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Not What You Meant?  There are 40 definitions for Universal.  Also try: Extension or UHC.

Universal health care

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Universal health care refers to government programs intended to ensure that all citizens, and sometimes permanent residents, of a governmental region have access to most types of health care. Patients may pay for some portion of their care directly, but most care is subsidized by taxpayers and/or by compulsory health insurance. In the 1880s, most Germans became covered under the mandatory health care system championed by Bismarck. The National Health Service (NHS), established in the United Kingdom in 1948, was the world's first universal health care system provided by government. Universal health care is provided in most developed countries and in many developing countries. The United States is the only wealthy, industrialized nation that does not provide universal health care.[1] Universal health care programs vary widely in their structure, funding mechanisms, and the level and nature of the government's involvement. Some government health care systems allow private practitioners to provide services, and some do not. In the UK, doctors are allowed to provide services outside the government system; in Canada, some services can be offered and some cannot.

Contents

Implementation

Main article: Health care systems
Map of countries with universal health care
Map of countries with universal health care

Universal health care is a broad concept that has been implemented in several ways. The common denominator for all such programs is some form of government action aimed at extending access to health care as widely as possible. Most countries implement universal health care through legislation, regulation and taxation. Legislation and regulation direct what care must be provided, to whom, and on what basis. Usually some costs are borne by the patient but are subsidized by taxation and compensated to the patient by the government. Many programs utilize some form of compulsory insurance to accomplish this goal. Other programs are paid for entirely out of tax revenues and provide automatic coverage for every citizen.[2]

Europe

Most of Europe has publicly sponsored and regulated health care. Countries include Austria, Belgium, Bosnia, Bulgaria, Croatia, Czech Republic, Denmark, Finland, Estonia, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Malta, the Netherlands, Norway, Lichtenstein, Luxembourg, Poland, Portugal,[3] Romania, Russia, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland and the United Kingdom.[4]

United Kingdom

The logo of the NHS
The logo of the NHS
Main article: National Health Service

The NHS provides a very wide range of health services to virtually the entire population. It is entirely funded from general taxation. As a consequence, it does not bill its services to either its patients or an insurance fund. Medicines, hospital supplies (such as bandages and hip joints), and hospital supplied meals and refreshments are all available free of charge to in-patients. Even outpatients receive free loans of medical aids such as crutches. This is a factor which reduces administration costs considerably over insurance based systems. It was created in the aftermath of World War II, by Clement Attlee's Labour government, based on the proposals of the Beveridge Report, prepared in 1942.[5] The structure of the NHS in England and Wales was established by the National Health Service Act 1946 (1946 Act). Governments since 1997 have spent more money on the NHS and UK spending on health is now closer to (but still below) the European average. The new money has reduced waiting times and modernized the infrastructure, and has improved the salaries of medical staff. The outsourcing of medical services and support to the private sector is a recent innovation. Hospitals may have both medical services (such as "surgicentres"),[6] and non-medical services (such as catering) provided under long-term contracts by the private sector. Capital projects such as new hospitals have been privatized through the Private Finance Initiative, enabling the public sector borrowing requirement to be reduced. See also Health care in the United Kingdom.

Americas

Argentina, Brazil, Costa Rica, Chile, Cuba and Uruguay all have public health care provided. Mexico is planning to launch its own universal health care network.[7]

United States

Main article: Health care in the United States
Health care in the United States
Government
Private
Private consumer driven
Others
This box:  •  • edit

