Healthcare by country

Question

This piglix contains articles or sub-piglix about Healthcare by country

Answer 1

Healthcare in Iceland

Healthcare in Iceland is universal. The healthcare system is largely paid for by taxes (85%) and to some extent by service fees (15%) and is administrated by the Ministry of Welfare. A considerable portion of government spending is assigned to health care. There is almost no private health insurance in Iceland and no private hospitals.

Healthcare providers in Iceland fall into one of the following legally defined categories of healthcare providers:

Health care system in Iceland relies on general taxation, instead of local funding. This is affected by the Nordic welfare state model, in which public service is heavily funded through taxation to support the general public, in order for the population to have equal access to health care and welfare system. Although local authorities have limited influence over the national health care system, Iceland has recently adapted to similar structures to other Nordic countries, implementing decentralized structure by dividing the country into seven local health care regions. The health care regions were implemented to promote cooperations between institutions, and to provide quality care through regional provisions. However, this has not affected the financial responsibility of the central government. Although health care is generally funded through taxation, some out-of-pocket expenses are still required, such as service fees. Iceland does not operate its health care system based on financial need, but some disadvantaged groups, including disabled and elders, generally receive discounts on personal health expenses.

As of recently, out-of-pocket expenditure has increased significantly, resulted in approximately 76% increase in private expenditure from 1995 to 2010. By 2011, Iceland's out-of-pocket payments have become an important financial source for the universal health care system, which made up 18.2% of total health expenditures. The general population, however, still showed overwhelming support for governmental funding and providing the health care system at the same time. Through a research survey conducted in 2013 focused on Icelandic adults, in which 94% of the respondents want the government to spend more on public health care, and 81% of the respondents prefer and supports primary health care to be provided by the government. Although the government aimed to provide easy and accessible health care to all population regardless of income and social status, there are still some problems faced due to benefits given to disadvantaged groups. Some people without additional help face postponement or even cancellation to medical treatment.

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Answer 2

Healthcare in India

India does not have a National health insurance or universal health care system for all its citizens which has allowed the private sector to become the dominant healthcare provider in the country.

The private healthcare sector is responsible for the majority of healthcare in India. Most healthcare expenses are paid out of pocket by patients and their families, rather than through insurance. This has led many households to incur Catastrophic Health Expenditure (CHE) which can be defined as health expenditure that threatens a household's capacity to maintain a basic standard of living. One study found that over 35% of poor Indian households incur CHE and this reflects the detrimental state in which Indian health care system is at the moment. With government expenditure on health as a percentage of GDP falling over the years and the rise of private health care sector, the poor are left with fewer options than before to access health care services. Private insurance is available in India, as are various through government-sponsored health insurance schemes. According to the World Bank, about 25% of India's population had some form of health insurance in 2010. A 2014 Indian government study found this to be an over-estimate, and claimed that only about 17% of India's population was insured. Public healthcare is free for those below the poverty line.

Penetration of health insurance in India is low by international standards. Also private health insurance schemes, which constitute the bulk of insurance schemes availed by the population, do not cover costs of consultation or medication. Only hospitalisation and associated expenses are covered. India has typically addressed concerns pertaining to pricing of medication through indirect but more pragmatic means such as tax sops for medical expenses and patent law. Indian patent law only protects formulation and not the composition of a drug. This means that generic drugs that typically become available after the patent protections afforded to a drug's original developer expire, are available in India much earlier. Indian pharmaceutical companies routinely re-engineer processes for manufacturing generic drugs to make medication available at much lower costs. Accordingly, most of the research budget in Indian pharmaceutical companies is oriented at developing processes for synthesizing drugs, rather than drug development.

According to National Family Health Survey-3, the private medical sector remains the primary source of health care for 70% of households in urban areas and 63% of households in rural areas. Reliance on public and private health care sector varies significantly between states. Several reasons are cited for relying on private rather than public sector; the main reason at the national level is poor quality of care in the public sector, with more than 57% of households pointing to this as the reason for a preference for private health care. Most of the public healthcare caters to the rural areas; and the poor quality arises from the reluctance of experienced health care providers to visit the rural areas. Consequently, the majority of the public healthcare system catering to the rural and remote areas relies on inexperienced and unmotivated interns who are mandated to spend time in public healthcare clinics as part of their curricular requirement. Other major reasons are distance of the public sector facility, long wait times, and inconvenient hours of operation. The study conducted by IMS Institute for Healthcare Informatics in 2013, across 12 states in over 14,000 households indicated a steady increase in the usage of private healthcare facilities over the last 25 years for both Out Patient and In Patient services, across rural and urban areas.

