Australia The Australian public health system is called
Medicare, which provides free universal access to hospital treatment and subsidised out-of-hospital medical treatment. It is funded by a 2% tax levy on all taxpayers, an extra 1% levy on high income earners, as well as general revenue. The private health system is funded by a number of private health insurance organizations. The largest of these is
Medibank, which was, until 2014, a government-owned entity, when it was
privatized and listed on the
Australian Securities Exchange. Australian health funds can be either 'for profit' including
Bupa and
nib;
'mutual' including
Australian Unity; or
'non-profit' including
GMHBA,
HCF and
HBF. Some, such as Police Health, have membership restricted to particular groups, but the majority have open membership. Membership to most health funds is now also available through comparison websites. These comparison sites operate on a commission-basis by agreement with their participating health funds. The Private Health Insurance Ombudsman also operates a free website that allows consumers to search for and compare private health insurers' products, which includes information on price and level of cover. 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 The private health system in Australia operates on a "community rating" basis, whereby premiums do not vary solely because of a person's previous medical history, the current state of health, or (generally speaking) their age (but see Lifetime Health Cover below). Balancing this are waiting periods, in particular for pre-existing conditions (usually referred to within the industry as PEA, which stands for "pre-existing ailment"). Funds are entitled to impose a waiting period of up to 12 months on benefits for any medical condition the signs and symptoms of which existed during the six months ending on the day the person first took out insurance. They are also entitled to impose a 12-month waiting period for benefits for treatment relating to an obstetric condition, and a 2-month waiting period for all other benefits when a person first takes out private insurance. Funds have the discretion to reduce or remove such waiting periods in individual cases. They are also free not to impose them, to begin with, but this would place such a fund at risk of "adverse selection", attracting a disproportionate number of members from other funds, or from the pool of intending members who might otherwise have joined other funds. It would also attract people with existing medical conditions, who might not otherwise have taken out insurance at all because of the denial of benefits for 12 months due to the PEA Rule. The benefits paid out for these conditions would create pressure on premiums for all the fund's members, causing some to drop their membership, which would lead to further rises in premiums, and a vicious cycle of higher premiums-leaving members would ensue. The
Government of Australia 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 31st birthday, then when (and if) they do so after this time, their premiums must include a loading of 2% per annum for each year they were without hospital cover. Thus, a person taking out private cover for the first time at age 40 will pay a 20 percent loading. The loading is removed after 10 years of continuous hospital cover. 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 ( from 2025-26 financial year $101,000 for singles and $202,000 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 if 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. An amended 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%, depending on age. The
Rudd Government announced in May 2009 that as of July 2010, the Rebate would become means-tested, and offered on a sliding scale. While this move (which would have required legislation) was defeated in the Senate at the time, in early 2011 the Gillard Government announced plans to reintroduce the legislation after the Opposition loses the balance of power in the Senate. The
ALP and
Greens have long been against the rebate, referring to it as "middle-class welfare".
Canada As per the
Constitution of Canada, health care is mainly a provincial government responsibility in Canada (the main exceptions being federal government responsibility for services provided to aboriginal peoples covered by treaties, the
Royal Canadian Mounted Police, the armed forces, and
Members of Parliament). Consequently, each province administers its own health insurance program. The federal government influences health insurance by virtue of its fiscal powers – it transfers cash and tax points to the provinces to help cover the costs of the universal health insurance programs. Under the
Canada Health Act, the federal government mandates and enforces the requirement that all people have free access to what are termed "medically necessary services," defined primarily as care delivered by physicians or in hospitals, and the nursing component of long-term residential care. If provinces allow doctors or institutions to charge patients for medically necessary services, the federal government reduces its payments to the provinces by the amount of the prohibited charges. Collectively, the public provincial health insurance systems in Canada are frequently referred to as
Medicare. This public insurance is tax-funded out of general government revenues, although
British Columbia and
Ontario levy a mandatory premium with flat rates for individuals and families to generate additional revenues – in essence, a surtax. Private health insurance is allowed, but in six provincial governments only for services that the public health plans do not cover (for example, semi-private or private rooms in hospitals and prescription drug plans). Four provinces allow insurance for services also mandated by the
Canada Health Act, but in practice, there is no market for it. All Canadians are free to use private insurance for elective medical services such as laser vision correction surgery, cosmetic surgery, and other non-basic medical procedures. Some 65% of Canadians have some form of supplementary private health insurance; many of them receive it through their employers. Private-sector services not paid for by the government account for nearly 30 percent of total health care spending. In 2005, the
Supreme Court of Canada ruled, in
Chaoulli v. Quebec, that the province's prohibition on private insurance for health care already insured by the provincial plan violated the
Quebec Charter of Rights and Freedoms, and in particular, the sections dealing with the
right to life and
security, if there were unacceptably long wait times for treatment, as was alleged in this case. The ruling has not changed the overall pattern of health insurance across Canada, but has spurred on attempts to tackle the core issues of supply and demand and the impact of wait times.
