Global Healthcare Report 2014 Edition

Transcript of Global Healthcare Report 2014 Edition

Global H

ealthcare Report

Global HealthcareReport
04 Countries154 Statistics170 Hospital Hierarchy172 Sources

Content
04 Countries154 Statistics170 Hospital Hierarchy172 Sources

Content
3Welcome2 Global Healthcare Report

All Global are international healthcare data specialists. We provide high quality healthcare research services for top global research companies and agencies across Europe, North and South America and Asia-Pacific. We target the right people using the right channels to deliver global, regional, local and niche stakeholder insights that will make a tangible difference to your business. Over time, we have established great relationships with our stakeholders payers, key opinion leaders, healthcare professionals and patients which translate into higher response rates and stronger, more reliable data for you.

We will partner with you to find the right combination of methodologies qualitative and quantitative, online and traditional to produce bold, considered, clear research that puts you and your clients ahead of the competition.

Welcome
3Welcome2 Global Healthcare Report

All Global are international healthcare data specialists. We provide high quality healthcare research services for top global research companies and agencies across Europe, North and South America and Asia-Pacific. We target the right people using the right channels to deliver global, regional, local and niche stakeholder insights that will make a tangible difference to your business. Over time, we have established great relationships with our stakeholders payers, key opinion leaders, healthcare professionals and patients which translate into higher response rates and stronger, more reliable data for you.

We will partner with you to find the right combination of methodologies qualitative and quantitative, online and traditional to produce bold, considered, clear research that puts you and your clients ahead of the competition.

Welcome
Countries
Countries
7Argentina

Healthcare System The Ministry of Health is responsible

for public health services, government hospitals and medical services.

There are three levels of healthcare provision: Public, Social (Obras Sociales) and Private.

Public health is financed via the national budget and managed by the national, provincial and municipal governments. It mostly covers the unemployed and low income groups but it also runs the majority of emergency care.

Social healthcare provision is funded by employers and employees who pay into a scheme organized by the trade union linked to the occupation of the beneficiary. These schemes are overseen by the National Health Insurance Administration.

The day-to-day provision of public services is done at a municipal level, leading to variation in levels of care.

The private sector accounts for 44% of total health expenditure.

Reimbursement Policies The public sector is funded by taxation

and accounts for 22% of total health expenditure. 2% is raised nationally, 16% provincially and 4% municipally.

Obras Sociales account for 24% of total health expenditure.

The unions outsource the provision of healthcare services to the private sector and patients have to pay the difference between the cost of treatment and a fixed fee.

Out-of-pocket payments account for 28% of the total health expenditure.

Argentina

Public versus PrivatePublic The national Ministry of Health

administers only four hospitals. About 1,000 public hospitals are run

by the provinces, while the remainder are run by municipalities.

Obras Sociales 3% of hospital beds are in the

Obras Sociales. There are over 300 Obras Sociales

schemes, the top 10% cover 75% of the groups beneficiaries.

Private 47% of hospital beds are in the

private sector. Approximately four million individuals,

10% of the population, have private insurance.

News, Developments and Notes Language: Spanish. Regulator: The National Administration

of Drugs, Foods and Medical Technology. Free healthcare for all is written into

Argentinas constitution.
7Argentina

Healthcare System The Ministry of Health is responsible

for public health services, government hospitals and medical services.

There are three levels of healthcare provision: Public, Social (Obras Sociales) and Private.

Public health is financed via the national budget and managed by the national, provincial and municipal governments. It mostly covers the unemployed and low income groups but it also runs the majority of emergency care.

Social healthcare provision is funded by employers and employees who pay into a scheme organized by the trade union linked to the occupation of the beneficiary. These schemes are overseen by the National Health Insurance Administration.

The day-to-day provision of public services is done at a municipal level, leading to variation in levels of care.

The private sector accounts for 44% of total health expenditure.

Reimbursement Policies The public sector is funded by taxation

and accounts for 22% of total health expenditure. 2% is raised nationally, 16% provincially and 4% municipally.

Obras Sociales account for 24% of total health expenditure.

The unions outsource the provision of healthcare services to the private sector and patients have to pay the difference between the cost of treatment and a fixed fee.

Out-of-pocket payments account for 28% of the total health expenditure.

Argentina

Public versus PrivatePublic The national Ministry of Health

administers only four hospitals. About 1,000 public hospitals are run

by the provinces, while the remainder are run by municipalities.

Obras Sociales 3% of hospital beds are in the

Obras Sociales. There are over 300 Obras Sociales

schemes, the top 10% cover 75% of the groups beneficiaries.

Private 47% of hospital beds are in the

private sector. Approximately four million individuals,

10% of the population, have private insurance.

News, Developments and Notes Language: Spanish. Regulator: The National Administration

of Drugs, Foods and Medical Technology. Free healthcare for all is written into

Argentinas constitution.
9Argentina8 Global Healthcare Report

Population

41,660,417 Area size

2,780,400 km2 Total doctors

131,647 Total hospitals

3,310 Total hospital beds

187,472

Buenos Aires

Crdoba Crdoba

Rosario Santa Fe

Mendoza Mendoza

Tucuman Tucuman

Demographics

7.32%

3.29%

2.98%

2.12%

1.89%

Capital Federal

Rank City Population Administrative division





1

2

3

4

5
9Argentina8 Global Healthcare Report

Population





187,472

Buenos Aires

Crdoba Crdoba

Rosario Santa Fe

Mendoza Mendoza

Tucuman Tucuman

Demographics

7.32%

3.29%

2.98%

2.12%

1.89%

Capital Federal






1

2

3

4

5
11 Australia

Australia

Healthcare System The government sets national health

policies and subsidizes health services provided by state and territory governments and the private sector.

State and territory governments deliver health services, including most acute and psychiatric hospitals.

The public healthcare system is known as Medicare. It is funded through the Medicare Levy and taxes.

The Medicare Benefits Schedule (MBS) is the schedule of fees set by the federal government for medical services.

In 2008, public spending accounted for 69% of total health expenditure, 43% from the Australian government and 26% by state and territory governments.

