Private sector funded, with more than half from private sources. Private health insurance available through employer, government or private schemes. 15.3% of population (45.7 million people) do not have health insurance. Federal government is largest healthcare insurer – involved in two main schemes, Medicaid and Medicare, each covering about 13% of population. Medicaid – joint funded federal-state programme for certain low income and needy groups – eg children, disabled. Medicare – for people 65 years old and above and some younger disabled people and those with permanent kidney failure undergoing dialysis or transplant. Most doctors are in private practice and paid through combination of charges, discounted fees paid by private health plans, public programmes, and direct patient fees. In-patient care is provided in public and private hospitals. Hospitals are paid through a combination of charges, per admission, and capitation.
UK – Universal, tax-funded system Public sector funded by taxation and some national insurance contributions. About 11% have private health insurance. Private GP services very small. Healthcare free at point of delivery but charges for prescription drugs (except in Wales), ophthalmic services and dental services unless exempt. Exemptions include children, elderly, and unemployed. About 85% of prescriptions are exempt. Most walk-in care provided by GP practices but also some walk-in clinics and 24-hour NHS telephone helpline. Free ambulance service and access to accident and emergency. In patient care through GP referral and follow contractual arrangements between health authorities, Primary Care Trusts and the hospital. Hospitals are semi-autonomous self-governing public trusts.
France – Social insurance system All legal residents covered by public health insurance funded by compulsory social health insurance contributions from employers and employees with no option to opt out. Most people have extra private insurance to cover areas that are not eligible for reimbursement by the public health insurance system and many make out of pocket payments to see a doctor. Patients pay doctor’s bills and are reimbursed by sickness insurance funds. Government regulates contribution rates paid to sickness funds, sets global budgets and salaries for public hospitals. In-patient care is provided in public and private hospitals (not-for-profit and for-profit). Doctors in public hospitals are salaried whilst those in private hospitals are paid on a fee-for-service basis. Some public hospital doctors are allowed to treat private patients in the hospital. A percentage of the private fee is payable to the hospital. Most out-patient care is delivered by doctors, dentists and medical auxiliaries working in their own practices.
Singapore – Dual system Dual system funded by private and public sectors. Public sector provides 80% of hospital care 20% primary care. Financed by combination of taxes, employee medical benefits, compulsory savings in the form of Medisave, insurance and out-of-pocket payments. Patients expected to pay part of their medical expenses and to pay more for higher level of service. Government subsidises basic healthcare. Public sector health services cater for lower income groups who cannot afford private sector charges. In private hospitals and outpatient clinics, patients pay the amount charged by the hospitals and doctors on a fee-for-service basis.
