Health insurance in Malaysia

Healthcare in Malaysia is mainly under the responsibility of the government's Ministry of Health. Malaysia generally has an efficient and widespread system of health care, operating a two-tier health care system consisting of both a government-run universal healthcaresystem and a co-existing private healthcare system. Infant mortality rate – a standard in determining the overall efficiency of healthcare – in 2005 was 10, comparing favourably with the United States and western Europe. Life expectancy at birth in 2005 was 74 years.

History of Healthcare in Malaysia

Healthcare in Malaysia has under gone radical transformations. Earliest pre-colonial medical care was confined to traditional remedies current among local populations of Malays, Chinese, Indian and other ethnic groups. The advent of colonialism brought western medical practice into the country. Since the country's independence in August 1957, the system of medical care transferred from the British colonial rule has been transformed to meet the needs of emerging diseases, as well as national political requirements.

Healthcare today in Malaysia

Malaysia has a widespread system of health care. It implements a universal healthcare system, which co-exists with the private healthcare system.Infant mortality rate – a standard in determining the overall efficiency of healthcare – in 2005 was 10, comparing favourably with the United States and western Europe. Life expectancy at birth in 2005 was 74 years.Infant mortality fell from 75 per 1000 live births in 1957 to 7 in 2013.

Healthcare in Malaysia is divided into private and public sectors. Public provision is rather basic, especially in rural areas.^[5] The government produced a plan,1Care for 1Malaysia, in 2009, with the intention of reform based on the principle ‘use according to need, pay according to ability’, but little progress towards its implementation has been made.^[6] Malaysian society places importance on the expansion and development of healthcare, putting 5% of the government social sector development budget into public healthcare – an increase of more than 47% over the previous figure. This has meant an overall increase of more than RM 2 billion. With a rising and ageing population, the Government wishes to improve in many areas including the refurbishment of existing hospitals, building and equipping new hospitals, expansion of the number of polyclinics, and improvements in training and expansion of telehealth. Over the last couple of years they have increased their efforts to overhaul the systems and attract more foreign investment.

Government policy and action

The Malaysian government places importance on the expansion and development of health care, putting 5% of the government social sector development budget into public health care—an increase of more than 47% over the previous figure. This has meant an overall increase of more than RM 2 billion. With a rising and ageing population, the Government wishes to improve in many areas including the refurbishment of existing hospitals, building and equipping new hospitals, expansion of the number of polyclinics, and improvements in training and expansion of 

Government policy and action

The Malaysian government places importance on the expansion and development of health care, putting 5% of the government social sector development budget into public health care—an increase of more than 47% over the previous figure. This has meant an overall increase of more than RM 2 billion. With a rising and ageing population, the Government wishes to improve in many areas including the refurbishment of existing hospitals, building and equipping new hospitals, expansion of the number of polyclinics, and improvements in training and expansion of health. A major problem with the health care sector is the lack of medical centres for rural areas, which the government is trying to counter through the development of and expansion of a system called "tele-primary care". Another issue is the overperscription of drugs, though this has decreased in recent years.Over the last couple of years, the Malaysian Health Ministry has increased its efforts to overhaul the system and attract more foreign investment.

Influenza

The Malaysian government has developed a National Influenza Pandemic Preparedness Plan (NIPPP) which serves as a time bound guide for preparedness and response plan for influenza pandemic. It provides a policy and strategic framework for a multisectoral response and contains specific advice and actions to be undertaken by the Ministry of Health at the different levels, other governmental departments and agencies and non-governmental organisations to ensure that resources are mobilised and used most efficiently before, during and after a pandemic episode.^[13] Since the Nipah virus outbreak in 1999, the Malaysian Health Ministry have put in place processes to be better prepared to protect the Malaysian population from the threat of infectious diseases. Malaysia was fully prepared during the Severe Acute Respiratory Syndrome (SARS) situation (Malaysia was not a SARS affected country) and the episode of the H5N1 (bird flu) outbreak in 2004.

Medicine via Post

In January 2011 the Malaysia government launched a program to renew prescriptions via mail. Medicine via Post targets patients with chronic diseases. To be eligible to participate patients have to receive a certification from a pharmacist that their condition is stable and that they understand how to properly use their medication. Patients pay delivery costs which are RM3.5 in Putrajaya, RM5.0 for other locations in Peninsular Malaysia, and RM8.0 for Sabah and Sarawak. The program is based on a pilot-project conducted at Putrajaya Hospital started in October 2009.^[14]. A major problem with the health care sector is the lack of medical centres for rural areas, which the government is trying to counter through the development of and expansion of a system called "tele-primary care". Another issue is the overperscription of drugs, though this has decreased in recent years.Over the last couple of years, the Malaysian Health Ministry has increased its efforts to overhaul the system and attract more foreign investment.

