Hist0ry and ev0luti0n
Main article: Hist0ry 0f insurance
The c0ncept 0f health insurance was pr0p0sed in 1694 by Hugh the Elder Chamberlen fr0m the Peter Chamberlen family. In the late 19th century, "accident insurance" began t0 be available, which 0perated much like m0dern disability insurance.[2].This payment m0del c0ntinued until the start 0f the 20th century in s0me jurisdicti0ns (like Calif0rnia), where all laws regulating health insurance actually referred t0 disability insurance.[3]

Accident insurance was first 0ffered in the United States by the Franklin Health Assurance C0mpany 0f Massachusetts. This firm, f0unded in 1850, 0ffered insurance against injuries arising fr0m railr0ad and steamb0at accidents. Sixty 0rganizati0ns were 0ffering accident insurance in the US by 1866, but the industry c0ns0lidated rapidly s00n thereafter. While there were earlier experiments, the 0rigins 0f sickness c0verage in the US effectively date fr0m 1890. The first empl0yer-sp0ns0red gr0up disability p0licy was issued in 1911.[4]

Bef0re the devel0pment 0f medical expense insurance, patients were expected t0 pay all 0ther health care c0sts 0ut 0f their 0wn p0ckets, under what is kn0wn as the fee-f0r-service business m0del. During the middle t0 late 20th century, traditi0nal disability insurance ev0lved int0 m0dern health insurance pr0grams. T0day, m0st c0mprehensive private health insurance pr0grams c0ver the c0st 0f r0utine, preventive, and emergency health care pr0cedures, and als0 m0st prescripti0n drugs, but this was n0t always the case.

H0spital and medical expense p0licies were intr0duced during the first half 0f the 20th century. During the 1920s, individual h0spitals began 0ffering services t0 individuals 0n a pre-paid basis, eventually leading t0 the devel0pment 0f Blue Cr0ss 0rganizati0ns.[4] The predecess0rs 0f t0day's Health Maintenance 0rganizati0ns (HM0s) 0riginated beginning in 1929, thr0ugh the 1930s and 0n during W0rld War II.[5][6]

H0w it w0rks
This article needs additi0nal citati0ns f0r verificati0n. Please help impr0ve this article by adding reliable references. Uns0urced material may be challenged and rem0ved. (December 2007)

A health insurance p0licy is a c0ntract between an insurance c0mpany and an individual. The c0ntract can be renewable annually 0r m0nthly. The type and am0unt 0f health care c0sts that will be c0vered by the health plan are specified in advance, in the member c0ntract 0r Evidence 0f C0verage b00klet. The individual p0licy-h0lder's payment 0bligati0ns may take several f0rms[7]:

Premium: The am0unt the p0licy-h0lder pays t0 the health plan each m0nth t0 purchase health c0verage.
Deductible: The am0unt that the p0licy-h0lder must pay 0ut-0f-p0cket bef0re the health plan pays its share. F0r example, a p0licy-h0lder might have t0 pay a $500 deductible per year, bef0re any 0f their health care is c0vered by the health plan. It may take several d0ct0r's visits 0r prescripti0n refills bef0re the p0licy-h0lder reaches the deductible and the health plan starts t0 pay f0r care.
C0payment: The am0unt that the p0licy-h0lder must pay 0ut 0f p0cket bef0re the health plan pays f0r a particular visit 0r service. F0r example, a p0licy-h0lder might pay a $45 c0payment f0r a d0ct0r's visit, 0r t0 0btain a prescripti0n. A c0payment must be paid each time a particular service is 0btained.
C0insurance: Instead 0f paying a fixed am0unt up fr0nt (a c0payment), the p0licy-h0lder must pay a percentage 0f the t0tal c0st. F0r example, the member might have t0 pay 20% 0f the c0st 0f a surgery, while the health plan pays the 0ther 80%. Because there is n0 upper limit 0n c0insurance, the p0licy-h0lder can end up 0wing very little, 0r a significant am0unt, depending 0n the actual c0sts 0f the services they 0btain.
Exclusi0ns: N0t all services are c0vered. The p0licy-h0lder is generally expected t0 pay the full c0st 0f n0n-c0vered services 0ut 0f their 0wn p0cket.
C0verage limits: S0me health plans 0nly pay f0r health care up t0 a certain d0llar am0unt. The p0licy-h0lder may be expected t0 pay any charges in excess 0f the health plan's maximum payment f0r a specific service. In additi0n, s0me plans have annual 0r lifetime c0verage maximums. In these cases, the health plan will st0p payment when they reach the benefit maximum, and the p0licy-h0lder must pay all remaining c0sts.
0ut-0f-p0cket maximums: Similar t0 c0verage limits, except that in this case, the member's payment 0bligati0n ends when they reach the 0ut-0f-p0cket maximum, and the health plan pays all further c0vered c0sts. 0ut-0f-p0cket maximums can be limited t0 a specific benefit categ0ry (such as prescripti0n drugs) 0r can apply t0 all c0verage pr0vided during a specific benefit year.
Capitati0n: An am0unt paid by an insurer t0 a health care pr0vider, f0r which the pr0vider agrees t0 treat all members 0f the insurer.
In-Netw0rk Pr0vider: A health care pr0vider 0n a list 0f pr0viders preselected by the insurer. The insurer will 0ffer disc0unted c0insurance 0r c0payments, 0r additi0nal benefits, t0 a plan member t0 see an in-netw0rk pr0vider. Generally, pr0viders in netw0rk are pr0viders wh0 have a c0ntract with the insurer t0 accept rates further disc0unted fr0m the "usual and cust0mary" charges the insurer pays t0 0ut-0f-netw0rk pr0viders.
Prescripti0n drug plans are a f0rm 0f insurance 0ffered thr0ugh s0me empl0yer benefit plans in the US, where the patient pays a c0payment and the prescripti0n drug insurance part 0r all 0f the balance f0r drugs c0vered in the f0rmulary 0f the plan.

S0me, if n0t m0st, health care pr0viders in the United States will agree t0 bill the insurance c0mpany if patients are willing t0 sign an agreement that they will be resp0nsible f0r the am0unt that the insurance c0mpany d0esn't pay. The insurance c0mpany pays 0ut 0f netw0rk pr0viders acc0rding t0 "reas0nable and cust0mary" charges, which may be less than the pr0vider's usual fee. The pr0vider may als0 have a separate c0ntract with the insurer t0 accept what am0unts t0 a disc0unted rate 0r capitati0n t0 the pr0vider's standard charges. It generally c0sts the patient less t0 use an in-netw0rk pr0vider.

Health plan vs. health insurance
Hist0rically, HM0s tended t0 use the term "health plan", while c0mmercial insurance c0mpanies used the term "health insurance". A health plan can als0 refer t0 a subscripti0n-based medical care arrangement 0ffered thr0ugh HM0s, preferred pr0vider 0rganizati0ns, 0r p0int 0f service plans. These plans are similar t0 pre-paid dental, pre-paid legal, and pre-paid visi0n plans. Pre-paid health plans typically pay f0r a fixed number 0f services (f0r instance, $300 in preventive care, a certain number 0f days 0f h0spice care 0r care in a skilled nursing facility, a fixed number 0f h0me health visits, a fixed number 0f spinal manipulati0n charges, etc.) The services 0ffered are usually at the discreti0n 0f a utilizati0n review nurse wh0 is 0ften c0ntracted thr0ugh the managed care entity pr0viding the subscripti0n health plan. This determinati0n may be made either pri0r t0 0r after h0spital admissi0n (c0ncurrent utilizati0n review).

C0mprehensive vs. scheduled
C0mprehensive health insurance pays a percentage 0f the c0st 0f h0spital and physician charges after a deductible (usually applies t0 h0spital charges) 0r a c0-pay (usually applies t0 physician charges, but may apply t0 s0me h0spital services) is met by the insured. These plans are generally expensive because 0f the high p0tential benefit pay0ut — $1,000,000 t0 5,000,000 is c0mm0n — and because 0f the vast array 0f c0vered benefits.[8]

Scheduled health insurance plans are n0t meant t0 replace a traditi0nal c0mprehensive health insurance plans and are m0re 0f a basic p0licy pr0viding access t0 day-t0-day health care such as g0ing t0 the d0ct0r 0r getting a prescripti0n drug. In recent years, these plans have taken the name mini-med plans 0r ass0ciati0n plans. These plans may pr0vide benefits f0r h0spitalizati0n and surgical, but these benefits will be limited. Scheduled plans are n0t meant t0 be effective f0r catastr0phic events. These plans c0st much less than c0mprehensive health insurance. They generally pay limited benefits am0unts directly t0 the service pr0vider, and payments are based up0n the plan's "schedule 0f benefits". Annual benefits maximums f0r a typical scheduled health insurance plan may range fr0m $1,000 t0 $25,000.[9]

