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Index

Published online by Cambridge University Press:  01 October 2020

Edited by
Sarah Thomson ,
Anna Sagan  and
Elias Mossialos
Assisted by
Jonathan North
Sarah Thomson
Affiliation:
WHO Barcelona Office for Health Systems Strengthening
Anna Sagan
Affiliation:
European Observatory on Health Systems and Policies
Elias Mossialos
Affiliation:
London School of Economics and Political Science
Jonathan North
Affiliation:
European Observatory on Health Systems and Policies
Type
Chapter
Information
Private Health Insurance
History, Politics and Performance
 , pp. 552 - 574
Publisher: Cambridge University Press
Print publication year: 2020
Creative Commons
Creative Common License - CCCreative Common License - BYCreative Common License - NCCreative Common License - ND
This content is Open Access and distributed under the terms of the Creative Commons Attribution licence CC-BY-NC-ND 3.0 https://creativecommons.org/cclicenses/

Index

access, 9, 12–13, 18–19, 25, 27–29, 31–32, 35, 208–209, 320
Australia, 47
Brazil, 66, 74–77
Chile, 202
Egypt, 78, 83–84
India, 85, 91–92
Israel, 282, 288, 291
Netherlands, 358, 361, 373–374
South Africa, 386, 397, 402
Switzerland, 463, 468
United States of America (United States), 501see also Canada; France; Ireland; Kenya
Access to Health Insurance Act (WTZ), 353
Act to Promote Competition, 185
actuarial fairness, 9, 498, 515, 517
Actuarial Society of South Africa, 419
acute care, 227–228
Adelaide Hospital Society, 255
administration, 431, 458, 477
administration fees, 58, 436
administrative costs (expenses), 30–31, 71, 130, 213, 330, 355, 367–368, 436, 466, 536see also France; Ireland
adverse retention, 238–239
adverse selection, 53–56, 87, 118, 312, 314, 320, 339
advertising, 52–53, 90, 459
Advisory Committee to Strengthen the Public Health Care System, 290, 295
Advisory Council for Medical Fund Societies, 387
Aetna, 536
affordability, 32, 89, 358
Kenya, 330, 332, 340–341, 346
South Africa, 394, 397, 421, 426, 441
Affordable Care Act (ACA)see Patient Protection and Affordable Care Act (ACA)
Aflac Japan, 310
Africa Air Rescue health Services, 333–334
African National Congress, 391, 406
African National Congress Health Plan, 419
African National Council, 389
age profiles, 53, 437–440, 443, 451
age restrictions, 317, 394
ageing populations, 231, 254, 318
Allende, Salvador, President, 195
Allin, S., 100, 128, 129, 132
Altman, D., 239
ambiguity, 91
ambulatory care, 146, 182, 190, 202, 207
American Association for Labor Legislation, 496
American Economics Association, 473
American Hospital Association, 497
American Medical Association, 509
Anthem, 538
apartheid, 377–378, 387, 397, 399
Arabs, 274, 292
areas, ruralsee rural areas
assets, 340, 431, 500, 544
associations, 189, 351, 356–357, 495
Assura, 476
Assuris, 120
Atlantic Canada Blue Cross, 119
auditory services, 175
Australia, 11, 14, 15–16, 18, 23, 25, 27, 34
before 1974, 46–47
1975–1996, 47–9
1996–2006, 49–51
2007 onwards, 56–60
adverse selection, hospital use, cost to government, 53–56
conclusions, 60–61
current mix, 44–46
effectiveness, 51–53
financing the health system, 42–44
overview, 41–42
Australian Health care Agreements, 45
Australian Prudential Regulatory Authority, 44
autonomy, 389, 450, 463, 530
AVIVA Health, 237
Baldassare, R.M., 69
ballots, 13, 450, 481, 482, 483, 484–485
Bank of Brazil (CASSI), 67
bankruptcy, 420
Barrett, G.F., 53
barriers, 72, 206, 213, 288, 312, 325, 344–345see also access
barriers, financial, 29, 128, 159, 162, 165, 402, 436
basic health insurance scheme, 359
Beck, K., 477
beds, acute care, 313
beds, private (hospital), 229–231, 250, 309, 316, 326, 379, 403
Beihilfe, 181, 188
beneficiaries, 207
Brazil, 68, 71–72
Canada, 104
France, 146, 155, 164–167
India, 88
Taiwan, China, 316, 318
USA, 502, 504, 509, 513see also South Africa
benefit designs, 398see also South Africa
benefits
Canada, 129
Chile, 201–202
Egypt, 84
France, 147
Germany, 189
Ireland, 236
Israel, 284, 292
Netherlands, 351, 353–354, 361
South Africa, 387, 423–425, 428
USA, 498, 510
Berkshire Hathaway, 240
Beveridge Commission, 498
Bhatti, T., 127
bias, 378, 402
biometrics, 88, 337
birth rates, 513
blue-collar workers, 28, 183, 194, 307
Blue Cross (Blues), 13, 109, 115, 496–498, 508–509, 515, 538
Blue Shield Association, 115
Blue Shield (Blues), 13, 496–498, 508–509
brain drain, 291
Brazil, 11, 16, 27, 32, 34, 65–67
assessment of market impact on health system goals, 74–77
conclusions, 92–94
market origins, 67
market overview and development, 68–72
public policy towards private health insurance, 72–74
Brazilian Unified Health System (SUS), 66–67, 72
Brick, A., 226
Britain, 496, 498
British North America Act, 101
British United Provident Association (BUPA) Group, 50, 57, 59
brokers, 393–395, 397, 404, 418, 423, 438
Browne Commission, 386, 419
Budget Division (Ministry of Finance, Israel), 293
budget plans, 364–365
budgets, 254, 291, 328, 369, 384
BUPA Ireland, 237, 241, 242–243
Bush, George W., President, 503
Butler, J.R., 52
Cadillac Tax, 545
Cajas system, 194
call-centres, 91, 158
Campbell, T., 130
Canada, 11, 17–18, 23, 25, 34, 99–101
current coverage, 112–113
development of private health care, 108–112
discussion, 134–136
Canada (cont.)
