A universal health care system guarantees access to healthcare for all citizens of a certain nation or region. It is also known as universal health coverage, universal coverage, or universal care. With the ultimate goal of improving health outcomes, it is typically structured around offering health services or the means to obtain them to either all citizens or just those who cannot pay them on their own.(Source: )
The idea of universal healthcare is that everyone has access to healthcare when and when they need it, without facing financial hardship. It does not mean that all cases or persons will be covered. While some universal healthcare programs are supported by the government, others are predicated on mandating that every person obtain private health insurance.
Three important factors can be taken into consideration when determining universal healthcare: who is covered, what services are covered, and how much of the cost is covered.The World Health Organization defines it as [1] a state in which people can obtain healthcare services without experiencing financial hardship.Universal health care, according to then-WHO Director General Margaret Chan, is the “single most powerful concept that public health has to offer” because it “delivers them in a comprehensive and integrated way” and unites “services.”[3]
Creating a protection system that offers everyone the same opportunities to experience the best possible level of health is one of the objectives of universal healthcare.*[4] Opponents claim that greater wait times and lower-quality healthcare result from universal healthcare.(5)
History of Universal health care
With the passage of the Sickness Insurance Law in Germany in 1883, the first steps toward a national health insurance program were taken. The “sick funds” system, which was financed and managed by employers and employees through wage deductions and company contributions, was required by law for industrial firms to offer accident and illness insurance to their low-paid employees.
The first example of universal healthcare in contemporary times was this social health insurance concept, known as the Bismarck concept after Prussian Chancellor Otto von Bismarck.(8) Soon after, other nations started to do the same. About one-third of wage earners in the United Kingdom were covered for primary care (but not hospital or specialty care) by the National Insurance Act 1911.
In 1912, the Russian Empire instituted a comparable framework, which was subsequently adopted by other developed nations. Similar systems were in place almost everywhere in Western and Central Europe by the 1930s.
Japan passed legislation pertaining to employee health insurance in 1927, and it was later strengthened in 1935 and 1940. In 1920, Soviet Russia built a completely public and organized health care system in the wake of the 1917 Russian Revolution.[10][9] At that time, nevertheless, it was not a fully universal system because it did not cover rural residents.
Between 1938 and 1941, a comprehensive health care system was established in New Zealand.[11, 12] In 1946, the Australian state of Queensland established a free public hospital system.
Global efforts to establish universal health care systems started after World War II. The United Kingdom began offering its comprehensive National Health Service on July 5, 1948. The Nordic nations of Sweden (1955),[13] Iceland (1956),[14] Norway (1956),[15] Denmark (1961)[16] and Finland (1964) were the next to implement universal health care.(17)
Japan implemented universal health insurance in 1961, and Canada followed suit in phases, introducing it to the entire country in 1968 and Saskatchewan in 1962.11]18] After the 1952 Egyptian Revolution, Egypt established a public healthcare system. In the former Soviet bloc, centralized public healthcare systems were established. In 1969, the Soviet Union began providing universal health care to its rural citizens.11]19]
Prior to gaining independence, Kuwait and Bahrain implemented their universal healthcare programs in 1950 and 1957, respectively.20] In 1978, Italy launched the Servizio Sanitario Nazionale, or National Health Service. Australia’s Medibank program, which introduced universal health insurance in 1975, paved the way for the current Medicare system, which went into effect in 1984.[Reference required]
Western European nations started implementing universal coverage in the 1970s and 2000s; the majority of these programs expanded on earlier ones to provide health insurance to the entire population. France’s national health insurance system was established in 1928 and was subsequently expanded by legislation to cover an increasing proportion of the population. In 2000, the last 1% of the uninsured population was covered.21]21] Finland implemented single-payer healthcare systems in 1972.
Furthermore, a number of Asian nations, including Israel (1995), Thailand (2001), Singapore (1993), Taiwan (1995), and South Korea (1989), implemented universal health care.
Russia and the other now-independent former Soviet republics and Eastern Bloc nations kept and modified their universal health care systems after the fall of the Soviet Union [24].
Following the 1990s, numerous nations in Latin America, the Caribbean, Africa, and the Asia-Pacific area—including developing nations—took action to ensure that all of their citizens had access to universal health care. Notable examples of these nations include China, which boasts the world’s largest universal health care system [25], and Brazil’s SUS [26], which increased coverage to 80% of the population.In [27] India implemented a decentralized, tax-funded universal healthcare program that significantly decreased death rates and enhanced the country’s healthcare infrastructure.
