Private Health Insurance最新文献

{"title":"Private health insurance in the Netherlands","authors":"H. Maarse, P. Jeurissen","doi":"10.1017/9781139026468.011","DOIUrl":"https://doi.org/10.1017/9781139026468.011","url":null,"abstract":"Private health insurance has been a constituent part of the Dutch health system since the early 20th century. Before the major reform in 2006, almost a quarter of the population held so-called pure private health insurance cover as a substitute for sickness fund cover. The 2006 Health Insurance Act created a single, mandatory health insurance scheme covering the whole population under private law. One of its most important consequences was the abolition of the traditional division between statutory health insurance operated by sickness funds and all other insurance schemes including substitutive private health insurance with experience-based underwriting. However, the newly created scheme is not a pure private arrangement (the term ‘pure’ will be explained later in this chapter) but one extensively regulated by the state to protect public interests including, among others, solidarity in health care financing and access to health care. This chapter starts with a brief overview of the history of private health insurance in the Netherlands and its structure in the 1990s and early 2000s. The focus in the second part is on the 2006 reform and its consequences for the health insurance market. Developments in longterm care insurance are beyond the scope of the chapter.","PeriodicalId":187387,"journal":{"name":"Private Health Insurance","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116704639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uncovering the complex role of private health insurance in Ireland","authors":"B. Turner, Samantha Smith","doi":"10.1017/9781139026468.007","DOIUrl":"https://doi.org/10.1017/9781139026468.007","url":null,"abstract":"The role of private health insurance in the Irish health system can be assessed from different angles and from all angles it appears complex. Despite universal entitlement to public hospital services, private cover – predominantly for hospital services – is purchased by nearly half of the population. This high level of demand has remained buoyant over time in the face of premium increases, adverse economic conditions, reductions in public subsidies and controversy within the market. Also, while private health insurance accounts for less than 15% of total spending on health, it commands a high profile in media and policy discussions and has substantial leverage over how public and private resources are allocated within the health system, particularly in the acute care sector. This chapter analyses the structure and development of the market for private health insurance in Ireland and considers its impact on the wider health system. The market’s development has been complicated, involving a series of high-level Irish and European court cases, highly visible exits from the market and other structural changes. In addition, its role has changed over time, as entitlements to publicly financed health care have also changed. However, one of the most distinctive aspects of the Irish experience comes from the complex interaction between publicly and privately financed health care and the impact of private health insurance on the distribution of resources in the wider health system. The chapter unpicks these complexities, highlighting critical issues around equity and efficiency.","PeriodicalId":187387,"journal":{"name":"Private Health Insurance","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115045862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The challenges of pursuing private health insurance in low- and middle-income countries: lessons from South Africa","authors":"D. Mcintyre, H. McLeod","doi":"10.1017/9781139026468.012","DOIUrl":"https://doi.org/10.1017/9781139026468.012","url":null,"abstract":"South Africa’s apartheid history of legislated discrimination on the basis of race has left a legacy of massive income inequalities – with, at 0.63 in 2011, one of the highest Gini coefficients in the world (World Bank, 2017) – and inequalities in access to social services. It has also left an indelible imprint on the health sector, where private health insurance was developed to serve white workers, whereas the public health sector served the majority black population and lower-income whites.1 Since the first democratic elections in 1994, there has been considerable commitment to addressing these inequalities. However, progress has been limited: income inequalities have in fact been growing and inequalities within the health sector are increasingly related to class rather than race. The development of private health insurance, and policy related to it, has been heavily influenced by the social and political context. Medical schemes (the name given to private health insurance organizations in South Africa) were introduced at the turn of the 20th century, under British rule, for white mineworkers, and restricted to white South Africans until the 1970s. The number of schemes grew rapidly from the 1940s, alongside the growth of private providers. The apartheid government actively promoted privatization of health care financing and provision during the 1980s, deregulating medical schemes in 1988. Following transition to a democratic government in 1994, there were concerted efforts to re-regulate medical schemes, but in spite of","PeriodicalId":187387,"journal":{"name":"Private Health Insurance","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128929280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Private health insurance in Canada","authors":"J. Hurley, G. Guindon","doi":"10.1017/9781139026468.004","DOIUrl":"https://doi.org/10.1017/9781139026468.004","url":null,"abstract":"Although a majority of Canadians hold some form of private health care insurance -- most commonly obtained as an employment benefit -- private insurance finances only 12% of health care expenditures in Canada and its financing role is essentially limited to complementary coverage for services not covered by public insurance programs. Private supplementary insurance for services covered by the public insurance system does not exist in Canada. This limited role for private insurance in health care reflects the core policy vision for health care financing in Canada, which emphasizes equal access to medically necessary health care, especially physician and hospital services. Compared to many other countries, Canada's private health insurance market is relatively uncomplicated, viewed in terms of either the products offered or the regulations imposed. Although Canadians regularly debate the relative split between public and private finance overall, and a small set of advocates have persistently pressed for a