Private expenditure was just over 7% of total health spending.

Reimbursement Policies Medicare rebates 100% of the full

schedule fee for GP services, 85% of the non-hospital procedure fee, 75% of any inpatient fee and 85% of specialist consultations fees.

Taxpayers contribute at least 1.5% of income.

Out-of-pocket spending accounted for nearly 17% of healthcare expenditure.

Recommendations about which medications should be subsidized under the Pharmaceutical Benefits Schedule (PBS) are made by the Pharmaceutical Benefits Advisory Committee.

The PBS subsidizes a range of prescription medicines, with patients paying an additional premium on more expensive brands.

There are some 3,000 items listed on the PBS; in 2008, 334 attracted a premium.

Public versus PrivatePublic 10.5% of patients in public hospitals

are private patients. 752 public hospitals account for

68% of hospital beds. 60% of patients are treated in

public hospitals. In 2012, AUD864 million in

accommodation fees was paid by private health funds to public hospitals.

Private 40% of patients are treated in

private hospitals. 46.6% of residents have private insurance. 588 private hospitals account for about

32% of beds.

News, Developments and Notes Language: English. Regulator: Therapeutic Goods

Administration. In 2012, the government began

means testing for its 30% private healthcare rebate.

Ambulance fees are not covered by Medicare.

Patients can choose their GP. The Northern Territory only has

one private hospital.
11 Australia

Australia

Healthcare System The government sets national health

policies and subsidizes health services provided by state and territory governments and the private sector.

State and territory governments deliver health services, including most acute and psychiatric hospitals.

The public healthcare system is known as Medicare. It is funded through the Medicare Levy and taxes.

The Medicare Benefits Schedule (MBS) is the schedule of fees set by the federal government for medical services.

In 2008, public spending accounted for 69% of total health expenditure, 43% from the Australian government and 26% by state and territory governments.

Private expenditure was just over 7% of total health spending.

Reimbursement Policies Medicare rebates 100% of the full

schedule fee for GP services, 85% of the non-hospital procedure fee, 75% of any inpatient fee and 85% of specialist consultations fees.

Taxpayers contribute at least 1.5% of income.

Out-of-pocket spending accounted for nearly 17% of healthcare expenditure.

Recommendations about which medications should be subsidized under the Pharmaceutical Benefits Schedule (PBS) are made by the Pharmaceutical Benefits Advisory Committee.

The PBS subsidizes a range of prescription medicines, with patients paying an additional premium on more expensive brands.

There are some 3,000 items listed on the PBS; in 2008, 334 attracted a premium.

Public versus PrivatePublic 10.5% of patients in public hospitals

are private patients. 752 public hospitals account for

68% of hospital beds. 60% of patients are treated in

public hospitals. In 2012, AUD864 million in

accommodation fees was paid by private health funds to public hospitals.

Private 40% of patients are treated in

private hospitals. 46.6% of residents have private insurance. 588 private hospitals account for about

32% of beds.

News, Developments and Notes Language: English. Regulator: Therapeutic Goods

Administration. In 2012, the government began

means testing for its 30% private healthcare rebate.

Ambulance fees are not covered by Medicare.

Patients can choose their GP. The Northern Territory only has

one private hospital.
13 Australia12 Global Healthcare Report

Population





91,048

Sydney

Melbourne Victoria

Brisbane Queensland

Perth Western Australia

Adelaide South Australia

Demographics

20.91%

19.02%

9.81%

8.50%

5.72%






New South Wales

1

2

3

4

5
13 Australia12 Global Healthcare Report

Population





91,048

Sydney

Melbourne Victoria

Brisbane Queensland

Perth Western Australia

Adelaide South Australia

Demographics

20.91%

19.02%

9.81%

8.50%

5.72%






New South Wales

1

2

3

4

5
14 Global Healthcare Report 15 Austria

Austria

Healthcare System The federal government sets out the

legislation for outpatient care and lays down the legislative framework for inpatient care.

Provincial authorities define inpatient legislation in terms of enforcement as well as ensuring its implementation.

There are 24 social insurance institutions, of which 21 are health insurance funds. Membership of a health insurance fund is mandatory and is linked to occupation. Social insurance institutions are structured either regionally or according to occupation.

99% of inhabitants are covered by the healthcare system.

In 2007, about 76% of total health expenditure was generated from public sources.

Reimbursement Policies The federal government finances 25% of

healthcare and social health insurance finances around 45% .

21% of costs are covered by user charges and direct payments, with 15% of healthcare expenditure going on out-of-pocket levies.

Drugs placed on the positive list for outpatient care medicines, known as the Reimbursement Codex (or EKO), are generally paid for by the insurers. Of the approximately 9,800 permitted medications, around 4,200 are on the Codex.

Public versus PrivatePublic Of the 272 hospitals, 137 are covered by

public budgets. 60% of hospitals are publicly owned. Around 58% of beds are in public hospitals.

Private Around 30% of Austrians have additional

private health insurance, mainly linked to hospital costs insurance.

25% of beds are in private for- profit hospitals.

16% of beds are in private not-for- profit hospitals.

News, Developments and Notes Language: German. Regulator: Austrian Agency for Health

and Food Safety. Patients choose their GP. Austria has one of the highest doctor-

to-population ratios in the EU.
14 Global Healthcare Report 15 Austria

Austria

Healthcare System The federal government sets out the

legislation for outpatient care and lays down the legislative framework for inpatient care.

Provincial authorities define inpatient legislation in terms of enforcement as well as ensuring its implementation.

There are 24 social insurance institutions, of which 21 are health insurance funds. Membership of a health insurance fund is mandatory and is linked to occupation. Social insurance institutions are structured either regionally or according to occupation.

99% of inhabitants are covered by the healthcare system.

In 2007, about 76% of total health expenditure was generated from public sources.

Reimbursement Policies The federal government finances 25% of

healthcare and social health insurance finances around 45% .

21% of costs are covered by user charges and direct payments, with 15% of healthcare expenditure going on out-of-pocket levies.

Drugs placed on the positive list for outpatient care medicines, known as the Reimbursement Codex (or EKO), are generally paid for by the insurers. Of the approximately 9,800 permitted medications, around 4,200 are on the Codex.