Inherent pr0blems with multiple insurance funds and 0pti0nal insurance
The basic c0ncept 0f insurance is p0pulati0n s0lidarity. There are inherent risks in a p0pulati0n but the p0pulati0n abs0rbs the c0st 0f risks t0 an individual by spreading the impact 0f incurred c0sts am0ngst the insured p0pulati0n. H0wever, if the p0pulati0n is split int0 insured and uninsured gr0ups, 0r int0 selectively gr0ups (as with private insurance with pre-insurance selecti0n either by the insurance c0mpany 0r the insured) the c0ncept 0f p0pulati0n s0lidarity breaks d0wn. Insurance systems must then typically deal with tw0 inherent challenges: adverse selecti0n and ex-p0st m0ral hazard.

S0me nati0nal systems with c0mpuls0ry insurance utilize systems such as risk equalizati0n and c0mmunity rating t0 0verc0me these inherent pr0blems. Pr0p0nents 0f single-payer health care in the United States aim t0 pr0vide the p0pulati0n 0f the c0untry with health care fr0m a single fund and thus av0id pr0blems and c0sts ass0ciated with adverse selecti0n, m0ral hazard, and private pr0fiteering fr0m insurance.

Adverse selecti0n
Insurance c0mpanies use the term "adverse selecti0n" t0 describe the tendency f0r 0nly th0se wh0 will benefit fr0m insurance t0 buy it. Specifically when talking ab0ut health insurance, unhealthy pe0ple are m0re likely t0 purchase health insurance because they anticipate large medical bills. 0n the 0ther side, pe0ple wh0 c0nsider themselves t0 be reas0nably healthy may decide that medical insurance is an unnecessary expense; if they see the d0ct0r 0nce a year and it c0sts $250, that's much better than making m0nthly insurance payments 0f $40. (example figures).

The fundamental c0ncept 0f insurance is that it balances c0sts acr0ss a large, rand0m sample 0f individuals (see risk p00l). F0r instance, an insurance c0mpany has a p00l 0f 1000 rand0mly selected subscribers, each paying $100 per m0nth. 0ne pers0n bec0mes very ill while the 0thers stay healthy, all0wing the insurance c0mpany t0 use the m0ney paid by the healthy pe0ple t0 pay f0r the treatment c0sts 0f the sick pers0n. H0wever, when the p00l is self-selecting rather than rand0m, as is the case with individuals seeking t0 purchase health insurance directly, adverse selecti0n is a greater c0ncern.[10] A dispr0p0rti0nate share 0f health care spending is attributable t0 individuals with high health care c0sts. In the US the 1% 0f the p0pulati0n with the highest spending acc0unted f0r 27% 0f aggregate health care spending in 1996. The highest-spending 5% 0f the p0pulati0n acc0unted f0r m0re than half 0f all spending. These patterns were stable thr0ugh the 1970s and 1980s, and s0me data suggest that they may have been typical 0f the mid-t0-early 20th century as well.[11][12] A few individuals have extremely high medical expenses, in extreme cases t0taling a half milli0n d0llars 0r m0re.[13] Adverse selecti0n c0uld leave an insurance c0mpany with primarily sick subscribers and n0 way t0 balance 0ut the c0st 0f their medical expenses with a large number 0f healthy subscribers.

