single-payer

Single-payer healthcare is a type of universal healthcare in which the costs of essential healthcare for all residents are covered by a single public system (hence "single-payer").

Single-payer systems may contract for healthcare services from private organizations (as is the case in Canada) or may own and employ healthcare resources and personnel (as is the case in the United Kingdom). "Single-payer" describes the mechanism by which healthcare is paid for by a single public authority, not a private authority, nor a mix of both.

Description

Within single-payer healthcare systems, a single government or government-related source pays for all covered healthcare services.Medical Subject Headings thesaurus, National Library of Medicin
"Single-Payer System"
Year introduced: 1996, (From Slee and Slee, Health Care Reform Terms, 1993, p. 106) Governments use this strategy to achieve several goals, including universal healthcare, decreased economic burden of health care, and improved health outcomes for the population. In 2010, the World Health Organization's member countries adopted universal healthcare as a goal; this goal was also adopted by the United Nations General Assembly in 2015 as part of the 2030 Agenda for Sustainable Development.

A single-payer health system establishes a single risk pool, consisting of the entire population of a geographic or political region. It also establishes a single set of rules for services offered, reimbursement rates, drug prices, and minimum standards for required services.

In wealthy nations, single-payer health insurance is typically available to all citizens and legal residents. Examples include the United Kingdom's National Health Service, Australia's Medicare, Canada's Medicare, and Taiwan's National Health Insurance.

History of the term

The term was coined in the 1990s to characterize the differences between the Canadian healthcare system with those such as the United Kingdom's NHS. In the Canadian healthcare system, the government pays private agencies to provide healthcare for qualifying individuals. In other systems, the government both funds and delivers care.Liu, J. L., & Brook, R. H. (2017). What is single-payer health care? A review of definitions and proposals in the U.S. Journal of General Internal Medicine, 32(7), 822-831.

Typically, "single-payer healthcare" refers to health insurance provided as a public service and offered to citizens and legal residents; it does not usually refer to delivery of healthcare services. The fund can be managed by the government directly or as a publicly owned and regulated agency. Single-payer contrasts with other funding mechanisms like 'multi-payer' (multiple public and/or private sources), 'two-tiered' (defined either as a public source with the option to use qualifying private coverage as a substitute, or as a public source for catastrophic care backed by private insurance for common medical care), and 'insurance mandate' (citizens are required to buy private insurance which meets a national standard and which is generally subsidized). Some systems combine elements of these four funding mechanisms.

In contrast to the standard usage of the term, some writers describe all publicly administered systems as "single-payer plans", and others have described any system of healthcare which intends to cover the entire population, such as voucher plans, as "single-payer plans", although these usages generally do not meet strict definitions of the term.

Regions with single-payer systems

Several nations worldwide have single-payer health insurance programs. These programs generally provide some form of universal health care, which is implemented in a variety of ways. In some cases doctors are employed and hospitals are run by the government, such as in the UK or Spain. Alternatively, the government may purchase healthcare services from outside organizations, such as the approach taken in Canada.

Canada

Healthcare in Canada is delivered through a publicly funded health care system, which is mostly free at the point of use and has most services provided by private entities.Public vs. private health care ''CBC'', December 1, 2006. The system was established by the provisions of the Canada Health Act of 1984. The government assures the quality of care through federal standards. The government does not participate in day-to-day care or collect any information about an individual's health, which remains confidential between a person and their physician.

Canada's provincially based Medicare systems are cost-effective partly because of their administrative simplicity. In each province, every doctor handles the insurance claim against the provincial insurer. There is no need for the person who accesses healthcare to be involved in billing and reclaim.

In general, costs are paid through funding from income taxes. A health card is issued by the Provincial Ministry of Health to each individual who enrolls for the program and everyone receives the same level of care.

There is no need for a variety of plans because virtually all essential basic care is covered, including maternity and infertility problems. Depending on the province, dental and vision care may not be covered but are often insured by employers through private companies. In some provinces, private supplemental plans are available for those who desire private rooms if they are hospitalized.

