• How health insurance works in different countries

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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.

    Health insurance in the United States

    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:

    • More than 90% of the entire population in the country have some form of health insurance (private or public). The percentage of people covered by mediclaim policies increases every year.
    • Employer-provided health insurance continues to be the most common type of health coverage in the country. About 61% of health insurance in the country is offered by employers.
    • Employer health insurance plans are popular mainly because employers often negotiate better deals for group insurance policies. This is relatively cheaper than the insurance plans offered by private insurers.
    • Insurance premiums in employer-related health insurance are shared by both employers and employees. Employers are free to choose the portion of premiums paid by their employees.
    • Internal health insurance plans are also sometimes developed within large organisations. This involves employers and employees developing their own plans with minimal support from an external commercial insurance company.
    • Conventional health insurance plans in the United States offered access to healthcare providers of one’s choice. However, the managed care medical insurance plans offered by employers in the recent days provide access to only a select group of service providers.
    • The premium amount paid for health insurance is subsidised by the state and federal governments in the form of income tax relief.
    • More than 26% of the US population is covered by public insurance schemes offered by the government. The two most common forms of public health insurance schemes are Medicare and Medicaid.

    Public health insurance plans in the United States

    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.

    Top private health insurers in the United States based on sales

    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

    Health Insurance in the UK

    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:

    • The NHS in England, Scotland, and Wales have slightly different terms and conditions with regard to coverage.
    • In Northern Ireland, healthcare is provided through Health and Social Care (HSC), an organisation equivalent to NHS.
    • In order to receive benefits through NHS or HSC, you must be registered with a general practitioner (GP) located in the country.
    • Any legal citizen of the country registered with a GP is eligible for healthcare under NHS or HSC. Under this coverage, the beneficiaries are entitled to all possible medical treatments free of costs.

    How it works?

    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:

    • Emergency hospitalisation (accidental injuries or illnesses)
    • Dental care
    • Eye care
    • Sexual health services
    • Mental health services
    • Prescription drugs

    Private health insurance in the UK

    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:

    • There is a long waiting period for certain conditions under NHS due to the limited availability of specialists.
    • Since NHS is offered to all citizens in the country, it normally runs on limited funds. In certain cases, the range of treatments offered under NHS may be limited.
    • Expatriates living in the country can take private health insurance to skip the queue and get easy access to healthcare.
    • Premiums for private health insurance is high, but the cost of medical treatment is extremely high if you are not insured.

    Top private health insurers in the UK

    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

    Health Insurance in Canada

    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:

    • People enrolled in the health insurance scheme will be issued a card by the respective provinces. This card must be shown every time during the time of treatment.
    • For emergency medical requirements, free treatment will be provided in all provinces and territories even if the patient does not have a health insurance card.
    • There is an unlimited choice of physicians for people getting treatment under this health insurance scheme.
    • As the name implies, the universal healthcare scheme is available for all citizens in the country with just a few exceptions.
    • Any copayments required from the consumer for a specific medical treatment is negligible.
    • Physicians enrolled in this scheme receive their payments based on the pre-negotiated service fee for specific treatments. They are paid based on the service provided, and they can exert autonomy when they practice their services.
    • Patients are not involved in the reimbursement process of health insurance. The reimbursement happens between the healthcare service provider and the government (public insurer).
    • The universal healthcare scheme pays for all kinds of hospitalisation treatments. However, this scheme does not provide any coverage for prescription drugs, dental care, home care treatment, prescription glasses, etc.
    • For the above mentioned exclusions, patients must pay from their own hand or use a private insurer to provide the extra coverage.
    • There is a waiting period of 3 months for health insurance coverage in most provinces. It is better to use a private health insurer during this waiting period.

    How it works?

    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:

    • Healthcare costs are controlled by the ministry of health in each province and territory of the country.
    • The ministry of health negotiates the annual budget with each individual hospital in the country.
    • The physician fee for a specific service is predetermined through periodic negotiations between the government and the respective medical associations in each province.
    • There is absolutely no monetary exchange between a patient and a hospital during the treatment process.
    • Capital expenditures of various healthcare service providers must be approved by the ministry of health.

    Private health insurers in Canada

    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

    Health Insurance in Germany

    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:

    • Since health insurance is compulsory in Germany, even students and expatriates are required to have health insurance. Proof of health insurance is required by many foreign offices during the visa verification process in Germany.
    • The government health insurance scheme in Germany is known as Gesetzliche Krankenversicherung (GKV). For people earning less than 59,400 Euros per year in 2018, GKV is mandatory.
    • Private health insurance policies can also be taken by people in Germany provided their income is over the above mentioned threshold. It is also possible to use a combination of both types of coverages.
    • Premiums for medical insurance are directly collected from the salaries of citizens as payroll tax deduction. As of 2018, German citizens contribute about 14.6% of their income to health insurance premiums.
    • The premium amount charged for a person is based on his/her income. Hence, the percentage of contribution does not increase as a person’s income increases.
    • Beneficiaries are free to choose from any of the 113 Krankenkassen (non-profit health insurance associations) that provide coverage under the government health insurance scheme.
    • The general period of coverage under a government health insurance policy is 18 months. You can switch service providers at the time of renewal.
    • There are about 40 private health insurance companies operating in Germany. These companies offer a diverse range of plans. The cost of insurance is based on the plan chosen by a person.

    How it works?

    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.

    Private health insurers in Germany

    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

    Health Insurance in India

    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:

    • State governments in India have their own free health insurance schemes for the underprivileged sections of the society. These plans are mostly provided as cashless schemes rather than reimbursement schemes.
    • In India, free healthcare is offered by all state governments across the country. However, funding restrictions and administrative issues have lowered the quality of care offered to patients.
    • Free health insurance plans are available only for the underprivileged population of the country. These schemes are typically limited insurance plans that provide protection only to a certain extent.
    • For other sections of the society, health insurance has to be purchased on their own or offered by their employers. The cost of health insurance varies based on the different types of plans available in the market.
    • Most of the top healthcare service providers in the country are privately owned. Some of the top hospital chains like Apollo have their own insurance tie-ups with international firms.
    • There are about 4 state-owned general insurance companies in the country that offer health insurance service. In addition to this, there are private general insurance companies and standalone health insurance service providers.
    • Health insurance companies in the country have tie-ups with various service providers in different locations.
    • Policyholders can get cashless treatment benefit by getting medical treatment in these network hospitals. Reimbursement claims are also allowed after the completion of the medical treatment.
    • All the rules and regulations regarding health insurance are administered by the Insurance Regulatory and Development Authority of India (IRDAI).

    How it works?

    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.

    Public health insurance companies in India

    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

    Conclusion

    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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