China Cyprus In 2020 in
Cyprus introduced the
General Healthcare System (GHS, also known as GESY) which is an independent insurance fund through which clinics, private doctors, pharmacists, laboratories, microbiological laboratories, and physiotherapists will be paid so that they can offer medical care to permanent residents of Cyprus who will be paying contributions to this fund. In addition to GESY, more than 12 local and international insurance companies (e.g.
Bupa,
Aetna,
Cigna,
Metlife) provide individual and group medical insurance plans. The plans are divided into two main categories plans providing coverage from inpatient expenses (i.e. hospitalization, operations) and plans covering inpatient and outpatient expenses (such as doctor visits, medications, physio-therapies).
France The national system of health insurance was instituted in 1945, just after the end of the Second World War. It was a compromise between
Gaullist and
Communist representatives in the French parliament. The Conservative Gaullists were opposed to a state-run healthcare system, while the Communists were supportive of a complete
nationalisation of health care along a British
Beveridge model. The resulting programme is profession-based: all people working are required to pay a portion of their income to a not-for-profit health insurance fund, which mutualizes the risk of illness, and which reimburses medical expenses at varying rates. Children and spouses of insured people are eligible for benefits, as well. Each fund is free to manage its own budget, and used to reimburse medical expenses at the rate it saw fit, however following a number of reforms in recent years, the majority of funds provide the same level of reimbursement and benefits. The government has two responsibilities in this system. • The first government responsibility is the fixing of the rate at which medical expenses should be negotiated, and it does so in two ways: The Ministry of Health directly negotiates prices of medicine with the manufacturers, based on the average price of sale observed in neighboring countries. A board of doctors and experts decides if the medicine provides a valuable enough medical benefit to be reimbursed (most medicine is reimbursed, including homeopathy). In parallel, the government fixes the reimbursement rate for medical services: this means that a doctor is free to charge the fee that he wishes for a consultation or an examination, but the social security system will only reimburse it at a pre-set rate. These tariffs are set annually through negotiation with doctors' representative organizations'. • The second government responsibility is oversight of the health-insurance funds, to ensure that they are correctly managing the sums they receive, and to ensure oversight of the public hospital network. Today, this system is more or less intact. All citizens and legal foreign residents of
France are covered by one of these mandatory programs, which continue to be funded by worker participation. However, since 1945, a number of major changes have been introduced. Firstly, the different health care funds (there are five: General, Independent, Agricultural, Student, Public Servants) now all reimburse at the same rate. Secondly, since 2000, the government now provides health care to those who are not covered by a mandatory regime (those who have never worked and who are not students, meaning the very rich or the very poor). This regime, unlike the worker-financed ones, is financed via general taxation and reimburses at a higher rate than the profession-based system for those who cannot afford to make up the difference. Finally, to counter the rise in health care costs, the government has installed two plans, (in 2004 and 2006), which require insured people to declare a referring doctor in order to be fully reimbursed for specialist visits, and which installed a mandatory co-pay of €1 for a doctor visit, €0.50 for each box of medicine prescribed, and a fee of €16–18 per day for hospital stays and for expensive procedures. An important element of the French insurance system is solidarity: the more ill a person becomes, the less the person pays. This means that for people with serious or chronic illnesses, the insurance system reimburses them 100% of expenses, and waives their co-pay charges. Finally, for fees that the mandatory system does not cover, there is a large range of private complementary insurance plans available. The market for these programs is very competitive, and often subsidised by the employer, which means that premiums are usually modest. 85% of French people benefit from complementary private health insurance.