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Answer 3

Healthcare in Hungary

Hungary has a tax-funded universal healthcare system, organized by the state-owned National Health Insurance Fund (Hungarian: Országos Egészségbiztosítási Pénztár (OEP)). According to the OECD 100% of the total population is covered by universal health insurance, which is absolutely free for children (all people under 16), mothers or fathers with baby, students, pensioners (everyone over 62), people with low income, handicapped people (including physical and mental disorders),priests and other church employees. Health in Hungary can be described with a rapidly increasing life expectancy (7.48 years for men and 4.92 years for women between 1993 and 2013) and a very low infant mortality rate (4.6 per 1,000 live births in 2014). According to the OECD Hungary spent 7.8% of its GDP on health care in 2012. Total health expenditure was 1,688.7 US$ per capita in 2011, 1,098.3 US$ governmental-fund (65%) and 590.4 US$ private-fund (35%).

The first hospitals go back to the 13th-century mining towns of Hungary. The first mining health insurance was founded by János Thurzó in 1496. The first modern insurer was established in 1907, named Országos Munkásbetegsegélyező és Balesetbiztosító Pénztár ("National Workers' Sick-benefit and Accident Fund").

The first steps to overall health insurance took place in the Horthy era with the creation of Országos Társadalombiztosítási Intézet (lit. "National Social Insurance Institution") in 1928 (This is the predecessor of present-day Országos Egészségbiztosítási Pénztár.). Social services were complete to 1938, at that time the Hungarian social health insurance system was the most progressive and charitable in East-Central Europe.

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Answer 4

Healthcare in Greece

Healthcare in Greece consists of a universal health care system provided through national health insurance, and private health care. According to the 2011 budget, the Greek healthcare system was allocated 6.1 billion euro, or 2.8% of GDP. In a 2000 report by the World Health Organization, the Greek healthcare system was ranked 14th worldwide in the overall assessment, above other countries such as Germany (25) and the United Kingdom (18), while ranking 11th at level of service.

Healthcare in Greece is provided by the National Healthcare Service, or ESY (Greek: Εθνικό Σύστημα Υγείας, ΕΣΥ).

Healthcare in Greece traces its roots to the ancient Greek civilization. Hospitals did not exist in the modern sense in the ancient Greek world, but temples dedicated to the healing god Aesculapius (called Asclepieia) functioned as healing places as well as places of worship. It is not known whether or not cities in ancient Greece provided free healthcare to their citizens, but recent study of the ruins of the Kos Asclepieion show that medical services were offered to everyone who could pay for them, including slaves and foreigners.

The Byzantine Empire is accredited by some for having invented the hospital as the institution we know it to be today. Professor Timothy S. Miller of the Johns Hopkins University argues that the Byzantine Empire was the first to employ a system of hospital-based healthcare, where the hospital became the chief institution of the medical profession in contrast to its function as a last resort in Western medieval Europe, carrying forward the medical knowledge of ancient Greece and Rome.

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Answer 5

Healthcare in Iraq

Iraq had developed a centralized free healthcare system in the 1970s using a hospital based, capital-intensive model of curative care. The country depended on large-scale imports of medicines, medical equipment and even nurses, paid for with oil export income, according to a “Watching Brief” report issued jointly by the United Nations Children’s Fund and the World Health Organization in July 2003. Unlike other poorer countries, which focused on mass health care using primary care practitioners, Iraq developed a Westernized system of sophisticated hospitals with advanced medical procedures, provided by specialist physicians. The UNICEF/WHO report noted that prior to 1990, 97 percent of the urban dwellers and 71 percent of the rural population had access to free primary health care; just 2 percent of hospital beds were privately managed.

During its last decade, the regime of Saddam Hussein cut health funding by 90 percent, contributing to a substantial deterioration in health care. During that period, maternal mortality increased nearly threefold, and the salaries of medical personnel decreased drastically. Medical facilities, which in 1980 were among the best in the Middle East, deteriorated. Conditions were especially serious in the south, where malnutrition and water-borne diseases became common in the 1990s. In 2005 the incidence of typhoid, cholera, malaria, and tuberculosis was higher in Iraq than in comparable countries. The conflict of 2003 destroyed an estimated 12 percent of hospitals and Iraq’s two main public health laboratories. In 2004 some improvements occurred. Using substantial international funds, some 240 hospitals and 1,200 primary health centers were operating, shortages of some medical materials had been alleviated, the training of medical personnel had begun, and the inoculation of children was widespread. However, sanitary conditions in hospitals remained unsatisfactory, trained personnel and medications were in short supply, and health care remained largely unavailable in regions where violent insurgency continued. In 2005 there were 15 hospital beds, 6.3 doctors, and 11 nurses per 10,000 population. Plans called for US$1.5 billion of the national budget to be spent on health care in 2006.