Influenza

The Malaysian government has developed a National Influenza Pandemic Preparedness Plan (NIPPP) which serves as a time bound guide for preparedness and response plan for influenza pandemic. It provides a policy and strategic framework for a multi-sectoral response and contains specific advice and actions to be undertaken by the Ministry of Health at the different levels, other governmental departments and agencies and non-governmental organisations to ensure that resources are mobilised and used most efficiently before, during and after a pandemic episode.^[Since the Nipah virus outbreak in 1999, the Malaysian Health Ministry have put in place processes to be better prepared to protect the Malaysian population from the threat of infectious diseases. Malaysia was fully prepared during the Severe Acute Respiratory Syndrome  situation (Malaysia was not a SARS affected country) and the episode of the H5N1outbreak in 2004.

Medicine via Post

In January 2011 the Malaysia government launched a program to renew prescriptions via mail. Medicine via Post targets patients with chronic diseases. To be eligible to participate patients have to receive a certification from a pharmacist that their condition is stable and that they understand how to properly use their medication. Patients pay delivery costs which are RM3.5 in Putrajaya, RM5.0 for other locations in Peninsular Malaysia, and RM8.0 for Sabah and Sarawak. The program is based on a pilot-project conducted at Putrajaya Hospital started in October 2009.^[14]

Health insurance in Brazil

Healthcare in Brazil is a Constitutional right.It is provided by both private and government institutions. The Health Minister administers national health policy. Primary healthcare remains the responsibility of the federal government, elements of which (such as the operation of hospitals) are overseen by individual states. Public healthcare is provided to all Brazilian permanent residents and foreigners in Brazilian territory through the National Healthcare System, known as Unified Health System - SUS. The SUS is universal and free for everyone.

Healthcare system

National health policies and plans: The national health policy is based on the Federal Constitution of 1988, which sets out the principles and directives for the delivery of healthcare in the country through the Unified Health System (SUS). Under the constitution, the activities of the federal government are to be based on multiyear plans approved by the national congress for four-year periods. The essential objectives for the health sector were improvement of the overall health situation, with emphasis on reduction of child mortality, and political-institutional reorganization of the sector, with a view to enhancing the operative capacity of the SUS. The plan for the next period (2000–2003) reinforces the previous objectives and prioritizes measures to ensure access at activities and services, improve care, and consolidate the decentralization of SUS management

Health sector reform

The current legal provisions governing the operation of the health system, instituted in 1996, seek to shift responsibility for administration of the SUS to municipal governments, with technical and financial cooperation from the federal government and states. Another regionalization initiative is the creation of health consortia, which pools the resources of several neighboring municipalities. A vital instrument of support for regionalization is the project for strengthening and reorganizing the SUS.

Regulatory actions

Procedures for the registration, control, and labelling of foods are established under federal legislation, which assigns specific responsibilities to the health and agriculture sectors. In the health sector, health inspection activities have been decentralized to the state and municipal governments. The environmental policy derives from specific legislation and from the Constitution of 1988.

Public healthcare services

The main strategy for strengthening primary healthcare is the Family Health Program, introduced by the municipal health secretariats in collaboration with the states and the Ministry of Public Health. The federal government supplies technical support and transfers funding through Piso de Atenção Básica. Disease prevention and control activities follow guidelines established by technical experts in the Ministry of Public Health. The National Epidemiology Center (CENEPI), an agency of the National Health Foundation (FUNASA) coordinates the national epidemiological surveillance system, which provides information about and analysis of the national health situation.

