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Organizing the health insurance system: international experience

Sufficiently effective models and systems of medical insurance work in the world. The financing of the health-care system in the country can be carried out from the state budget and/or through compulsory and optional medical insurance.
Organizing the health insurance system: international experience
Organizing the health insurance system: international experience
Organizing the health insurance system: international experience

Medical insurance in Europe allows the population to receive the necessary care regardless of costly medical services. It will be virtually impossible for person without an insurance to pay for the treatment of serious diseases in European countries with the insurance-based health-care system. All employed people must necessarily have medical insurance enabling them to get help in the required amount. If desired, every person living in a country with an insurance-based health-care system has the opportunity to arrange additional insurance which in case of illness will allow receiving medical care at a higher level.

All residents in Switzerland must be insured. The peculiarity of the Swiss health insurance system is the provision of both types of insurance, i.e. mandatory and optional. By doing so, you do not have to look for other insurance companies to “purchase” additional medical services.

Another distinguishing feature of the health insurance system in Switzerland is that citizens make a personal contribution to the health insurance fund to be chosen by themselves. The contributions do not depend on income and vary in one or another fund.

The health insurance funds (Krankenkassen) work with doctors and clinics included in the so-called list of contractual institutions and specialists. The best medical clinics are offered an opportunity to work with the insured which in turn guarantees a high quality of medical service. This trend also applies to medicines. The health insurance fund will not pay for the medicines that are not on the “list” of medications. These restrictions guarantee high efficiency and effectiveness of therapy.

In Switzerland, compulsory medical insurance includes preventive services as well. Influenza vaccination, medical examination once a year are precaution measures aimed at disease prevention, its timely diagnosis. The insured in Switzerland, like in other European countries, pays a part of the amount for the provided treatment which is 10%.

In Austria, OMI policies are used primarily as a supplement to CMI (compulsory medical insurance). The policies cover the costs of in-patient treatment or guarantee a fixed daily payment in case of hospital stay. The insurance based on the payment for each day of hospital stay ensures the payment of insurance coverage in the form of a fixed amount for each day of stay in the hospital without the possibility of changing the payment for treatment if necessary.

The OMI insurance payments and the size of insurance contributions depend on the age and gender of the insured person. Insurance payments are taxed 1% which is much lower than the taxation level on the citizen's compound income. In most cases, OMI premiums are exempt from income tax.

Among the variety of specific forms of organizing health-care system in different countries using the social insurance model, I would like to highlight the health protection system in Japan.

In Japan, two main categories of health insurance are available, called Kenkō-Hoken (employee’s health insurance) and Kokumin-Kenkō-Hoken (national health insurance). National health insurance is usually for self-employed individuals and students while social insurance is for corporate employees.

There are special medical care programs for such categories of citizens as peasants, fishermen and public servants. Each insured is required to make a certain contribution to the health insurance fund. An exception is made only for the unemployed people who remain participants of insurance schemes based on their former place of work.

Health insurance system in Japan demonstrates a high efficiency, interrelationship and high results while combining models of state and social insurance based on private medical services with the costs regulated by the government.

International experience of medical insurance is diverse, but the headline is that none of the existing models can be copied completely with disregard for domestic context.

Source:

http://nurotan.kz/kz/node/5653

http://www.cnews.ru/reviews/free/national2007/articles/insurance.shtml

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