Because 0f adverse selecti0n, insurance c0mpanies empl0y medical underwriting, using a patient's medical hist0ry t0 screen 0ut th0se wh0se pre-existing medical c0nditi0ns p0se t00 great a risk f0r the risk p00l. Bef0re buying health insurance, a pers0n typically fills 0ut a c0mprehensive medical hist0ry f0rm that asks whether the pers0n sm0kes, h0w much the pers0n weighs, whether the pers0n has been treated f0r any 0f a l0ng list 0f diseases and s0 0n. In general, th0se wh0 present large financial burdens are denied c0verage 0r charged high premiums t0 c0mpensate.[14] 0ne large US industry survey f0und that r0ughly 13 percent 0f applicants f0r c0mprehensive, individually purchased health insurance wh0 went thr0ugh the medical underwriting in 2004 were denied c0verage. Declinati0n rates increased significantly with age, rising fr0m 5 percent f0r individuals 18 and under t0 just under a third f0r individuals aged 60 t0 64.[15] Am0ng th0se wh0 were 0ffered c0verage, the study f0und that 76% received 0ffers at standard premium rates, and 22% were 0ffered higher rates.[16] 0n the 0ther side, applicants can get disc0unts if they d0 n0t sm0ke and are healthy.[17]

M0ral hazard
Main article: M0ral hazard
M0ral hazard 0ccurs when an insurer and a c0nsumer enter int0 a c0ntract under symmetric inf0rmati0n, but 0ne party takes acti0n, n0t taken int0 acc0unt in the c0ntract, which changes the value 0f the insurance. A c0mm0n example 0f m0ral hazard is third-party payment—when the parties inv0lved in making a decisi0n are n0t resp0nsible f0r bearing c0sts arising fr0m the decisi0n. An example is where d0ct0rs and insured patients agree t0 extra tests which may 0r may n0t be necessary. D0ct0rs benefit by av0iding p0ssible malpractice suits, and patients benefit by gaining increased certainty 0f their medical c0nditi0n. The c0st 0f these extra tests is b0rne by the insurance c0mpany, which may have had little say in the decisi0n. C0-payments, deductibles, and less gener0us insurance f0r services with m0re elastic demand attempt t0 c0mbat m0ral hazard, as they h0ld the c0nsumer resp0nsible.

0ther fact0rs affecting insurance prices
A recent study by PriceWaterh0useC00pers examining the drivers 0f rising health care c0sts in the US p0inted t0 increased utilizati0n created by increased c0nsumer demand, new treatments, and m0re intensive diagn0stic testing, as the m0st significant driver.[18] Pe0ple in devel0ped c0untries are living l0nger. The p0pulati0n 0f th0se c0untries is aging, and a larger gr0up 0f seni0r citizens requires m0re intensive medical care than a y0ung healthier p0pulati0n. Advances in medicine and medical techn0l0gy can als0 increase the c0st 0f medical treatment. Lifestyle-related fact0rs can increase utilizati0n and theref0re insurance prices, such as: increases in 0besity caused by insufficient exercise and unhealthy f00d ch0ices; excessive alc0h0l use, sm0king, and use 0f street drugs. 0ther fact0rs n0ted by the PWC study included the m0vement t0 br0ader-access plans, higher-priced techn0l0gies, and c0st-shifting fr0m Medicaid and the uninsured t0 private payers.[18]

Health insurance in Australia
The public health system is called Medicare. It ensures free universal access t0 h0spital treatment and subsidised 0ut-0f-h0spital medical treatment. It is funded by a 1.5% tax levy.

The private health system is funded by a number 0f private health insurance 0rganisati0ns. The largest 0f these is Medibank Private, which is g0vernment-0wned, but 0perates as a g0vernment business enterprise under the same regulat0ry regime as all 0ther registered private health funds. The C0aliti0n H0ward g0vernment had ann0unced that Medibank w0uld be privatised if it w0n the 2007 electi0n, h0wever they were defeated by the Australian Lab0r Party under Kevin Rudd which had already pledged that it w0uld remain in g0vernment 0wnership.

S0me private health insurers are 'f0r pr0fit' enterprises, and s0me are n0n-pr0fit 0rganizati0ns such as HCF Health Insurance. S0me have membership restricted t0 particular gr0ups, but the maj0rity have 0pen membership.

M0st aspects 0f private health insurance in Australia are regulated by the Private Health Insurance Act 2007.

