Social health insurance

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Social health insurance (SHI) is a method for financing health care costs through a (governnment-mandated) social insurance program based on the collection of funds contributed by individuals, employers, and sometimes government subsidies.[1] It is one of the five main ways that health care systems are funded.[2]

SHI systems are characterized by the presence of sickness funds which usually receive a proportional contribution of their members' wages. With this insurance contributions these funds pay medical costs of their members, to the extent that the services are included in the, sometimes nationally defined, benefit package. Affiliation to such funds is usually based on professional, geographic, religious/political and/or non-partisan criteria. (Saltman 2004, p.8-9) Usually, there are user fees for several health care services to inhibit usage and to keep social health insurance affordable.[3]

Otto von Bismarck was the first to make social health insurance mandatory on a national scale (in Germany), but social health insurance was already common for many centuries before among guilds mainly in continental Europe. Countries with SHI systems include Austria, Belgium, Germany, France, and Luxembourg. Generally, their per capita health expenditures is higher than in tax-based systems. Such predominantly tax-based systems tend to be called "National Health Systems" (or, "Beveridge systems", named after William Beveridge, who was in charge of writing the Beveridge report). Some see this label as inappropriate as the health care systems have been largely decentralized beyond the national level in these countries. [4] , Chapter 2

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[edit] Specific references

  1. ^ Eldis.com. "Social Health Insurance." Retrieved August 18, 2006.
  2. ^ World Health Organization. "Regional Overview of Social Health Insurance in South-East Asia:Overview of Health Care Financing. Retrieved August 18, 2006.
  3. ^ Individual incentive schemes in SHI. "Individual incentive schemes in SHI"
  4. ^ SHI in western Europe. "SHI in western Europe"

[edit] General references

  • Saltman, R.B., Busse, R. and Figueras, J. (2004) Social health insurance systems in western Europe. Berkshire/New York: Open University Press/McGraw-Hill. ISBN 0-335-21363-4
  • Saltman, R.B. and Dubois, H.F.W. (2004) Individual incentive schemes in social health insurance systems, 10(2): 21-25. Full text
  • Van de Ven, W.P.M.M., Beck, K., Buchner, F. et al. (2003) Risk adjustment and risk selection on the sickness fund market in five European countries, Health Policy, 65(1=: 75-98.
  • Veraghtert, K.F.E. and Widdershoven, B.E.M. (2002) Twee eeuwen solidariteit: De Nederlandse, Belgische en Duitse ziekenfondsen tijdens de negentiende en twintigste eeuw. Amsterdam: Aksant. ISBN 90-5260-014-7
  • Saltman, R.B. and Dubois, H.F.W. (2005) Current reform proposals in social health insurance countries, Eurohealth, 11(1): 10-14. Full text


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