Individual healthcare services

In 2014 there were 6,706 hospitals in Brazil. Over 50% of hospitals are found in 5 states: São Paulo, Minas Gerais, Bahia, Rio de Janeiro and Parana.
Throughout the country, 78% of hospitals practice general medicine while 16% are specialized and 6% provide outpatient care only.^[2] In 2012, 66% of the country's hospitals, 70% of its 485,000 hospital beds, and 87% of its 723 specialized hospitals belonged to the private sector. In the area of diagnostic support and therapy, 95% of the 7,318 establishments were also private. 73% of the 41,000 ambulatory care facilities were operated by the public.^[3]
The public hospital infrastructure required hospitals to be spread over a territory of 8.516 million square kilometres (3.288 million square miles). As such, the public hospital infrastructure relies on a vast network of small hospitals. Over 55% of public hospitals have less than 50 beds.
Hospital beds in the public sector were distributed as follows: surgery (21%), clinical medicine (30%), pediatrics (17%), obstetrics (14%),psychiatry (11%) and other areas (7%). In the same year, 43% of public hospital beds, and half the hospital admissions were in municipal establishments.
Since 1999, the Ministry of Public Health has been carrying out a health surveillance project in Amazonia that includes epidemiological and environmental health surveillance, indigenous health and disease control components. With US 600 million dollars from a World Bankloan, efforts are being made to improve the operational infrastructure, training of human resources and research studies. An estimated 25% of the population is covered by at least one form of health insurance; 75% of the insurance plans are offered by commercial operators and companies with self-managed plans.

Health insurance in the United Kingdom

Healthcare in the United Kingdom is a devolved matter, with England, Northern Ireland, Scotland and Wales each having their own systems of publicly funded healthcare, funded by and accountable to separate governments and parliaments, together with smaller private sector and voluntary provision. As a result of each country having different policies and priorities, a variety of differences now exist between these systems.

Despite there being separate health services for each country, the performance of the NHS across the UK can be measured for the purpose of making international comparisons. In a 2014 report ranking developed-country healthcare systems, the United Kingdom was ranked the best healthcare system in the world overall and in the following categories: Quality of Care Access to Care, Efficiency, and Equity.The UK's palliative care has also been ranked as the best in the world. On the other hand, in 2005-09 cancer survival rates lagged ten years behind the rest of Europe, although survival rates continue to increase.

In 2015, the UK was 14th (out of 35) in the annual Euro health consumer index. It was criticised for its poor accessibility and "an autocratic top-down management culture".The index has in turn been criticized by academics, however.

Common features

Each NHS system uses General Practitioners to provide primary healthcare and to make referrals to further services as necessary. Hospitals then provide more specialist services, including care for patients with psychiatric illnesses, as well as direct access to Accident and Emergency (A&E) departments. Community pharmacies are privately owned but have contracts with the relevant health service to supply prescription drugs.

The public healthcare system also provides free (at the point of service) ambulance services for emergencies, when patients need the specialist transport only available from ambulance crews or when patients are not fit to travel home by public transport. These services are generally supplemented when necessary by the voluntary ambulance services (British Red Cross, St Andrews Ambulance Association and St John Ambulance). In addition, patient transport services by air are provided by the Scottish Ambulance Service in Scotland and elsewhere by county or regional air ambulance trusts (sometimes operated jointly with local police helicopter services) throughout England and Wales.^[15] In specific emergencies, emergency air transport is also provided by naval, military and air force aircraft of whatever type might be appropriate or available on each occasion, and dentists can only charge NHS patients at the set rates for each country. Patients opting to be treated privately do not receive any NHS funding for the treatment. About half of the income of dentists in England comes from work sub-contracted from the NHS, however not all dentists choose to do NHS work.

Assessment of the UK as a whole

The OECD publication Health at a Glance 2015 enabled comparisons of the UK as a whole with other countries. It was reported that the UK had an “outstandingly poor” record of preventing ill health and that hospitals in the UK were now so short-staffed (needing 75,000 more doctors and nurses to match standards in similar countries) and under equipped that people were dying because of a chronic lack of investment since 2010. The UK survival rates were 21st out of 23 countries for cervical cancer, 20th out of 23 countries on breast and bowel cancer and 19th out of 31 countries for stroke.

Healthcare in England

Most healthcare in England is provided by the National Health Service (NHS), England's publicly funded healthcare system, which accounts for most of the Department of Health's budget (£110 billion in 2013-14 

In April 2013, under the terms of the Health and Social Care Act 2012, a reorganisation of the NHS took place regarding the administration of the NHS. Primary care trusts  and strategic health authorities ) were abolished, and replaced by clinical commissioning groups ). Cogs now commission most of the hospital and community NHS services in the local areas for which they are responsible. Commissioning involves deciding what services a population is likely to need, and ensuring that there is provision of these services. The Cogs are overseen by NHS England, formally known as the NHS Commissioning Board (NHS CB) which was established on 1 October 2012 as an executive non-departmental public body. NHS England also has the responsibility for commissioning primary care services - General Practitioners, opticians and NHS dentistry, as well as some specialised hospital services. Services commissioned include general practice physician services (most of whom are private businesses working under contract to the NHS), community nursing, local clinics and mental health services.

