Universal health care is health care coverage for all eligible residents of a political region and often covers medical, dental and mental health care. Typically, costs are borne in the majority by publicly-funded programs.
Universal health care systems vary according to the extent of government involvement in providing care and/or health insurance. In some countries, such as the UK, Spain, and the Nordic countries, the government has a high degree of involvement in the commissioning or delivery of health care services and access is based on residence rights not on the purchase of insurance. Others have a much more pluralistic delivery system based on obligatory health with contributory insurance rates related to salaries or income, and usually funded by employers and beneficiaries jointly. Sometimes the health funds are derived from a mixture of insurance premiums and government taxes. These insurance based systems tend to have a higher proportion of private medical providers obtaining reimbursement, often at heavily regulated rates, through mutual or publicly owned medical insurers. A few countries such as the Netherlands and Switzerland operate via privately owned but heavily regulated private insurers. Americans use the term single-payer health care to describe the pooling of health care funds into a single not-for-profit fund for a region or nation.
Universal health care is implemented in all industrialized countries, with the exception of the United States. It is also provided in many developing countries.
History
Germany has the world's oldest universal health care system, with origins dating back to Otto von Bismarck's social legislation, which included the Health Insurance Bill of 1883, Accident Insurance Bill of 1884, and Old Age and Disability Insurance Bill of 1889. In Britain, the National Insurance Act 1911 marked the first steps there towards universal health care, covering most employed persons and their financial dependents and all persons who had been continuous contributors to the scheme for at least five years whether they were working or not. This system of health insurance continued in force until the creation of the National Health Service in 1948 which extended health care security to all legal residents. Most current universal health care systems were implemented in the period following the Second World War as a process of deliberate healthcare reform, intended to make health care available to all, in the spirit of Article 25 of the Universal Declaration of Human Rights of 1948, signed by every country doing so. The US did not ratify the social and economic rights sections, including Article 25's right to health.
Implementation and Comparisons
See also: Health care systemUniversal health care is a broad concept that has been implemented in several ways. The common denominator for all such programs is some form of government action aimed at extending access to health care as widely as possible and setting minimum standards. Most implement universal health care through legislation, regulation and taxation. Legislation and regulation direct what care must be provided, to whom, and on what basis. Usually some costs are borne by the patient at the time of consumption but the bulk of costs come from a combination of compulsory insurance and tax revenues. Some programs are paid for entirely out of tax revenues. In others tax revenues are used either to fund insurance for the very poor or for those needing long term chronic care. The UK government's National Audit Office in 2003 published an international comparison of ten different health care systems in ten developed countries, nine universal systems against one non-universal system (the U.S.), and their relative costs and key health outcomes. A wider international comparison of 16 countries, each with universal health care, was published by the World Health Organization in 2004 In some cases, government involvement also includes directly managing the health care system, but many countries use mixed public-private systems to deliver universal health care.
Americas
Argentina, Brazil (see below), Canada (see below), Chile, Costa Rica, Cuba, Mexico (see below), Panama, Peru (see below), Uruguay, Trinidad and Tobago and Venezuela all have public universal health care provided.
Brazil
Main article: Health care in BrazilThe universal health care system was adopted in Brazil in 1988 after the end of the military regime's rule.
Canada
Main article: Health care in CanadaIn 1984, the Canada Health Act was passed, which prohibited extra billing by doctors on patients while at the same time billing the public insurance system. In 1999, the prime minister and most premiers reaffirmed in the Social Union Framework Agreement that they are committed to health care that has "comprehensiveness, universality, portability, public administration and accessibility."
The system is for the most part publicly funded, yet most of the services are provided by private enterprises or private corporations, although most hospitals are public. Most doctors do not receive an annual salary, but receive a fee per visit or service. About 29% of Canadians' health care is paid for by the private sector or individuals. This mostly goes towards services not covered or only partially covered by Medicare such as prescription drugs, dentistry and vision care. Many Canadians have private health insurance, often through their employers, that cover these expenses.
The Canada Health Act of 1984 "does not directly bar private delivery or private insurance for publicly insured services," but provides financial disincentives for doing so. "Although there are laws prohibiting or curtailing private health care in some provinces, they can be changed," according to a report in the New England Journal of Medicine. The legality of the ban was considered in a decision of the Supreme Court of Canada which ruled in Chaoulli v. Quebec that "the prohibition on obtaining private health insurance, while it might be constitutional in circumstances where health care services are reasonable as to both quality and timeliness, is not constitutional where the public system fails to deliver reasonable services." The appellant contended that waiting times in Quebec violated a right to life and security in the Quebec Charter of Human Rights and Freedoms. The Court agreed, but acknowledged the importance and validity of the Canada Health Act, and at least four of the seven judges explicitly recognized the right of governments to enact laws and policies which favour the public over the private system and preserve the integrity of the public system.
Colombia
Main article: Health in ColombiaIn 1993 a reform transformed the health care system in Colombia, trying to provide a better, sustainable, health care system and to reach every Colombian citizen.
Mexico
Further information: Health care in MexicoOn December 1, 2006 the Mexican government created the Health Insurance for a New Generation also known as "life insurance for babies".
On May 28, 2009 Mexico announced Universal Care Coverage for Pregnant Women.
Peru
On April 9, 2009 the Government of Peru published the Law on Health Insurance to enable all Peruvians to access quality health services, and contribute to regulate the financing and supervision of these services. The law enables all population to access diverse health services to prevent illnesses, and promote and rehabilitate people, under a Health Basic Plan (PEAS).
Trinidad and Tobago
Main article: Health care in Trinidad and TobagoThe universal health care system is used in Trinidad and Tobago and is the primary form of health-care available in the country. It is used by the majority of the population seeking medical assistance, as it is free for all citizens.
United States
See also: Health care reform in the United States and Health care in the United StatesThe United States is the only industrialized nation that does not have a universal health care system. Federal law was changed in 1986 with the Emergency Medical Treatment and Active Labor Act requiring certain hospitals to provide stabilizing treatment for patients with emergency medical conditions including childbirth without first demanding evidence of ability to pay. According to the Institute of Medicine of the National Academies of Science, this unfunded “safety net” mandate has contributed to increasing strain on the health system. Emergency treatment is not free or subsidized and some patients cannot or will not pay their bills. Furthermore, this system encourages use of the emergency facilities for primary care and not just for emergency purposes.
In lieu of a national program, some states and municipalities have made attempts to approach universality of insurance in their respective jurisdictions. The state of Massachusetts implemented a near-universal health care system by mandating that residents purchase health insurance by July 1, 2007. The City of San Francisco is also undertaking a universal health care system for uninsured residents. Hawaii has, since 1974, required employers to provide employees working more than 20 hours per week with a comprehensive health insurance plan. California, Maine and Vermont are also
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