financial regulation, 120
insurance organizations, 113–115
insurance product regulation, 120–122
market performance, 124–134
overview, 101–108
products, 115–120
tax regulations, 122–123
Canada Health Act, 101–102, 112
Canada’s Medicare, 103
Canadian Community Health Survey, 112
Canadian Life and Health Insurance Association (CLHIA), 112, 114
Canadian Medical Association, 109
Canadian Pension Plan and Employment Insurance, 127
Cancer Care Ontario’s Program in Evidence-Based Care, 133
cantons, 450, 463–464, 470, 481, 484
capital Market Authority, 80
care, 46, 60, 147, 190, 233, 332
India, 85–86
Netherlands, 359, 361see also acute care; long-term care
care, hospital, 212
Australia, 46, 48, 54–56, 60
Brazil, 73
Canada, 104
France, 149, 172
Ireland, 224, 228–229, 247–248, 256–257
Netherlands, 351
South Africa, 400, 404, 434
Switzerland, 462
USA, 498, 500, 508
care in the community, 60, 266
care, managed
Egypt, 79, 82
France, 157–158
South Africa, 395, 403–404, 416
Switzerland, 458, 479–480, 483see also United States of America (United States)
care management programmes, 458–459
care, outpatients, 208–209
Australia, 73
France, 146–147, 172
Israel, 266, 269
Kenya, 337
Korea, 314
South Africa, 394, 430
Switzerland, 468
Taiwan, China, 316, 318
care, primary
Australia, 44, 56, 58–60
Canada, 106, 108
Chile, 195
France, 146
Ireland, 226–227, 252–253, 256
Israel, 269
Netherlands, 368see also South Africa
care, private, 247
care, quality of, 32, 333, 344, 357, 368–369, 403–404, 440–442
care, specialist, 25, 350, 399, 543
care, tertiary, 266, 268–269, 283, 313–314, 320
care, secondary, 269
cartels, 367
cash benefits insurance, 461–462
Catholicism, 449
Central Council for Medical Schemes, 387
Central Statistics Office, 231
charges, 250–251, 278, 328–329
charities, 12, 349
Cheng, T.C., 56
children, 225, 316, 337, 360–361, 380, 394, 505
Children’s Health Insurance Program, 520, 532–533
Chile, 4–6, 11, 15–17, 31–32, 34, 36, 180–181
financing and delivery, 191–193
future, 213–214
history of health insurance, 193–199
impact, 203–213
market overview, 199–203
policy conditions, 200–201
China, 11–12, 25
choice, 293–294, 312, 316, 397
Australia, 52, 54
Netherlands, 350, 364–365, 368–369, 374see also enhanced choice
chronic conditions, 53, 200, 318, 429, 477, 542
Canada, 129, 132see also South Africa
Chronic Disease List, 428, 429
chronic disease management, 58, 60see also diseases, chronic
citizens, 466–467, 481–482, 485, 504–506, 517
civil servants, 187, 194
claims, 68, 89, 91, 320, 330
Clalit, 265–266, 280
clinics, 316, 326, 378
primary care, 59, 379, 383
specialist, 313
Clinton, Bill, President, 503
co-payments, 3, 30, 156, 317, 320
Australia, 43–44, 50–51
South Africa, 381, 383, 443
USA, 506, 534
Code de la Mutualité, 160, 162
Cohn, D., 131
cohort effect, 152
coinsurance, 313, 320, 381, 529
Cold War, 498
collusion, 203
commercial insurance (CI), 271, 278–279, 283–289, 295
Commission on Health Funding, 248
Commissioner of Insurance, 339, 340
Committee on the Cost of Medical care, 496
Committee on the Future of Healthcare, 256
communities, 497, 498
community rating, 11, 14, 370
Australia, 48–50, 53
Ireland, 234–235, 239, 242–246, 350, 352
Switzerland, 457, 477, 482
USA, 510, 515see also South Africa
community services, 224
Companies Act, 339
compensation, 30, 77, 361, 370
competition, 203, 212
Australia, 43
Chile, 197
Egypt, 84
France, 152, 158, 160–162
Germany, 191
India, 88
Ireland, 230, 237–239, 245
Israel, 274, 282, 288–9, 293, 295–296
Netherlands, 351, 360–361, 365, 368, 371–372
Switzerland, 451, 453–454, 457–459, 483
Taiwan, China, 313–314, 316, 319
USA, 501, 507see also South Africa
Competition Commission, 390, 391, 404
competition, managed, 503–504
competition, regulated, 356–359, 370, 374, 448
complementary contracts, 170, 174
complementary coverage, 99, 446see also France
complementary health insurance, 119, 199
France, 142–143, 151, 155–156
Netherlands, 361–362, 368
complementary medicine, 157, 385
complementary plans, 189, 360, 364
Comprehensive Health Insurance Plan, 501
Confederation, 463–464
confessional funds, 449
Conlon, R., 53
Connolly, S., 229
consensus, 229, 319, 390, 420, 464, 502, 505
Consolidated Omnibus Budget Reconciliation Act, 511
consultants, 231, 248, 251see also specialists (specialist consultations)
consultations, 42, 80, 228, 281
consumer behaviour, 362–364
consumer choice, 545–546
consumer dissatisfaction, 279
consumer price index (CPI), 57, 231, 405
consumers, 1, 19, 66, 207
Brazil, 72
Chile, 203
Egypt, 84
France, 156
Germany, 191
India, 90
consumers (cont.)
Ireland, 230–232, 244, 255
Japan, 311–312
Kenya, 340, 346
Netherlands, 352, 357, 359–360, 364
South Africa, 388, 395
Switzerland, 446, 469, 478
USA, 495, 501–503, 505–506, 531see also Israel
contracting, 368–373, 458
contracts, 73, 156, 169, 227, 457, 460see also complementary contracts
contracts, collective, 364, 452
contracts, managed-care, 458, 480
contributions, 126–127
Netherlands, 351, 353, 365see also South Africa
contributions, employers, 498, 525see also employers
contributions, financial, 31
contributions, income-related, 31, 351, 354, 362, 369–370, 374, 396–397
controversy, 350
Ireland, 239–245
cooperation, 174, 449, 497
cooperatives, insurance, 109
corporations, 55, 78, 82, 187, 538
corruption, 510
Corscadden, L., 127
cosmetic procedures (surgery), 131, 430
cost containment, 146–147
cost-effectiveness, 133, 295
cost sharing
Canada, 115, 125
Chile, 202
Egypt, 81
France, 144–146
Germany, 189
India, 88
Kenya, 337
South Africa, 381, 409
USA, 528–529, 533, 541
costs, 207
Australia, 46, 50, 53–56
Chile, 193, 203
France, 162
Germany, 190
India, 89
Japan, 310
Kenya, 330
Netherlands, 350, 359, 368
Switzerland, 458, 468–469, 480
Taiwan, China, 318see also administrative costs (expenses); Canada; South Africa; United States of America (United States)
costs, transaction, 19, 34, 35, 478
Council for Medical Schemes (CMS), 389–395, 398, 404, 416, 418, 422, 425, 431, 437, 439
Council of Public Relief, 193
Couverture maladie universelle complémentaire (CMUC), 142, 149, 165–166, 173
cover, 336
coverage, 50, 110, 334–335, 504, 510
employer-based, 512, 514–520, 529see also complementary coverage; participation
coverage, dual, 149, 264, 277, 284, 288–291, 296
coverage gaps, 27, 321
coverage, universalsee universal coverage
credibility, insurance companies, 344–345
crises, 170, 232
critical illness, 89, 118
Croatia, 25
cross-subsidization, 207, 518
France, 173
Netherlands, 355see also South Africa
CSS Group, 476
culture, 448, 516–520
Cunningham, N., 229
customers, 333, 359, 365see also consumers; patients
Cutler, D., 239
data, 21, 23, 208
Australia, 52
Canada, 112–113, 125
India, 85
Korea, 314
South Africa, 403
Switzerland, 462
USA, 500, 514
databases, insurance, 172
Dawes Ibáñez, A.V., 212
De Beers Consolidated Mines Ltd Benefit Society, 387
debates
Canada, 134–136
France, 159, 162, 172, 175
Germany, 185
Ireland, 248
Israel, 280–281, 283, 295–296
Netherlands, 362, 372, 374
policy, 34–36
debt, national, 312
debts, 47
deductibles, 30, 59, 189, 208, 352
Canada, 115, 125
Netherlands, 354
South Africa, 392–393, 429, 438
Switzerland, 457–458, 468–469, 479–480
USA, 506, 527, 529, 534, 536–538
deductibles, mandatory, 361, 364, 369, 374
defaulters, 365–367
Definity, 538
Dekker Plan, 356–357
delivery, 30
delivery of services, 129–130, 195, 403–404
demand, 46, 231–233
demographies, 268see also populations (population groups)
dental services (care), 81, 104, 106, 310, 337, 351, 438
Australia, 44–45, 58, 60
France, 144, 157, 164, 175
Israel, 269, 271see also Canada
dentists, 43, 434
Department of Health, 378, 390, 436
depression, economic, 109, 496
deprivation, 226
deregulation, 314, 379, 389
developments, major, 14–19
devices, medical, 316, 318
Devlin, R.A., 100, 132
Dhalla, I.A., 129
diagnostic-related groups (DRGs), 317
diagnostic services, 189
differences, geographical (pricing), 90, 92
direct democracy, 448, 466
disability income insurance, 118, 120
disability, national, 198
disability tax credit, 123
disabled people, 316, 380
disclosure, 288, 389
discontent, public, 193see also dissatisfaction; public opinion
Discovery Health, 416–417, 419, 423, 437, 442
Discovery Health Limited, 434
Discovery Health Medical Scheme, 415, 417, 426, 429
discrimination, 121, 159
discussions, 171
disease management, 158, 458–459
disease, national, 198
diseases, chronic, 58, 60, 146, 386, 404, 423, 437–438
Diserens, D., 477
disputes, 90, 431
dissatisfaction, 42, 67, 186, 213, 265, 279, 542
doctors, 32–33, 207, 209
Australia, 43–44, 46–47
Canada, 132
Chile, 195
Kenya, 336, 344
South Africa, 379, 384, 388, 400, 434
Switzerland, 484
USA, 542see also physicians
Doiron, D., 53, 55
donors, 326, 380
drugs, 81, 147, 222, 224, 317, 519see also Canada
Drugs Payment Scheme, 224
earnings, 113, 180, 183, 187, 206, 210
economic Bill of Rights, 496
economy, national, 350, 351
ECuity group, 128
education, 83, 135, 294, 314, 335, 346
effectiveness, 51–53
efficiency, 1, 9–10, 28, 30, 35, 207, 212–213
efficiency (cont.)