Provider trusts are NHS bodies delivering health care service. They are involved in agreeing major capital and other health care spending projects in their region.NHS trustsare care deliverers which spend money allocated to them by CCG's. Secondary care (sometimes termed acute health care) can be either elective care or emergency care and providers may be in the public or private sector.

Health insurance in Australia

Health care in Australia is provided by both private and government institutions. The federal Minister for Health, currently Susan Lee, administers national health policy, and state and territory governments administer elements of health care within their jurisdictions, such as the operation of hospitals.

Medicare, administered by the federal government, is the publicly funded universal health care system in Australia which was instituted in 1984. It coexists with a private health system. Medicare is funded partly by a 2% Medicare levy with exceptions for low-income earners), with the balance being provided by government from general revenue. An additional levy of 1% is imposed on high-income earners without private health insurance. As well as Medicare, there is a separate Pharmaceutical Benefits Scheme also funded by the federal government which considerably subsidises a range of prescription medications.

National health policy

Financial year	% of GDP	Current price ($ billions)
1981–82	6.3	10.8
1991–92	7.2	30.5
2001–02	8.4	63.1
2008–09	9.0	114.4
2009–10	9.4	121.7
2010–11	9.3	131.6
2011–12	9.5	142.0
2012–13	9.7	147.0
2013–14	9.8	154.6
Source: Australian Institute of Health and Welfare [6]

Australia has a universal health care structure, with the federal government paying a large part of the cost of health services, including those in public hospitals. The amount paid by the federal government includes:

1. patient health costs based on the Medicare benefits schedule. Typically, Medicare covers 75% of general practitioner, 85% of specialist and 100% of public in-hospital costs.
2. patients may be entitled to other concessions or benefits^[7]
3. patients may be entitled to further benefits once they have crossed a so-called safety net threshold, based on total health expenditure for the year.^[7]

Government expenditure on healthcare is about 67% of the total, below the COED average of 72%.

The remainder of health costs (called out of pocket costs or the co payment) are paid by the patient, unless the provider of the service chooses to use bulk billing, charging only the scheduled fee, leaving the patient with no out of pocket costs. Where a particular service is not covered, such as dentistry, optometry, and ambulance transport, patients must pay the full amount, unless they hold a Low Income Earner card, which may entitle them to subsidised access.

Individuals can take out private health insurance to cover out-of-pocket costs, with either a plan that covers just selected services, to a full coverage plan. In practice, a person with private insurance may still be left with out-of-pocket payments, as services in private hospitals often cost more than the insurance payment.

The government encourages individuals with income above a set level to privately insure. This is done by charging these (higher income) individuals a surcharge of 1% to 1.5% of income if they do not take out private health insurance, and a means-tested rebate. This is to encourage individuals who are perceived as able to afford private insurance not to resort to the public health system,^[10] even though people with valid private health insurance may still elect to use the public system if they wish.

Insurance

Private health insurance funds private health and is provided by a number of private health insurance organisations, called health funds. The largest health fund with a 30% market share is Median. Median was set up to provide competition to private "for-profit" health funds. Although government owned, the fund has operated as a government business enterprise since 2009, operating as a fully commercialised business paying tax and dividends under the same regulatory regime as do all other registered private health funds. Highly regulated regarding the premiums it can set, the fund was designed to put pressure on other health funds to keep premiums at a reasonable level.The Coalition Howard Government had announced that Median would be sold in a public float if it won the 2007 election, however they were defeated by the Australian Lab or Party under Kevin Rudd which had already pledged that it would remain in government ownership. The Coalition under Tony Abbott made the same pledge to privatise Median if it won the 2010 election but was again defeated by Labour. Privatisation was again a Coalition policy for the 2013 election, which the Coalition won. However, public perception that privatisation would lead to reduced services and increased costs makes privatising Median a "political hard sell."

Some private health insurers are "for profit" enterprises, and some are non-profit organisations such as CFC Health Insurance and CBS Health Fund. Some have membership restricted to particular groups, some focus on specific regions – like BF which centres on Western Australia, but the majority have open membership as set out in the PHIAL annual report. Membership to most of these funds is also accessible using a comparison websites or the decision assistance sites. These sites operate on a commission-basis by agreement with their participating health funds and allow consumers to compare policies before joining on-line.

