Healthcare Funding Mechanisms: How European Nations Finance Their Insurance Systems – Good health is an important part of our good life. In this entry we focus on health
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Healthcare Funding Mechanisms: How European Nations Finance Their Insurance Systems
Public health insurance is a legacy of the Last Age.1 The first legal example of health insurance dates back to the 19th century. 2 Data from this early system show that health care spending only began to increase several years after the expansion of insurance coverage. , with the discovery of powerful new treatments.3
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The impact that scientific development has had on health care spending is evident in the US experience: in recent years, as health care has expanded rapidly, the use money for health has increased – in any way you want to measure it: private and public, both per capita and as a person. part of all household goods. This happens without major changes in insurance coverage and has two main benefits: (i) The United States now spends more federal money per person on more health care. as many countries that subsidize international services, and (ii) spending more than 1% of the user accounts for more than 20% of all medical expenses.4
Global spending on health care as a share of global income has been increasing, steadily but slowly over the past few years. In the background, however, there are many differences between different countries, both in degree and trends. In the region, high-income countries spend – and have spent – more of their income on health care than low-income countries (about twice). In addition, in contrast to high-income countries, in low- and middle-income countries the share of the population in health care is lower – although it caught – and the responsibility of spending more money out of pocket (more than 50). % of total expenditure in various countries).5
Financial health in developing countries in the 21st century has been largely driven by the flow of resources through development assistance. This flow – which has seen an increase after the introduction of the Millennium Development Goals – accounts for approximately 0.7% of the resources used by high-income countries in health . Although this may seem small in the commitment of the countries of rich countries, for low-income countries when receiving the end of the transition, these resources are very much; In Sub-Saharan Africa they finance more than 25% of the total expenditure on health care.6 This means that the development of health, if necessary and controlled , the potential to reduce inequalities in health: the relationship between health. Benefits and health care spending are showing a large return on investment in health care, especially at a low level of cost base.7
Today, health care is often considered a ‘good’ – a product that is determined that an individual or society should have as needed. instead of being able and willing to pay. This view, part of the recognition of the external quality of health care, is perhaps the most visible as the fact that access to medical care is now the way laws in many countries.8
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However, just a few generations ago the situation was very different. In fact, during the Middle Ages health was considered a matter of fate throughout most of Western Europe; It was only later, under the influence of Mercantilism and the Enlightenment, that this attitude began to change and public officials increased their thinking about promoting public health. test.9 Sundin and Willner (2007) say that “[g]enerally, before the time of enlightenment, it was thought that health is a gift of God and disease and death are His the punishment for the sins of a person, the church, the whole country or its leaders. Therefore, to live a good life according to His will and repent for any guilt is considered the best defense against disease”. 10
To show this development we have created long-term data with estimates of government spending on health as a percentage of gross domestic product (GDP) for selection of countries with income, back to 1880.
According to the data, in 1880 government welfare was less than 1% of GDP in all countries; but this began to change rapidly in the first half of the 20th century and by 1970 government spending on health was above 2% of GDP in all these countries.
The increased spending on public health was seen in Europe after the Second World War mainly due to the fact that medicine had a major impact during the second of the 20th century – beginning, in particular, with the discovery and use of penicillin and others. Antibiotics. Before these studies appeared, the main point of treatment was not medical care but income insurance, insurance that paid for people who could not work because of consumption poor health. In fact, public health insurance for workers was already common in many European countries before the Second World War. The visualization shows public health insurance as a percentage of the workforce for several European countries (no analysis in this figure shows the no public insurance for the corresponding year/country). Tanzi and Schuknecht (2000) – the source for the data in this picture – note that by 1929 all eleven European countries were shown in this visualization to have minimal resources intervention schemes; and that by 1935 half of their workforce was covered by health insurance.
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After the introduction of universal health care in 1948 by the National Health Service, the United Kingdom is a special example that needs to be studied in detail.11 The observation showed that The cost of this global use has grown even more in the first decade of the 21st century. , than they did in the first two decades immediately after it began.
How did insurance policies change in the United States during the rapid growth of health care spending in the 20th century?
The lion’s share of the aforementioned historical increase in health care spending in the United States has occurred without an increase in the number of people who receive health insurance. The visual supports this; it presents the coverage plans by type of plan (special care should be taken when reading this picture, because the insurance plans are not mutually exclusive; this means that the services from ‘private’ and ‘government’ plans add up to more than those covered by ‘all arrangements’). As it can be seen, the total health insurance coverage has remained around 85% for several decades, while private and public health spending has increased steadily. at the same time. Interestingly, this data also shows that there was a change in coverage after 2012, when the ‘Affordable Care Act’ started to kick in. The most recent Gallup estimates (fourth quarter of 2015) put the total coverage at 88.1%.
The fact that insurance coverage has remained stable while health care spending has increased rapidly due to major improvements in health care in the 20th century, means that health care spending in the United States America is very advanced. The chart, produced by the National Institutes of Health and Human Services (NIHCM), shows the distribution of health care spending in the United States, using 2009 personal expenditure data. , across all ‘non-family citizens’.
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The source of data for this view is the Health Care Expenditure Survey – a long-term national survey that collects data on health care use and spending, management health insurance, and health, as well as aspects of health and business for non-corporate citizens. According to the source, the data refers to ‘citizenship not as a public entity’, in the sense that it does not include care for people living at home, such as viewing centers long-term care and penitentiaries, including military care and other non. public members of the public. The data correspond to ‘personal health services’, in the sense that they do not include administrative costs, research, capital investment and many other public services and private sector such as school health and workplace.
This figure should be read in the same way as the Lorenz curve: the fact that the distribution of spending bends away from the 45% degree line is a measure of high inequality (this is the Gini hypothesis coefficient that we discuss in our income inequality. input data). As it can be seen, the top 5% of consumers account for almost half of the spending, and the top 1% account for more than 20%. Although some of the costs should be considered when looking at the distribution across the entire population – because it is in the nature of treatment that some people, especially the elderly and have difficult health, will need to spend a lot of money -, these pictures look amazing. big They show significant disparities in access, over and above disparities in demand. Indeed, the publisher of the figure notes that a report by the Medicare Payment Assessment Commission shows that private spending for individuals covered by Medicaid is slightly lower than for the general population. all. 12
We have already pointed out that European countries pioneered the expansion of health insurance in the first half of the twentieth century. Those
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