Brazil, 77
Canada, 129–130
delivery of services, 403–404, 440–442
Egypt, 84–85
France, 159, 161, 169–172, 175
India, 92
Ireland, 251–252, 257
Netherlands, 359, 370, 372
South Africa, 397, 408
Switzerland, 468, 480
Taiwan, China, 318
efficiency-discounted options, 398, 421
Egypt, 34, 35, 65
assessment of market impact on health system goals, 83–85
conclusions, 92–94
market origins, 78–81
private and state-owned companies, 81–83
Egyptian Bankers Takaful Insurance Company, 79
Egyptian Financial Supervisory Authority (EFSA), 80, 84
Egyptian Insurance Supervisory Authority (EISA), 80
Eisenhower, Dwight, President, 499
elderly people, 292, 380
elections, 59–60, 504
Electricity Supply Board, 230
eligibility, 48, 282, 354
Germany, 187–188
Ellis, R.P., 53
Eloy Chaves Law, 67
emergency departments, 55
Employee Retirement Income Security Act (ERISA), 510–11, 513, 534
employees, 25, 67, 151, 335
Canada, 113, 115
Egypt, 78
France, 154, 163, 172
Germany, 181, 188
higher-earning, 5, 15
Japan, 307
Kenya, 330, 336–337
Korea, 312–313
Netherlands, 351, 355
South Africa, 395, 404, 418, 430
Switzerland, 449, 473
USA, 526, 528, 533see also workers
employees, government, 29, 354, 397, 407, 409, 426
Employer Mandate, 515
employers
Brazil, 72
Canada, 115, 119, 130
France, 154–155, 163, 170
Germany, 181, 188
Israel, 284
Japan, 309
Kenya, 330, 332, 336–337
Korea, 313
Netherlands, 349–351, 355, 364
Switzerland, 462see also South Africa; United States of America (United States)
employment, 10–12, 25, 305, 396
Canada, 112–113
France, 154
Japan, 309
Kenya, 329–330, 332, 334, 344
Korea, 315
South Africa, 406
USA, 504
enhanced choice, 30–31, 281
enrolment, 80, 83, 90
Enthoven, A., 266
entrepreneurship, 357–358
equality, 281, 293–294
equity, 28, 209–210
financing, 125–127, 400–401, 439–440, 481
France, 162–168, 175
Ireland, 229, 245–249, 257
Kenya, 330, 340
provision and use, 402
quality of care and efficiency, 440–442
service provision and use, 440
South Africa, 382, 386, 397
USA, 517, 544–545
of utilization, 128–129
European Commission (EC), 1, 240, 242
European Court of First Instance, 242
European Economic Community, 362
European Mutual Society Status, 162
European Third Non-Life Insurance Directive, 234, 245
European Union (EU), 160
evidence, 135, 438see also data
exchanges, national health insurance, 505–506, 507
exiting, 458–459, 478, 483, 485
expectations, 36, 399
expenditure, 332, 372, 379, 430, 467
experience rating, 386, 498, 516
expertise, 77, 415, 538
Explicit Health Guarantees, 192, 198
extra-billing, 311–312, 313, 317–319
facilities, 330, 333, 336, 340, 378, 384, 388
failures, market, 3, 6, 66, 72
fairness, 49, 169, 352
families, 57, 87, 394
Federal Association of Sickness Funds, 212
Federal Constitution, 464
Federal Health Insurance Act (KVG), 453–464
Federal Office of Private Insurance, 459
Federal Office of Public Health, 459
federal poverty level, 507, 515, 527, 532–533
Federal Social Insurance Office, 459
Federal Supervisory Office for Financial Services, 190
federalism, 448, 450, 481
Fédération Nationale de la Mutualitée Française (FNMF), 159
fees, 51, 81, 203, 328–329, 355
Canada, 121–122, 133
South Africa, 399, 405, 436
females, 314see also maternity care (benefits); women
Fiebig, D.G., 54, 55
Field Assistance Bulletin, 534
Fillon law, 155
Finance Agency, 311
Financial Markets Authority, 120
financial protection, 21–27, 35, 125, 399–400, 438–439
Financial Supervisory Service, 315
financing, 379
Ireland, 221–226
Financing Law, 198
financing systems, Switzerland, 464–467
firms, 511, 513–514, 540
First World War, 496
fiscal federalism, 466
fiscal pressures, 19, 35
Fondo Nacional de Salud (FONASA), 191, 195
For a More Effective and Better Quality Health Care System Thanks to greater Competition, 484
Formula Consultative Task Team, 390, 420
France, 4, 6, 12, 16–18, 22–23, 25, 27–29, 33–34
conclusions, 172–175
context and private health insurance, 143–151
market development and public policy, 158–172
overview, 142–143
overview of markets, 151–158
Frank, R.G., 479
fraudulent behaviour (activities), 336–337, 341, 345, 346
Frech, H.E., 53
Friendly Societies, 44, 379
Friendly Societies Act, 385, 387
Fuchs, Victor, 473
funding, 31
Australia, 43, 56
France, 173
India, 85
Israel, 268
Kenya, 330
South Africa, 390, 407
USA, 517
funds, 379, 380, 449
Gama, F.N.D., 76
gap-filling, 519, 520
Gardiol, L., 479
gatekeeping, 146, 169, 174, 307, 313, 458, 501
Gelpe, V., 477
General Insurance Corporation, 87
General Medical Services, 227
general practitioners
Australia, 44
Canada, 128
France, 147–148
Germany, 182
Ireland, 227
Netherlands, 355, 361, 372see also South Africa
General Services Tax, 127
Genesis Medical Scheme, 422
Geoffard, P.Y., 479
Germany, 4–6, 12–13, 15–17, 21, 27–28, 31–34, 36, 180–181, 496
financing and delivery, 181–182
future, 213–214
history of health insurance, 182–187
impact, 203–213
market overview, 187–191
recent policy developments, 184–187
Gesetzliche Krankenversicherung (GKV), 181
Global Financial Crisis, 56
GloHealth, 230, 237
Gluckman Commission, 387
Golden Rule Insurance, 530, 538
Goodman, John, 417
Gore, Adrian, 416–417, 418, 419, 441, 444
governance, 330, 351
Government Employees Medical Scheme (GEMS), 397, 407, 426–428, 441
government, federal, 463–464
government funding, 56, 329, 409
government intervention, 14–19, 61, 295, 350, 499
government spending, 34, 135, 326
Australia, 51, 56
Israel, 264–265, 291, 297
governments, 12, 22, 42, 45, 295
Grandchamp, C., 479
grants, 43, 112
Grootendorst, P., 127
group cover, 333
group insurance, voluntary, 462
group markets, 512–516
Group Medicine and Dentistry schemes, 66
Group Medicine and Group Dentistry, 68
Group Mutuel, 476
group plans, 66, 354–355, 365
groups, 345, 505see also mutual support groups
guaranteed issue, 506, 510
guaranteed minimum benefits (GMBs), 388
guidelines, 345, 458, 513
guilds, 10, 182, 349
Hacker, J., 500
Hall Commission, 111–112
Hanley, G., 127
healers, traditional, 326, 385
healing modalities, 385
health authorities, 106
Health Authority Act, 198
Health Care Allowance Act, 361
Health Insurance Accountability and Portability Act, 510–511, 530
Health Insurance Act, 245, 307, 359, 361, 365, 370, 374
Health Insurance Act 2006, 349