The United States is the only wealthy, industrialized nation that does not have a universal health care system.[1] The government directly covers a little over one-quarter of the population[8] through health care programs for the elderly, disabled, military service families and veterans, children, and the poor.[9] Federal law ensures public access to emergency services regardless of ability to pay.[10] However, this unfunded mandate has contributed to a health care safety net that some analyses say is increasingly strained.[11] Certain types of medical spending and particularly health insurance benefit from significant tax subsidies; in particular, employer-sponsored health insurance is a non-taxable benefit. In all, government spending accounted for 45.1% of total health spending in the U.S. in 2005.[12] Current estimates put U.S. health care spending at approximately 15% of GDP, the highest in the world.[13] Despite this, only an estimated 84.2% of citizens have some form of health insurance coverage, either through their employer, purchased individually, or through government sources.[8] One study estimates that about 25% of the country's uninsured, or roughly another 11 million people, are eligible for government health care programs but unenrolled. However, extending coverage to all who are eligible remains a fiscal challenge.[14] In 2003, approximately 61 million adults, or 35 percent of individuals ages 19 to 64, had either no insurance, sporadic coverage, or insurance coverage that exposed them to high health care costs.[15] Employers that do provide insurance, on average, spend between 4.6 and 8.7% of their payroll in health insurance premiums. The cost of health care premiums is rising much faster than the general rate of inflation or employee wages. Since 2001, premiums for family coverage have increased 78%, while inflation has risen 17% and wages have risen 19%, according to a 2007 study by the Kaiser Family Foundation.[16] In the absence of a national program, universal health care is being attempted at more local levels. The Commonwealth of Massachusetts is implementing a near-universal health care system by mandating that residents purchase health insurance by July 1, 2007.[17] The City of San Francisco is also undertaking a universal health care system for uninsured residents.[18][19] California, Maine, Vermont and Hawaii are also considering or seeking to implement universal or near-universal systems.[20] There have been numerous proposals to stimulate the current system into extending coverage more universally, rather than through a more comprehensive restructuring. For example, since most Americans with private coverage receive it through employer-sponsored plans, many have suggested employer "pay or play" requirements as a way to increase coverage levels. However, one study suggests that current pay or play proposals are limited in their ability to increase coverage among the "working poor".[21] The study's criticisms of these proposals included the observations that they generally exclude small firms, do not distinguish between individuals who have access to other forms of coverage and those who do not, and increase the overall compensation costs to employers. One study that examined several such market-based reform packages concluded that if market-oriented reforms are not implemented on a systematic basis with appropriate safeguards, they have the potential to cause more problems than they solve.[22] Others have proposed premium subsidies to help individuals purchase their own health insurance as a way to increase coverage rates. Research confirms that consumers in the individual health insurance market are sensitive to price. Estimates of the demand elasticity in this market vary, but generally fall in the range of -0.3 to -0.1. It appears that price sensitivity varies among population subgroups, and is generally higher for those at younger ages and lower incomes. However, research also suggests that subsidies alone are unlikely to solve the uninsured problem in the U.S.[23][24]

Canada

Main article: Health care in Canada

In 1984, the Canada Health Act was passed, which prohibited user fees and extra billing by doctors. In 1999, the prime minister and most premiers reaffirmed in the Social Union Framework Agreement that they are committed to health care that has "comprehensiveness, universality, portability, public administration and accessibility."[25] The Canadian system is for the most part publicly funded, yet most of the services are provided by private enterprises or private corporations, although most hospitals are public. Most doctors do not receive an annual salary, but receive a fee per visit or service.[26] About 30% of Canadians' health care is paid for by the private sector or individuals.[27] This mostly goes towards services not covered or only partially covered by Medicare such as prescription drugs, dentistry and vision care.[28] Many Canadians have private health insurance, often through their employers, that cover these expenses.[29] Canada is the only industrialized country that has banned private medical insurance for services covered by the public health plan.[30] The legality of the ban was considered in a decision of the Canadian Supreme Court which ruled in Chaoulli v. Quebec that "the prohibition on obtaining private health insurance, while it might be constitutional in circumstances where health care services are reasonable as to both quality and timeliness, is not constitutional where the public system fails to deliver reasonable services." The appellant contended that waiting times in Quebec violated a right to life and security. The Court agreed, but acknowledged the importance and validity of the Canada Health Act, and at least four of the seven judges explicitly recognized the right of governments to enact laws and policies which favour the public over the private system and preserve the integrity of the public system. But not if the public system fails to deliver reasonable service as to quality or timeliness, as the court found in this case.[31]

Asia and Africa

Brunei, India, Kuwait, Qatar, UAE, Saudi Arabia, Israel [32] Japan, Malaysia, New Zealand, South Korea, Seychelles, Sri Lanka[33], Taiwan[34] and Thailand have universal health care.