Most aspects of private health insurance in Australia are regulated by the Private Health Insurance Act 2007. Complaints and reporting of the private health industry is carried out by an independent government agency, the Private Health Insurance Ombudsman.The ombudsman publishes an annual report that outlines the number and nature of complaints per health fund compared to their market share.

There are a number of other matters about which funds are not permitted to discriminate between members in terms of premiums, benefits or membership – these include racial origin, religion, sex, sexual orientation, nature of employment, and leisure activities. Premiums for a fund's product that is sold in more than one state can vary from state to state, but not within the same state.

The Australian government has introduced a number of incentives to encourage adults to take out private hospital insurance. These include:

• Lifetime Health Cover: If a person has not taken out private hospital cover by 1 July after their 31 Th birthday, then when (and if) they do so after this time, their premiums must include a loading of 2% per annum. Thus, a person taking out private cover for the first time at age 40 will pay a 20 per cent loading. The loading continues for 10 years. The loading applies only to premiums for hospital cover, not to ancillary (extras) cover.
• Medicare Levy Surcharge: People whose taxable income is greater than a specified amount (in the 2011/12 financial year $80,000 for singles and $168,000 for couples and who do not have an adequate level of private hospital cover must pay a 1% surcharge on top of the standard 1.5% Medicare Levy. The rationale is that if the people in this income group are forced to pay more money one way or another, most would choose to purchase hospital insurance with it, with the possibility of a benefit in the event that they need private hospital treatment – rather than pay it in the form of extra tax as well as having to meet their own private hospital costs.
  • The Australian government announced in May 2008 that it proposes to increase the thresholds, to $100,000 for singles and $150,000 for families. These changes require legislative approval. A bill to change the law has been introduced but was not passed by the Senate. A changed version was passed on 16 October 2008. There have been criticisms that the changes will cause many people to drop their private health insurance, causing a further burden on the public hospital system, and a rise in premiums for those who stay with the private system. Other commentators believe the effect will be minimal.
• Private Health Insurance Rebate: The government subsidises the premiums for all private health insurance cover, including hospital and ancillary (extras), by 10%, 20% or 30%. In May 2009, The Lab or Government under Kevin Rudd announced that as of June 2010, the Rebate would become means-tested and offered on a sliding scale.

health insurance in germany

Germany has a universal multi-payer health care system with two main types of health insurance: "Statutory Health Insurance"  known as sickness funds and "Private Health Insurance" 

The turnover of the health sector was about US$368.78 billion (€287.3 billion) in 2010, equivalent to 11.6 percent of gross domestic product (GDP) and about US$4,505 (€3,510) per capita.According to the World Health Organization, Germany's health care system was 77% government-funded and 23% privately funded as of 2004.In 2004 Germany ranked thirtieth in the world in life expectancy (78 years for men). It had a very low infant mortality rate (4.7 per 1,000 live births), and it was tied for eighth place in the number of practising physicians, at 3.3 per 1,000 persons. In 2001 total spending on health amounted to 10.8 percent of gross domestic product.

According to the Euro health consumer index, which placed it in seventh position in its 2015 survey, Germany has long had the most restriction-free and consumer-oriented healthcare system in Europe. Patients are allowed to seek almost any type of care they wish whenever they want it.

History

Germany has the world's oldest national social health insurance system, with origins dating back to Otto Von Bismarck's social legislation, which included the Health Insurance Bill of 1883, Accident Insurance Bill of 1884, and Old Age and Disability Insurance Bill of 1889. Bismarck stressed the importance of three key principles; solidarity, the government is responsible to ensure access by those who are in need, subsidiarity, policies are implemented with smallest no political and administrative influence, and corporatism, the government representative bodies in health care professions deems feasible procedures. Mandatory health insurance originally applied only to low-income workers and certain government employees, but has gradually expanded to cover the great majority of the population. The system is decentralized with private practice physicians providing ambulatory care, and independent, mostly non-profit hospitals providing the majority of inpatient care. Approximately 92% of the population is covered by a 'Statutory Health Insurance' plan, which provides a standardized level of coverage through any one of approximately 1,100 public or private sickness funds. Standard insurance is funded by a combination of employee contributions, employer contributions and government subsidies on a scale determined by income level. Higher income workers sometimes choose to pay a tax and opt out of the standard plan, in favour of 'private' insurance. The latter's premiums are not linked to income level but instead to health status.Historically, the level of provider reimbursement for specific services is determined through negotiations between regional physician's associations and sickness funds.