Public versus PrivatePublic Of the 272 hospitals, 137 are covered by

public budgets. 60% of hospitals are publicly owned. Around 58% of beds are in public hospitals.

Private Around 30% of Austrians have additional

private health insurance, mainly linked to hospital costs insurance.

25% of beds are in private for- profit hospitals.

16% of beds are in private not-for- profit hospitals.

News, Developments and Notes Language: German. Regulator: Austrian Agency for Health

and Food Safety. Patients choose their GP. Austria has one of the highest doctor-

to-population ratios in the EU.
17 Austria16 Global Healthcare Report

Population

8,414,638 Area size

83,855 km2 Total doctors


310 Total hospital beds

63,951

Wien

Graz Steiermark

Linz Obersterreich

Salzburg Salzburg

Innsbruck Tirol

Demographics

19.78%

2.94%

2.24%

1.77%

1.40%

Wien






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2

3

4

5
17 Austria16 Global Healthcare Report

Population

8,414,638 Area size




63,951

Wien

Graz Steiermark

Linz Obersterreich

Salzburg Salzburg

Innsbruck Tirol

Demographics

19.78%

2.94%

2.24%

1.77%

1.40%

Wien






1

2

3

4

5
19 Belgium

Belgium

Healthcare System Healthcare is funded through mandatory

social security contributions and through health insurance schemes (mutuelle/mutualiteits) run by private or mutual insurers.

Individuals can choose an insurance scheme, although their employer usually enrolls them in one automatically, which may be linked to a union.

It is compulsory for residents to register with a social security organization to receive the Carte SIS (Social Identity Card), which is used to access care.

Belgium has one of the highest healthcare expenditures as a percentage of GDP in the EU.

74% of total health expenditure is in the public sector and 26% in the private.

Reimbursement Policies The cost of care is partially or fully

refunded, depending on criteria fixed by law.

In cases of hospitalization, patients pay supplemental charges but the main costs are paid directly to the hospital by insurers.

Out-of-pocket expenditure is around 23% of total health expenditure.

Drug reimbursements amount to, on average, 60%. The pharmacist only charges the non-insured amount.

About 2,500 pharmaceuticals are reimbursable. The amount reimbursed is determined by the pharmaceutical category.

The mutual insurers negotiate as a cartel with the drug companies on reimbursement rates under the supervision of the central government.

Public versus PrivatePublic 34% of beds are in public hospitals.

Private 66% of beds are in private hospitals. 70% of all hospitals are private. 99% of private hospitals are not-for

profit hospitals. Around 30% of the population have

private health insurance.

News, Developments and Notes Language: French, Flemish, German. Regulator: Federal Agency for Medicines

and Health Products. Patients can choose their doctor. Belgium has one of the highest rates

of GPs per capita in the EU. The number of nurses, however, is below average.
19 Belgium

Belgium

Healthcare System Healthcare is funded through mandatory

social security contributions and through health insurance schemes (mutuelle/mutualiteits) run by private or mutual insurers.

Individuals can choose an insurance scheme, although their employer usually enrolls them in one automatically, which may be linked to a union.

It is compulsory for residents to register with a social security organization to receive the Carte SIS (Social Identity Card), which is used to access care.

Belgium has one of the highest healthcare expenditures as a percentage of GDP in the EU.

74% of total health expenditure is in the public sector and 26% in the private.

Reimbursement Policies The cost of care is partially or fully

refunded, depending on criteria fixed by law.

In cases of hospitalization, patients pay supplemental charges but the main costs are paid directly to the hospital by insurers.

Out-of-pocket expenditure is around 23% of total health expenditure.

Drug reimbursements amount to, on average, 60%. The pharmacist only charges the non-insured amount.

About 2,500 pharmaceuticals are reimbursable. The amount reimbursed is determined by the pharmaceutical category.

The mutual insurers negotiate as a cartel with the drug companies on reimbursement rates under the supervision of the central government.

Public versus PrivatePublic 34% of beds are in public hospitals.

Private 66% of beds are in private hospitals. 70% of all hospitals are private. 99% of private hospitals are not-for

profit hospitals. Around 30% of the population have

private health insurance.

News, Developments and Notes Language: French, Flemish, German. Regulator: Federal Agency for Medicines

and Health Products. Patients can choose their doctor. Belgium has one of the highest rates

of GPs per capita in the EU. The number of nurses, however, is below average.
21Belgium20 Global Healthcare Report

Population





72,147

Antwerp

Gent Oost-Vlaanderen

Charleroi Hainaut

Lige Lige

Brussels (city) Brussels

Demographics

4.58%

2.24%

1.84%

1.77%

1.52%

Antwerp






1

2

3

4

5
21Belgium20 Global Healthcare Report

Population





72,147

Antwerp

Gent Oost-Vlaanderen

Charleroi Hainaut

Lige Lige

Brussels (city) Brussels

Demographics

4.58%

2.24%

1.84%

1.77%

1.52%

Antwerp






1

2

3

4

5
23 Brazil

Brazil

Healthcare System Healthcare in Brazil is funded

through compulsory salary-based contributions as well as federal, state and municipal taxes.

There are 26 states, one federal district and 5,564 municipalities, alongside the federal government.

The constitution guarantees unrestricted access to health services for all citizens. It is delivered via the Sistema nico de Sade (SUS).

In 2011, 45.7% of total health expenditure was on public services.

Reimbursement Policies The public healthcare system is limited

to medicines on the National List of Essential Drugs.

75% of drugs are reimbursed by the healthcare system and the remainder are paid out of pocket by patients.

Public versus PrivatePublic 36.6% of hospitals are public. 2.4% are University/Teaching hospitals. 28.6% of the population rely on the SUS. 40% of Brazilians do not have primary

care cover and so rely on emergency hospital care.

Private 61% of all hospitals are private. 25% of people have private medical

insurance.

News, Developments and Notes Language: Portuguese. Regulator: Health Surveillance Agency. In So Paolo there are 2.49 doctors

per 1,000 inhabitants. In wider Brazil there are 1.8.

