Health insurance, National


Health insurance, National, is government- provided insurance that pays the health care expenses of all or most of a nation’s citizens. Such programs are usually financed by income or payroll taxes on individuals. The government determines the medical services the program will cover and the prices it will pay for those services. There are two basic types of health care systems that incorporate national health insurance: public-only (or single-payer) systems and two-tiered (or multi-payer) systems.

With public-only health care, the government is the sole payer of all covered medical costs. It may be illegal for individuals to pay for health services covered by the national insurance, and health care providers may only receive payment for covered services from the state. The government exercises a great deal of control over the price of health care under this system, which usually keeps prices lower. Some people criticize public-only systems by pointing out that patients have little choice over how their care is managed and may face a lengthy wait for services. Canada (with the exception of Quebec) has a public-only health care system.

A two-tiered health system, like the public-only system, provides basic health care to all citizens. A two-tiered system, however, allows people to receive health care from government providers or to pay for private health services. A common criticism of this system is that the most skilled health care providers sometimes choose to practice in the private sector, where financial gains are greater. France and Germany have two-tiered health care systems. Other countries have variations on these systems, and in some places individuals buy private (nongovernment) health insurance to help with services that are not otherwise covered.

In the United States, most insured people have private health insurance, which they acquire through their employer. A portion of the population is covered by such government-run insurance programs as Medicaid and Medicare. In 2010, Congress passed a bill enacting a new program that would permit uninsured and self-employed Americans to purchase health insurance through state-based exchanges. The government would provide subsidies for purchasing insurance to individuals who had income below a certain level. These provisions begin in 2014.

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