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Health insurance has become an absolute necessity no matter where you live in this world. The type of insurance offered to the general public may vary from one country to another. Governments across the world are doing their part to contribute to the healthcare of their citizens. Even in developed countries, the government is doing its part to help all its citizens access quality healthcare. Health insurance framework in a country is dependent on various factors. For instance, the framework suitable for Canada which has just 36 million people may not be suitable for India which has more than 1 billion people. Here is an analysis of how health insurance system works in different countries across the world.
The type of health insurance offered in the United States varies based on the requirements of customers. There are various commercial insurance companies operating in the United States. Customers are free to choose an insurance cover from these companies by paying the appropriate premiums. The government provides health insurance to certain groups in the country in the form of social insurance or social welfare schemes. Some of the key highlights of health insurance coverage in the United States can be listed as follows:
Medicare: This plan is available for people who are older than 65 years. Younger people with certain types of disabilities can also avail this cover. This comes in four parts: Part A is intended for hospitalisation expenses, Part B covers outpatient care and other physician services, Part C involves expenses covered under both Part A and Part B, and part D focuses on providing coverage for prescription drugs.
Medicaid: This plan is mainly intended for the poor and disadvantaged sections of the society. This program is jointly funded by the federal government and the respective state governments of the country. This program has provisions for both inpatient and outpatient care under mandatory benefits. Eligible people can also get optional benefits like prescription drugs, physical therapy, occupational therapy, etc.
Service provider | Types of plans offered | Popular plans |
United Healthcare | Individual, family, and group health insurance plans | Self-employed health insurance Health insurance for small business Critical illness insurance Accident insurance Dental insurance |
Anthem Health Insurance | Individual, family, and group health insurance plans | Family health insurance plan Group medical insurance Medicare Medicaid Dental insurance |
Cigna Health Insurance | Individual, family, and group health insurance plans | Global health insurance Accident expense insurance Lump sum cancer insurance Heart attack & stroke insurance Cancer treatment insurance |
In the United Kingdom, healthcare is predominantly delivered with the help of the country’s public healthcare system - National Health Service (NHS). Though NHS is a publicly-funded health care system, it does not remain the same in all parts of the country. Different regions like England, Scotland, Wales, and Northern Ireland operate their own healthcare systems, and they are funded individually by their respective regions. Some of the key highlights of health insurance in the United Kingdom can be listed as follows:
In the UK, GPs are the central part of the healthcare system. They are the first points of contact for any illnesses or injuries. Following the approval of the GP, inpatient hospitalisation will be approved for a particular patient. Any citizen of the UK can get the following treatment benefits free of charge in the public healthcare system:
As noted above, the UK offers comprehensive medical treatments for its citizens free of cost. The affordable public healthcare offered by the country makes private health insurance almost irrelevant. According to the latest estimates, only 10.5% of the country’s population have opted for private health insurance. The following list of reasons are often cited by citizens for using private health insurance:
Service provider | Types of plans offered | Popular plans |
Bupa Health Insurance | Individual and family plans | Health insurance plan Health cash plan Dental insurance Cosmetic dentistry Elderly care |
Aviva Insurance | Individual and family plans | Health insurance Health essentials Cancer essentials International health insurance |
AXA Insurance | Individual and family plans | Personal health cover Child health insurance Dental insurance |
Healthcare in Canada is predominantly funded by the government. Canadian citizens and permanent residents in the country can apply for the publicly funded health insurance program. The universal healthcare offered by the Canadian government is funded through the tax revenues collected from citizens. The healthcare system of Canada is named ‘Medicare’, which is not to be confused with the health insurance scheme offered by the United States. Some of the key features of Canada’s universal healthcare can be listed as follows:
More than 70% of the country’s healthcare requirements are satisfied through the universal healthcare service provided by the government. It is illegal to use private health insurance for any of the covered services. The additional private health insurance coverage can be taken only for the services that are not covered under the universal scheme. The universal health insurance scheme works in the following process:
Though the government offers universal healthcare through ‘Medicaid’, the insurance process involved in the treatment is administered with the help of various private entities. Some of the top health insurers in the market can be listed as follows:
Service provider | Types of plans offered | Popular plans |
Blue Cross Insurance | Individual and family plans | Individual healthcare benefits (prescription drugs, dental benefits, critical illness cover, vision coverage, disability benefit) Group life insurance and healthcare benefits Travel health insurance |
Sun Life Financial | Individual and family plans | Personal health insurance coverage Critical illness insurance Long term insurance Disability insurance |
Arbetov Insurance | Individual and family plans | Personal health insurance Critical illness insurance Long term insurance Disability insurance Group health insurance for businesses |
Germany is another example of a major industrial nation with a large public healthcare scheme. The country is renowned for offering one of the best health insurance services in the world through its public healthcare scheme. It is mandatory for everyone living in Germany to have health insurance coverage. More than 85% of the country’s population are covered under the public health insurance scheme. The rest of the population are serviced with the help of private insurers. Some of the highlights of health insurance in Germany can be listed as follows:
Unlike many developed countries in the world, Germany has made health insurance mandatory for its citizens. It is illegal to be uninsured if you are living in Germany. Expatriates and students are also required to have health insurance. For students, there are various discounts offered by private insurers in the country. Students and expatriates visiting the country can check out the private insurance plans available in the market.