The richest 15% of the population is responsible for over 40% of drug expenditure.

In February 2011, it was announced that medicines for hypertension and diabetes would be free.

30% of a medicines price relates to fees and taxes.

Brazil is one of the leading medical tourism destinations in South America.
23 Brazil

Brazil

Healthcare System Healthcare in Brazil is funded

through compulsory salary-based contributions as well as federal, state and municipal taxes.

There are 26 states, one federal district and 5,564 municipalities, alongside the federal government.

The constitution guarantees unrestricted access to health services for all citizens. It is delivered via the Sistema nico de Sade (SUS).

In 2011, 45.7% of total health expenditure was on public services.

Reimbursement Policies The public healthcare system is limited

to medicines on the National List of Essential Drugs.

75% of drugs are reimbursed by the healthcare system and the remainder are paid out of pocket by patients.

Public versus PrivatePublic 36.6% of hospitals are public. 2.4% are University/Teaching hospitals. 28.6% of the population rely on the SUS. 40% of Brazilians do not have primary

care cover and so rely on emergency hospital care.

Private 61% of all hospitals are private. 25% of people have private medical

insurance.

News, Developments and Notes Language: Portuguese. Regulator: Health Surveillance Agency. In So Paolo there are 2.49 doctors

per 1,000 inhabitants. In wider Brazil there are 1.8.

The richest 15% of the population is responsible for over 40% of drug expenditure.

In February 2011, it was announced that medicines for hypertension and diabetes would be free.

30% of a medicines price relates to fees and taxes.

Brazil is one of the leading medical tourism destinations in South America.
25Brazil24 Global Healthcare Report

Population

201,032,714 Area size




462,375

So Paulo

Rio de Janeiro Rio de Janeiro

Salvador Bahia

Brasilia Distrito Federal

Fortaleza Cear

Demographics

5.59%

3.15%

1.33%

1.27%

1.27%

So Paulo






1

2

3

4

5
25Brazil24 Global Healthcare Report

Population

201,032,714 Area size




462,375

So Paulo

Rio de Janeiro Rio de Janeiro

Salvador Bahia

Brasilia Distrito Federal

Fortaleza Cear

Demographics

5.59%

3.15%

1.33%

1.27%

1.27%

So Paulo






1

2

3

4

5
27 Canada

Canada

Healthcare System Canada has a national program

composed of 14 interlocking provincial and territorial health insurance plans.

The system is framed by the Canada Health Act.

Roles and responsibilities are shared between the federal and provincial-territorial governments.

Federal government plans cover veterans, native Canadians, Royal Canadian Mounted Police and members of the armed forces.

Care is delivered through a mix of private and public channels.

There is no national insurance plan for outpatient prescription drugs, yet roughly 10% of the population has no insurance cover for prescription drugs.

The public sector accounts for almost 70% of total health expenditure.

Reimbursement Policies The system is predominantly publicly

financed via taxation. All provinces have publicly-funded

drug plans. Many employers provide private group

insurance coverage. 15% of total healthcare expenditure

is from out-of-pocket payments. Each province makes its own decision

about funding new drugs. 30% of total expenditure is paid

through private insurance or out- of-pocket payments.

Public versus PrivatePublic Almost all hospital care is considered

a fully insured service under the Canada Health Act.

Private 66% of the population has private

health insurance. Private health insurance accounts for

12% of total healthcare expenditure.

News, Developments and Notes Language: English/French. Regulator: Health Products and

Food Branch. Canadas healthcare system is

sometimes referred to as Medicare. The system is closer to the European

model than the US system.
27 Canada

Canada

Healthcare System Canada has a national program

composed of 14 interlocking provincial and territorial health insurance plans.

The system is framed by the Canada Health Act.

Roles and responsibilities are shared between the federal and provincial-territorial governments.

Federal government plans cover veterans, native Canadians, Royal Canadian Mounted Police and members of the armed forces.

Care is delivered through a mix of private and public channels.

There is no national insurance plan for outpatient prescription drugs, yet roughly 10% of the population has no insurance cover for prescription drugs.

The public sector accounts for almost 70% of total health expenditure.

Reimbursement Policies The system is predominantly publicly

financed via taxation. All provinces have publicly-funded

drug plans. Many employers provide private group

insurance coverage. 15% of total healthcare expenditure

is from out-of-pocket payments. Each province makes its own decision

about funding new drugs. 30% of total expenditure is paid

through private insurance or out- of-pocket payments.

Public versus PrivatePublic Almost all hospital care is considered

a fully insured service under the Canada Health Act.

Private 66% of the population has private

health insurance. Private health insurance accounts for

12% of total healthcare expenditure.

News, Developments and Notes Language: English/French. Regulator: Health Products and

Food Branch. Canadas healthcare system is

sometimes referred to as Medicare. The system is closer to the European

model than the US system.
29 Canada28 Global Healthcare Report

Population





112,507

Toronto

Montral Quebec

Calgary Alberta

Ottawa Ontario

Edmonton Alberta

Demographics

7.81%

4.93%

3.28%

2.64%

2.45%

Ontario






1

2

3

4

5
29 Canada28 Global Healthcare Report

Population





112,507

Toronto

Montral Quebec

Calgary Alberta

Ottawa Ontario

Edmonton Alberta

Demographics

7.81%

4.93%

3.28%

2.64%

2.45%

Ontario






1

2

3

4

5
31 China

China

Healthcare System There are three healthcare provision

programs in China. The New Rural Co-operative Medical

Scheme (NRCMS) covers some 80% the rural population.

The mandatory Urban Employee Basic Medical Insurance (UEBMI) covers some 300 million people in employment.

The Urban Residents Basic Medical Insurance (URBMI), for those who are unemployed, covers 60% of the 200 million target population.

In 2011, over 95% of the population was covered by one of these three schemes.

Reimbursement Policies The Ministry of Finance is responsible

for the total budget. NRCMS and URBMI are mostly funded by central government, provincial governments and patients.

UEBMI is funded through payroll deductions, with employers paying 6% and employees 2%.