Singapore

Singapore has a highly privatized universal health care system with an emphasis on individual fiscal responsibility. Overall spending on health care amounts to only 3% of annual GDP. Of that, 66% comes from private sources. This system has proven successful; Singapore currently has the lowest infant mortality rate in the world and among the highest life expectancies from birth (according to the latest data published by the World Health Organization). Singapore's system uses a combination of compulsory savings from payroll deductions (funded by both employers and workers) a nationalized catastrophic health insurance plan, and government subsidies, as well as "actively regulating the supply and prices of healthcare services in the country" to keep costs in check; the specific features have been described as potentially "very difficult system to replicate in many other countries." Many Singaporeans also have supplemental private health insurance (often provided by employers) for services not covered by the national programs.[35]

Thailand

Thailand introduced universal coverage reforms in 2001, becoming one of only a handful of lower-middle income countries to do so. Means-tested health care for low income households was replaced by a new more comprehensive insurance scheme - originally known as the 30 baht project, in line with the small co-payment charged for treatment. People joining the scheme receive a gold card which allows them to access services in their health district, and - if necessary - to be referred for specialist treatment elsewhere. The Thai system is relatively unusual in having a single, central purchasing agency - the National Health Security Office - which channels funds to a large number of contracting units for primary care (CUPs) that co-ordinate services in local districts. The bulk of finance comes from public revenues, with funding allocated to CUPs annually on a population basis. All public hospitals and some private hospitals participate in the scheme. Although the reforms have received a good deal of critical comment, they have proved popular with poorer Thais, especially in rural areas, and appear likely to survive even after the 2006 military coup. The current Public Health Minister, Mongkol Na Songkhla, recently announced his intention to abolish the 30 baht co-payment and make the UC scheme free.[36][7][37]

India

India has partial universal health care system run by the local governments. The "government hospitals", some of which are among the best hospitals in India[38], provide treatment at taxpayer cost. Selected drugs are offered free of charge in some hospitals. In 1946 a Health Survey and Development Committee in India put forward a plan for a universal health care system. According to India today, the country has not lived up to their outlined plan. As of 2007, the hospitals contain only a tenth of the recommended ratio of hospital beds; there are only 70 beds for every 100,000 people.[39]

Oceania

Australia

Medicare brand
Medicare brand
Main article: Medicare (Australia)

Medicare was introduced by the Whitlam Labor Government on 1 July 1975 through the Health Insurance Act 1973. The Australian Senate rejected the changes multiple times and they were passed only after a joint sitting after the 1974 double dissolution election. Yet Medicare has been supported by subsequent governments and became a key feature of Australia’s public policy landscape. The exact structure of Medicare, in terms of the size of the rebate to doctors and hospitals and the way it has administered, has varied over the years. The original Medicare program proposed a 1.35% levy (with low income exemptions) but these bills were rejected by the Senate, and so Medicare was originally funded from general taxation. In October 1976, the Fraser Government introduced a 2.5% levy. The program is now nominally funded by an income tax surcharge known as the Medicare levy, which is currently set at 1.5% with exemptions for low income earners. In practice the levy raises only a fraction of the money required to pay for the scheme. If the levy was to fully pay for the services provided under the medicare banner then it would need to be set at about 8%. There is an additional levy of 1.0%, known as the Medicare Levy Surcharge, for those on high annual incomes ($50,000) who do not have adequate levels of private hospital coverage. This was part of an effort by the previous Coalition Federal Government to encourage takeup of private health insurance.

New Zealand

As with Australia, New Zealand's healthcare system is funded through general taxation.

Economics

Main article: Health care economics

Funding models

Universal health care in most countries has been achieved by a mixed model of funding. General taxation revenue is the primary source of funding, but in many countries it is supplemented by specific levies (which may be charged to the individual and/or an employer) or with the option of private payments (either direct or via optional insurance) for services beyond that covered by the public system. Most all European systems are financed through a mix of public and private contributions.[40] The majority of universal health care systems are funded primarily by tax revenue (e.g. Portugal[40]). Some nations, such as Germany, France[4] and Japan[41] employ a multi-payer system in which health care is funded by private and public contributions. A distinction is also made between municipal and national healthcare funding. For example, one model is that the bulk of the healthcare is funded by the municipality, speciality healthcare is provided and possibly funded by a larger entity, such as a municipal co-operation board or the state, and the medications are paid by a state agency.