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Answer 6

Healthcare in the Republic of Ireland

Health care in Ireland is two-tier: public and private sectors exist. The public health care system is governed by the Health Act 2004, which established a new body to be responsible for providing health and personal social services to everyone living in Ireland – the Health Service Executive. The new national health service came into being officially on 1 January 2005; however the new structures are currently in the process of being established as the reform programme continues. In addition to the public-sector, there is also a large private healthcare market.

In 2010 Ireland spent €2,862 per capita on health, compared to a European Union average of €2,172 per capita, of this spending approximately 79% was government expenditure.

All persons resident in Ireland are entitled to receive health care through the public health care system, which is managed by the Health Service Executive and funded by general taxation. A person may be required to pay a subsidised fee for certain health care received; this depends on income, age, illness or disability. All maternity services and child care up to the age of six months are provided free of charge. Emergency care is provided at a cost of €100 for a visit to the Accident and Emergency department.

Everyone living in the country, and visitors to Ireland who hold a European Health Insurance Card, are entitled to free maintenance and treatment in public beds in Health Service Executive and voluntary hospitals, UK and CTA (Common Travel Area) citizens do not require an EHIC card and can instead present their NHS number, NHS card, driving licence or other proof of residence within the CTA. Outpatient services are also provided for free. However the majority of patients on median incomes or above, are required to pay subsidised hospital charges.

The Medical Card – which entitles holders to free hospital care, GP visits, dental services, optical services, aural services, prescription drugs and medical appliances- is available to those receiving welfare payments, low earners, those with certain long-term or severe illnesses and in certain other cases. Many political parties support extending the availability of the Medical Card to eventually cover everyone resident in Ireland – they currently cover 31.9% of the population. Those on slightly higher incomes are eligible for a GP Visit Card which entitles the holder to free general practitioner visits. For persons over 70 years who are not entitled to a medical card or GP visit card they instead receive an annual cash grant of €400 up to a certain income.

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Answer 7

Health care in Israel

Health care in Israel is universal and participation in a medical insurance plan is compulsory. All Israeli citizens are entitled to basic health care as a fundamental right. The Israeli healthcare system is based on the National Health Insurance Law of 1995, which mandates all citizens resident in the country to join one of four official health insurance organizations which are run as not-for-profit organizations, and are prohibited by law from denying any Israeli citizen membership. Israelis can increase their medical coverage and improve their options by purchasing private health insurance. In a survey of 48 countries in 2013, Israel's health system was ranked fourth in the world in terms of efficiency, and in 2014 it ranked seventh out of 51. In 2015, Israel was ranked sixth-healthiest country in the world by Bloomberg rankings and ranked eighth in terms of life expectancy.

During the Ottoman era, health care in Palestine was poor and underdeveloped. Most medical institutions were run by Christian missionaries, who attracted the indigent by offering free care. In the late nineteenth century, as the Yishuv, the pre-state Jewish community, began to grow in the wake of the First Aliyah, the Jews attempted to establish their own medical system. In 1872, Max Sandreczky, a German Christian physician, settled in Jerusalem and opened the first children's hospital in the country, Marienstift, which admitted children of all faiths. The Jewish agricultural settlements, financially backed by Baron Edmond de Rothschild, hired a physician who traveled between the communities and ran a pharmacy in Jaffa which he visited twice a week.

In 1902, the first Jewish hospital, Shaarei Zedek, opened in the Old City of Jerusalem. Additional Jewish hospitals were built in Jerusalem and Jaffa. In 1911, the Judea Worker's Health Fund, which later evolved into Clalit Health Services, was established as the first Zionist health insurance fund in the country.

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Answer 8

Healthcare in Italy

For a general article on health in Italy, see health in Italy

Healthcare spending in Italy accounted for 9.2% of GDP in 2012 (about $3,200 per capita) of which about 77% is public, slightly lower than the average of 9.3% in OECD countries. In 2000 Italy's healthcare system was regarded, by World Health Organization's ranking, as the 2nd best in the world after France, and according to the CIA World factbook, Italy has the world's 14th highest life expectancy. Thanks to its good healthcare system, the life expectancy at birth in Italy was 82.3 years in 2012, which is over two years above the OECD average.