Co-payments can be as much as 35% and under NRCMS can account for as much as 90% of the total bill.

Public versus Private There are three tiers of hospital, with

Tier 3 being the highest. Tier 3 and Tier 2 are general hospitals and Tier 1 are community hospitals.

Public Around 90% of hospitals in China

are public. Patients are given prescriptions

in hospitals and buy those drugs in hospitals.

Private Private healthcare insurance is usually

taken out to supplement state care. About 30% of Chinas urban population

has a form of private healthcare.

News, Developments and Notes Language: Mandarin. Regulator: Chinas State Food and

Drug Administration. The government is trying to encourage

more patients to go to Tier 1 hospitals to alleviate the burden on higher tier hospitals.

As of 2012, reforms have seen the diagnosis and registration fee increased so the hospitals dont have to rely on earnings from selling prescribed drugs. However, this has yet to be applied anywhere outside Beijing.

Foreign companies in healthcare services must have Chinese partners that hold at least 30% of total equity.
31 China

China

Healthcare System There are three healthcare provision

programs in China. The New Rural Co-operative Medical

Scheme (NRCMS) covers some 80% the rural population.

The mandatory Urban Employee Basic Medical Insurance (UEBMI) covers some 300 million people in employment.

The Urban Residents Basic Medical Insurance (URBMI), for those who are unemployed, covers 60% of the 200 million target population.

In 2011, over 95% of the population was covered by one of these three schemes.

Reimbursement Policies The Ministry of Finance is responsible

for the total budget. NRCMS and URBMI are mostly funded by central government, provincial governments and patients.

UEBMI is funded through payroll deductions, with employers paying 6% and employees 2%.

Co-payments can be as much as 35% and under NRCMS can account for as much as 90% of the total bill.

Public versus Private There are three tiers of hospital, with

Tier 3 being the highest. Tier 3 and Tier 2 are general hospitals and Tier 1 are community hospitals.

Public Around 90% of hospitals in China

are public. Patients are given prescriptions

in hospitals and buy those drugs in hospitals.

Private Private healthcare insurance is usually

taken out to supplement state care. About 30% of Chinas urban population

has a form of private healthcare.

News, Developments and Notes Language: Mandarin. Regulator: Chinas State Food and

Drug Administration. The government is trying to encourage

more patients to go to Tier 1 hospitals to alleviate the burden on higher tier hospitals.

As of 2012, reforms have seen the diagnosis and registration fee increased so the hospitals dont have to rely on earnings from selling prescribed drugs. However, this has yet to be applied anywhere outside Beijing.

Foreign companies in healthcare services must have Chinese partners that hold at least 30% of total equity.
33 China32 Global Healthcare Report

Population

1,350,695,000 Area size


1,966,612 Total hospitals


5,132,641

Guangzhou

Shanghai Shanghai

Beijing Beijing

Shantou Guangdong

Shenzen Guangdong

Demographics

3.31%

2.09%

1.48%

0.87%

0.77%

Guangdong






1

2

3

4

5
33 China32 Global Healthcare Report

Population

1,350,695,000 Area size


1,966,612 Total hospitals


5,132,641

Guangzhou

Shanghai Shanghai

Beijing Beijing

Shantou Guangdong

Shenzen Guangdong

Demographics

3.31%

2.09%

1.48%

0.87%

0.77%

Guangdong






1

2

3

4

5
35 Czech Republic

Czech Republic

Healthcare System The Czech Republic has a social

health system based on compulsory membership in insurance funds.

There are nine decentralized, independent and not-for-profit insurers, which collect the funds.

Eligible residents can choose the insurance fund.

State-guaranteed insurance covers almost 63% of the population, including most of the unemployed.

In 2011, 84.2% of total healthcare expenditure was in the public sector.

Reimbursement Policies Financed through mandatory

contributions usually through payroll contributions from both employers and employees.

Out-of-pocket expenses account for over 10% of healthcare expenditure.

Public versus PrivatePublic Accounts for 71% of hospital beds.

Private Accounts for 29% of hospital beds.

News, Developments and Notes Language: Czech. Regulator: State Institute for

Drug Control. Patients are free to choose a GP. The Czech Republic has more

physicians per capita than many other OECD countries.
35 Czech Republic

Czech Republic

Healthcare System The Czech Republic has a social

health system based on compulsory membership in insurance funds.

There are nine decentralized, independent and not-for-profit insurers, which collect the funds.

Eligible residents can choose the insurance fund.

State-guaranteed insurance covers almost 63% of the population, including most of the unemployed.

In 2011, 84.2% of total healthcare expenditure was in the public sector.

Reimbursement Policies Financed through mandatory

contributions usually through payroll contributions from both employers and employees.

Out-of-pocket expenses account for over 10% of healthcare expenditure.

Public versus PrivatePublic Accounts for 71% of hospital beds.

Private Accounts for 29% of hospital beds.

News, Developments and Notes Language: Czech. Regulator: State Institute for

Drug Control. Patients are free to choose a GP. The Czech Republic has more

physicians per capita than many other OECD countries.
37 Czech Republic36 Global Healthcare Report

Population




357Total hospital beds

73,592

Praha

Brno Jihomoravsky

Ostrava Moravskolezsky

Plzen Plzensky

Liberec Liberecky

Demographics

11.81%

3.67%

2.85%

1.62%

0.97%

Praha






1

2

3

4

5
37 Czech Republic36 Global Healthcare Report

Population





73,592

Praha

Brno Jihomoravsky

Ostrava Moravskolezsky

Plzen Plzensky

Liberec Liberecky

Demographics

11.81%

3.67%

2.85%

1.62%

0.97%

Praha






1

2

3

4

5
39 Denmark

Denmark

Healthcare System The health system has three

administrative levels: state, region and local.

There are five regions and 98 municipalities.

The regions are responsible for delivering both primary and secondary sector health services.

There are two levels: Group 1 members (98% of the population) are attached to one GP and need a referral for specialist visits. Visits to GPs and specialists are free. Group 2 members can choose a GP and visit a specialist without a referral.

In 2010, health expenditure was 85% public and 15% private.