Germany 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. Beginning with 10% of blue-collar workers in 1885, mandatory insurance has expanded; in 2009, health insurance was made mandatory for all citizens. While most are insured through the statutory system, individuals with an income above a certain threshold, the self-employed, or civil servants may choose between statutory and private health insurance. As of 2016, 85% of the population is covered by the compulsory Statutory Health Insurance (SHI) (
Gesetzliche Krankenversicherung or
GKV), with the remainder covered by
private insurance (
Private Krankenversicherung or
PKV). Germany's health care system was 77% government-funded and 23% privately funded as of 2004. While public health insurance contributions are based on the individual's income, private health insurance contributions are based on the individual's age and health condition. Reimbursement is on a
fee-for-service basis, but the number of physicians allowed to accept Statutory Health Insurance in a given locale is regulated by the government and professional societies. Co-payments were introduced in the 1980s in an attempt to prevent over utilization. The average length of hospital stay in Germany has decreased in recent years from 14 days to 9 days, still considerably longer than average stays in the United States (5 to 6 days). Part of the difference is that the chief consideration for hospital reimbursement is the number of hospital days as opposed to procedures or diagnosis. Drug costs have increased substantially, rising nearly 60% from 1991 through 2005. Despite attempts to contain costs, overall health care expenditures rose to 10.7% of GDP in 2005, comparable to other western European nations, but substantially less than that spent in the U.S. (nearly 16% of GDP). Germans are offered three kinds of social security insurance dealing with the physical status of a person and which are co-financed by employer and employee: health insurance, accident insurance, and long-term care insurance. Long-term care insurance (
Gesetzliche Pflegeversicherung) emerged in 1994 and is mandatory.
Greece The National Health System in Greece covers both out and in-patient treatment. The out-patient treatment is carried out by social administrative structures as following: • EOPPY (National Organization for the Provision of Health Services): contracted private healthcare providers • PEDY (National Primary Healthcare Network) units: public healthcare • State hospitals, rural and regional medical units, health centers of the ESY (National Health System) • Private health professionals: Medical professionals and services not contracted with EOPYY. The in-patient treatment is carried out by: • State hospitals of the National Health System (ESY). • Private Clinics contracted with the National Health Carrier (EOPYY) • Private hospitals and clinics that are not contracted with the National Health Carrier. In Greece anyone can cover the hospitalization expenses using a private insurance policy, that can be bought by any of the local or multinational insurance companies that operate in the region (e.g. Metlife, Interamerican, Aetna, IMG).
India In India, provision of healthcare services and their efficiency varies state-wise. Public health services are prominent in most of the regions with the national government playing an important role in funding, framing and implementing policies and operating public health insurances. The vast majority of Indians are covered by either a comprehensive public health insurance scheme run by the
National Health Authority called the
Ayushman Bharat Yojana or a private health insurance scheme providing comprehensive coverage and that is tightly regulated by the
Insurance Regulatory and Development Authority of India.
Japan There are three major types of insurance programs available in Japan: Employee Health Insurance (健康保険 Kenkō-Hoken), National Health Insurance (国民健康保険 Kokumin-Kenkō-Hoken), and the Late-stage Elderly Medical System (後期高齢医療制度 Kouki-Kourei-Iryouseido). Although private health insurance is available, all Japanese citizens, permanent residents, and non-Japanese with a visa lasting one year or longer are required to be enrolled in either National Health Insurance or Employee Health Insurance. National Health Insurance is designed for those who are not eligible for any employment-based health insurance program. The Late-stage Elderly Medical System is designed for people who are age 75 and older. National Health Insurance is organised on a household basis. Once a household has applied, the entire family is covered. Applicants receive a health insurance card, which must be used when receiving treatment at a hospital. There is a required monthly premium, but co-payments are standardized so payers are only expected to cover ten to thirty percent of the cost, depending on age. If out-of-pocket costs exceed pre-determined limits, payers may apply for a rebate from the National Health Insurance program. The Late-stage Elderly Medical System began in 1983 following the Health Care for the Aged Law of 1982. It allowed many health insurance systems to offer financial assistance to elderly people. There is a medical coverage fee. To be eligible, those insured must be either: older than 70, or older than 65 with a recognized disability. The Late-stage Elderly Medical System includes preventive and standard medical care.
