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Publicly-funded health care is a form of health care financing designed to meet the cost of all or most health care needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population contributing to the fund or receiving benefits from it. The fund may be a not-for-profit trust which pays out for health care according to common rules established by the members or by some other democratic form. In some countries the fund is controlled directly by the government or by an agency of the government for the benefit of the entire population. This distinguishes it from other forms of private medical insurance, the rights of access to which are subject to contractual obligations between an insurer (or his sponsor) and an insurance company which seeks to make a profit by managing the flow of funds between funders and providers of health care services.


Publicly funded health care systems are usually financed in one of two ways: through taxation or via required national health insurance.

When taxation is the primary means of financing health care, everyone receives the same level of coverage regardless of their ability to pay, their level of taxation, or risk factors..

In compulsory insurance models, healthcare is financed through a "sickness fund", which can receive income from a number of places such as employees' salary deductions, employers' contributions, or top-ups from the state.

Varieties of public systems

Most developed countries currently have partially or fully publicly funded health systems. For example, each country of the United Kingdom has a National Health Service (NHS). Other examples would be the Medicare systems in Canada and in Australia. In most countries of Europe, a system of social insurance based on the principle of social solidarity shields the citizen from bearing the burden of most health care expenditures at the time of consumption. The citizen contributes to these costs in taxation during his or her lifetime.

Among countries with significant public funding of health care there are many different approaches exist to the funding and provision of medical services. Systems may be funded from general government revenues (as in the United Kingdommarker and Canadamarker), or through a government social security system (as in Francemarker, Belgiummarker, Japanmarker, and Germanymarker) with a separate budget and hypothecated taxes. The proportion of the cost of care covered also differs: in Canada, all hospital care is paid for by the government, while in Japan patients must pay 10 to 30% of the cost of a hospital stay. Services provided by public systems vary. For example, the Belgian government pays the bulk of the fees for dental and eye care, while the Australian government covers eye care, but not dental.

Publicly funded medicine may be administered and provided by the government, as in the United Kingdom; in some systems, though, medicine is publicly funded but most health providers are private entities, as in Canada. The organization providing public health insurance is not necessarily a public administration, and its budget may be isolated from the main state budget. Some systems do not provide universal healthcare, or restrict coverage to public health facilities. Some countries, such as Germany, have multiple public insurance organizations linked by a common legal framework. Some, like Holland, allow private for-profit insurers to participate.

Innovations in health care can be very expensive. Population aging generally implies more health care, at a time when the taxed working population decreases.

Two-tier health care

Almost every major country that has a publicly funded health care system also has a parallel private system, generally catering to private insurance holders. While one goal of public systems is to provide equal service to all, this egalitarianism is often partial. Every nation either has parallel private providers or its citizens are free to travel to a nation that does, so there is effectively a two-tier healthcare system that reduces the equality of service.

From the inception of the NHS model (1948), public hospitals in the United Kingdom have included "amenity beds" which would typically be siderooms fitted more comfortably, and private wards in some hospitals where for a fee more amenities are provided. Patients using these beds are in an NHS hospital for surgical treatment, and operations are generally carried out in the same operating theatres as NHS work and by the same personnel but the hospital and the physician will receive funding from an insurance company. These amenity beds do not exist in all publicly funded systems, such as in Spain. From time to time, the NHS pays for private hospitals (arranged hospitals) to take on surgical cases under contract.

Policy discussion

Many countries are seeking the right balance of public and private insurance, public subsidies, and out-of-pocket payments.

Many OECD countries have implemented reforms to achieve policy goals of ensuring access to health-care, improving the quality of health care and health outcomes, allocating anappropriate level of public sector other resources to health care, whilst at the same time ensuring that services are provided in a cost-efficient and cost-effective manner (microeconomicefficiency). A range of measures, such as better payment methods, have improved the microeconomic incentives facing providers. However, introducing improved incentives through a more competitive environment among providers and insurers has proved difficult.

There are deaths from insufficient coverage, of both people and procedures, by private health insurance in the US. A 2009 Harvard study published in the American Journal of Public Health found more than 44,800 excess deaths annually in the United States due to Americans lacking health insurance, equivalent to one excess death every 12 minutes. More broadly, the total number of people in the United States, whether insured or uninsured, who die because of lack of medical care were estimated in a 1997 analysis to be nearly 100,000 per year.

See also


  1. Claude Blanchette, Erin Tolley. "PUBLIC- AND PRIVATE-SECTOR INVOLVEMENT IN HEALTH-CARE SYSTEMS: A COMPARISON OF OECD COUNTRIES." May 1997. Retrieved September 12, 2006.
  2. Canadian Supreme Court after expert testimony found that all OECD countries (including 4 of the 10 Canadian provinces, but excluding the 6 that did not) allow private insurance to compete
  3. American Journal of Public Health | December 2009, Vol 99, No.12
  4. State-by-state breakout of excess deaths from lack of insurance
  5. A 1997 study carried out by Professors David Himmelstein and Steffie Woolhandler (New England Journal of Medicine 336, no. 11 [1997]) "concluded that almost 100,000 people died in the United States each year because of lack of needed care—three times the number of people who died of AIDs." The Inhuman State of U.S. Health Care, Monthly Review, Vicente Navarro, September 2003. Retrieved 2009-09-10

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