Reimbursement Policies 82% of health spending is funded by

state and municipal taxation. 8% of taxable income goes towards

healthcare. 14% of private expenditure was out-of-

pocket spending on drugs. The state makes block grants to the five

regions (80%) and the municipalities (20%). The regions only cover part of the costs

for Group 2 members.

Public versus PrivatePublic 53 hospitals (Note: several different

locations have merged so that many hospitals now consist of several geographically distinct units being managed together.)

Private Private hospitals have a capacity

of approximately 500 beds, or 2.5% of all hospital beds.

About 30% of the population purchases Voluntary Health Insurance to cover the costs of statutory co-payments.

13.5% of the population has private insurance, mainly as an employment benefit.

News, Developments and Notes Language: Danish. Regulators: The Danish Medicines Agency. If waiting times exceed one month,

individuals may seek treatment at private hospitals (even abroad as long as the chosen hospital has an agreement with the regions association).

In 2013, Denmark announced a $7 billion plan to build 16 new hospitals, including eight super hospitals.
39 Denmark

Denmark

Healthcare System The health system has three

administrative levels: state, region and local.

There are five regions and 98 municipalities.

The regions are responsible for delivering both primary and secondary sector health services.

There are two levels: Group 1 members (98% of the population) are attached to one GP and need a referral for specialist visits. Visits to GPs and specialists are free. Group 2 members can choose a GP and visit a specialist without a referral.

In 2010, health expenditure was 85% public and 15% private.

Reimbursement Policies 82% of health spending is funded by

state and municipal taxation. 8% of taxable income goes towards

healthcare. 14% of private expenditure was out-of-

pocket spending on drugs. The state makes block grants to the five

regions (80%) and the municipalities (20%). The regions only cover part of the costs

for Group 2 members.

Public versus PrivatePublic 53 hospitals (Note: several different

locations have merged so that many hospitals now consist of several geographically distinct units being managed together.)

Private Private hospitals have a capacity

of approximately 500 beds, or 2.5% of all hospital beds.

About 30% of the population purchases Voluntary Health Insurance to cover the costs of statutory co-payments.

13.5% of the population has private insurance, mainly as an employment benefit.

News, Developments and Notes Language: Danish. Regulators: The Danish Medicines Agency. If waiting times exceed one month,

individuals may seek treatment at private hospitals (even abroad as long as the chosen hospital has an agreement with the regions association).

In 2013, Denmark announced a $7 billion plan to build 16 new hospitals, including eight super hospitals.
41Denmark40 Global Healthcare Report

Population

5,602,536 Area size




19,609

Kobenhavn

rhus rhus

Odense Fyn

lborg Nordjylland

Frederiksberg rhus

Demographics

9.43%

4.34%

2.99%

1.83%

1.77%

Kobenhavns Kommune






1

2

3

4

5
41Denmark40 Global Healthcare Report

Population

5,602,536 Area size




19,609

Kobenhavn

rhus rhus

Odense Fyn

lborg Nordjylland

Frederiksberg rhus

Demographics

9.43%

4.34%

2.99%

1.83%

1.77%

Kobenhavns Kommune






1

2

3

4

5
43 Finland

Finland

Healthcare System Every resident in Finland has the right

to health services regardless of ability to pay or place of residence.

The 342 municipalities have, by law, the main responsibility for healthcare. They can work alone or in partnership.

There are three levels of cover: municipal healthcare funded by taxes, private healthcare partly funded by National Health Insurance (NHI), and occupational (or preventative) healthcare partly funded by NHI.

Under the Occupational Health Act, employers are required to arrange, at their own expense, professional- level occupational health services for employees.

The government social insurance agency, known as KELA, is responsible for coordinating the state contribution system.

75% of total health expenditure was in the public sector while the private sector accounted for 25%.

Reimbursement Policies The Finnish healthcare service receives

80% of its funding through general taxation, which is collected by local and national government.

Reimbursement is calculated based on a set of fixed fees, which means that citizens may have to pay some of the costs themselves.

Municipalities have the right to levy taxes and to collect out-of-pocket user fees.

Public versus PrivatePublic Hospitals are owned and run by

joint authorities. Mainland Finland has 20 hospital

districts. Every municipality must belong to a hospital district.

The largest district is Helsinki and Uusimaa (32 hospitals).

95% of beds are in public hospitals.

Private 3.5% of beds are private.

News, Developments and Notes Language: Finnish/Swedish. Regulator: Finnish Medicines Agency. In 2011, health spending as a share

of GDP was lower than in all other Nordic countries, except Iceland (which had the same share).

Healthcare services on the autonomous land Islands are provided based on the Act on the Autonomy of land.
43 Finland

Finland

Healthcare System Every resident in Finland has the right

to health services regardless of ability to pay or place of residence.

The 342 municipalities have, by law, the main responsibility for healthcare. They can work alone or in partnership.

There are three levels of cover: municipal healthcare funded by taxes, private healthcare partly funded by National Health Insurance (NHI), and occupational (or preventative) healthcare partly funded by NHI.

Under the Occupational Health Act, employers are required to arrange, at their own expense, professional- level occupational health services for employees.

The government social insurance agency, known as KELA, is responsible for coordinating the state contribution system.

75% of total health expenditure was in the public sector while the private sector accounted for 25%.

Reimbursement Policies The Finnish healthcare service receives

80% of its funding through general taxation, which is collected by local and national government.

Reimbursement is calculated based on a set of fixed fees, which means that citizens may have to pay some of the costs themselves.

Municipalities have the right to levy taxes and to collect out-of-pocket user fees.

Public versus PrivatePublic Hospitals are owned and run by

joint authorities. Mainland Finland has 20 hospital

districts. Every municipality must belong to a hospital district.

The largest district is Helsinki and Uusimaa (32 hospitals).

95% of beds are in public hospitals.

Private 3.5% of beds are private.

News, Developments and Notes Language: Finnish/Swedish. Regulator: Finnish Medicines Agency. In 2011, health spending as a share

of GDP was lower than in all other Nordic countries, except Iceland (which had the same share).