Health insurance

German health care spending (red) as a percentage of GDP for 1970 to 2007 compared with other nations

Health insurance is compulsory for the whole population in Germany. Salaried workers and employees below the relatively high income threshold of almost 50,000 Euros per year are automatically enrolled into one of currently around 130 public non-profit "sickness funds" at common rates for all members, and is paid for with joint employer-employee contributions. Provider payment is negotiated in complex corporatist social bargaining among specified self-governed bodies (e.g. physicians' associations) at the level of federal states (Lender). The sickness funds are mandated to provide a unique and broad benefit package and cannot refuse membership or otherwise discriminate on an actuarial basis. Social welfare beneficiaries are also enrolled in statutory health insurance, and municipalities pay contributions on behalf of them.

Besides the "Statutory Health Insurance"  covering the vast majority of residents, the better off with a yearly income above almost €50,000 (US$66,337), students and civil servants for complementary coverage can opt for private health insurance (about 11% of the population). Most civil servants benefit from a tax-funded government employee benefit scheme covering a percentage of the costs, and cover the rest of the costs with a private insurance contract.Health insurance in Germany is split in several parts. The largest part of 89% of the population is covered by a comprehensive health insurance plan provided by statutory public health insurance funds regulated under specific the legislation set with the Soul-searching V, which defines the general criteria of coverage, which are translated into benefit packages by the Federal Joint Committee. The remaining 11% opt for private health insurance, including government employees.

health insurance in england

Healthcare in England is mainly provided by England's public health service, the National Health Service, that provides healthcare to all permanent residents of the United Kingdom that is free at the point of use and paid for from general taxation. Since health is a devolved matter, there are differences with the provisions for healthcare elsewhere in the United Kingdom.Though the public system dominates healthcare provision in England, private health care and a wide variety of alternative and complementary treatments are available for those willing to pay.

National Health Service (NHS)

The National Health Service (NHS) is free at the point of use for the patient though there are charges associated with eye tests, dental care, prescriptions, and many aspects of personal care.

The NHS provides the majority of healthcare in England, including primary care, in-patient care, long-term healthcare, ophthalmology and dentistry. The National Health Service Act 1946 came into effect on 5 July 1948. Private health care has continued parallel to the NHS, paid for largely by private insurance, but it is used by less than 8% of the population and generally as a top-up to NHS services. Recently there have been some examples where unused private sector capacity has been used to increase NHS capacity and in some cases the NHS has commissioned the private sector to establish and run new facilities on a sub contracted basis. Some new capital programs have been financed through the private finance initiative. 

Funding and management

The NHS is divided conceptually into two parts covering primary and secondary care with trusts given the task of health care delivery. There are two main kinds of trusts in the NHS reflecting purchaser/provider roles: commissioning trusts are responsible for examining local needs and negotiating with providers to provide health care services to the local population, and provider trusts which are NHS bodies delivering health care service. Commissioning trusts negotiate service delivery with providers that may be NHS bodies or private entities. They will be involved in agreeing major capital and other health care spending projects in their region.

By far the most known and most important purchases are services including general practice physician services (most of whom are private businesses working under exclusive contract to the NHS), community nursing, local clinics and mental health service. For most people, the majority of health care is delivered in a primary health care setting. Provider trusts are care deliverers, the main examples being the hospital trusts and the ambulance trusts which spend the money allocated to them by the commissioning trusts. Because hospitals tend to provide more complex and specialised care, they receive the lion's share of NHS funding.

Patient experience

A patient needing specialist care at a hospital or clinic, will be informed by the GP of the hospitals where they can get their treatment. This choice usually includes public and private hospitals. The NHS will pay for treatment in a private setting if the hospital meets the cost and service criteria that NHS hospitals adhere to. Otherwise opting for a private hospital makes the patient liable for private hospital fees. Because the private sector often has higher costs, most people choose to be treated for free in an NHS hospital. If the GP judges the case to be extremely urgent, the doctor may by-pass the normal booking system and arrange an emergency admission. The median wait time for a consultant led first appointment in English hospitals is a little over 3 weeks.Patients can be seen by the hospital as out-patients or in-patients, with the latter involving overnight stay. The speed of in-patient admission is based on medical need and time waiting with more urgent cases faster though all cases will be dealt with eventually. Only about one third of hospital admissions are from a waiting list. For those not admitted immediately, the median wait time for in-patient treatment in English hospitals is a little under 6 weeks.Trusts are working towards an 18 week guarantee that means that the hospital must complete all tests and start treatment within 18 weeks of the date of the referral from the GP.^[11] Some hospitals are introducing just in time workflow analysis borrowed from manufacturing industry to speed up the processes within the system and improve efficiencies.