A 2012 study focused on nine countries—Ghana, Rwanda, Nigeria, Mali, Kenya, Indonesia, the Philippines, and Vietnam—in order to analyze the progress these nations are making.29][/30]
The majority of developed nations as well as many emerging nations currently run publically funded health care systems with the aim of achieving universal coverage. The National Academy of Medicine and other organizations claim that the US is the only affluent, developed country without universal health care.
The only healthcare programs offered by the government are the Indian Health Service (for members of federally recognized Native American tribes), Medicare (for low-income individuals and elderly patients as well as those with disabilities), and the Military Health System (for active, reserve, and retired military personnel and their dependents).
Funding models
The majority of nations have attained universal health care through a combination of funding models. The main source of funding comes from general taxation revenue, but in many nations it is also enhanced by specific charges (which can be levied against an individual or their employer) or the option to pay privately (through direct or optional insurance) for services that are not covered by the public system.
The majority of European systems are funded by a combination of governmental and private funding.(35) As in Portugal,[35] India, Spain, Denmark, and Sweden, tax money is the main source of funding for the majority of universal health care systems. A multi-payer system is used in several countries, like Germany, France,[36], and Japan,[37], where both public and private funds are used to pay for healthcare.
Nonetheless, a large portion of non-government funding originates from donations made to regulated non-profit sickness funds by businesses and employees. Contributions are required and outlined by law. Additionally, a distinction between federal and local funding for healthcare is emphasized.
One arrangement, for instance, has the municipality pay for the majority of healthcare, speciality healthcare is given and may be subsidized by a larger institution, such the state or a municipal cooperation board, and state agencies pay for the prescriptions. According to a Columbia University study, progressivity in health care finance has little effect on total economic inequality, and universal health care systems are only somewhat redistributive.37]
Compulsory insurance
Usually, laws requiring residents to obtain insurance are used to enforce this, although occasionally the government offers the insurance. Occasionally, as in Germany, there can be an option between several public and private funds offering a standard service, or occasionally there might only be one public fund (as in the Canadian provinces). Switzerland bases its healthcare system on mandatory insurance.39].(40)
In several European nations, including Germany, Belgium, and the Netherlands, where universal health care and private insurance coexist, the issue of adverse selection is resolved by utilizing a risk compensation pool to fairly distribute risks among funds as much as feasible.
Therefore, a fund with a younger, mostly healthy population must contribute to a compensation pool, and funds from the pool would be distributed to a fund with an older, mostly less healthy population.
Sickness funds compete on the basis of cost in this manner, and since risk-adjusted capitation payments are used to compensate for higher-risk individuals, there is no benefit to excluding them. Funds compete primarily on price and service, but they are not permitted to refuse coverage or pick and choose which policyholders they work with. In certain nations, the government establishes the minimum coverage threshold and it cannot be changed.(41)
There was once a “community rating” system by VHI in the Republic of Ireland, which was essentially a common risk pool or single payer.
Later on, the government let VHI go up for bid, but without providing a compensation fund. Due to this, foreign insurance companies entered the Irish market and began providing comparatively healthy sectors of the population with health insurance at a far lower cost. As a result, these companies increased their profits at VHI’s expense. Later, the government brought back community rating through a pooling arrangement, and BUPA, one of the biggest insurance companies, pulled out of the Irish market.[Reference required]
Even if an individual has private insurance, they are still required to pay the state a portion of their average monthly salary in Poland.[42] While self-employed individuals pay a fixed rate based on the average national wage, employees under an employment contract pay a percentage of their pay.
Single-payer
A single-payer health care system is one in which all medical expenses are covered by the government as opposed to private insurance.45] Single-payer systems can either own and employ healthcare resources and personnel, as was the situation in England before to the introduction of the Health and Social Care Act, or they can enter into contracts with private groups to provide healthcare services.
There are some places where both of these realities might coexist, like Italy and Spain.(8) Thus, “single-payer” refers to health care that is supported by a single public entity from a single fund and solely identifies the payment system; it does not specify the manner of delivery or the patients for whom doctors work. While states typically handle the funds, some single-payer systems employ a hybrid public-private structure.[Reference required]