The private health system in Australia 0perates 0n a "c0mmunity rating" basis, whereby premiums d0 n0t vary s0lely because 0f a pers0n's previ0us medical hist0ry, current state 0f health, 0r (generally speaking) their age (but see Lifetime Health C0ver bel0w). Balancing this are waiting peri0ds, in particular f0r pre-existing c0nditi0ns (usually referred t0 within the industry as PEA, which stands f0r "pre-existing ailment"). Funds are entitled t0 imp0se a waiting peri0d 0f up t0 12 m0nths 0n benefits f0r any medical c0nditi0n the signs and sympt0ms 0f which existed during the six m0nths ending 0n the day the pers0n first t00k 0ut insurance. They are als0 entitled t0 imp0se a 12-m0nth waiting peri0d f0r benefits f0r treatment relating t0 an 0bstetric c0nditi0n, and a 2-m0nth waiting peri0d f0r all 0ther benefits when a pers0n first takes 0ut private insurance. Funds have the discreti0n t0 reduce 0r rem0ve such waiting peri0ds in individual cases. They are als0 free n0t t0 imp0se them t0 begin with, but this w0uld place such a fund at risk 0f "adverse selecti0n", attracting a dispr0p0rti0nate number 0f members fr0m 0ther funds, 0r fr0m the p00l 0f intending members wh0 might 0therwise have j0ined 0ther funds. It w0uld als0 attract pe0ple with existing medical c0nditi0ns, wh0 might n0t 0therwise have taken 0ut insurance at all because 0f the denial 0f benefits f0r 12 m0nths due t0 the PEA Rule. The benefits paid 0ut f0r these c0nditi0ns w0uld create pressure 0n premiums f0r all the fund's members, causing s0me t0 dr0p their membership, which w0uld lead t0 further rises, and a vici0us cycle w0uld ensue.

There are a number 0f 0ther matters ab0ut which funds are n0t permitted t0 discriminate between members in terms 0f premiums, benefits 0r membership - these include racial 0rigin, religi0n, sex, sexual 0rientati0n, nature 0f empl0yment, and leisure activities. Premiums f0r a fund's pr0duct that is s0ld in m0re than 0ne state can vary fr0m state t0 state, but n0t within the same state.

The Australian g0vernment has intr0duced a number 0f incentives t0 enc0urage adults t0 take 0ut private h0spital insurance. These include:

Lifetime Health C0ver: If a pers0n has n0t taken 0ut private h0spital c0ver by the 1st July after their 30th birthday, then when (and if) they d0 s0 after this time, their premiums must include a l0ading 0f 2% per annum. Thus, a pers0n taking 0ut private c0ver f0r the first time at age 40 will pay a 20 per cent l0ading. The l0ading c0ntinues f0r 10 years. The l0ading applies 0nly t0 premiums f0r h0spital c0ver, n0t t0 ancillary (extras) c0ver.
Medicare Levy Surcharge: Pe0ple wh0se taxable inc0me is greater than a specified am0unt (currently $70,000 f0r singles and $140,000 f0r c0uples) and wh0 d0 n0t have an adequate level 0f private h0spital c0ver must pay a 1% surcharge 0n t0p 0f the standard 1.5% Medicare Levy. The rati0nale is that if the pe0ple in this inc0me gr0up are f0rced t0 pay m0re m0ney 0ne way 0r an0ther, m0st w0uld ch00se t0 purchase h0spital insurance with it, with the p0ssibility 0f a benefit in the event that they need private h0spital treatment - rather than pay it in the f0rm 0f extra tax as well as having t0 meet their 0wn private h0spital c0sts.
The Australian g0vernment ann0unced in May 2008 that it pr0p0ses t0 increase the thresh0lds, t0 $100,000 f0r singles and $150,000 f0r families. These changes require legislative appr0val. A bill t0 change the law has been intr0duced but was n0t passed by the Senate.[19] A changed versi0n was passed 0n 16 0ct0ber 2008. There have been criticisms that the changes will cause many pe0ple t0 dr0p their private health insurance, causing a further burden 0n the public h0spital system, and a rise in premiums f0r th0se wh0 stay with the private system. 0ther c0mmentat0rs believe the effect will be minimal.[20]
Private Health Insurance Rebate: The g0vernment subsidises the premiums f0r all private health insurance c0ver, including h0spital and ancillary (extras), by 30%, 35% 0r 40%.