Netherlands In 2006, a new system of health insurance came into force in the Netherlands. This new system avoids the two pitfalls of adverse selection and moral hazard associated with traditional forms of health insurance by using a combination of regulation and insurance
equalization pool. Moral hazard is avoided by mandating that insurance companies provide at least one policy that meets a government set minimum standard level of coverage, and all adult residents are obliged by law to purchase this coverage from an insurance company of their choice. All insurance companies receive funds from the equalization pool to help cover the cost of this government-mandated coverage. This pool is run by a regulator which collects salary-based contributions from employers, which make up about 50% of all health care funding, and funding from the government to cover people who cannot afford health care, which makes up an additional 5%. The remaining 45% of health care funding comes from insurance premiums paid by the public, for which companies compete on price, though the variation between the various competing insurers is only about 5%. However, insurance companies are free to sell additional policies to provide coverage beyond the national minimum. These policies do not receive funding from the equalization pool but cover additional treatments, such as dental procedures and physiotherapy, which are not paid for by the mandatory policy.
New Zealand Since 1974, New Zealand has had a system of universal no-fault health insurance for personal injuries through the
Accident Compensation Corporation (ACC). The ACC scheme covers most of the costs of related to treatment of injuries acquired in New Zealand (including overseas visitors) regardless of how the injury occurred, and also covers lost income (at 80 percent of the employee's pre-injury income) and costs related to long-term rehabilitation, such as home and vehicle modifications for those seriously injured. Funding from the scheme comes from a combination of levies on employers' payroll (for work injuries), levies on an employee's taxable income (for non-work injuries to salary earners), levies on vehicle licensing fees and petrol (for motor vehicle accidents), and funds from the general taxation pool (for non-work injuries to children, senior citizens, unemployed people, overseas visitors, etc.)
Rwanda Rwanda is one of a handful of
low income countries that has implemented community-based health insurance schemes in order to reduce the financial barriers that prevent poor people from seeking and receiving needed health services. This scheme has helped reach 90% of the country's population with health care coverage.
Singapore Singaporeans have one of the longest
life expectancy at birth in the world. During this long life, encountering uncertain situations requiring hospitalization are inevitable. Health insurance or medical insurance cover high healthcare costs during hospitalization.
Health insurance for Singapore Citizens and Permanent Residents MediShield Life, is a universal health insurance covering all Singapore Citizens and Permanent Residents. MediShield Life covers hospitalization costs for a stay in ward B2 or C in a Public hospital. For the hospitalization in a Private hospital, or in ward A or B1 in Public hospital, MediShield Life coverage is pegged to B2 or C ward prices and insured is required to pay the remaining bill amount. This remaining bill amount can be paid using
MediSave but limits are applied on the MediSave usage. MediShield Life does not cover overseas medical expenses and the treatment of serious pre-existing illnesses for which one has been receiving treatment during the 12 months before the start of the MediShield Life coverage. MediShield Life also does not cover treatment of congenital anomalies (medical conditions that are present at birth), cosmetic surgery, pregnancy-related charges and mental illness. As the MediShield Life benefits are capped for B2 or C ward hospitalization in public hospitals, Integrated Shield plans provide coverage for the hospitalization in private hospitals, or ward A or B1 in public hospitals. Integrated Shield insurance plans cover large hospitalization bills for Private hospitals or, ward A or B1.
Health insurance for Foreigners in Singapore Unlike Singapore citizens and permanent residents, foreigners are not automatically covered by the MediShield Life. Foreigners can purchase the health insurance plans from several life insurers in Singapore. Health care in South Korea is provided by the
National Health Insurance (NHI), which is mandatory. Anyone residing in South Korea, regardless of nationality or occupation, can purchase this insurance.
Switzerland Healthcare in Switzerland is
universal and is regulated by the Swiss Federal Law on Health Insurance. Health insurance is compulsory for all persons residing in
Switzerland (within three months of taking up residence or being born in the country). It is therefore the same throughout the country and avoids double standards in healthcare. Insurers are required to offer this basic insurance to everyone, regardless of age or medical condition. They are not allowed to make a profit off this basic insurance, but can on supplemental plans. These are the world's best figures.