Healthcare services on the autonomous land Islands are provided based on the Act on the Autonomy of land.
45 Finland44 Global Healthcare Report

Population

5,421,827 Area size




31,989

Helsinki

Espoo Uusimaa

Tampere Pirkanmaa

Vantaa Uusimaa

Turku Varsinais

Demographics

10.65%

4.90%

3.87%

3.62%

3.36%

Uusimaa






1

2

3

4

5
45 Finland44 Global Healthcare Report

Population

5,421,827 Area size




31,989

Helsinki

Espoo Uusimaa

Tampere Pirkanmaa

Vantaa Uusimaa

Turku Varsinais

Demographics

10.65%

4.90%

3.87%

3.62%

3.36%

Uusimaa






1

2

3

4

5
47 France

France

Healthcare System France has a national social insurance

system that covers almost the entire population. It is complex, with allowances and contributions varying according to a persons status.

It is supported by tax-based financing and voluntary health insurance.

All residents in France are obliged by law to have health insurance.

Most of the population has complementary health insurance to cover their share of the costs from the public and private system.

In 2011, public spending accounted for 76.8% of total healthcare expenditure.

Reimbursement Policies The public health insurance scheme is

financed by employer and employee payroll taxes (43%); a national income tax (33%); revenue from taxes levied on tobacco and alcohol (8%); state subsidies (2%); and transfers from other branches of social security (8%).

Out-of-pocket expenses amount to 7.8%. Most drugs are covered at a rate of 65%

but, depending on the type and perceived merit of the product, this can range from 15% to 100%.

Direct payments by households constitute 7.6% of total health expenditures, while 13.8% are paid by health insurance schemes.

Public versus PrivatePublic 65.5% of all beds are in public hospitals. Health authorities regulate the size

and numbers of hospitals, managing the allocation of technical equipment such as MRI/CT scans, etc.

Public hospitals have specific obligations such as continuity of care and teaching.

Private 34.5% of all beds are in the private

sector, of which 20% are in private for-profit hospitals and nearly 15% are in private not-for-profit hospitals.

68% of GPs are self-employed. Clinics concentrate on surgical

procedures and depend on fee-for-service for funding.

News, Developments and Notes Language: French. Regulator: National Agency for the

Safety of Medicine and Health Products. In 2011, the number of hospital beds

in France was significantly higher than the OECD average.

About 4,500 pharmaceuticals are reimbursable in France, which represents approximately one half of the drugs available.
47 France

France

Healthcare System France has a national social insurance

system that covers almost the entire population. It is complex, with allowances and contributions varying according to a persons status.

It is supported by tax-based financing and voluntary health insurance.

All residents in France are obliged by law to have health insurance.

Most of the population has complementary health insurance to cover their share of the costs from the public and private system.

In 2011, public spending accounted for 76.8% of total healthcare expenditure.

Reimbursement Policies The public health insurance scheme is

financed by employer and employee payroll taxes (43%); a national income tax (33%); revenue from taxes levied on tobacco and alcohol (8%); state subsidies (2%); and transfers from other branches of social security (8%).

Out-of-pocket expenses amount to 7.8%. Most drugs are covered at a rate of 65%

but, depending on the type and perceived merit of the product, this can range from 15% to 100%.

Direct payments by households constitute 7.6% of total health expenditures, while 13.8% are paid by health insurance schemes.

Public versus PrivatePublic 65.5% of all beds are in public hospitals. Health authorities regulate the size

and numbers of hospitals, managing the allocation of technical equipment such as MRI/CT scans, etc.

Public hospitals have specific obligations such as continuity of care and teaching.

Private 34.5% of all beds are in the private

sector, of which 20% are in private for-profit hospitals and nearly 15% are in private not-for-profit hospitals.

68% of GPs are self-employed. Clinics concentrate on surgical

procedures and depend on fee-for-service for funding.

News, Developments and Notes Language: French. Regulator: National Agency for the

Safety of Medicine and Health Products. In 2011, the number of hospital beds

in France was significantly higher than the OECD average.

About 4,500 pharmaceuticals are reimbursable in France, which represents approximately one half of the drugs available.
49 France48 Global Healthcare Report

Population




4,171Total hospital beds

418,836

Paris

Marseille Bouches du Rhne

Lyon Rhne

Toulouse Haute Garonne

Nice Alpes Maritimes

Demographics

3.35%

1.26%

0.70%

0.62%

0.54%

Paris






1

2

3

4

5
49 France48 Global Healthcare Report

Population





418,836

Paris

Marseille Bouches du Rhne

Lyon Rhne

Toulouse Haute Garonne

Nice Alpes Maritimes

Demographics

3.35%

1.26%

0.70%

0.62%

0.54%

Paris






1

2

3

4

5
51 Germany

Germany

Healthcare System Responsibility for the healthcare

system is shared between the states, the federal government and civil society organizations.

About 87% of the population is covered by statutory health insurance offered by the statutory sickness funds.

10% of people have private health insurance.

2% are covered by other governmental schemes, such as the scheme for soldiers.

About 9% of the population purchases supplementary health insurance (SHI) to cover items that arent part of the standard benefit package.

In 2011, the public sector accounted for 76.5% of total healthcare expenditure.

Reimbursement Policies Sickness fund contributions are set

by the government. The contribution rate of 15.5% is split between employers and employees. Employees currently pay 8.2% and employers 7.3%.

Out-of-pocket payments (13.3%), are mostly spent on OTC medicines and co-payments for prescription drugs, outpatient visits and hospital stays.

All prescription drugs including newly licensed ones are covered unless explicitly excluded by law.

If a physician issues a prescription for a specific medicine without excluding substitution, a pharmacist must dispense the prescribed medicine or one of the three cheapest alternatives.

Pharmacists are paid a flat amount for filling prescriptions, so have no financial incentive to dispense the more expensive drugs.

Public versus PrivatePublic 53% of hospitals are public. Regardless of ownership, hospitals are

staffed principally by salaried doctors. The 16 state governments determine

hospital capacity.

Private 39% are not-for-profit private hospitals. 8% are for-profit hospitals. Based on risk-related premiums, with

separate premiums for dependents. Risk is assessed upon entry and contracts are based on lifetime underwriting.

