Health Insurance

Health insurance is a device responsible for an individual facing financial risk of care in case of illness, and a minimum income when the disease deprives the working person.

In most Western countries, a large share of health insurance is supported by the state. This is also a fundamental component of social security, and a duty of the State under the Universal Declaration of Human Rights of 1948.

A public health insurance system can be managed by a state agency, delegated to private organizations, or be mixed.

The operation, like all insurance is based on risk-sharing: each person contributes, in exchange for which it is paid according to a fixed scale.

On a public health insurance system, the insurance premium paid by the insured does not necessarily follow the rules of pure insurance, that is to say, it is not based solely on risk . Indeed, the public system fulfills both pure insurance function and distribution function in which the wealthier pay for the insurance of the poor.
History

Until the eighteenth century, the protection against the risks of life are provided by personal wealth, the local support (family, village) or professional (guilds, guilds), and charity. In the nineteenth century, the Industrial Revolution concentrated populations in cities where local solidarity can not play while the number of accidents increases. In addition, develops an intellectual and scientific movement that promotes individual pension (originally private insurance), mutual insurance companies that provide the collective welfare and the concept of "sacred debt" provided by the French Revolution which Article 21 of the Declaration of the Rights of Man and of the Citizen of 1793 recognizes every citizen the right to assistance and social protection, giving rise to social security.

These new concepts are applied in Prussia where Otto von Bismarck, seeking a strong state, develops the first compulsory social insurance system with bills relating to insurance against accidents at work and social insurance adopted in 1883 and 18843.
Models of health insurance

Health insurance can take two different forms:

    or it is simply a financial insurance: the individual is insured for a risk (accident, illness), and care (compensation practitioners, cost of products and medications, prosthetics, orthotics ...) are reimbursed according to the scale;
    or the insurer is a network of care: he contacted practitioners, suppliers ... Insurance buys a subscription to this kind of care network and resells to the user;
    in its most extreme form, the insured does not have the choice of practitioner, at least if he wants to receive free health care or reimbursement.

There may be a coexistence of these two models.

Health insurance can be a pure state (government), this can be only private insurers or you can have a mixed system: the user has a public insurance and private insurance is with a company or mutual insurance (called "complementary health" in France), which provides full refund or access to a network of complementary care.

It was found that the countries that have adopted a purely private competitive system are also those for which expenses are the highest. Thus, while developed countries spend on average 10% of their GDP on health care system, the United States spends 14% and Switzerland 13%. However, in a competitive insurance system, insured choose the level of spending they want with regard to the level of health insurance they want. The level of spending in a competition system thus reveals the desired level of consumer spending. In a public system, the government sets the level of spending and rationing the use of health services for the limit (eg, doctor in France). Comparing the levels of public expenditure between systems and systems competition is biased because it is not comparable systems in their use.
Health insurance in the world
Germany

Founded on the principles of professional insurance through the company and Social Security, the German system is in a process of reform since the late 1980s including financial and organizational dimension.

In 1883, the Law on Health Insurance establishes the implementation of compulsory insurance for workers in the industry. Entered into force in 1914, this system remains the main legal basis for legislation on health insurance until the adoption in 1988 of the first law on the reform of the health system.

- Public Plan: 88% of the population are affiliated. Health insurance is mandatory below a certain income level.

- Private Plan: 12% of the population are affiliated. Beyond a certain income level, people can opt for the statutory scheme or private insurance. This private insurance covers 10% of the population and has the option of not choosing the compulsory membership beyond a threshold of income but can also combine the two types of public and private protection.

The characteristics of the German system are:

    social security contributions (employee and employer) mainly finance the health risks
    the insurance funds in which includes representatives of funders (trade unions and employers' organizations) have a managerial role
    a very wide range (nearly three hundred different public bodies) and autonomy of health insurance (they each freely set premium rates, which are different from one fund to another)
    the third-party payer generalized
    the important role of collective bargaining between unions and representatives of doctors and hospitals,
    the federal system that gives an important role to the states (especially in hospitals).

The German health insurance system is close to the French model in its philosophy and facing similar challenges.

In Germany, the homeless no longer benefit from the insurance.
Belgium:

The Health and Disability insurance is insurance "health care" mandatory managed by the National Health Insurance Institute (NIHDI). It is a cornerstone of the Belgian social security.

This insurance is a deficit of € 634 million in 2004, mainly because of the aging population and the degradation of the "number of contributors" / "number of beneficiaries".

The Belgian federal government in accordance with the medical sector actors seek different solutions to this problem. The increased use of generic medicines, the drug equivalent big brand but much cheaper efficiency, for example, would reduce drug costs (at the expense of the pharmaceutical industry). Reducing unnecessary medical examinations is another track. Others argue for the regionalization of health insurance, arguing that the Flemish overconsumers subsidize the health care of Walloon.
Canada:

In education and health, it is the provinces administer policies and budgets in these areas, according to the division of responsibilities, authorities and federal, provincial, regional and municipal levels.
United States:
In the United States, health insurance mostly depends privés6 insurers. The public authorities guarantee the care of the elderly (Medicare) or poor (Medicaid). On the other hand, and contrary to popular belief, even the uninsured have access to free health care provided by public hospitals, community health centers, university hospitals, etc.. According to OECD data, public health expenditure of $ 2,464 per capita.

In 2010, 83.5% of Americans had health insurance and 50 million were privés8. This rate must be qualified: half of uninsured individuals under 35 years9 and distribution of uninsured by age that 95% of health problems affecting assurées9 populations. In addition, two thirds of the uninsured have higher incomes $ 25,000 and households whose incomes are below the poverty line, only one-fifth of the uninsured. According Bundorf and Pauly in the Journal of Health Economics, "up to three-quarters of uninsured Americans could afford health insurance without breaking their budget constraint." It is therefore rather voluntary uninsured.

A significant portion of contributions, 30%, is not reinvested in health but share in administrative costs, marketing and profits. [Ref. needed] health insurance cost twice as much as in France: 5500 USD per person in 2005, this represents 16% of GDP.

The reform of the health insurance required by U.S. President Barack Obama is passed by the Senate in November 2009 and by the House of Representatives on March 21 201012. It requires all Americans to buy insurance by 2014 or face a fine. It prohibits insurance refuse to cover their policyholders because of their medical history. It provides financial assistance to families who earn less than 88,000 dollars annually8 income. The reform is expected to cost $ 940 billion (695 billion euros) over ten years. Funding should be provided by taxes on high incomes and lower care costs.