Universal Healthcare - How others do it

Giving citizens access to healthcare without enduring financial hardship is known as "universal healthcare".

Financial Mail, 26 February 2016

Around the world there is growing recognition that health and economic development are inextricably linked. In 2012, the UN called on countries to aim for universal healthcare coverage, and included it in its Sustainable Development Goals. Here are some examples of approaches to universal healthcare.

Britain's National Health Service (NHS) was launched (by its first Labour Party government) in 1948 as a universal, free health service. For years it was regarded as one of the best public health systems in the world, but it is under strain and about 10 percent of the population now pay for private health insurance. The NHS is 98.8 percent funded by general taxation and National Insurance contributions, the balance from patient charges.

The UK spent 8.5 percent of GDP on healthcare in 2013, 83 percent of which was public health expenditure. It is a single payer system. In Brazil, the idea of collective responsibility for providing healthcare is enshrined in the constitution. In 1998 it established the Sistema Único de Saude (unified health system, or SUS) which provides free public healthcare.

SUS is overstretched and so about 25 percent of the population opt for private healthcare which they pay for with private medical insurance or out-of-pocket. SUS is funded by a variety of taxes at federal, state and municipal level, as well as contributions from employers and employees. Brazil spent 9.3 percent of GDP on health in 2013, 48.2 percent of which was government-funded.

In the US, President Barack Obama's 2010 "Affordable Health Act" introduced laws to provide health insurance to the estimated 15 percent of the population who didn't have it. "Obamacare" requires all Americans to have health insurance and established insurance exchanges that offer a choice of regulated health plans. These plans are subsidised with state and federal taxes. Government also runs Medicaid for low-income citizens, and Medicare for people over 65.

The US spent 16.4 percent of GDP on health in 2013, of which 48.2 percent was funded by the government. In the Netherlands everyone is obliged to take out health insurance. Health insurers are heavily regulated so everyone pays the same rate for the government-determined standard benefits package; no-one can be turned away because they are old or ill, and premiums cannot be risk-rated - the same principles that underpin the laws governing medical schemes in SA.

People can opt to take out additional insurance - for example, for physiotherapy or optical care, but this cover is not as tightly regulated. This is known as a multiple payer system. The country spends 11.1 percent of GDP on health, 87.7 percent of it funded by government. In Japan, the employed are required to take out public health insurance, typically paid by the employer.

They pay 20 percent of their medical costs at the point of delivery. The self-employed are required to join the national health insurance scheme, with premiums based on economic status. These patients typically face co-payments of 30 percent of their medical costs. Fees are waived for the poor and unemployed, and are covered by the state if they rise above a specific threshold. Japan spent 10.2 percent of GDP on health in 2013, 83 percent of which was state-funded.