Health Insurance (Amendment) Act, 236, 241
Health Insurance and Social Security Financing Act, 171
Health Insurance Authority (HIA), 230, 239
Health Insurance (Miscellaneous Provisions) Act, 237, 243
Health Insurance Organization (HIO), 78
Health Insurance Portability and Accountability Act, 516, 525
Health Insurers Netherlands, 355
Health Maintenance Organizations (HMOs)
Egypt, 80, 82–83
Kenya, 330, 333–334, 337, 339
Switzerland, 458, 480
USA, 501–503, 508–509
health plans, high-deductible, 531–532, 536
Health Professions’ Council of South Africa, 403
Health Reimbursement Accounts, 526
health savings accounts (HSAs), 503–504, 525–527
academic research, 527–529
conclusions, 546
current status, 531–533
effects, 543–546
entrepreneurial lobbying, 529–530
forms of plans, 535–537
market structure, 538
market vacuum, 530–531
participation, 539–540
performance, 540–543
regulation, 533–535
savings plans, 537–538
Health Service Executive (HSE), 223
health spending, 454
Health Spending Accounts, 119
health status, 27, 210
Australia, 53
Brazil, 73
Canada, 107
France, 157, 163–164, 166
India, 91, 93
Ireland, 226, 236, 252
Israel, 279
Korea, 314
South Africa, 400, 405
Switzerland, 451
USA, 498, 512, 515, 541, 546
hearing aids, 89, 189, 271
Helsana, 476
Herfindahl-Hirschman Index (HHI), 473
Herzlinger, R.E., 447
Hibernian AVIVA Health, 254
Himmelstein, D., 130
Hirschman, A., 476, 483
history (past events), 10–19, 36–37
Hixton, Jesse, 530
home care services, 111, 112, 124, 125, 225, 316
Honorary Medical Officers, 46
Hopkins, S., 53
hospital admissions, 44–45, 54–55, 429
hospital coverage, complementary, 118
Hospital Insurance and Diagnostic Services Act, 110, 112
hospital prepayment plans, 109
hospital substitute services, 58
hospital use, 53–56
hospitalization, 46, 88–89, 310, 352
hospitals, 11, 207
Australia, 43–47
Canada, 106, 110, 121, 128–129, 133
France, 147, 157
Germany, 182
Ireland, 229, 247–248
Israel, 266, 269, 296
Korea, 315
Netherlands, 368–369, 372
South Africa, 378, 383–385
Switzerland, 457
Taiwan, China, 316
USA, 497
hospitals, acute care, 313
hospitals, private, 14, 33
Australia, 45, 49, 55
Brazil, 66
France, 148
Israel, 271
Japan, 309
Kenya, 329
Korea, 313
South Africa, 379, 383–384, 400, 403
teaching, 55see also Ireland
Household health Service Utilization and Expenditure Survey, 83
household spending, 276–277
households, 167–168, 170, 318, 326, 335, 440, 467
Human Development Index, 76
human resources, 33
Hurley, J., 100, 132
I’Aide Complémentaire Santé (ACS), 149, 151, 156, 167, 173
Ibáñez Campo, Carlos, President, 194
ill health, 3, 5, 9, 31, 212
Canada, 118
Netherlands, 373
South Africa, 398
Switzerland, 486
illness, chronic, 172, 440, 546
illness, critical, 89, 118
imaging, 44
immigrants, 507
impact, 1–3, 52, 344
Imperial Supervisory Agency for Private Insurance, 183
incentives, 30, 36, 212–213, 369, 486
Australia, 52, 54, 58
Brazil, 66, 73
Canada, 129–130
incentives (cont.)
France, 157, 169–172
India, 91–92
Ireland, 229, 250–251, 255
South Africa, 395, 441
USA, 501, 525–526see also tax relief
incentives, provider, 33, 36
income protection, 349
incomes, 3, 13, 27, 529, 532–533
Australia, 50, 57–58
Brazil, 74
Canada, 123, 126–128, 132
Chile, 191–192
Egypt, 79, 83
France, 167–169, 172
India, 86
Ireland, 223, 225, 246
Israel, 274, 276, 292, 294
Japan, 309, 311
Kenya, 329
Korea, 314
Netherlands, 350–352, 354, 360–361, 370
Taiwan, China, 317
USA, 498–499, 507, 526–527see also Switzerland
indemnity cover, 389, 392
Independent Practice Associations (IPAs), 458, 480
India, 11, 17, 65, 85–86
assessment of market impact on health system goals, 91–92
conclusions, 92–94
market origins, 86
market overview and development, 86–88
pricing, 89–91
types of policies, 88–89
inefficiency, 6–10, 356, 357, 378, 397, 401
inequality, 6–10, 27, 33, 35–36, 210
Brazil, 74
Egypt, 84
France, 163, 172
Israel, 282, 294
Kenya, 344
Netherlands, 356–358
South Africa, 377–379, 408
Switzerland, 440
USA, 512
inflation, 231, 265, 268
medical, 89, 236
information, 289, 291, 335, 369, 434, 478, 542–543
information campaigns, 231
Information Exchange in Supplementary Health, 73
information reporting, 91
information systems, 108
information technology, 252, 346, 545
infrastructure, 66, 341
initiatives, 73, 109
innovations, 314, 448
South Africa, 415, 417, 426
USA, 498, 501–502, 506, 517, 536
institutions, provident, 151–152, 154, 160, 164
Insurance Amendment Act, 337, 339–340
Insurance Code, 160
Insurance Regulatory and Development Authority (IRDA) Act, 86–87, 90
Insurance Regulatory Authority, 340
insurance, voluntary, 43, 110–111, 149, 447, 494
Switzerland, 459–462, 466, 478
Insurances Holding Company, 83
insurers, 352, 359, 364, 368, 372, 515
commercial, 81–82
types, 151–154
integration, vertical, 192–193
interactions
Israel, 295–296
publicly and privately financed health systems, 130–134
Internal Revenue Code, 528
International Monetary Fund, 325, 330
International Review Panel, 390, 398, 420
intervention, state, 353
interventions, 14, 18–19, 61, 82, 191
France, 143, 157–158, 163
Israel, 293, 295
Netherlands, 350, 353
South Africa, 386, 404, 415
Switzerland, 454, 464
USA, 499, 519
investment, 214
Australia, 57
Brazil, 72
France, 158
Ireland, 252
Japan, 307
Kenya, 325, 345
South Africa, 396, 431
Switzerland, 476
Taiwan, China, 317
USA, 531, 534
investment, financial, 12, 319
Ireland, 16–18, 23, 25, 32, 33, 34, 35
conclusions, 257
delivery structures, 226–228
future, 253–256
government objectives, 233–234
impact of insurance, 245–253
market development and public policy, 233–239
overview, 221–226
overview of markets, 229–233
public/private interaction, 228–229
sources of controversy, 239–245
Irish Health Insurance Act, 234
Irish Life Health, 230
Israel, 11–12, 16–18, 23, 25, 33–34, 264
debate on inclusion of life-saving medications, 282–283
development of commercial market, 283–288
development of NHI, 266–268
development of SI market, 279–282
discussion and conclusion, 292–297
dual coverage, 288–290
health expenditure, 269–271
historical background, 265–266
impact on national health spending, 290–291
market role, size and regulation, 271–274
market structure, 274–278
private health insurance policy terms, 278–279
