Private health insurance in social health insurance countries: Market outcomes and policy implications

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Recent Changes in Dutch Health Insurance: Individual Mandate or Social Insurance?

Dutch health insurance changed dramatically in 2006 with the abolition of the sick fund insurance that had covered wage earners and their dependents for over hundred years. In 2005, with surprisingly little political debate or public opposition, the Dutch Parliament passed a law introducing a new form of population-wide health insurance that replaced the former public and private health insurance systems. In essence, the law was similar to earlier proposals of the 1980s and 1990s that failed to gain lasting public and political support, but it meant a further push towards privatization of Dutch health insurance. As of January 2006, all residents of the Netherlands have to take out health insurance with one of the forty or so insurers of their own choice. Insurers have to accept any applicant for the government-determined basic coverage. Half of insurers ’ income consists of the income-related contribution that employers withhold as earmarked taxation, channeled to insurers through a central fund under the authority of the tax department. For the remaining 50 percent, insured persons pay a flat rate premium directly to their insurer, and patients pay modest amounts of user fees. Low-income groups—amazingly, for this purpose, 40 percent of the population counts as low income—can apply for a fiscal subsidy. Enthusiastically, a lengthy front-page article in the Wall Street Journal sees the Dutc

Health financing reform towards universal insurance coverage: A case study of six cities in China

The Urban Resident Basic Medical Insurance (URBMI) is a core component of the ongoing health financing reform towards universal insurance coverage in China. This paper reviews the introduction of URBMI in six Chinese cities, based on comparative institutional analysis and use of publicly available data. In the early 21st century, the Chinese government announced plans for universal health insurance. Rather than one populationwide scheme, however, it designed several separate schemes for specific populations, with a fair degree of autonomy and independent administrative responsibilities of the regions and large cities. In this study, we have selected six cities with different levels of economic development and fiscal resources. The cities also differ, as we will show, in their target populations, financing level, insurance coverage and benefits level, management of health services and referral rules. Following an analysis of the similarities and differences in the institutional features of the various URBMI schemes and an exploration of the underlying causes, we analyze the challenges and policy implications facing China as it moves towards universal coverage. To reduce the inequality in financing and benefits of insurance across cities, for example, we conclude that the central government should give priority to less-developed cities in the distribution of subsidies. Other concerns that require some form of collective action are the extension of the benefit package with outpatient care for all, strengthening primary care and developing a rational referral system. Two major challenges for the longer term are the establishment of wider risk pools for thehealth insurance and the merger of segmented insurance programs

Six Countries, six health reform models? health care reform in Chile, Israel, Singapore, Switzerland, Taiwan and The Netherlands

10.1080/13876980903076237Journal of Comparative Policy Analysis: Research and Practice121-275-11