Compulsory insurance

This is usually enforced via legislation. Sometimes there may be a choice of several funds providing a basic service (e.g. as in Germany) or sometimes just a single fund (as in Canada). In some European countries where there is private insurance and universal health care, such as Germany, Belgium and Holland, the problem of adverse selection (see Private Insurance below) is overcome using a risk compensation pool to equalize, as far as possible, the risks between funds. Thus a fund with a predominantly healthy, younger population has to pay into a compensation pool and a fund with an older and predominantly less healthy population would receive funds from the pool. In this way, sickness funds compete on price and there is no advantage to eliminate people with higher risks. because they are compensated for by means of risk-adjusted capitation payments. Funds are not allowed to pick and choose their policyholders or deny coverage, but then mainly compete on price and service. In some countries the basic coverage level is set by the government and cannot be modified. [42] Ireland at one time had a "community rating" system through VHI, effectively a single payer or common risk pool. The government later opened VHI to competition but without a compensation pool. This resulted in foreign insurance companies entering the Irish market and offering cheap health insurance to relatively healthy segments of the market which then made super profits at VHI's expense. The government later re-introduced community rating through a pooling arrangement and at least one main major insurance company BUPA then withdrew from the Irish market.

Taxation

Some countries (notably the UK) have eliminated insurance entirely and choose to fund health care directly from taxation. Other countries with insurance-based systems effectively meet the cost of insuring those unable to insure themselves via social security arrangements funded from taxation.

Single-payer

This term is used in the U.S. debate to describe a funding mechanism meeting the costs of medical care from a single fund. Although the fund holder is sometimes assumed to be the government allocating funding from taxation, its proponents do not rule out the possibility of some other mechanism. It is therefore as yet undetermined whether a future U.S. single-payer universal health care system would be funded from taxation, from compulsory insurance or a mixture of both.

See also: Single-payer healthcare and Publicly funded healthcare

Private insurance

In countries with universal coverage, private insurance is most often used as a supplement, covering what the core safety net service does not provide, Examples include elective cosmetic surgery and special comforts like private rooms. In some countries, people can use private insurance to obtain treatment more quickly than would otherwise be possible. Where voluntary insurance (often private) is predominant, such as in the U.S., medical (health) insurance is subject to the well-known economic problem of adverse selection which may also be referred to as a market failure. Adverse selection in insurance markets occurs because those providing insurance have limited information with which to estimate the health risks on which they may need to pay future claims. In simple terms, those with poor health are more likely to apply for insurance and more likely to need treatments requiring high insurance company payouts. Those with good health may find the cost of insurance too high for the perceived benefit, and some will remove themselves from the risk pool. This adverse selection concentrates the risk pool, thereby further raising costs. In practical terms, the potential for adverse selection means that private insurers have an economic incentive to use medical underwriting to 'weed out' high cost applicants in order to avoid adverse selection. Among the potential solutions posited by economists are single payer systems as well as other methods of ensuring that health insurance is universal, such as by requiring all citizens to purchase insurance and limiting the ability of insurance companies to deny insurance to individuals or vary price between individuals.[43] [44]

Politics

Main article: Health care politics

Because most developed and many developing countries already have systems for universal health care that have been in place for many years, universal health care per se is not a matter of political debate. However, health care systems throughout the world face sustainability challenges that may require far-reaching changes in national policy.[45] Over the last decade, health spending has been accelerating as a percent of Gross Domestic Product (GDP) among Organisation for Economic Co-operation and Development (OECD) countries.[45] Many industrialized countries have aging populations, with resulting increases in health care utilization, while others face rapid population growth. One recent study, by global consulting firm PriceWaterhouseCoopers, projected that global health care spending would triple in real dollars by 2020, consuming 21% of GDP in the U.S. and 16% of GDP in other OECD countries.[45]

United States

Whether a government mandated system of universal health care should be implemented in the U.S. remains a hotly debated political topic. Those in favor of universal health care, such as the non-partisan Institute of Medicine of the National Academies, which has called for the U.S. to implement universal health care by 2010, argue that the current rate of uninsurance creates direct and hidden costs shared by all, and that extending coverage to all would lower costs and improve quality.[46] Americans have a lower average life expectancy than those in other industrialized nations with universal health care, such as Australia, the United Kingdom, Canada, and Sweden.[47] Infant mortality rates also remain higher in the U.S., despite declines in recent decades, and are higher than the average of the European Union.[48][49] Critics of this argument note that there is very little correlation between life expectancy and infant mortality with the quality of health care, due to such factors as alternate causality and variations in the way countries collect their statistical data.[50] In fact, the U.S. led the world in life expectancy twenty years ago with virtually the same health system. Rather, many analysts attribute the lower life expectancy to the astronomical surge in obesity rates.[51][52][53] Opponents of government mandates or programs for universal health care, including libertarian think tanks such as The Cato Institute, argue that people should be free to opt out of health insurance[54] and that government programs would require higher taxes, increase utilization, and reduce health care quality. Opponents also claim that the absence of a market mechanism may slow innovation in treatment and research, and lead to rationing of care through waiting lists.[55] Both sides of the political spectrum have also looked to more philosophical arguments, debating whether people have a fundamental right to have health care provided to them by their government.

