Pub Date : 2020-10-01DOI: 10.1017/9781139026468.014
L. Crivelli
When compared with the other case studies analysed in this book, the role played by private health insurance in Switzerland may seem peculiar and perhaps corresponds only with the Netherlands post-2006 (see Chapter 11). The crux of the Swiss health sector is a system of federally established universal health insurance coverage with atypical characteristics lying somewhere between private and social insurance (OECD 2006; Leu et al., 2007). Swiss statutory health insurance is run by competing private institutions called sickness funds. It is strongly reliant on consumer choice and mainly financed through non-income-related premiums. Consumers (not employers or the government) buy health insurance plans, pay the bulk of health care costs through insurance premiums, co-payments and out-of-pocket payments, and choose the size of the deductible and other characteristics of the plan according to their own needs and preferences. Health insurers, whose business providing basic coverage is framed by social law, are also entitled to make profits by selling voluntary supplementary and complementary coverage governed by private law.2 From this perspective, health insurance in Switzerland conceptually belongs within the scope of private insurance.
与本书分析的其他案例研究相比，瑞士私人医疗保险所起的作用似乎有些特殊，也许只与2006年后的荷兰相对应(见第11章)。瑞士卫生部门的关键是联邦建立的全民健康保险体系，其非典型特征介于私人保险和社会保险之间(经合组织，2006年;Leu et al.， 2007)。瑞士的法定健康保险是由相互竞争的称为疾病基金的私人机构经营的。它强烈依赖于消费者的选择，主要通过与收入无关的保费来融资。消费者(不是雇主或政府)购买健康保险计划，通过保险费、共同支付和自付支付来支付大部分医疗费用，并根据自己的需要和偏好选择免赔额的大小和计划的其他特征。健康保险公司提供基本保险的业务是根据社会法制定的，它们也有权通过销售受私法管辖的自愿补充和补充保险来获利从这个角度来看，瑞士的健康保险在概念上属于私人保险的范围。
{"title":"Consumer-driven health insurance in Switzerland, where politics is governed by federalism and direct democracy","authors":"L. Crivelli","doi":"10.1017/9781139026468.014","DOIUrl":"https://doi.org/10.1017/9781139026468.014","url":null,"abstract":"When compared with the other case studies analysed in this book, the role played by private health insurance in Switzerland may seem peculiar and perhaps corresponds only with the Netherlands post-2006 (see Chapter 11). The crux of the Swiss health sector is a system of federally established universal health insurance coverage with atypical characteristics lying somewhere between private and social insurance (OECD 2006; Leu et al., 2007). Swiss statutory health insurance is run by competing private institutions called sickness funds. It is strongly reliant on consumer choice and mainly financed through non-income-related premiums. Consumers (not employers or the government) buy health insurance plans, pay the bulk of health care costs through insurance premiums, co-payments and out-of-pocket payments, and choose the size of the deductible and other characteristics of the plan according to their own needs and preferences. Health insurers, whose business providing basic coverage is framed by social law, are also entitled to make profits by selling voluntary supplementary and complementary coverage governed by private law.2 From this perspective, health insurance in Switzerland conceptually belongs within the scope of private insurance.","PeriodicalId":187387,"journal":{"name":"Private Health Insurance","volume":"624 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":"116468388","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}
Pub Date : 2020-10-01DOI: 10.1017/9781139026468.009
Soonman Kwon, N. Ikegami, Lee Yue-Chune
Japan, the Republic of Korea and Taiwan, China are neighbouring high-income countries with some similarities in health systems policy. All three have historically organized publicly financed health coverage around the labour market, with the government paying for some or all of the costs of self-employed, retired or poorer people, but Japan has a much higher share of public spending on health and a much lower share of out-of-pocket payments than the other two. All three rely heavily on the private sector to deliver health services. And in all three, private health insurance plays a supplementary role, offering subscribers daily cash benefits in case of hospitalization or lump sum payments in case of severe illness such as cancer. Although private health insurance markets in these countries are marginal in terms of spending on health, they cover relatively large shares of the population. This chapter reviews the origins and development of private health insurance in the three countries and considers why the market is not larger in terms of health spending, especially given the relatively high share of out-of-pocket payments in the Republic of Korea and Taiwan, China and the widespread use of cost sharing for publicly financed health services in all three countries.