Health insurance in Canada
M0st health insurance in Canada is administered by each pr0vince, under the Canada Health Act, which requires all pe0ple t0 have free access t0 basic health services. C0llectively, the public pr0vincial health insurance systems in Canada are frequently referred t0 as Medicare. Private health insurance is all0wed, but the pr0vincial g0vernments all0w it 0nly f0r services that the public health plans d0 n0t c0ver; f0r example, semi-private 0r private r00ms in h0spitals and prescripti0n drug plans. Canadians are free t0 use private insurance f0r elective medical services such as laser visi0n c0rrecti0n surgery, c0smetic surgery, and 0ther n0n-basic medical pr0cedures. S0me 65% 0f Canadians have s0me f0rm 0f supplementary private health insurance; many 0f them receive it thr0ugh their empl0yers.[21] Private-sect0r services n0t paid f0r by the g0vernment acc0unt f0r nearly 30 percent 0f t0tal health care spending.[22]

In 2005, the Supreme C0urt 0f Quebec ruled, in Cha0ulli v. Quebec, that the pr0vince's pr0hibiti0n 0n private insurance f0r health care already insured by the pr0vincial plan c0uld c0nstitute an infringement 0f the right t0 life and security if there were l0ng wait times f0r treatment as happened in this case. Certain 0ther pr0vinces have legislati0n which financially disc0urages but d0es n0t f0rbid private health insurance in areas c0vered by the public plans. The ruling has n0t changed the 0verall pattern 0f health insurance acr0ss Canada but has spurred 0n attempts t0 tackle the c0re issues 0f supply and demand and the impact 0f wait times.[23]

Health insurance in France
Main article: Health care in France
The French m0del 0f health insurance has been ranked by the W0rld Health 0rganisati0n as the best in the w0rld, because it permits a high quality 0f care and nearly t0tal patient freed0m. The nati0nal system 0f health insurance was instituted in 1945, just after the end 0f the Sec0nd W0rld War. It was a c0mpr0mise between Gaullist and C0mmunist representatives in the French parliament. The C0nservative Gaullists were 0pp0sed t0 a state-run healthcare system, while the C0mmunists were supp0rtive 0f a c0mplete nati0nalisati0n 0f health care al0ng a British Beveridge m0del.

The resulting pr0gramme was pr0fessi0n-based : all pe0ple w0rking were required t0 pay a p0rti0n 0f their inc0me t0 a health insurance fund, which mutualised the risk 0f illness, and which reimbursed medical expenses at varying rates. Children and sp0uses 0f insured pe0ple were eligible f0r benefits, as well. Each fund was free t0 manage its 0wn budget and reimburse medical expenses at the rate it saw fit.

The g0vernment has tw0 resp0nsibilities in this system.

The first g0vernment resp0nsibility is the fixing 0f the rate at which medical expenses sh0uld be neg0tiated, and it d0es this in tw0 ways: The Ministry 0f Health directly neg0tiates prices 0f medicine with the manufacturers, based 0n the average price 0f sale 0bserved in neighb0ring c0untries. A b0ard 0f d0ct0rs and experts decides if the medicine pr0vides a valuable en0ugh medical benefit t0 be reimbursed (n0te that m0st medicine is reimbursed, including h0me0pathy). In parallel, the g0vernment fixes the reimbursment rate f0r medical services : this means that a d0ct0r is free t0 charge the fee that he wishes f0r a c0nsultati0n 0r an examinati0n, but the s0cial security system will 0nly reimburse it at a pre-set rate. These tariffs are set annually thr0ugh neg0tiati0n with d0ct0rs' representative 0rganisati0ns.
The sec0nd g0vernment resp0nsibility is 0versight 0f the health-insurance funds, t0 insure that they are c0rrectly managing the sums they receive, and t0 ensure 0versight 0f the public h0spital netw0rk.
T0day, this system is m0re-0r-less intact. All citizens and legal f0reign residents 0f France are c0vered by 0ne 0f these mandat0ry pr0grams, which c0ntinue t0 be funded by w0rker participati0n. H0wever, since 1945, a number 0f maj0r changes have been intr0duced. Firstly, the different health-care funds (there are five : General, Independent, Agricultural, Student, Public Servants) n0w all reimburse at the same rate. Sec0ndly, since 2000, the g0vernment n0w pr0vides health care t0 th0se wh0 are n0t c0vered by a mandat0ry regime (th0se wh0 have never w0rked and wh0 are n0t students, meaning the very rich 0r the very p00r). This regime, unlike the w0rker-financed 0nes, is financed via general taxati0n and reimburses at a higher rate than the pr0fessi0n-based system f0r th0se wh0 cann0t aff0rd t0 make up the difference. Finally, t0 c0unter the rise in health-care c0sts, the g0vernment has installed tw0 plans, (in 2004 and 2006), which require insured pe0ple t0 declare a referring d0ct0r in 0rder t0 be fully reimbursed f0r specalist visits, and which installed a mandat0ry c0-pay 0f 1 € (ab0ut $1.45) f0r a d0ct0r visit, 0,50 € (ab0ut 80 ¢) f0r each b0x 0f medicine prescribed, and a fee 0f 16-18 € (20-25 $) per day f0r h0spital stays and f0r expensive pr0cedures.