United Kingdom The
UK's National Health Service (NHS) is a
publicly funded healthcare system that provides coverage to everyone normally resident in the UK. It is not strictly an insurance system because (a) there are no premiums collected, (b) costs are not charged at the patient level and (c) costs are not pre-paid from a pool. However, it does achieve the main aim of insurance which is to spread
financial risk arising from ill-health. The costs of running the NHS (est. £104 billion in 2007–8) are met directly from general taxation. The NHS provides the majority of health care in the UK, including
primary care,
in-patient care,
long-term health care,
ophthalmology, and
dentistry. 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. There are many treatments that the private sector does not provide. For example, health insurance on
pregnancy is generally not covered or covered with restricting clauses. Typical exclusions for
Bupa schemes (and many other insurers) include: aging, menopause and puberty; AIDS/HIV; allergies or allergic disorders; birth control, conception, sexual problems and sex changes; chronic conditions; complications from excluded or restricted conditions/ treatment; convalescence, rehabilitation and general nursing care ; cosmetic, reconstructive or weight loss treatment; deafness; dental/oral treatment (such as fillings, gum disease, jaw shrinkage, etc.); dialysis; drugs and dressings for out-patient or take-home use† ; experimental drugs and treatment; eyesight; HRT and bone densitometry; learning difficulties, behavioural and developmental problems; overseas treatment and repatriation; physical aids and devices; pre-existing or special conditions; pregnancy and childbirth; screening and preventive treatment; sleep problems and disorders; speech disorders; temporary relief of symptoms. († = except in exceptional circumstances) There are a number of other companies in the United Kingdom which include, among others,
Chubb Limited,
Axa,
Aviva,
Bupa,
Groupama Healthcare, WPA and
VitalityHealth. Similar exclusions apply, depending on the policy which is purchased. In 2009, the main representative body of British Medical physicians, the British Medical Association, adopted a policy statement expressing concerns about developments in the health insurance market in the UK. In its Annual Representative Meeting which had been agreed earlier by the Consultants Policy Group (i.e. Senior physicians) stating that the BMA was "extremely concerned that the policies of some private healthcare insurance companies are preventing or restricting patients exercising choice about (i) the consultants who treat them; (ii) the hospital at which they are treated; (iii) making top up payments to cover any gap between the funding provided by their insurance company and the cost of their chosen private treatment." It went in to "call on the BMA to publicise these concerns so that patients are fully informed when making choices about private healthcare insurance." The practice of insurance companies deciding which consultant a patient may see as opposed to GPs or patients is referred to as
Open Referral. The NHS offers patients a choice of hospitals and consultants and does not charge for its services. The private sector has been used to increase NHS capacity despite a large proportion of the British public opposing such involvement. According to the
World Health Organization, government funding covered 86% of overall health care expenditures in the UK as of 2004, with private expenditures covering the remaining 14%.
United States Short Term Health Insurance On the 1st of August, 2018 the
DHHS issued a final rule which made federal changes to
Short-Term, Limited-Duration Health Insurance (STLDI) which lengthened the maximum contract term to 364 days and renewal for up to 36 months. This new rule, in combination with the expiration of the penalty for the
Individual Mandate of the
Affordable Care Act, has been the subject of independent analysis. The United States health care system relies heavily on private health insurance, which is the primary source of coverage for most Americans. As of 2018, 68.9% of American adults had private health insurance, according to
The Center for Disease Control and Prevention. The
Agency for Healthcare Research and Quality (AHRQ) found that in 2011, private insurance was billed for 12.2 million U.S. inpatient hospital stays and incurred approximately $112.5 billion in aggregate inpatient hospital costs (29% of the total national aggregate costs). Public programs provide the primary source of coverage for most senior citizens and for low-income children and families who meet certain eligibility requirements. The primary public programs are
Medicare, a federal
social insurance program for seniors and certain disabled individuals; and
Medicaid, funded jointly by the federal government and states but administered at the state level, which covers certain very low income children and their families. Together, Medicare and Medicaid accounted for approximately 63 percent of the national inpatient hospital costs in 2011. In the late 1990s and early 2000s,
health advocacy companies began to appear to help patients deal with the complexities of the healthcare system. The complexity of the healthcare system has resulted in a variety of problems for the American public. A study found that 62 percent of persons declaring bankruptcy in 2007 had unpaid medical expenses of $1000 or more, and in 92% of these cases the
medical debts exceeded $5000. Nearly 80 percent who filed for bankruptcy had health insurance. The Medicare and Medicaid programs were estimated to soon account for 50 percent of all national health spending. These factors and many others fueled interest in an overhaul of the health care system in the United States. In 2010 President Obama signed into law the
Patient Protection and Affordable Care Act. This Act includes an 'individual mandate' that every American must have medical insurance (or pay a fine). Health policy experts such as
David Cutler and
Jonathan Gruber, as well as the American medical insurance lobby group
America's Health Insurance Plans, argued this provision was required in order to provide "guaranteed issue" and a "community rating," which address unpopular features of America's health insurance system such as premium weightings, exclusions for pre-existing conditions, and the pre-screening of insurance applicants. During 26–28 March, the Supreme Court heard arguments regarding the validity of the Act. The Patient Protection and Affordable Care Act was determined to be constitutional on 28 June 2012. The Supreme Court determined that Congress had the authority to apply the individual mandate within its taxing powers.