purchasing services and payments, 268–269
revenue collection, funds and allocation, 268
Israel Medical Association, 268
Japan, 11–12, 25
conclusions, 321
discussion, 320
overview, 304–307
private health insurance, 310–312
publicly financed health coverage, 307–310
Japan Medical Association, 312
Jimenez-Rubio, D., 128
Johnson, Lyndon B. President, 500
Jones, G., 53
Jost, T.S., 417, 437
Journal of the American Medical Association, 447
Kaiser Health Tracking Poll, 506
Kaiser Permanente, 537
Kaplan, J., 426
Keegan, C., 239
Kenya, 11, 17, 325
barriers to expansion, 344–345
conclusions, 345–346
cost-sharing revenues, 326–329
impact of private health insurance, 340–344
market origins and expansion, 332–334
NHIF, 329–332
public policy towards private health insurance, 337–340
public-private mix, 325–326
take-up of private health insurance, 334–336
types of cover, 336–337
types of providers, 336
Kenya Health policy 2014–2030, 329
Kenya Women Finance Trust, 345
Key African National Congress Health Plan, 389
Kirby Commission, 124
Korean Hospital Association, 314–315
Korean Medical Association, 314–315
Kratzer, J., 129
Labor Government, 57
Labor (party), 47, 56
Labour Party, 351, 359
Labour Welfare and Health Committee, 283
Lamiraud, K., 479
Laporte, A., 129, 132
Laske-Aldershof, T., 478
Law, M.R., 129, 132
Law on Sickness and Accident Insurance (KUVG), 450
Laws of Kenya
Chapter, 253, 337
Chapter, 255, 329
Laya Healthcare, 230, 254
Leal, R.M., 77
legislation
Chile, 194, 197–198
France, 130, 133
Germany, 190–191
Ireland, 234–237
Israel, 283
Netherlands, 350, 367–368, 373
South Africa, 389, 420
Switzerland, 450
USA, 500, 533
Lehmann, H., 480
lessons, 35–37
Leumit, 266
leverage, 10, 30, 33, 190, 514
France, 157, 173
Ireland, 221, 248, 250–251, 257
levies, 48, 54
Liberal Party, 47, 49
licensing, 72, 90, 325, 340
Life, 379
lifestyle health care services, 131
lifetime community rating, 255
lifetime cover, 27, 235, 236, 239, 352
lifetime exclusions, 386, 418
Lifetime Health Cover, 50–51, 52
liquidity, 71
lobbying, 14, 159, 315, 437
Israel, 280, 282, 293
USA, 499, 510, 529–530
Loi Evin, 163
long-term care, 124, 125, 227, 280, 319
long-term care insurance (LTCI), 118, 278
loss-of-earnings schemes, 10
loss ratios, 71, 526, 535
Low Income Medical Schemes, 391
loyalty, 478
Lu, M., 55
Lumenos, 538
Maccabi, 266, 280
Macdonald, G., 53
Macron, Emmanuel, President, 175
managed care, 501–503
management, 66, 318, 330, 339
managers, hospital, 250, 268
Mandatory Palestine, 283
market development, 2, 93, 349, 546
France, 158–172
Ireland, 233–239
Israel, 279–290
South Africa, 385–398
market expansion, 292–294
market failures, 121, 356, 358, 503
market fragmentation, 213
market performance, 399–406
market segmentation, 201
USA, 543–544
market shares, 462, 498, 508–509
market structure, 229–231
Chile, 199–203
Germany, 187
Switzerland, 473–476
USA, 538
market vacuums, 530–531
marketing, 81, 152, 239, 283–284, 344
Netherlands, 353, 355, 368
South Africa, 423, 438
Marketplaces, 507
markets, 3–6, 473, 476, 483–484, 515
growth in Kenya, 332–337
Israel, 271–278
structure, 254
markets, group, 512–516
markets, insurer, 367–368
Marsden, D., 128
materials, high quality, 316
maternity care (benefits), 81, 196–197, 316, 350, 361, 511
Matisson, S., 429
McGrail, K., 126
McLeod, Heather, 395, 428
means-testing, 48, 57, 223–224, 225
Medavie Blue Cross, 119
Medi-Clinic, 379
media, 52, 239, 289, 372, 482, 530
Medibank, 47
Medibank Private, 14, 48, 57, 58
Medicaid, 499–500, 502, 506, 519, 526, 532
Medical and Dental Co-operatives, 66, 68
Medical Association, 351
Medical Cards, 252
category I, 222–224
category II, 224–225
GP visit, 225–226
Medical Care Act, 112
medical expense tax credit, 123
medical insurance providers (MIPs), 336, 339
Medical Practitioners and Dentists Act, 337, 339–340
medical savings accounts (MSAs), 27, 386see also South Africa
medical schemes, 377–378, 379, 380, 401, 409
Medical Schemes Act, 392
Medical Schemes Act 1967, 386, 387, 388
Medical Schemes Act 1984, 388
Medical Schemes Act 1998, 386, 389, 393, 415, 418, 420
Medical Schemes Act 2008, 391, 398
Medical Schemes Amendment Bill, 398
Medical Union, 79
Medicare, 49, 499–500, 502, 505, 507–508, 519–520, 526, 532see also Australia
Medicare Advantage programme, 504, 508–509
Medicare Benefits Scheme (MBS), 45, 57, 58
Medicare Locals, 56, 59
Medicare Modernization Act, 530–531
Medicare Prescription Drug, Improvement and Modernization Act, 546
Medicare Private, 50
Medicare Safety Net, 51
medications, life-saving, 282–283
Mediciad, 313
medicine, complementary, 157, 385
medicines, 309, 316, 390, 434see also prescription drugs (medication)
medicines, generic, 345, 403
Mediclaim, 86
MediPlus, 334, 339
Melamet Commission, 388, 389, 415, 419
membership, 151, 182, 230
mental health benefits, 511
Meuhedet, 266, 280
Middle East Medicare Plan, 79
migration, 32–33, 344
miners, 200
minimum benefit package, 428
minimum benefits, 27, 415
Ministry of Finance, 332
Ministry of Health, 191, 312, 332, 334
Ministry of Health and Welfare, 315, 316
Ministry of Strategy and Finance, 314, 315
minorities, 296see also Arabs; immigrants
mismanagement, 345, 346
mobility, 282, 362, 364, 460, 478see also switching
Modalidad de Libre Eleccion, 192
monitoring, 36, 44, 268, 462
monopolies, 9
moral hazards, 9
Australia, 55–56
Kenya, 336–337, 339
South Africa, 438, 441, 443see also United States of America (United States)
mortality rates, 479–480
Musau, S.N., 341
Mustard, C., 126
mutual aid associations, 11, 18
mutual organizations, 44
mutual support groups, 449–450, 473
mutuality, 449, 486
mutuelles, 151, 154, 157–158, 159, 160–161
Nairobi, 335
National AIDS Control Council, 326
National Association of Sickness Funds, 355
National Center for Policy Analysis, 417
National Council for Social care, 68
National Disability Insurance Scheme, 43
National Economic Prosecutor, 203
National Forum on Health, 124
National Health Act, 390
National Health and Hospitals Reforms Commission, 56
National Health Fund, 77, 374
National Health Insurance Administration (NHIA), 316, 317–318
National Health Insurance Authority, 421
National Health Insurance Committee of Inquiry, 389, 420
National Health Insurance (NHI), 406–407