After World War II Italy (re-)established its social security system including a social health insurance administered by sickness funds. In the 1970s the social health insurance faced several equity problems as coverage differed between the sickness funds and around 7% of the population remained uninsured. Moreover, sickness funds went practically bankrupt by the mid-1970s. Due to growing public dissatisfaction with the existing healthcare system, Italian policymakers fostered a structural reform. In 1978, the government established the SSN (Servizio Sanitario Nazionale) — the Italian version of a National Health Service — including universal coverage and tax funding.

Healthcare is provided to all citizens and residents by a mixed public-private system. The public part is the national health service, Sistema sanitario nazionale (SSN), which is organized under the Ministry of Health and is administered on a regional basis.

Family doctors are entirely paid by the SSN, must offer visiting time at least five days a week and have a limit of 1500 patients. Patients can choose and change their GP, subjected to availability.

Prescription drugs can be acquired only if prescribed by a doctor. If prescribed by the family doctor, they are generally subsidized, requiring only a copay that depends on the medicine type and on the patient income (in many regions all the prescribed drugs are free for the poor). Over-the-counter drugs are paid out-of-pocket. Both prescription and over-the-counter drugs can only be sold in specialized shops (farmacia). In a sample of 13 developed countries, Italy was sixth in its population weighted usage of medication in 14 classes in 2009 and fifth in 2013. The drugs studied were selected on the basis that the conditions treated had a high incidence, prevalence and/or mortality, caused significant long-term morbidity and incurred high levels of expenditure and significant developments in prevention or treatment had been made in the last 10 years. The study noted considerable difficulties in cross-border comparison of medication use.

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Answer 9

Health care system in Japan

The health care system in Japan provides healthcare services, including screening examinations, prenatal care and infectious disease control, with the patient accepting responsibility for 30% of these costs while the government pays the remaining 70%. Payment for personal medical services is offered by a universal health care insurance system that provides relative equality of access, with fees set by a government committee. All residents of Japan are required by the law to have health insurance coverage. People without insurance from employers can participate in a national health insurance programme, administered by local governments. Patients are free to select physicians or facilities of their choice and cannot be denied coverage. Hospitals, by law, must be run as non-profit and be managed by physicians. For-profit corporations are not allowed to own or operate hospitals. Clinics must be owned and operated by physicians.

Japan's system is now being revamped by the current Prime Minister Shinzo Abe as popularized by Abenomics.

Medical fees are strictly regulated by the government to keep them affordable. Depending on the family income and the age of the insured, patients are responsible for paying 10%, 20%, or 30% of medical fees, with the government paying the remaining fee. Also, monthly thresholds are set for each household, again depending on income and age, and medical fees exceeding the threshold are waived or reimbursed by the government.

Uninsured patients are responsible for paying 100% of their medical fees, but fees are waived for low-income households receiving a government subsidy. Fees are also waived for homeless people brought to the hospital by ambulance.

In 2008, Japan spent about 8.5% of the nation's gross domestic product (GDP), or US$2,873 per capita, on health, ranking 20th among Organisation for Economic Co-operation and Development (OECD) countries. That amount was less than the average of 9.6% across OECD countries in 2009, and about half as much as that in the United States. In 2013 expenditure was $479 billion, 10.3% of GDP - about the midpoint of OECD countries.

The government has well controlled cost over decades by using the nationally uniform fee schedule for reimbursement. The government is also able to reduce fees when the economy stagnates. In the 1980s, health care spending was rapidly increasing as was the case with many industrialized nations. While some countries like the U.S. allowed costs to rise, Japan tightly regulated the health industry to rein in costs. Fees for all health care services are set every two years by negotiations between the health ministry and physicians. The negotiations determine the fee for every medical procedure and medication, and fees are identical across the country. If physicians attempt to game the system by ordering more procedures to generate income, the government may lower the fees for those procedures at the next round of fee setting. This was the case when the fee for an MRI was lowered by 35% in 2002 by the government. Thus, as of 2009, in the U.S. an MRI of the neck region could cost $1,500, but in Japan it cost US$98. Japan has had "catastrophic coverage" since 1973. Once a patient's monthly copayment reaches a cap, no further copayment is required. The threshold for the monthly copayment amount is tiered into three levels according to income and age.

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Answer 10

Healthcare in Kuwait

Kuwait has a state-funded healthcare system, which provides treatment without charge to holders of a Kuwaiti passport. A public insurance scheme exists to provide reduced cost healthcare to non-citizens. Private healthcare providers also run medical facilities in the country, available to members of their insurance schemes.

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