Health insurance

The health insurance is a device charged to ensure an individual vis-a-vis financial risks of care in the event of disease, as well as a minimal income when the affection deprives the person of work.

In the majority of the Western countries, a great part of the health insurance is dealt with by the State. It is besides one of the basic components of the Social security, and a duty of the State according to the Universal declaration of the human rights of 1948.

An official system of health insurance can be managed by an organization of State, delegated at private organizations, or be mixed.

Operation, like all the Insurance S, is based on the mutualisation of the risk: each person cotise, in exchange of what it is refunded according to a fixed scale.

Concerning an official system of health insurance, the premium paid by the policy-holder inevitably does not follow the rules of the pure insurance, i.e. only based on the risk. Indeed, the official system fulfills at the same time a function of pure insurance and a function of distribution in which easiest pay the insurance of most underprivileged.

Models of health insurance

The health insurance can take two different forms:

is it acts simply of a financial insurance: the individual is ensured for a risk (the accident, the disease), and his care (remuneration of the experts, cost of the products and Médicament S, Prothèse S, Orthèse S…) are refunded according to the scale;
is the organization insurer constitutes a network of care: he contacts experts, suppliers… the insurance buys a kind of subscription to this network of care and resells it with the user;
in its most extreme form, the policy-holder does not have the choice of its expert, at least if he wants to profit from the exemption from payment of the care or their refunding.

One can have a coexistence of these two models.

The health insurance can be a purely official organization, that can be only private insurers or one can have an analog and digital system: the user has an official insurance and can contract an private insurance near a company or mutual insurance (called “complementary health” in France) which supplements refunding or provides an access to a complementary network of care.

It is noted that the countries having adopted a purely deprived and competing system are also those for which the expenditure is highest. Thus, whereas the Pays developed S spend on average 10 % of their GDP in their health-care system, the the United States spend about it 14% and the Suisse 13%. Nevertheless, in a system of insurance in competition, the policy-holders choose the level of expenditure which they wish compared to the level of cover health which they wish. The level of expenditure in a system in competition thus reveals the level of expenditure wished by the consumers. In an official system, the State fixes the level of the expenditure and rations the use of the departments of health to limit them (for example, attending physician in France). The comparison of the levels of expenditure between official systems and systems in competition is thus skewed owing to the fact that they are noncomparable systems in their use.

The health insurance in Belgium

The sickness and disablement insurance is a Assurance " care of Health " obligatory managed by the National institute of health insurance disability (the INAMI). It is one of the bases of the Belgian social security.

This insurance is in deficit of 634 million euros in 2004, in particular because of the Vieillissement of the population and the degradation of the " report/ratio; number of cotisants" /" number of bénéficiaires".

The Belgian Federal government in agreement with the actors of the medical sector seeks various solutions with this problem. The increased use of generic medicines, the effectiveness equivalent to the drugs of famous brand but definitely less expensive, would make it possible for example to reduce the costs of the drugs (with the costs of the drug company). The reduction of the superfluous medical examinations is another track. Others plead for the regionalization of the health insurance, asserting that Flemish subsidizes Walloons surconsommateurs of health care.

The health insurance with the the United States

In the United States, the health insurance depends especially on private insurers. The authorities guarantee the care with the people old (médicare) or stripped (médicaid)

According to the data of OECD, the public expenditure of health per capita are of 2364$.

The number of not-policy-holders is raised, 45 million, but it represents a minority (15,6%) compared to the total population of 288 million inhabitants. Of another shares, and contrary with a spread idea, even the not-policy-holders have accesses to free health care offered by the public hospitals, health centres Community, university hospitals, etc

An important part from the contributions, 30%, is not reinvested in health but share in general and administration expenses, Mercatique and Bénéfice S. the health insurance costs twice expensive than in France: : 5500 dollars per anybody in 2005, that accounts for 16% of GDP.

The health insurance in France

The health insurance with the Quebec

See also: Governed health insurance of Quebec

The Swiss health insurance in

Organization

There exists in Switzerland several tens of cases of health insurance which all are of the privately held companies. There does not exist in Switzerland of official sickness insurance.

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