{"title":"Private health insurance in Japan, Republic of Korea and Taiwan, China","authors":"Soonman Kwon, N. Ikegami, Lee Yue-Chune","doi":"10.1017/9781139026468.009","DOIUrl":"https://doi.org/10.1017/9781139026468.009","url":null,"abstract":"Japan, the Republic of Korea and Taiwan, China are neighbouring high-income countries with some similarities in health systems policy. All three have historically organized publicly financed health coverage around the labour market, with the government paying for some or all of the costs of self-employed, retired or poorer people, but Japan has a much higher share of public spending on health and a much lower share of out-of-pocket payments than the other two. All three rely heavily on the private sector to deliver health services. And in all three, private health insurance plays a supplementary role, offering subscribers daily cash benefits in case of hospitalization or lump sum payments in case of severe illness such as cancer. Although private health insurance markets in these countries are marginal in terms of spending on health, they cover relatively large shares of the population. This chapter reviews the origins and development of private health insurance in the three countries and considers why the market is not larger in terms of health spending, especially given the relatively high share of out-of-pocket payments in the Republic of Korea and Taiwan, China and the widespread use of cost sharing for publicly financed health services in all three countries.","PeriodicalId":187387,"journal":{"name":"Private Health Insurance","volume":"35 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":"128327586","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}
Pub Date : 2020-10-01DOI: 10.1017/9781139026468.016
S. Glied, Dan P. Ly, L. Brown
The medical savings account model of health insurance in the United States combines a high-deductible health insurance plan 1 with a dedicated savings account used to pay expenses incurred below the deductible. Savings in the plan can roll over from one year to the next and, after some predefined period during which they are dedicated to health spending, can be used for non-health-related expenses. 2 In principle, this model combines the incentives for frugal use of health services that exist in high-deductible health insurance with assurance that the funds required in the event of true medical need will be available. In with this model began, scale, Beginning the use of this model voluntary health States was promoted through a series of tax The first of these incentives, a limited demonstration project (capped at a maximum of 750 000 enrollees), was passed as part of the Health Insurance Portability and Accountability Act of 1996, which allowed self-employed individuals and businesses with fewer than 50 employees who were covered under qualified high-deductible health plans to make tax-exempt contributions to medical savings accounts.
{"title":"Health savings accounts in the United States of America","authors":"S. Glied, Dan P. Ly, L. Brown","doi":"10.1017/9781139026468.016","DOIUrl":"https://doi.org/10.1017/9781139026468.016","url":null,"abstract":"The medical savings account model of health insurance in the United States combines a high-deductible health insurance plan 1 with a dedicated savings account used to pay expenses incurred below the deductible. Savings in the plan can roll over from one year to the next and, after some predefined period during which they are dedicated to health spending, can be used for non-health-related expenses. 2 In principle, this model combines the incentives for frugal use of health services that exist in high-deductible health insurance with assurance that the funds required in the event of true medical need will be available. In with this model began, scale, Beginning the use of this model voluntary health States was promoted through a series of tax The first of these incentives, a limited demonstration project (capped at a maximum of 750 000 enrollees), was passed as part of the Health Insurance Portability and Accountability Act of 1996, which allowed self-employed individuals and businesses with fewer than 50 employees who were covered under qualified high-deductible health plans to make tax-exempt contributions to medical savings accounts.","PeriodicalId":187387,"journal":{"name":"Private Health Insurance","volume":"138 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":"123252680","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}
Pub Date : 2020-10-01DOI: 10.1017/9781139026468.010
D. Muthaka
Kenya has a pluralistic health system, with the government, private actors and donors involved in the financing and provision of health care. Since the late 1980s, the government has encouraged private investment in health care and there is now a large and diverse private health care delivery sector comprising for-profit and non-profit facilities. The growth of private provision has in turn created demand for private health insurance. Private health insurance cover is mainly purchased by higher-income employees in urban areas and only covered under 2% of the population in 2013 (Ministry of Health, 2014). It is beyond the financial reach of most of the population in a country plagued by poverty and income inequality, where access to affordable health care depends not just on the availability of funds but also on the availability of health workers and facilities. Until 2006, health insurers operated in an unregulated environment and there have been issues with fraud. The chapter begins with an overview of health financing policy in Kenya, then outlines the nature of the private health insurance market, the regulatory framework and barriers to market expansion.