Almost all NHS hospital treatment is free of charge along with drugs administered in hospital, surgical consumables and appliances issued or loaned. However, if a patient has chosen to be treated in an NHS hospital as a private fee paying patient by arrangement with his consultant, the patient (or the insurance company) will be billed. This can happen because at the inception of the NHS, hospital consultants were allowed to continue doing private work in NHS hospitals and can enable private patients to "jump the NHS queue". This arrangement is nowadays quite rare as most consultants and patients choose to have private work done in private hospitals.

histry of health insurance

Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care and health system expenses, among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is available to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity. According to the Health Insurance Association of America, health insurance is defined as "coverage that provides for the payments of benefits as a result of sickness or injury. Includes insurance for losses from accident, medical expense, disability, or accidental death and dismemberment" 

A health insurance policy is:

1. A contract between an insurance provider (e.g. an insurance company or a government) and an individual or his/her sponsor (e.g. an employer or a community organization). The contract can be renewable (e.g. annually, monthly)or lifelong in the case of private insurance, or be mandatory for all citizens in the case of national plans. The type and amount of health care costs that will be covered by the health insurance provider are specified in writing, in a member contract or "Evidence of Coverage" booklet for private insurance, or in a national health policy for public insurance.
2. Provided by an employer-sponsored self-funded ERICA plan. The company generally advertises that they have one of the big insurance companies. However, in an ERICA case, that insurance company "doesn't engage in the act of insurance", they just administer it. Therefore, ERICA plans are not subject to state laws. ERICA plans are governed by federal law under the jurisdiction of the US Department of Lab or . The specific benefits or coverage details are found in the Summary Plan Description . An appeal must go through the insurance company, then to the Employer's Plan Fiduciary. If still required, the Fiduciary's decision can be brought to the DOLOROUS to review for ERICA compliance, and then file a lawsuit in federal court.

The individual insured person's obligations may take several forms:

• Premium: The amount the policy-holder or their sponsor (e.g. an employer) pays to the health plan to purchase health coverage.
• Deductible: The amount that the insured must pay out-of-pocket before the health insurer pays its share. For example, policy-holders might have to pay a $500 deductible per year, before any of their health care is covered by the health insurer. It may take several doctor's visits or prescription refills before the insured person reaches the deductible and the insurance company starts to pay for care. Furthermore, most policies do not apply co-pays for doctor's visits or prescriptions against your deductible.
• Co-payment: The amount that the insured person must pay out of pocket before the health insurer pays for a particular visit or service. For example, an insured person might pay a $45 co-payment for a doctor's visit, or to obtain a prescription. A co-payment must be paid each time a particular service is obtained.
• Coinsurance: Instead of, or in addition to, paying a fixed amount up front (a co-payment), the co-insurance is a percentage of the total cost that insured person may also pay. For example, the member might have to pay 20% of the cost of a surgery over and above a co-payment, while the insurance company pays the other 80%. If there is an upper limit on coinsurance, the policy-holder could end up owing very little, or a great deal, depending on the actual costs of the services they obtain.
• Exclusions: Not all services are covered. The insured are generally expected to pay the full cost of non-covered services out of their own pockets.
• Coverage limits: Some health insurance policies only pay for health care up to a certain dollar amount. The insured person may be expected to pay any charges in excess of the health plan's maximum payment for a specific service. In addition, some insurance company schemes have annual or lifetime coverage maxima. In these cases, the health plan will stop payment when they reach the benefit maximum, and the policy-holder must pay all remaining costs.
• Out-of-pocket maxima: Similar to coverage limits, except that in this case, the insured person's payment obligation ends when they reach the out-of-pocket maximum, and health insurance pays all further covered costs. Out-of-pocket maxima can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.
• Capitation: An amount paid by an insurer to a health care provider, for which the provider agrees to treat all members of the insurer.
• In-Network Provider: (U.S. term) A health care provider on a list of providers preselected by the insurer. The insurer will offer discounted coinsurance or co-payments, or additional benefits, to a plan member to see an in-network provider. Generally, providers in network are providers who have a contract with the insurer to accept rates further discounted from the "usual and customary" charges the insurer pays to out-of-network providers.
• Prior Authorization: A certification or authorization that an insurer provides prior to medical service occurring. Obtaining an authorization means that the insurer is obligated to pay for the service, assuming it matches what was authorized. Many smaller, routine services do not require authorization.
• Explanation of Benefits: A document that may be sent by an insurer to a patient explaining what was covered for a medical service, and how payment amount and patient responsibility amount were determined.

