International Profiles of Health Care Systems

[Pages:182]MAY 2017

EDITED BY Elias Mossialos and Ana Djordjevic London School of Economics and Political Science 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 Canada China Denmark England France Germany India Israel Italy Japan The Netherlands New Zealand Norway Singapore Sweden Switzerland Taiwan United States

EDITED BY Elias Mossialos and Ana Djordjevic London School of Economics and Political Science

Robin Osborn and Dana Sarnak The Commonwealth Fund

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

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

Australia Canada China

Denmark England

France Germany India Israel

Italy Japan

Netherlands New Zealand Norway Singapore

Sweden Switzerland Taiwan

United States

Government role

Public system financing

Private insurance role (core benefits; cost-sharing; noncovered benefits; private facilities or amenities; substitute for public insurance)

Caps on cost-sharinga

Exemptions and low-income protectiona

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

~47% buy complementary (e.g., private hospital and dental care, optometry) and supplementary coverage (increased choice, faster access for nonemergency services, rebates for selected services)

Caps for pharmaceutical out-of-pocket expenditure only, dependent on income and total out-of-pocket expenditure in the same year

Low-income and older people: Lower cost-sharing; lower pharmaceutical out-of-pocket cap and lower out-of-pocket maximum for 80% Medicare services rebate

Regionally administered universal public insurance program that plans and funds Provincial/federal general tax revenue (mainly private) provision

~67% buy complementary coverage for noncovered benefits (e.g., private No rooms in hospitals, drugs, dental care, optometry)

There is no cost-sharing for publicly covered services; protection for low-income people from cost of prescription drugs varies by region

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

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

ownership of hospitals

roll taxes, for formally employed urban residents), urban resident growth has been rapid

basic (mainly government-funded, for urban nonemployed

residents), and rural cooperative medical scheme (government-

funded, for rural residents)

Government subsidies to low-income families for insurance contributions and out-of-pocket costs; emergency assistance by local governments for specific diseases and unpaid emergency department or other expenses

National health care system; regulation, central planning, and funding by national government; provision by regional and municipal authorities

Earmarked income tax

~39% have complementary coverage (cost-sharing, noncovered benefits such as physiotherapy), ~26% have supplementary coverage (access to private providers)

No; decreasing copayments with higher drug out-ofpocket spending

Drug out-of-pocket cap for chronically ill (DKK3,775 [USD498]); financial assistance for low-income and terminally ill

National Health Service (NHS)

General tax revenue (includes employment-related insurance contributions)

~11% buy supplementary coverage for more rapid and convenient access (including to elective treatment in private hospitals)

No general cap, but out-of-pocket payments almost exclusively apply to prescription drugs and medical appliances only; for drugs, prepayment certificate with GBP29.10 [USD41.10] per three months or GBP104 [USD147] per year ceiling for those needing a large number of prescription drugs

Drug cost-sharing exemption for low-income, older people, children, pregnant women and new mothers, and some disabled/chronically ill; financial assistance with transport costs available to people with low incomes; vision tests free for young people, older people, and low-income people

Statutory health insurance system, with all SHI insurers incorporated into a single national exchange

Employer/employee earmarked income and payroll tax; general tax revenue, earmarked taxes

~95% buy or receive government vouchers for complementary coverage (mainly cost-sharing, some noncovered benefits); limited supplementary insurance

No; EUR50 [USD60] cap on deductibles for consultations and services

Exemption for low income, chronically ill and disabled, and children

Statutory health insurance system, with 118 competing SHI insurers ("sickness funds" in a national exchange); high income can opt out for private coverage

Employer/employee earmarked payroll tax; general tax revenue

~11% opt out from statutory insurance and buy substitutive coverage; some complementary (minor benefit exclusions from statutory scheme, copayments) and supplementary coverage (improved amenities)

Yes; 2% of household income; 1% of income for chronically ill

Children and adolescents ................
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