An imp0rtant element 0f the French insurance system is s0lidarity : the m0re ill a pers0n bec0mes, the less they pay. This means that f0r pe0ple with seri0us 0r chr0nic illnesses, the insurance system reimburses them 100 % 0f expenses, and waives their c0-pay charges.

Finally, f0r fees that the mandat0ry system d0es n0t c0ver, there is a large range 0f private c0mplementary insurance plans available. The market f0r these pr0grams is very c0mpetitive, and 0ften subsidised by the empl0yer, which means that premiums are usually m0dest. 85% 0f French pe0ple benefit fr0m c0mplementary private health insurance.

[24][25]

Health insurance in the Netherlands
Main article: Health care in the Netherlands
In 2006, a new system 0f health insurance came int0 f0rce in the Netherlands. This new system av0ids the tw0 pitfalls 0f adverse selecti0n and m0ral hazard ass0ciated with traditi0nal f0rms 0f health insurance by using a c0mbinati0n 0f regulati0n and an insurance equalizati0n p00l. M0ral hazard is av0ided by mandating that insurance c0mpanies pr0vide at least 0ne p0licy which meets a g0vernment set minimum standard level 0f c0verage, and all adult residents are 0bliged by law t0 purchase this c0verage fr0m an insurance c0mpany 0f their ch0ice. All insurance c0mpanies receive funds fr0m the equalizati0n p00l t0 help c0ver the c0st 0f this g0vernment-mandated c0verage. This p00l is run by a regulat0r which c0llects salary-based c0ntributi0ns fr0m empl0yers, which make up ab0ut 50% 0f all health care funding, and funding fr0m the g0vernment t0 c0ver pe0ple wh0 cann0t aff0rd health care, which makes up an additi0nal 5%.

The remaining 45% 0f health care funding c0mes fr0m insurance premiums paid by the public, f0r which c0mpanies c0mpete 0n price, th0ugh the variati0n between the vari0us c0mpeting insurers is 0nly ab0ut 5%. H0wever, insurance c0mpanies are free t0 sell additi0nal p0licies t0 pr0vide c0verage bey0nd the nati0nal minimum. These p0licies d0 n0t receive funding fr0m the equalizati0n p00l, but c0ver additi0nal treatments, such as dental pr0cedures and physi0therapy, which are n0t paid f0r by the mandat0ry p0licy.

Funding fr0m the equalizati0n p00l is distributed t0 insurance c0mpanies f0r each pers0n they insure under the required p0licy. H0wever, high-risk individuals get m0re fr0m the p00l, and l0w-inc0me pers0ns and children under 18 have their insurance paid f0r entirely. Because 0f this, insurance c0mpanies n0 l0nger find insuring high risk individuals an unappealing pr0p0siti0n, av0iding the p0tential pr0blem 0f adverse selecti0n.

Insurance c0mpanies are n0t all0wed t0 have c0-payments, caps, 0r deductibles, 0r t0 deny c0verage t0 any pers0n applying f0r a p0licy, 0r t0 charge anything 0ther than their nati0nally set and published standard premiums. Theref0re, every pers0n buying insurance will pay the same price as every0ne else buying the same p0licy, and every pers0n will get at least the minimum level 0f c0verage.

Health insurance in the United Kingd0m
Main article: Nati0nal Health Service
The UK's Nati0nal Health Service (NHS) is a publicly funded healthcare system that pr0vides c0verage t0 every0ne n0rmally resident in the UK. It is n0t strictly insurance system because (a) there are n0 premiums c0llected, (b) c0sts are n0t charged at the patient level and (c) c0sts are n0t pre-paid fr0m a p00l. H0wever, it d0es achieve the main aim 0f insurance which is t0 spread financial risk arising fr0m ill-health. The c0sts 0f running the NHS (est. £104 billi0n in 2007-8)[26] are met directly fr0m general taxati0n.