Prescription drug plans are a form of insurance offered through some health insurance plans. In the U.S., the patient usually pays a co-payment and the prescription drug insurance part or all of the balance for drugs covered in the formula of the plan. Such plans are routinely part of national health insurance programs. For example, in the province of Quebec, Canada, prescription drug insurance is universally required as part of the public health insurance plan, but may be purchased and administered either through private or group plans, or through the public plan.

Some, if not most, health care providers in the United States will agree to bill the insurance company if patients are willing to sign an agreement that they will be responsible for the amount that the insurance company doesn't pay. The insurance company pays out of network providers according to "reasonable and customary" charges, which may be less than the provider's usual fee. The provider may also have a separate contract with the insurer to accept what amounts to a discounted rate or capitation to the provider's standard charges. It generally costs the patient less to use an in-network provider.

health insuranse in canada

Health care in Canada is delivered through a publicly funded healthcare system, which is mostly free at the point of use and has most services provided by private entities. It is guided by the provisions of the Canada Health Act of 1984.

The government attempts to ensure the quality of care through federal standards. The government does not participate in day-to-day care or collect any information about an individual's health, which remains confidential between a person and his or her physician.Canada's provincially based Medicare systems are cost-effective partly because of their administrative simplicity. In each province, each doctor handles the insurance claim against the provincial insurer. There is no need for the person who accesses healthcare to be involved in billing and reclaim. Private health expenditure accounts for 30% of health care financing.The Canada Health Act does not cover prescription drugs, home care or long-term care, prescription glasses or dental care, which means most Canadians pay out-of-pocket for these services or rely on private insurance. Provinces provide partial coverage for some of these items for vulnerable populations (children, those living in poverty and seniors).Limited coverage is provided for mental health care.

Competitive practices such as advertising are kept to a minimum, thus maximizing the percentage of revenues that go directly towards care. In general, costs are paid through funding from income taxes. In British Columbia, taxation-based funding is supplemented by a fixed monthly premium which is waived or reduced for those on low incomes.There are no deductibles on basic health care and co-pays are extremely low or non-existent (supplemental insurance such as Fair Pharma care may have deductibles, depending on income). In general, user fees are not permitted by the Canada Health Act, though some physicians get around this by charging annual fees for services which include non-essential health options, or items which are not covered by the public plan, such as doctors notes, prescription refills over the phone.

Benefits and features

A health card is issued by the Provincial Ministry of Health to each individual who enrols for the program and everyone receives the same level of care.There is no need for a variety of plans because virtually all essential basic care is covered, including maternity. Infertility costs are not covered fully in any province other than Quebec, though they are now partially covered in some other provinces. In some provinces, private supplemental plans are available for those who desire private rooms if they are hospitalized. Cosmetic surgery and some forms of elective surgery are not considered essential care and are generally not covered. For example, Canadian health insurance plans do not cover non-therapeutic circumcision.These can be paid out-of-pocket or through private insurers. Health coverage is not affected by loss or change of jobs, health care cannot be denied due to unpaid premiums (in BC), and there are no lifetime limits or exclusions for pre-existing conditions. The Canada Health Act deems that essential physician and hospital care be covered by the publicly funded system, but each province has some license to determine what is considered essential, and where, how and who should provide the services. The result is that there is a wide variance in what is covered across the country by the public health system, particularly in more controversial areas, such as midwifery or autism treatments.

Canada is the only country with a universal healthcare system that does not include coverage of prescription medication.Pharmaceutical medications are covered by public funds in some provinces for the elderly or indigent, or through employment-based private insurance or paid for out-of-pocket. Most drug prices are negotiated with suppliers by each provincial government to control costs but more recently, the Council of the Federation announced an initiative for select provinces to work together to create a larger buying block for more leverage to control costs. More than 60 percent of prescription medications are paid for privately in Canada. Family physicians (often known as general practitioners in Canada) are chosen by individuals. If a patient wishes to see a specialist or is counselled to see a specialist, a referral can be made by a GP. Preventive care and early detection are considered important and yearly check ups are encouraged.