; noncovered benefits; private facilities or amenities;

substitute for public insurance)

Regionally administered, joint (national & state) public hospital funding; General tax revenue; earmarked income tax universal public medical insurance program (Medicare)

~47.3% buy complementary (e.g., private hospital and dental care, optometry) and supplementary coverage (increased choice, faster access for nonemergency services, rebates for selected services)

BENEFIT DESIGN

Caps on cost-sharing Caps for pharmaceutical OOP expenditure only, dependent on income and total OOP expenditure in the same year

Exemptions and low-income protection Low-income and older people: Lower cost-sharing; lower pharmaceutical OOP cap and lower OOP maximum for 80% Medicare services rebatea

Canada China

Denmark England

Regionally administered universal public insurance program that plans and funds (mainly private) provision

Provincial/federal general tax revenue

Supervision by health authorities (Health and Family Planning Commissions) at the national, provincial and local levels; some direct provision through public ownership of hospitals National health care system. Regulation, central planning, and funding by national government; provision by regional and municipal authorities.

There are three main publicly financed health insurance types with local-area risk-pooling: urban employer-based (mainly payroll taxes, for formally employed urban residents), urban resident basic (mainly government funded, for urban nonemployed residents), and rural cooperative medical scheme (government-funded, for rural residents) Earmarked income tax

National health service (NHS)

General tax revenue (includes employment-related insurance contributions)

France Germany India

Statutory health insurance system, with all SHI insurers incorporated into Employer/employee earmarked income and payroll tax;

a single national exchange

general tax revenue, earmarked taxes

Statutory health insurance (SHI) system, with 124 competing SHI insurers Employer/employee earmarked payroll tax; general

("sickness funds" in a national exchange); high income can opt out for

tax revenue

private coverage

Children and adolescents 3,400 noncompeting public, quasi-public, and employer-based insurers. National government sets provider fees, subsidizes local governments, insurers, and providers and supervises insurers and providers.

National earmarked corporate and value-added taxes; general tax revenue and regional tax revenue General tax revenue; insurance contributions

Netherlands

Statutory health insurance system, with universally-mandated private insurance (national exchange); government regulates and subsidizes insurance

Earmarked payroll tax; community-rated insurance premiums; general tax revenue

New Zealand National health care system. Responsibility for planning, purchasing, and General tax revenue provision devolved to geographically defined District Health Boards.

Norway

National health care system. Some direct funding and provision roles for national government and some responsibilities devolved to Regional Health Care Authorities and municipalities.

General tax revenue, national and municipal taxes

Singapore

Government subsidies at public health care institutions and some providers; Medisave: mandatory medical savings program for routine expenses; MediShield: catastrophic health insurance; Medifund: government endowment fund to subsidize health care for low-income and those with large bills. Government regulation of private insurance, central planning and financing of infrastructure and some direct provision through public hospitals and clinics.

General tax revenue

Sweden

National health care system. Regulation, supervision, and some funding Mainly general tax revenue raised by county councils; by national government; responsibility for most financing and purchasing/ some national tax revenue provision devolved to county councils.

Switzerland

Statutory health insurance system, with universally mandated private insurance (regional exchanges); some federal legislation, with cantonal (state) government responsible for provider supervision, capacity planning, and financing through subsidies

Community-rated insurance premiums; general tax revenue

United States

Medicare: age 65 and older, some disabled; Medicaid: some lowincome; for those without employer coverage, state-level insurance exchanges with income-based subsidies; insurance coverage mandated, with some exemptions (10.4% of adults uninsured)

Medicare: payroll tax, premiums, federal tax revenue; Medicaid: federal, state tax revenue

~67% buy complementary coverage for noncovered benefits

No

(e.g., private rooms in hospitals, drugs, dental care, optometry)

Complementary to cover cost-sharing and gaps,

No

as well as better health care quality and/or higher

reimbursements. No data on coverage, but growth

has been rapid.

There is no cost-sharing for publicly covered services; protection for low-income people from cost of prescription drugs varies by region Government subsidies to low-income families for insurance contributions and OOP; emergency assistance by local governments for specific diseases and unpaid emergency department or other expenses

~39% have complementary coverage (cost-sharing, noncovered benefits such as physiotherapy), ~26% have supplementary coverage (access to private providers) ~11% buy supplementary coverage for more rapid and convenient access (including to elective treatment in private hospitals)

~95% buy or receive government vouchers for complementary coverage (mainly cost-sharing, some noncovered benefits); limited supplementary insurance ~11% opt out from statutory insurance and buy substitutive coverage. Some complementary (minor benefit exclusions from statutory scheme, copayments) and supplementary coverage (improved amenities). Limited role ( ................
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