National Health Insurance Service (NHIS), 313, 315
National Health Insurance System, 391
National Health Reference Price List (NHRPL), 390–391
National Health Reform Agreement, 56, 57
National Health Service (NHS), 498
National Health Service (SNS), 194–195
National Health Survey, 53
National Hospital Insurance Fund Act, 337
National Hospital Insurance Fund (NHIF), 329–332, 334
National Inter-professional Agreement, 155
National Medical Association, 350
National Medical Service for Employees (SERMENA), 194
National Social Health Insurance Scheme (NSHIS), 330
National Supplementary Health Agency (ANS), 66, 72, 73
nationalization, 265
negotiations, 171
Netcare, 379
Netherlands, 3, 5, 11–15, 17–19, 21, 23, 25, 27, 31–32, 34, 35, 37
1990–2005, 353–5
2006 reform, 357–359
contracting, 368–373
Dekker Plan and its aftermath, 356–357
discussion and conclusion, 373–374
effects on consumer behaviour, 362–364
freedom of choice, 364–365
historical origins, 349–351
insurer markets, 367–368
non-insured and defaulters, 365–367
post 2006, 359–362
premiums and contributions, 365
Second World War to 1980s, 351–353
networks, provider, 157–158
New Deal, 496
NHI Law (1995), 266, 280
Nixon, Richard, President, 500
non-indemnity cover, 389, 390
non-insured, 365–367
nongovernmental organizations, 379
nonmedically necessary services, 131, 134
nurses, 60
nurses, private, 316
nursing care, 351
nursing homes, 227
Obama, Barak, President, 505
obstetrics, 51
Ocké-Reis, C.O., 76
Office of Education, Mendocino County, 530
Office of the Superintendent of Financial Institutions, 120
older people (elderly), 27, 32, 209, 235
Germany, 189
Japan, 309
Netherlands, 352–353
South Africa, 386
Switzerland, 453
USA, 500see also seniors
ombudsmen, 73
open enrolment, 11, 14, 25, 27
Australia, 43, 48
Germany, 188
Ireland, 235, 239, 352–354
Netherlands, 360, 370
South Africa, 389, 392, 415, 420, 422
Switzerland, 457
USA, 515
optical services, 58, 81, 157, 170
optical services (eyewear), 144, 164, 175, 189, 309, 337
organization, 30
Ostrom, E., 485
out-of-hospital services, 60
out-of-pocket expenses, 43, 51, 88
out-of-pocket payments (expenditure), 23, 35, 304, 320
Australia, 44–45
Brazil, 66, 74
Canada, 123
Chile, 202
Egypt, 78
France, 144, 149, 156, 175
India, 85
Ireland, 252–253
Israel, 277
Japan, 310
Kenya, 344
Korea, 313, 315
Netherlands, 362
Switzerland, 466, 468
Taiwan, China, 318
USA, 529see also South Africa
out-of-pocket spending, 79, 104, 125, 173, 269
outpatient benefits, 329
outpatient care, 172
outpatient generic drugs, 372
oversight, 36, 345, 352
Palangkaraya, A., 53
Parsa-Parsi, R., 447
participation, 539–540
partnerships, 59
pathology, 44
Patient Protection and Affordable Care Act (ACA), 6, 27, 495, 504–507, 511–513, 515–520, 527, 534–535, 545
patients, 47, 146, 182, 247, 313, 531
patients’ associations, 484
payouts, 59
peace borderline agreement, 355
penalties, 25, 33, 311
pensioners, 168see also retirees
performance, 31
health systems, 1–3
hospitals, 56
USA, 540–543
Performance Index of Supplementary health, 73
Perticara, M., 202
Pharmacare, 133
Pharmaceutical Benefits Scheme, 43, 44–46, 57
pharmaceuticals, 44, 46, 190, 314, 350
pharmacies, 157, 326
pharmacists, 434
physicians, 13, 209, 212
Canada, 108, 121–122, 131
France, 144, 146–147, 164, 170
Germany, 182, 190
Israel, 291, 296
Korea, 312–313
Netherlands, 350
Switzerland, 457
Taiwan, China, 316
USA, 496, 500, 508, 537see also doctors
physicians associations, 320
physicians, primary care, 269, 307, 313
physiotherapy, 45
Pinochet, General Augusto, 195
plans, 118, 120, 230, 384
hospital prepayment, 109
plans, corporate, 337
police forces, 230, 354
policies, 57, 59, 88–89, 120–121, 188, 284, 288–289
policy debates, 35–37
policy-making, 36, 355, 359
political parties, 374
politics, 10–19, 36
polls, 482
poor people, 316, 330
popular view, 135
population, ageing, 231, 254
population coverage, 319
populations (population groups), 5
Japan, 310
Kenya, 332
Netherlands, 351
South Africa, 378–379, 385, 394
Switzerland, 473
USA, 499, 507, 510see also Israel
portability, 88, 163, 510
poverty, 87–88, 167, 252, 328, 330, 341, 346
power, balance of, 463
practitioners, health care, 434
Preferred-Provider organizations (PPOs), 458, 480, 502, 508, 509
premium controls, 27
premiums, 208
age-related, 352
Australia, 57, 59
Canada, 122–123, 129
Chile, 196, 200–201
Egypt, 84
France, 155–156, 162, 170
Germany, 184, 186, 188, 190
India, 89
Ireland, 232, 240, 245–246, 255
Kenya, 336, 340–341
Netherlands, 353–354, 360–361, 364–365
Switzerland, 466, 468–473, 478, 482
Taiwan, China, 317
unsustainable, 468–473
USA, 501, 506, 528–529, 540see also Israel
prepayment plans, 109
prescribed minimum benefits (PMBs), 382–383, 392, 398, 404, 420, 430
prescription drugs (medication), 81, 372, 440
Canada, 100, 118, 132
USA, 508, 536
preventative services, 157, 169
preventive health care, 535–536
prices, 33
Canada, 131
France, 147
Germany, 189
Israel, 269
Korea, 313
Netherlands, 361
South Africa, 390
USA, 504
pricing, 89–90, 212, 516
medicines, 441
primary care, 58–59, 60, 378, 399
Primary Health Networks, 59
prison officers, 230
privacy, 172
Private Health Insurance Administration Council, 44
Private Hospitals Association, 227–228
Private Insurance Superintendence, 73
privatization, 60, 297, 319, 377, 379, 388
product bundling, 254, 314
products, 120–122, 154–158, 318, 320, 346, 352
professional associations, 71, 115
professional funds, 449
professionals, health (medical), 32–33, 133, 207, 246, 319
France, 164, 171
Kenya, 333, 344
South Africa, 384–385, 388, 405–406, 409
professions, 80, 388
health, 108
medical, 43, 47–48, 110
profitability, 71, 77, 89
Programme for Government (Ireland), 255
protection, financial, 83–84, 91–92, 208, 252–253, 292
Protection Universelle Maladie, 144
providers, 30, 33, 182
Chile, 202–203
France, 144–146, 157–158
Germany, 189–190
Kenya, 334
Netherlands, 355, 359, 368
South Africa, 383, 406, 436, 438, 443
Switzerland, 484see also United States of America (United States)
providers, primary care, 409, 518
Provincial Working Group, 133
public coverage, 5–6, 15–16, 31–32
Canada, 100, 122
France, 144, 146
Israel, 296
Japan, 311
USA, 518, 520
public funds, 449–450