{"title":"The role of private health insurance in financing health care in Kenya","authors":"D. Muthaka","doi":"10.1017/9781139026468.010","DOIUrl":"https://doi.org/10.1017/9781139026468.010","url":null,"abstract":"Kenya has a pluralistic health system, with the government, private actors and donors involved in the financing and provision of health care. Since the late 1980s, the government has encouraged private investment in health care and there is now a large and diverse private health care delivery sector comprising for-profit and non-profit facilities. The growth of private provision has in turn created demand for private health insurance. Private health insurance cover is mainly purchased by higher-income employees in urban areas and only covered under 2% of the population in 2013 (Ministry of Health, 2014). It is beyond the financial reach of most of the population in a country plagued by poverty and income inequality, where access to affordable health care depends not just on the availability of funds but also on the availability of health workers and facilities. Until 2006, health insurers operated in an unregulated environment and there have been issues with fraud. The chapter begins with an overview of health financing policy in Kenya, then outlines the nature of the private health insurance market, the regulatory framework and barriers to market expansion.","PeriodicalId":187387,"journal":{"name":"Private Health Insurance","volume":"74 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":"128803129","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}
Pub Date : 2020-10-01DOI: 10.1017/9781139026468.005
Agnès Couffinhal, C. Franc
Publicly financed health coverage in France is universal. Nevertheless, in 2015, private health insurance accounted for 13.3% of total spending on health (French Ministry of Health, 2016),5 one of the highest shares internationally. According to the most recent survey data available, 95% of the population is covered by a complementary health insurance contract that primarily reimburses statutory user charges. Nine out of ten people insured have a private contract while the rest benefit from publicly funded complementary coverage known as Couverture maladie universelle complémentaire (CMUC) due to their low income (Barlet, Beffy & Renaud, 2016; based on the 2012 Health, health care and insurance survey).6 The chapter begins by describing the basic features of the statutory health insurance system and the dynamics of its regulation, which explain the role that private health insurance has come to play over time.
{"title":"Regulating private health insurance:France’s attempt at getting it all","authors":"Agnès Couffinhal, C. Franc","doi":"10.1017/9781139026468.005","DOIUrl":"https://doi.org/10.1017/9781139026468.005","url":null,"abstract":"Publicly financed health coverage in France is universal. Nevertheless, in 2015, private health insurance accounted for 13.3% of total spending on health (French Ministry of Health, 2016),5 one of the highest shares internationally. According to the most recent survey data available, 95% of the population is covered by a complementary health insurance contract that primarily reimburses statutory user charges. Nine out of ten people insured have a private contract while the rest benefit from publicly funded complementary coverage known as Couverture maladie universelle complémentaire (CMUC) due to their low income (Barlet, Beffy & Renaud, 2016; based on the 2012 Health, health care and insurance survey).6 The chapter begins by describing the basic features of the statutory health insurance system and the dynamics of its regulation, which explain the role that private health insurance has come to play over time.","PeriodicalId":187387,"journal":{"name":"Private Health Insurance","volume":"27 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":"125569604","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}
Pub Date : 2020-10-01DOI: 10.1017/9781139026468.015
L. Brown, S. Glied
majorities in both congressional chambers.
国会参众两院的多数。
{"title":"Regression to the increasingly mean? Private health insurance in the United States of America","authors":"L. Brown, S. Glied","doi":"10.1017/9781139026468.015","DOIUrl":"https://doi.org/10.1017/9781139026468.015","url":null,"abstract":"majorities in both congressional chambers.","PeriodicalId":187387,"journal":{"name":"Private Health Insurance","volume":"12 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":"121819610","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}
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