greater role for private insurance, private insurance has not figured prominently in Canada's health care policy debates, which since the late 1960s have focused on the publicly funded health care system. Three Canadian health care policy challenges, however, are drawing the role of private health insurance into the centre of policy debate. The first has been the emergence in the last ten years of long wait times for some common, high-profile services such as orthopaedic surgery, eye surgery, diagnostic imaging, and cancer treatments. These wait times have fuelled advocates for parallel private finance alongside public insurance and for loosening restrictions on supplementary private insurance. Such advocates were emboldened by a landmark 2005 Supreme Court of Canada ruling (Chaoulli vs. Government of Quebec) that, in the presence of excessive wait times in the public system, Quebec's statute prohibiting private insurance for publicly insured services violated Quebec's Charter of Rights. Though the ruling has only narrow application to Quebec, the judgement has given momentum to those advocating for a fundamental change in the role of private insurance in Canadian health care. The second element drawing private insurance into the centre of policy debate is the growing importance of pharmaceuticals in the modern pantheon of medically necessary therapies. Prescription drugs are excluded from the core services covered by Canadian Medicare, so the majority of pharmaceutical costs are privately financed. Many Canadians, however, are either uninsured or underinsured for prescription drugs. This has prompted many to call for an expansion of public financing for prescription drugs (National Forum on Health 1997;Commission on the Future of Health Care in Canada 2002;Senate of Canada 2002). Some proposals call for full public coverage that would supplant the currently large role of private insurance in this sector; others, call for various types of public-p","PeriodicalId":187387,"journal":{"name":"Private Health Insurance","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124482660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why private health insurance?","authors":"S. Thomson, A. Sagan, Elias Mossialos","doi":"10.1017/9781139026468.001","DOIUrl":"https://doi.org/10.1017/9781139026468.001","url":null,"abstract":"Private health insurance makes a small contribution to spending on health in most countries around the world, but its effect on health system performance can be surprisingly large owing to market failures and weaknesses in public policy. Because private health insurance can have a disproportionate impact, leading to risk segmentation, inequality and inefficiency, it should be considered and monitored with care. Proponents of private health insurance fall into two camps. Some see private health insurance as attractive in its own right: in their view, a permanently mixed system of health financing will enhance efficiency and consumer choice. Others regard private health insurance as a second-best option in the context of fiscal constraints: not as desirable as public spending on health, but preferable to out-of-pocket payments. In richer countries, it is argued, encouraging the wealthy to pay more for health care or allowing public resources to focus on essential services will relieve pressure on government budgets (Chollet & Lewis, 1997). In poorer countries, private health insurance can play a transitional role, helping to boost pre-paid revenue and paving the way for public insurance institutions (Sekhri & Savedoff, 2005). A key assumption in both contexts is that private health insurance will fill gaps in publicly financed health coverage, even though economic theory indicates that gaps may be filled for some people, but not for others. Analysts who acknowledge this tension suggest that it can be addressed through regulation (Sekhri & Savedoff, 2005). Evidence of international interest in private health insurance first emerged in the early 1990s, in work funded by the European Commission. Studies systematically analysing private health insurance in the European Union (Schneider, 1995; Mossialos & Thomson, 2002; Thomson & Mossialos, 2009) were later extended to cover other countries in Europe (Thomson, 2010; Sagan & Thomson, 2016a, 2016b). Comparative","PeriodicalId":187387,"journal":{"name":"Private Health Insurance","volume":"164 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132404725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Undermining risk pooling by individualizing benefits: the use of medical savings accounts in South Africa","authors":"H. McLeod, D. Mcintyre","doi":"10.1017/9781139026468.013","DOIUrl":"https://doi.org/10.1017/9781139026468.013","url":null,"abstract":"South Africa has a dual health system in which the majority of the population is covered by the public health care sector and 16% of the population with higher incomes is covered by voluntary private health insurance delivered through medical schemes. Medical savings accounts (MSAs) were first introduced by medical schemes in 1994 and their usage grew rapidly in the first decade but declined in the second decade. By 2005, MSAs covered 88% of open scheme beneficiaries and 49% of restricted1 scheme beneficiaries but by December 2014 MSA coverage had declined to 67% of open scheme beneficiaries and 18% of restricted scheme beneficiaries. This chapter focuses on MSAs, but more information on medical schemes and private health insurance can be found in Chapter 12 in this volume.","PeriodicalId":187387,"journal":{"name":"Private Health Insurance","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115229934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Private health insurance in Brazil, Egypt and India","authors":"M. Diaz, N. Haber, P. Mladovsky, E. Pitchforth, Wael F. Saleh, F. Sarti","doi":"10.1017/9781139026468.003","DOIUrl":"https://doi.org/10.1017/9781139026468.003","url":null,"abstract":"The case studies presented in this chapter provide evidence of varied experience with private health insurance in three middle-income country settings – Egypt and India – where there are large and persisting socioeconomic differentials and where private spending accounts for half of health care financing. Brazil is private health insurance market system Egypt and India are very small markets with regulation.","PeriodicalId":187387,"journal":{"name":"Private Health Insurance","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130952780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating public and private insurance in the Israeli health system: an attempt to reconcile conflicting values","authors":"S. Brammli-Greenberg, R. Waitzberg","doi":"10.1017/9781139026468.008","DOIUrl":"https://doi.org/10.1017/9781139026468.008","url":null,"abstract":"The private health