Public Health Act, 387
public hospital insurance, 111
public interests, 12–14, 358
public opinion, 293, 373, 500, 506
public-private partnerships, 85–86, 87, 92
public reporting, 56
public resources, 1, 31, 34, 221, 246, 251–253
public spending, 23, 304, 463–464
public subsidization, 92, 247
purchaser-providers relations, 147–148
purchasing, 30, 436, 441
purchasing, selective, 372
pure private health insurance plans, 353–354
Quadagno, J., 519
quality, 30, 33, 212–213
Brazil, 77
Egypt, 84–85
India, 86, 92
Ireland, 233, 251–252
Kenya, 330, 332, 345
Netherlands, 359
Québec Charter of Rights and Freedoms, 130–131
Québec universal drug plan, 107–108
Question of Demand, A, 357
Quinn Healthcare, 237, 242–243, 254
race groups, 378
Raczynski, D., 197
Ramjee, S., 428
Rana, Z., 127
Ranchod, S., 426
Rashtriya Swasthya Bima Yojana (RSBY) scheme, 86, 92
rationing, 383, 519
rebates, 47, 50, 52–54, 57–59, 127
recessions, economic, 196, 265
reciprocity, 449, 485
reconstructive surgery, 511
Red Cross, 309
reference plans, 73
referendums, 454, 481
reforms, 13, 207–208
Australia, 58, 61
Egypt, 79
France, 147, 170–171
Germany, 186
Ireland, 229
Israel, 265, 274, 292
Kenya, 325
Netherlands, 374
South Africa, 388–9, 407, 419, 421
Switzerland, 464, 470, 481, 483–485
USA, 502, 526, 539
Registrar of Medical Schemes, 393
regulation, 9–10, 19–20, 25, 36, 320
Australia, 44
Brazil, 66, 72–74, 77
Canada, 113–114, 120, 135
France, 152, 159
Germany, 186, 190–191
India, 90
Israel, 284
Kenya, 339, 345–346
Netherlands, 350, 355, 359
South Africa, 390–391, 404, 418, 431
Switzerland, 453–454, 460, 483
Taiwan, China, 318see also United States of America (United States)
regulations
Canada, 131
Ireland, 240
Israel, 281, 288, 293, 296
Japan, 310
Kenya, 333
Netherlands, 362
South Africa, 387–388see also legislation; tax regulations
regulators, 389, 393
regulatory harmonization, 160–162
Regulatory Reform Council, 311
Regulatory Reforms Council, 312
reimbursement, 30, 212, 320
Brazil, 77
Canada, 122
Egypt, 81
France, 144, 155, 169, 170, 174
India, 88, 90
Ireland, 228
Israel, 288, 290
Kenya, 337, 344
Netherlands, 352
South Africa, 384, 390, 404, 439
Taiwan, China, 318
Reinach Committee, 387
Reinhardt, U.E., 447
reinsurance, 393, 418
relationships, 359, 384
religion, 92see also Catholicism
remuneration, 395, 397
Remuneration Committee, 387–388
reporting, public, 56
Representative Association of Medical Schemes, 388
reproductive services, 51
Republic of Korea, 11–12, 17, 25
conclusions, 321
discussion, 320
overview, 304–307
private health insurance, 314–315
publicly financed health coverage, 312–313
reputations, 157, 368
Research and Development Corporation (RAND), 528, 540–541
residents, 334, 335, 359, 360
resistance, 14, 356
resources
Canada, 110
Ireland, 249, 255
Israel, 295
Kenya, 326, 330, 344
Netherlands, 369
South Africa, 378, 385
responsible contracts, 161, 166, 174
restrictions, 59
retirees, 134, 163, 389, 508, 513
retirement, 31, 133–134, 151, 390–391, 395–396, 414, 537
retirement savings accounts, 538
returns, annual, 120
revenues
Australia, 59
Brazil, 68–69, 77
Canada, 106
cost-sharing, 326–329
Kenya, 341–344
Netherlands, 352, 362
South Africa, 383
USA, 512–513
reviews, 81
rewarding, 129–130
risk-adjustment, 360, 453, 506
risk aversion, 319, 364
risk equalization
Ireland, 238–239, 241–245, 254–255
Netherlands, 356, 360, 370
South Africa, 382, 390
Switzerland, 447
Risk Equalization Fund, 391, 398, 421, 423, 428, 437
Risk Equalization Scheme, 241, 243
risk factors, 199
risk pooling
Netherlands, 351–353, 367
Switzerland, 462, 476–479
USA, 543–544see also South Africa
risk profiles, 451
risk rating, 386, 388–389
risk segmentation, 6–10, 28, 180, 207, 210–212, 214
Germany, 184
risk selection, 9–10
France, 163
Ireland, 239, 244
Netherlands, 360, 370
South Africa, 428–429
Switzerland, 458, 460, 476, 479–481
Taiwan, China, 317
USA, 503, 518
risks, 30, 36, 152, 155
Robert Wood Johnson Foundation, 515
rollover (roll forward), 423, 526
Romanow Commission, 124, 126
Roosevelt, Franklin D., President, 496
Roosevelt, Theodore, President, 496
rural areas, 332, 341, 378–379, 399
Rürup Commission, 184
Russian Revolution, 496
Rütschi, C., 477
safety nets, 519, 520
sanctions, 237
Sarma, S., 100, 132
satisfaction, 542–543
Savage, E., 53, 54, 55
savings, 500
savings accounts, medical, 30, 33
savings balances, 436
Sax, S., 60
Second World War, 43, 183, 307, 498
security, 54, 294
segmented plans, 73
self-insured plans, 512
self-regulation, 81
seniors, 133, 168, 172see also older people (elderly)
Shinnick, E., 239
sick pay, 196–197
Sickness Fund Act, 351, 354, 355, 373
Sickness Fund Association, 452
sickness funds
Germany, 181
Switzerland, 476, 478–479, 483see also Netherlands
Sickness Funds Decree, 350–351, 373
Simons Plan, 356–357
Slovenia, 25
Small Business Health Options Program, 506
Smith, P.C., 128
Smyth, J.G., 126–127
Snyman Commission, 387
Social Code Book V, 190
Social Insurance Law, 459
social movements, 320
Social Security 2020, 186
Social Security Administration, 530
Social Security Code, 160
Social Security Financing Act, 168
socially responsible contracts, 169–170
socioeconomic groups, 296
solidarity
Israel, 281
social, 184
Switzerland, 449, 453, 467, 486
USA, 515–516, 520see also Netherlands
solvency, 90, 120, 240, 339, 368, 510
South Africa, 387, 431
Solvency II Directive, 160
South Africa, 11, 15–18, 23, 25, 29, 32–35, 377–378
benefit design and MSAs, 428–429
benefit expenditure, 434–436
changes to key actors, 395–396
conclusions, 408–410, 442–444
development of MSAs, 414–416
developments over last decade, 397–399
equity in financing, 400–401
equity in provision and use, 402
financial protection, 399–400
GEMS, 425–428
health system context, 378–385
historical overview, 385–391
impact on health system, 405–406
introduction of MSAs, 416–418
likely impact of imposed mandatory health insurance, 442
market performance, 438–442
Medical Schemes Act 1998, 392–393
MSA policy concerns, 436–437
MSA risk selection, 437–438
MSAs from 2000 onwards, 418–425
operation of MSAs, 429–434
proposed mandatory prepayment for universal coverage, 406–408
quality of care and efficiency, 403–404
trends in private health insurance, 393–394
