National health insurance

National health insurance (NHI) – sometimes called statutory health insurance (SHI) – is a legally enforced scheme of health insurance that insures a national population against the costs of health care. It may be administered by the public sector, the private sector, or a combination of both. Funding mechanisms vary with the particular program and country. National or Statutory health insurance does not equate to government-run or government-financed health care, but is usually established by national legislation. In some countries, such as Australia's Medicare system or the UK's National Health Service, contributions to the system are made via general taxation and therefore are not optional even though use of the health scheme it finances is. In practice, of course, most people paying for NHI will join the insurance scheme. Where the NHI scheme involves a choice of multiple insurance funds, the rates of contributions may vary and the person has to choose which insurance fund to belong to.

Germany has the world's oldest national social health insurance system, with origins dating back to Otto von Bismarck's Sickness Insurance Law of 1883. In Britain, the National Insurance Act 1911 included national social health insurance for primary care (not specialist or hospital care), initially for about one third of the population—employed working class wage earners, but not their dependents. This system of health insurance continued in force until the creation of the National Health Service in 1948 which created a universal service, funded out of general taxation rather than on an insurance basis, and providing health services to all legal residents.

National healthcare insurance programs differ both in how the money is collected, and in how the services are provided. In countries such as Canada, payment is made by the government directly from tax revenue. The collection is administered by government. In France a similar system of compulsory contributions is made, but the collection is administered by non-profit organisations set up for the purpose. This is known in the United States as single-payer health care. The provision of services may be through either publicly or privately owned health care providers.

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