History and evolution In the late 19th century, "accident insurance" began to be available, which operated much like modern disability insurance. This payment model continued until the start of the 20th century in some jurisdictions (like California), where all laws regulating health insurance actually referred to disability insurance. Accident insurance was first offered in the United States by the Franklin Health Assurance Company of
Massachusetts. This firm, founded in 1850, offered insurance against injuries arising from railroad and steamboat accidents. Sixty organizations were offering accident insurance in the U.S. by 1866, but the industry consolidated rapidly soon thereafter. While there were earlier experiments, the origins of sickness coverage in the U.S. effectively date from 1890. The first employer-sponsored group disability policy was issued in 1911. Before the development of medical expense insurance, patients were expected to pay health care costs
out of their own pockets, under what is known as the
fee-for-service business model. During the middle-to-late 20th century, traditional disability insurance evolved into modern health insurance programs. One major obstacle to this development was that early forms of comprehensive health insurance were enjoined by courts for violating the traditional ban on corporate practice of the
professions by for-profit corporations. State legislatures had to intervene and expressly legalize health insurance as an exception to that traditional rule. Today, most comprehensive private health insurance programs cover the cost of routine, preventive, and emergency health care procedures. They also cover or partially cover the cost of certain prescription and
over-the-counter drugs. Insurance companies determine what drugs are covered based on price, availability, and therapeutic equivalents. The list of drugs that an insurance program agrees to cover is called a
formulary. Additionally, some prescriptions drugs may require a
prior authorization before an insurance program agrees to cover its cost. Hospital and medical expense policies were introduced during the first half of the 20th century. During the 1920s, individual hospitals began offering services to individuals on a pre-paid basis, eventually leading to the development of
Blue Cross organizations. The
Employee Retirement Income Security Act of 1974 (ERISA) regulated the operation of a health benefit plan if an employer chooses to establish one, which is not required. The
Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) gives an ex-employee the right to continue coverage under an employer-sponsored group health benefit plan. Through the 1990s,
managed care insurance schemes including
health maintenance organizations (HMO),
preferred provider organizations, or
point of service plans grew from about 25% US employees with employer-sponsored coverage to the vast majority. With managed care, insurers use various techniques to address costs and improve quality, including negotiation of prices ("in-network" providers),
utilization management, and requirements for quality assurance such as being accredited by accreditation schemes such as the
Joint Commission and the American Accreditation Healthcare Commission. Employers and employees may have some choice in the details of plans, including
health savings accounts,
deductible, and
coinsurance. As of 2015, a trend has emerged for employers to offer
high-deductible plans, called consumer-driven healthcare plans which place more costs on employees, while employees benefit by paying lower monthly premiums. Additionally, having a high-deductible plan allows employees to open a health savings account, which allows them to contribute pre-tax savings towards future medical needs. Some employers will offer multiple plans to their employees.
Russia The private health insurance market, known in Russian as "voluntary health insurance" () to distinguish it from state-sponsored
Mandatory Medical Insurance, has experienced sustained levels of growth. It was introduced in October 1992.
Taiwan == See also ==