Debate in the United States

 It has been suggested that some of the information in this article's "Criticism" or "Controversy" section(s) be merged into other sections to achieve a more neutral presentation. ()

Common arguments forwarded by supporters of universal health care systems include:

  • Health care is a basic human right[56][57][58] or entitlement.[59]
  • Ensuring the health of all citizens benefits a nation economically.[60]
  • Coverage should be provided to all citizens regardless of ability to pay.
  • About 60% of the U.S. health care system is already publicly financed when federal and state taxes, property taxes and tax subsidies are included - a universal healthcare system would merely replace private/employer spending with taxes. Total spending would go down for individuals and employers.[61]
  • A single payer system could save $286 billion a year in overhead and paperwork.[62] Administrative costs in the U.S. health care system are substantially higher than those in other countries and than in the public sector in the US: one estimate put the total administrative costs at 24 percent of U.S. health care spending.[63]
  • Several studies have shown a majority of taxpayers and citizens across the political divide would prefer a universal healthcare system over the current U.S. system[64][65][66]
  • Health care is increasingly unaffordable for businesses and individuals.
  • Universal health care would provide for uninsured adults who may forgo treatment needed for chronic health conditions.[67]
  • Providing access to medical treatment to those who cannot afford it reduces the severity of epidemics by reducing the number of disease carriers.
  • Wastefulness and inefficiency in the delivery of health care would be reduced.[68]
  • America spends a far higher percentage of GDP on health care than any other country but has worse ratings on such criteria as quality of care, efficiency of care, access to care, safe care, equity, right care and wait times, according to the Commonwealth Fund.[69]
  • A universal system would align incentives for investment in long term health-care productivity, preventive care, and better management of chronic conditions.[70]
  • By reducing paperwork a universal system would allow doctors to spend more time with patients, thereby increasing physician productivity.[71]
  • Patients would be encouraged to seek preventive care, enabling problems to be detected and treated earlier.
  • A centralized national database would make diagnosis and treatment easier for doctors.
  • Universal health care could act as a subsidy to business, at no cost thereto. (Indeed, the Big Three of U.S. car manufacturers cite health-care provision as a reason for their ongoing financial travails. The cost of health insurance to U.S. car manufacturers adds between USD 900 and USD 1,400 to each car made in the U.S.A.)[72]
  • The profit motive adversely affects the cost and quality of health care. If managed care programs and their concomitant provider networks are abolished, then doctors would no longer be guaranteed patients solely on the basis of their membership in a provider group and regardless of the quality of care they provide. Theoretically, quality of care would increase as true competition for patients is restored.[73]
  • The profit motive adversely affects the motives of healthcare. Because of medical underwriting, which is designed to mitigate risk for insurance providers, applicants with pre-existing conditions, some of them minor, are denied coverage or prevented from obtaining health insurance at a reasonable cost. Health insurance companies have greater profits if fewer medical procedures are actually performed, so agents are pressured to deny necessary and sometimes life-saving procedures to help the bottom line.
  • According to an estimate by Dr. Marcia Angell roughly 50% of healthcare dollars are spent on healthcare, the rest go to various middlemen and intermediaries. A streamlined, non-profit, universal system would increase the efficiency with which is money spent on healthcare.[71]

Common arguments forwarded by opponents of universal health care systems include:

  • Health care is not a right.[74][75][76] As such, it is not the responsibility of government to provide health care.[77]
  • Higher Taxes
  • Universal heath care would result in increased wait times, which could result in unnecessary deaths.[74][78]
  • Poorer quality of care.[74]
  • Unequal access and health disparities still exist in universal health care systems.[74]
  • Universal health care would reduce efficiency because of more bureaucratic oversight and more paperwork, which could lead to fewer doctor-patient visits.[79] Advocates of this argument claim that the performance of administrative duties by doctors results from medical centralization and over-regulation, and may reduce charitable provision of medical services by doctors.[76]
  • The profit motive, competition, and individual ingenuity which lead to greater cost control and effectiveness would be eliminated by centralized control.
  • By law, uninsured citizens receive emergency care regardless of ability to pay. The health care safety net, which includes free medical clinics, charity care, and nonprofits and government-run community hospitals provides necessary care to the uninsured.[11]
  • Government-mandated procedures would further reduce doctor flexibility.
  • Healthy people who take care of themselves should not have to pay for the burden of those who smoke, are obese, etc.
  • Loss of private practice options and possible reduced pay would dissuade many would-be doctors from pursuing the profession.
  • Government efforts to incentivize college graduates to study medicine, which could include additional subsidies of medical student's education expenses, would increase the costs of a universal health care system.
  • Universal health care would eliminate the right to privacy between doctors and patients.[80]
  • Empirical evidence on single payer-insurance programs demonstrates that the cost exceeds the expectations of advocates.[80]
  • Universal health care systems, in an effort to control costs by gaining or enforcing monopsony power, sometimes outlaw medical care paid for by private, individual funds.[81]
  • Whether an individual can get treatment or not will be determined by their doctors or a bureaucrat
  • Opponents claim that if some Canadians travel to the United States for immediate treatment, and if private care is outlawed in the States, citizens won't have anywhere to go for immediate treatment.