Cosmetic surgery and some forms of elective surgery are not considered essential care and are generally not covered. These can be paid out-of-pocket or through private insurers. Health coverage is not affected by loss or change of jobs, and there are no lifetime limits or exclusions for pre-existing conditions.

Pharmaceutical medications are covered by public funds, privately out-of-pocket or through employment-based private insurance. Drug prices are negotiated with suppliers by the federal government to control costs.

Family physicians (often known as general practitioners or GPs in Canada) are chosen by individuals. If a patient wishes to see a specialist or is counseled to see a specialist, a referral can be made by a GP.

Canadians do wait for some treatments and diagnostic services. Survey data shows that the median wait time to see a special physician is a little over four weeks with 89.5% waiting less than three months. The median wait time for diagnostic services such as MRI and CAT scans is two weeks, with 86.4% waiting less than three months. The median wait time for surgery is four weeks, with 82.2% waiting less than three months.

While physician income initially boomed after the implementation of a single-payer program, a reduction in physician salaries followed, which many feared would be a long-term result of government-run healthcare. However, by the beginning of the 21st century, medical professionals were again among Canada's top earners.

Taiwan

Healthcare in Taiwan is administered by the Department of Health of the Executive Yuan. As with other developed economies, Taiwanese people are well-nourished but face such health problems as chronic obesity and heart disease.

In 2002, Taiwan had nearly 1.6 physicians and 5.9 hospital beds per 1,000 population, and there were a total of 36 hospitals and 2,601 clinics in the island. ''This article incorporates text from this source, which is in the public domain.'' Health expenditures constituted 5.8% of the GDP in 2001, 64.9% of which coming from public funds.

Despite the initial shock on Taiwan's economy from increased costs of expanded healthcare coverage, the single-payer system has provided protection from greater financial risks and has made healthcare more financially accessible for the population, resulting in a steady 70% public satisfaction rating.

The current healthcare system in Taiwan, known as National Health Insurance (NHI), was instituted in 1995. NHI is a single-payer compulsory social insurance plan which centralizes the disbursement of health care funds. The system promises equal access to health care for all citizens, and the population coverage had reached 99% by the end of 2004.

NHI is mainly financed through premiums, which are based on the payroll tax, and is supplemented with out-of-pocket payments and direct government funding. In the initial stage, fee-for-service predominated for both public and private providers. Most health providers operate in the private sector and form a competitive market on the health delivery side. However, many healthcare providers took advantage of the system by offering unnecessary services to a larger number of patients and then billing the government.

In the face of increasing loss and the need for cost containment, NHI changed the payment system from fee-for-service to a global budget, a kind of prospective payment system, in 2002. Taiwan's success with a single-payer health insurance program is owed, in part, to the country's human resources and the government's organizational skills, allowing for the effective and efficient management of the government-run health insurance program.

South Korea

South Korea used to have a multipayer social health insurance universal healthcare system, similar to systems used in countries like Japan and Germany, with healthcare societies providing coverage for the whole populace. Prior to 1977, the country had voluntary private health insurance, but reforms initiated in 1977 resulted in universal coverage by 1989. A major healthcare financing reform in 2000 merged all medical societies into the National Health Insurance Service. This new service became a single-payer healthcare system in 2004.

Regions with 'Beveridge Model' systems

Nordic countries

The Nordic countries are sometimes considered to have single-payer health care services, as opposed to single-payer national health care insurance like Taiwan or Canada. This is a form of the ' Beveridge Model' of health care systems that features public health providers in addition to public health insurance.

The term "Scandinavian model" or "Nordic model" of health care systems has a few common features: largely public providers, limited private health coverage, and regionally-run, devolved systems with limited involvement from the central government. Due to this third characteristic, they can also be argued to be single-payer only on a regional level, or to be multi-payer systems, as opposed to the nationally run health coverage found in Taiwan and South Korea.

United Kingdom

Healthcare in the United Kingdom is a devolved matter, meaning that England, Scotland, Wales, and Northern Ireland all have their own system of private and publicly funded healthcare, generally referred to as the