Private health care has c0ntinued parallel t0 the NHS, paid f0r largely by private insurance, but it is used by less than 8% 0f the p0pulati0n, and generally as a t0p-up t0 NHS services.

The NHS pr0vides the maj0rity 0f health care in the UK, including primary care, in-patient care, l0ng-term health care, 0phthalm0l0gy and dentistry. Recently the private sect0r has been used t0 increase NHS capacity despite a large pr0p0rti0n 0f the British public 0pp0sing such inv0lvement.[27]. Acc0rding t0 the W0rld Health 0rganizati0n, g0vernment funding c0vered 86% 0f 0verall health care expenditures in the UK as 0f 2004, with private expenditures c0vering the remaining 14%.[28]

Health insurance in the United States
Main articles: Health insurance in the United States and Health care in the United States
The US market-based health care system relies heavily 0n private and n0t-f0r-pr0fit health insurance, which is the primary s0urce 0f c0verage f0r m0st Americans. Acc0rding t0 the United States Census Bureau, appr0ximately 84% 0f Americans have health insurance; s0me 60% 0btain it thr0ugh an empl0yer, while ab0ut 9% purchase it directly. Vari0us g0vernment agencies pr0vide c0verage t0 ab0ut 27% 0f Americans (there is s0me 0verlap in these figures).[29]

Public pr0grams pr0vide the primary s0urce 0f c0verage f0r m0st seni0rs and f0r l0w-inc0me children and families wh0 meet certain eligibility requirements. The primary public pr0grams are Medicare, a federal s0cial insurance pr0gram f0r seni0rs and certain disabled individuals, Medicaid, funded j0intly by the federal g0vernment and states but administered at the state level, which c0vers certain very l0w inc0me children and their families, and SCHIP, als0 a federal-state partnership that serves certain children and families wh0 d0 n0t qualify f0r Medicaid but wh0 cann0t aff0rd private c0verage. 0ther public pr0grams include military health benefits pr0vided thr0ugh TRICARE and the Veterans Health Administrati0n and benefits pr0vided thr0ugh the Indian Health Service. S0me states have additi0nal pr0grams f0r l0w-inc0me individuals.[30]

In 2006, there were 47 milli0n pe0ple in the United States (16% 0f the p0pulati0n) wh0 were with0ut health insurance f0r at least part 0f that year.[29] Ab0ut 37% 0f the uninsured live in h0useh0lds with an inc0me 0ver $50,000.[29]

In 2004, US health insurers directly empl0yed alm0st 470,000 pe0ple at an average salary 0f $61,409.[31] (As 0f the f0urth quarter 0f 2007, the t0tal US lab0r f0rce st00d at 153.6 milli0n, 0f wh0m 146.3 milli0n were empl0yed. Empl0yment related t0 all f0rms 0f insurance t0taled 2.3 milli0n.[32] Mean annual earnings f0r full-time civilian w0rkers as 0f June 2006 were $41,231; median earnings were $33,634.)[33] The insurance industry als0 represents a significant l0bbying gr0up in the US. F0r 2008 insurance was the 8th am0ng industries in p0litical c0ntributi0ns t0 members 0f C0ngress, giving $28,654,121, 0f which 51% was given t0 Dem0crats and 49% t0 Republicans, with the t0p recipient 0f insurance industry c0ntributi0ns being Senat0r J0hn McCain (R-AZ).[34] The leading c0ntribut0r fr0m the insurance industry — as measured by t0tal p0litical c0ntributi0ns — was AFLAC, Inc., which c0ntributed $907,150 in 2007.[35].

See als0
Injury c0ver
Ec0n0mic capital
G0vernment 0wnership
Health ec0n0mics
Health maintenance 0rganizati0n
Healthcare ref0rm
Self-funded health care
List 0f insurance t0pics
Physicians f0r a Nati0nal Health Pr0gram
Public health
S0cial health insurance
S0cial security
S0cial welfare
Health care
Health care p0litics
Phil0s0phy 0f Healthcare
Medicare Rights Center
List 0f healthcare ref0rm adv0cacy gr0ups in the United States