See also

References

  1. ^ a b Insuring America's Health: Principles and Recommendations, Institute of Medicine at the National Academies of Science, 2004-01-14, accessed 2007-10-22
  2. ^ For an international comparison of ten different health care systems in ten developed countries - nine universal systems and one non-universal system (the U.S.) - and their relative costs and key health outcomes, see http://www.nao.org.uk/publications/Int_Health_Comp.pdf. For a wider international comparison of 16 countries, each with universal health care, see the World Health Organisation publication at http://www.euro.who.int/document/e85400.pdf.
  3. ^ Portugal: Bentes M, Dias CM, Sakellarides C, Bankauskaite V. Health Care Systems in Transition: Portugal. WHO are Regional Offices for Europe on behalf of the European Observatory on Health Systems and Policies, 2004.
  4. ^ a b Physicians for a National Health Program "International Health Systems".
  5. ^ http://www.spartacus.schoolnet.co.uk/2WWbeveridgereport.htm
  6. ^ New generation surgery-centers to carry out thousands more NHS operations every year. Department of Health (2002-12-03). Retrieved on 2006-09-15.
  7. ^ a b G20 Health Care: "Health Care Systems and Health Market Reform in the G20 Countries." Prepared for the World Economic Forum by Ernst & Young. January 3, 2006.
  8. ^ a b "Income, Poverty, and Health Insurance Coverage in the United States: 2006." U.S. Census Bureau. Issued August 2007.
  9. ^ Centers for Medicare & Medicaid Services. CMS Programs & Information. Retrieved August 30, 2006.
  10. ^ Centers for Medicare & Medicaid Services. Emergency Medical Treatment & Labor Act. Retrieved August 30, 2006.
  11. ^ a b Report Brief: America's Health Care Safety Net: Intact but Endangered (PDF). Institute of Medicine, National Academies of Science (2000-01-01). Retrieved on 2007-10-22. “In the absence of universal health insurance, a health care “safety net” is the default system of care for many of the 44 million low-income Americans with no or limited health insurance as well as many Medicaid beneficiaries and people who need special services. This safety net system is neither uniformly available throughout the country nor financially secure.”
  12. ^ Briefing note for OECD Health Data 2007: How Does the United States Compare, OECD Health Data 2007, accessed 2007-10-28
  13. ^ "The World Health Report 2006 - Working together for health."
  14. ^ Characteristics of the Uninsured: Who is Eligible for Public Coverage and Who Needs Help Affording Coverage? (PDF). Kaiser Commission on Medicaid and the Uninsured. Retrieved on 2007-07-19.
  15. ^ Insured But Not Protected: How Many Adults Are Underinsured. The Commonwealth Fund. Retrieved on 7/27/07.
  16. ^ Kaiser Family Foundation (2007-09-11). "Health Insurance Premiums Rise 6.1 Percent In 2007, Less Rapidly Than In Recent Years But Still Faster Than Wages And Inflation". Press release. Retrieved on 2007-09-13.
  17. ^ Fahrenthold DA. "Mass. Bill Requires Health Coverage." Washington Post; Wednesday, April 5, 2006; Page A01.
  18. ^ Healthy San Francisco: About Us. City of San Francisco. Retrieved on 2007-10-27.
  19. ^ Meredith, Adams. "San Francisco launches universal health care". Chicago Tribune. 2007-09-18. Retrieved on 2007-10-09
  20. ^ Steinhauer, Jennifer. "California Plan for Health Care Would Cover All", New York times, 2007-01-09. Retrieved on 2007-10-27. 
  21. ^ Richard Burkhauser and Kosali Simon,"Who Gets What From Employer “Pay or Play” Mandates", Employment Policies Institute, Cornell University, November 2007
  22. ^ Linda J. Blumberg and Len Nichols, "Health Insurance Market Reforms: What They Can and Cannot Do," Urban Institute, November 1, 1995
  23. ^ "The Price Sensitivity of Demand for Nongroup Health Insurance," Congressional Budget Office, 2005
  24. ^ M. Susan Marquis, Melinda Beeuwkes Buntin, Jose J. Escarce, Kanika Kapur, and Jill M. Yegian, "Subsidies and the Demand for Individual Health Insurance in California," Health Services Research 39:5 (October 2004)
  25. ^ Government of Canada, Social Union, News Release, "A Framework to Improve the Social Union for Canadians: An Agreement between the Government of Canada and the Governments of the Provinces and Territories, February 4, 1999," URL accessed 20 December 2006.
  26. ^ Public vs. private health care. CBC, December 1, 2006.
  27. ^ Press release, "Health care spending to reach $160 billion this year", Canadian Institute for Health Information, November 13, 2007, accessed November 19, 2007
  28. ^ National Health Expenditure Trends, 1975-2007, Canadian Institute for Health Information, November 13, 2007, accessed November 19, 2007
  29. ^ Private Health Insurance in OECD Countries OECD Health Project, 2004, accessed November 19, 2007
  30. ^ Kraus, Clifford. "As Canada's Slow-Motion Public Health System Falters, Private Medical Care Is Surging", New York Times, 2006-02-26. Retrieved on 2007-07-16. 
  31. ^ http://www.sgmlaw.com/PageFactory.aspx?PageID=488
  32. ^ The Health Care System in Israel- An Historical Perspective Israel Ministry of Foreign Affairs. Retrieved June 7, 2006.
  33. ^ Ministry of Health and Nutrition, Sri Lanka
  34. ^ Bureau of National Health Insurance, Taiwan
  35. ^ http://www.watsonwyatt.com/europe/pubs/healthcare/render2.asp?ID=13850 Watson Wyatt Healthcare Market Review, "The Singapore health system – achieving positive health outcomes with low expenditure."
  36. ^ The Universal Coverage Policy of Thailand: An Introduction
  37. ^ Hughes, D. and Leethongdee, S. Universal coverage in the land of smiles: lessons from Thailand's 30 baht health reforms, Health Affairs 26(4):999-1008, 2007.
  38. ^ A list of the top rated hospitals in India. Several hospitals among these are government hospitals, Including AIIMS
  39. ^ Universal care - still miles to go
  40. ^ a b Bentes M, Dias CM, Sakellarides C, Bankauskaite V. Health Care Systems in Transition: Portuagal. WHO are Regional Offices for Europe on behalf of the European Observatory on Health Systems and Policies, 2004.
  41. ^ Chua, Kao-Ping. "Single Payer 101". February 10, 2006.
  42. ^ http://goliath.ecnext.com/coms2/browse_R_R016
  43. ^ Michael Rothschild and Joseph Stiglitz, "Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information," Quarterly Journal of Economics, November 1976 (90:629-649) (known as the Rothschild-Stiglitz Model)
  44. ^ Paulo Belli, How Adverse Selection Affects the Health Insurance Market
  45. ^ a b c HealthCast 2020: Creating a sustainable future (PDF). PriceWaterhouseCoopers (requires registration. Retrieved on 2007-10-27.
  46. ^ Insuring America's Health: Principles and Recommendations. Institute of Medicine of the National Academies. Retrieved on 2007-10-27.
  47. ^ CIA World Factbook table of life expectancies by country
  48. ^ -see table
  49. ^ CIA World Factbook; Guide to Rank Order Pages[1] and the complete article on the United States [2]
  50. ^ National Center for Public Policy Analysis. [3] Retrieved August 08, 2007.
  51. ^ New England Journal of Medicine. [4] Retrieved August 08, 2007.
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