trends to income and risk cross-subsidies, 396
South African Revenue Service, 381
Soviet Union, 11
specialist providers, 51
specialist services, 128
specialists (specialist consultations), 320
Australia, 44
France, 144
Germany, 182
Ireland, 228
Israel, 268
Netherlands, 355
South Africa, 384, 400, 404
Specified Medical Costs, 312
spending, cantonal, 470
spending ceilings, 80
spending, health care, 371–372, 405, 466–467
Stabile, M., 100, 132
stability, financial, 72, 271
Stabilization Act, 498
stakeholders, 10, 12, 111, 265, 356–357, 464
status, 497
legal, 459–460
organizations, 114
socioeconomic, 27, 226
Stone, Deborah, 515
stop-loss clauses, 200
Strategic framework for Reform of the Health Service, 248
Structural Adjustment Programmes, 325
subsidies, 14, 23, 33
Australia, 47–48, 50, 60
Canada, 122
Egypt, 80, 84
Germany, 188, 191
Netherlands, 370
South Africa, 381, 397, 401
Switzerland, 463, 469–470, 473
USA, 504, 520, 529–532, 535
subsidies, government, 42, 57, 76, 313, 330, 378
substitutive private health insurance, 184, 206, 349
Superintendencia de Salud, 201, 203
supplementary health insurance, 199
supplementary hospital insurance, 461
supplementary insurance (SI), 134, 271, 278, 279–282, 296, 320
supplements, private coverage, 508
Supreme Court of Canada, 99
surgery, private, 281, 289
surveys, 230, 231–232, 238, 255, 395, 484
sustainability, 134–135
Suziedelyte, A., 55
Swica, 476
Swiss Financial Markets Supervisory Authority, 460
Swiss People’s Party, 483–484
Swiss Television, 484
switching, 238–239, 541
Netherlands, 355, 360, 362, 364, 371
Switzerland, 451, 457–458, 476–479, 483, 486
Switzerland, 3, 5, 12–13, 18, 19, 446–448
assessing performance, 464–481
direct democracy, 481–486
historical development, 448–453
KVG 1996, 453–464
syndicate scheme (nikabat), 80–81
syndicates, 80
Taft-Hartley plans, 499
Taiwan, China, 11–12, 25
conclusions, 321
discussion, 319–320
private health insurance, 317–319
publicly financed health coverage, 314–317
Tariff Advisory Committee, 89
tariffs, 87, 90, 148, 185, 387–388
tax credits, 119, 123, 232, 401, 439
USA, 504, 506, 532–533
tax cuts, 135
tax deductions, 378, 401
tax exemptions, 17, 115, 143, 439
France, 155, 160–161, 170
USA, 526, 529, 544–545
tax funds, 269, 383
tax incentives, 25, 66, 91–92, 525–526, 537
tax regulations, 119, 122–123
tax relief, 76, 229, 232–233, 244, 246, 401, 531
Tax Relief and Health Care Act, 526
tax revenues, 81, 149, 329, 380–381, 401, 407
tax subsidies, 19, 25, 29, 33–34, 37
Egypt, 80
Germany, 191
India, 91, 93
USA, 529–531, 533, 535
taxes (taxation)
Australia, 42, 47–48
Brazil, 67
Canada, 103–104, 126–127
Chile, 198
Egypt, 84
France, 169
Israel, 291
Japan, 310
Kenya, 330
Switzerland, 463, 482, 485
USA, 497, 506, 512, 517, 528
Taylor Committee, 390
technologies
Australia, 51
France, 158
Ireland, 231, 252, 254
Israel, 268, 279, 296–297
Japan, 309
Korea, 314
Taiwan, China, 318
USA, 531see also information technology
Ten-Year Long-Term Care Development Plans, 319
tenders, 88, 167
third party administrators (TPAs), 71–72, 86, 90, 91
tourism, medical, 314
trade union movements, 11, 47
trade unions (syndicates), 78–79, 284, 400, 449, 473
training, medical, 47, 246
transaction costs, 34, 36
transparency, 203, 212
France, 160–162, 174
Israel, 274, 289, 291
limited, 34, 36
Switzerland, 447, 476
travelling, 119
treatment protocols, 404
Truman, Harry, President, 499
Trump, Donald, President, 507
trust, 372–373
Turner, B., 239
understandability, 174
understanding, 36
uninsured people (households), 83–84, 132, 168, 191, 315
Netherlands, 360, 365–367see also United States of America (United States)
Union of Voluntary Health Insurers (Unocam), 171, 172
unions, 71, 274
Canada, 113, 115
France, 147, 171
Netherlands, 349, 356
USA, 495, 498–499
United States of America (United States), 3–4, 6, 11, 13, 16, 18–19, 21–22, 27, 33–34, 494–495
Affordable Care Act (ACA), 504–507
coverage and culture, 516–520
emergence of private health insurance, 495–496
group markets, 512–516
managed care era, 501–503
managed competition, 503–504
Medicare and Medicaid, 499–500
private health insurance pre-ACA, 507–512
third sector, 496–499
UnitedHealth, 538
universal comprehensive insurance, 111
universal coverage
Canada, 100, 107, 110–112
France, 143–144
Israel, 295
South Africa, 406–408, 410
Switzerland, 447, 451, 473
USA, 499–500, 506, 516–518
universal health coverage, 421
Universal Health Insurance (UHI) scheme, 87–88
urban areas, 379, 402
user charges, 3, 25
utilization
equity of, 128–129
USA, 541–542
Vaithianathan, R., 53
van Boxtel, R., 370
van Doorslaer, E., 128
Vermeend, W., 370
vertical equity, 125–126, 292, 466, 543, 545
veterans, 316
Vhi Healthcare, 229–230, 234, 237–243, 252, 254
Viney, R., 54
visits, physician, 132, 168, 169, 225
VIVAS Health, 237
voluntarism, 497
Voluntary Health Insurance Act, 234
Voluntary Health Insurance (Amendment) Act, 240
Voluntary Health Insurance Board (VHI), 234
voters, 59
voucher systems, 23
vouchers, 149, 167, 192, 195see also I’Aide Complémentaire Santé (ACS)
wages, 313, 332, 498, 514
Wagner-Murray-Dingell Bill, 498
waiting times (lists), 25, 33, 55, 206–207, 209, 318, 320
Canada, 99, 108, 130, 134–135
Ireland, 235, 248–249
waiting times (cont.)
Israel, 269, 278, 282, 291–292
Netherlands, 369
USA, 506
Waldendzik, A., 190
Wang, C., 132
websites, 289
welfare, 54
wellness programmes, 423, 516
white-collar workers, 182, 183, 194
White Paper on Universal Health Insurance, 248
Willingness to Change, 356, 374
women, 196, 380
Woolhandler, S., 130
workers, 127, 452
Kenya, 329, 333
Netherlands, 349, 351
South Africa, 377, 391, 394, 438
USA, 496, 501, 511–512, 514–516, 539–540see also employees
workers associations, 351
workers’ cooperatives, 44
workers, health, 325, 332, 344
workers, public sector, 397
workforces, 269, 498–499, 515
workloads, 55, 248, 291
workplaces, 113, 154, 350, 430, 516
World Bank, 325, 330
World Health Organization (WHO), 332
World War Two, 350see also Second World War
Worthington, Paul, 530
Wren, M.-A., 229
Wright, D.J., 55
Xu, S.Y., 128
Yong, J., 53
York Health Economics Consortium, 238, 239
Zeckhauser, R., 239
Zhang, Q., 100, 132
Zhong, H., 129
Zweifel, P., 480

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