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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