insurance market in Israel offers two voluntary products: the first, offered by the non-profit health plans (HPs), is referred to as supplemental insurance (SI); the second, provided by for-profit insurers, is known as commercial insurance (CI). Both types of cover play a complementary role, covering benefits excluded from the National Health Insurance (NHI) scheme such as dental health care for adults. They also play a supplementary role, providing faster access to care, greater choice of provider and improved amenities (in the private sector), and extended cover of services included in the NHI, such as more physiotherapy or psychotherapy sessions compared with what the NHI offers. The Israeli private health insurance market’s main distinctive feature is the very high levels of population coverage and dual coverage (almost all people who own CI also own SI). We observe two trends in the health care market: (i) the decrease in the public share of health spending in the last two decades, followed by a sharp growth in private activity and private health insurance coverage; and (ii) the growth of the private health insurance market accompanied by various negative impacts on the public system’s financial sustainabil-ity, accessibility and availability of services and quality of care. Analysis of the Israeli case highlights the complexity of integrating statutory and broad private (voluntary) health insurance. Integration efforts have created a range of, sometimes conflicting, incentives and dis-incentives, which have implications for achieving public policy goals such as choice, extended coverage, equity, solidarity and curbing government spending while maintaining a strong publicly financed health system.","PeriodicalId":187387,"journal":{"name":"Private Health Insurance","volume":"252 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122486141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Private finance publicly subsidized: the case of Australian health insurance","authors":"Jane Hall, D. Fiebig, K. Gool","doi":"10.1017/9781139026468.002","DOIUrl":"https://doi.org/10.1017/9781139026468.002","url":null,"abstract":"Australia’s Medicare is a universal, publicly funded comprehensive insurance scheme that provides all its citizens with free treatment in public hospitals, and subsidizes out-of-hospital medical services and pharmaceuticals. Yet alongside this public insurance there exists a strong private health insurance sector that covers private in-hospital treatment or general (largely dental and other) ancillary services. Policy initiatives implemented since 1997 have provided both incentives and penalties to encourage the uptake of private insurance. The proportion of the population with insurance for hospital treatment grew from around 33% in December 1996 to a high of 45% in 2000; it then declined slightly until 2007 and has increased since then to 47% in December 2015 (APRA, 2016). Consequently, significant public funds have been directed to support the private health insurance industry and, by extension, the private health care sector. Current policies reflect the ambiguities of the electoral popularity of Medicare alongside the push to restrain public spending. This apparently anomalous situation can only be understood in the context of the contested ground between public and private interests in health care financing. In less than 40 years, from 1970 to 2010, Australia moved through the following approaches to health care financing: voluntary private insurance with public subsidies (pre-1974); publicly financed national universal health insurance (Medibank, 1974–1976); a series of policy changes that returned the system to voluntary, predominantly private, insurance with public subsidies (1976–1984); publicly financed national universal health insurance (Medicare, 1984–1996); publicly financed national universal health insurance with publicly subsidized private health insurance (1996–2006); and publicly financed national universal health insurance with an expanded role for publicly subsidized private health insurance (2006 until time of publication). Following a change of government in 2007, a new direction in health care financing was sought. Interestingly, given the previous focus on the roles of","PeriodicalId":187387,"journal":{"name":"Private Health Insurance","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115347349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statutory and private health insurance in Germany and Chile: two stories of coexistence and conflict","authors":"Stefanie Ettelt, A. Roman-Urrestarazu","doi":"10.1017/9781139026468.006","DOIUrl":"https://doi.org/10.1017/9781139026468.006","url":null,"abstract":"In Germany and Chile, the market for private health insurance exists alongside and “within” a statutory health insurance system that covers a large majority of the population. Private cover comes in two forms: substitutive, chosen to replace statutory cover, which means that the privately insured do not contribute to this aspect of the social security system (unless statutory health insurance is partly funded through the government budget); and complementary or supplementary, allowing people to “top up” publicly financed benefits. In both countries, the vast majority of the population is covered by statutory health insurance. However, some parts of the population, mostly those who are able to afford it, have the option of choosing between private and statutory coverage. In Germany, the group of people given this choice is limited by regulation, with those allowed to “opt out” of the statutory system having to demonstrate that they have earnings above a threshold. Once they have chosen the private option, the possibility of returning to statutory cover is limited. In Chile, choice of substitutive private cover is also dependent on earnings as a private plan is significantly more expensive than contributions to the statutory system, but there is no fixed threshold for those who wish to opt out. Also, the privately insured in Chile are allowed to re-enter the statutory system at any time, an option that has been intentionally precluded in the German system to reduce the potential for further risk segmentation. This chapter describes the origins and development of private health insurance in Germany and Chile, providing a comparative assessment of its effects on consumers and the health financing system as a whole. The chapter provides a detailed overview of the market for private health insurance in both countries, followed by a comparative assessment of the impact of private cover in relation to financial protection, equity","PeriodicalId":187387,"journal":{"name":"Private Health Insurance","volume":"147 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123781127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}