In Germany, government health insurance works in the form of a social benefit scheme. A percentage of income is deducted from everyone and unlimited health insurance is offered when a person falls sick. Dependent family members of the primary insured are also covered without any extra premium charge deduction. Though the country is facing a hard time due to rising medical expenses, it still provides universal healthcare for all its citizens.
In case of long-term illness, the employer of the insured person is required to provide salary for at least 6 weeks. Following this 6 weeks, the insurance plan will provide a certain percentage of your income as statutory sick pay for a maximum of 78 weeks. In private health insurance plans, sick pay insurance can be bought by paying additional premium charges.
Some of the top private health insurance companies in Germany can be listed as follows:
Service provider | Types of plans offered | Popular plans |
Gothaer Group | Individual and family plans | Comprehensive health insurance International health insurance Hospital insurance Outpatient supplementary insurance |
Allianz Group | Individual and family plans | Comprehensive health insurance International health insurance |
Mawista Insurance | Students and expats | Mawista student Mawista expatcare Mawista visum Mawista reisecare |
India is a country renowned for its billion plus population. The huge population of the country makes it a little bit challenging for the government to administer healthcare programs. Moreover, the economy of the country is still in its growth phase. The central and state governments in India are pushing for improvement in the healthcare sector and easy healthcare access to the poorest sections of the population. Despite the efforts of the government, health insurance penetration in India is still relatively low. Health insurance is not mandatory in India, and only certain sections of the society have access to comprehensive health insurance plans. Some of the highlights of health insurance in India can be listed as follows:
In India, health insurance works similar to that of any other countries in the world. The benefits offered under various government welfare schemes are extremely limited. Hence, it is better to have a comprehensive health insurance plan if you are living in India. Even the state-owned general insurance companies function similar to private companies in the market. Most of the comprehensive health insurance schemes provide fixed benefit within the chosen sum insured range. As of 2018, it is mandatory for health insurance beneficiaries to provide their Aadhaar (unique identification number) number during enrollment.
If a person subscribes to a policy, he/she must pay premiums regularly for the health insurance plan to remain active. A policy period is typically one year. Most of the health insurance plans provide coverage for hospitalisation expenses, specific day care treatment, pre and post hospitalisation expenses, medical consultations, etc. Outpatient treatment expenses are covered by only a few service providers in the market. If the medical expenses exceed the sum insured limit, the patient must pay from his/her own hand.
Any non-medical expenses incurred by a patient during hospital stay will not be covered by medical insurance in India. Moreover, the specific extent of coverage will be provided in the policy document. Before making reimbursement claims, a policyholder must know the list of items covered under a health insurance plan.
Service provider | Types of plans offered | Popular plans |
United India Insurance | Individual, family, and group plans | Family Medicare Policy Individual Mediclaim Policy Workmen Medicare Policy Senior Citizen Policy |
New India Assurance | Individual, family, and group plans | New Mediclaim 2012 Swasthya Bima Policy Jan Arogya Policy Senior Citizen Mediclaim |
National Insurance | Individual, family, and group plans | National Mediclaim Policy National Parivar Mediclaim Policy Overseas Mediclaim Employment and Studies |
Oriental Insurance | Individual, family, and group plans | Happy Family Floater Policy Oriental Happy Cash Policy Jan Arogya Bima Policy Group Mediclaim Policy |
Private health insurance companies in India
Based on the gross direct premiums collected, the following are the top 3 private health insurance companies in India:
Service provider | Types of plans offered | Popular plans |
ICICI Lombard | Individual and family plans | Complete Health Protect Health Booster Personal Protect Policy |
Star Health Insurance | Individual and family plans | Family Health Optima Senior Citizen Red Carpet Cancer Care Gold Diabetes Safe Insurance Policy |
Apollo Munich | Individual and family plans | Easy Health Individual Optima Restore Individual Optima Cash Senior Citizen Optima |
Health insurance works in different ways in different countries. In many developed countries across the world, a large part of healthcare is contributed by the government. The premiums for health insurance in these countries are collected from the taxes paid by citizens. In India, healthcare and health insurance is still in the development phase. Healthcare infrastructure in the country is still expanding, and the government is doing its part to provide easy healthcare access to the underprivileged sections of the society.
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