Financing health care in high-income countries

Abstract

The main lesson from the experience of high-income countries with health care financing is a simple one: financing reforms should support the ultimate goal of universal coverage. Most high-income countries started with voluntary health insurance systems, which were then gradually extended to compulsory social insurance for certain groups and finally reached universal coverage, either as nationwide social health insurance schemes or as tax-financed national health services. The risk pooling and prepayment functions are essential. Moreover, the revenue collection mechanisms, whether as general tax revenues or payroll taxes, are secondary to the basic object of providing financial protection through effective risk pooling mechanisms. The experience of high-income countries indicates that private health insurance, medical savings accounts, and other forms of private resource collection are supplementary methods for increasing universal coverage.