News, Developments and Notes Language: German. Regulator: Federal Institute for Drugs

and Medical Devices. German law requires everyone living in

Germany to be insured for at least hospital and outpatient medical treatment.

Anyone earning more than 49,500 per annum has the option of purchasing a private health insurance plan, although upwards of 85% opt to remain with SHI.

Germany has one of the highest levels of hospital beds per capita amongst OECD countries.
51 Germany

Germany

Healthcare System Responsibility for the healthcare

system is shared between the states, the federal government and civil society organizations.

About 87% of the population is covered by statutory health insurance offered by the statutory sickness funds.

10% of people have private health insurance.

2% are covered by other governmental schemes, such as the scheme for soldiers.

About 9% of the population purchases supplementary health insurance (SHI) to cover items that arent part of the standard benefit package.

In 2011, the public sector accounted for 76.5% of total healthcare expenditure.

Reimbursement Policies Sickness fund contributions are set

by the government. The contribution rate of 15.5% is split between employers and employees. Employees currently pay 8.2% and employers 7.3%.

Out-of-pocket payments (13.3%), are mostly spent on OTC medicines and co-payments for prescription drugs, outpatient visits and hospital stays.

All prescription drugs including newly licensed ones are covered unless explicitly excluded by law.

If a physician issues a prescription for a specific medicine without excluding substitution, a pharmacist must dispense the prescribed medicine or one of the three cheapest alternatives.

Pharmacists are paid a flat amount for filling prescriptions, so have no financial incentive to dispense the more expensive drugs.

Public versus PrivatePublic 53% of hospitals are public. Regardless of ownership, hospitals are

staffed principally by salaried doctors. The 16 state governments determine

hospital capacity.

Private 39% are not-for-profit private hospitals. 8% are for-profit hospitals. Based on risk-related premiums, with

separate premiums for dependents. Risk is assessed upon entry and contracts are based on lifetime underwriting.

News, Developments and Notes Language: German. Regulator: Federal Institute for Drugs

and Medical Devices. German law requires everyone living in

Germany to be insured for at least hospital and outpatient medical treatment.

Anyone earning more than 49,500 per annum has the option of purchasing a private health insurance plan, although upwards of 85% opt to remain with SHI.

Germany has one of the highest levels of hospital beds per capita amongst OECD countries.
53 Germany52 Global Healthcare Report

Population





668,861

Berlin

Hamburg Hamburg

Mnchen Bayern

Kln Nordrhein-Westfallen

Frankfurt Hessen

Demographics

4.31%

2.23%

1.69%

1.23%

0.85%

Berlin






1

2

3

4

5
53 Germany52 Global Healthcare Report

Population





668,861

Berlin

Hamburg Hamburg

Mnchen Bayern

Kln Nordrhein-Westfallen

Frankfurt Hessen

Demographics

4.31%

2.23%

1.69%

1.23%

0.85%

Berlin






1

2

3

4

5
55 Greece

Greece

Healthcare System The Greek system is a mixture of public-

private provision of healthcare services. The National Health System comprises

public hospitals, health centers and emergency care.

The Social Security Institution (IKA) and other social insurance funds offer different insurance coverage. Approximately 30 social health insurance funds provide coverage to about 97% of the population. IKA is the largest fund, covering 50% of the population.

The private sector tends to comprise diagnostic centers, private clinics, laboratories, etc.

Health insurance in Greece is compulsory, with people being designated a fund linked to their occupation.

Employees must have worked at least 50 days in the last year or within the preceding 15 months (the last three months are not taken into account) to benefit from IKA insurance.

In 2011, 65% of total healthcare expenditure goes on the public sector.

Reimbursement Policies Healthcare is funded by general taxation,

social premiums and private premiums. The tax system contributes 29.1% of total health expenditure while health insurance accounts for 31.2%.

Medicines are vastly subsidized only 25% of the cost of the prescription is charged.

Out-of-pocket expenditure constitutes about 37% of total health expenditure.

Public versus PrivatePublic The availability of public hospitals

is limited to certain areas, normally clustering in big cities.

Although they can be consulted directly, public hospital residents usually have long waiting lists.

Around 72% of beds are in public hospitals. Doctors working in public hospitals

and health centers are not allowed to engage in private practice.

Private About 12% of the population has

private insurance. Private hospitals account for 28% of

all beds.

News, Developments and Notes Language: Greek. Regulator: National Organization

for Medicines. Despite much upheaval, there remain

more physicians per capita in Greece than in any other OECD country.

Under-the-table payments are a continuing problem.

While patients cant choose their insurer, there is a large degree of choice of provider.
55 Greece

Greece

Healthcare System The Greek system is a mixture of public-

private provision of healthcare services. The National Health System comprises

public hospitals, health centers and emergency care.

The Social Security Institution (IKA) and other social insurance funds offer different insurance coverage. Approximately 30 social health insurance funds provide coverage to about 97% of the population. IKA is the largest fund, covering 50% of the population.

The private sector tends to comprise diagnostic centers, private clinics, laboratories, etc.

Health insurance in Greece is compulsory, with people being designated a fund linked to their occupation.

Employees must have worked at least 50 days in the last year or within the preceding 15 months (the last three months are not taken into account) to benefit from IKA insurance.

In 2011, 65% of total healthcare expenditure goes on the public sector.

Reimbursement Policies Healthcare is funded by general taxation,

social premiums and private premiums. The tax system contributes 29.1% of total health expenditure while health insurance accounts for 31.2%.

Medicines are vastly subsidized only 25% of the cost of the prescription is charged.

Out-of-pocket expenditure constitutes about 37% of total health expenditure.

Public versus PrivatePublic The availability of public hospitals

is limited to certain areas, normally clustering in big cities.

Although they can be consulted directly, public hospital residents usually have long waiting lists.

Around 72% of beds are in public hospitals. Doctors working in public hospitals

and health centers are not allowed to engage in private practice.

Private About 12% of the population has

private insurance. Private hospitals account for 28% of

all beds.

News, Developments and Notes Language: Greek. Regulator: National Organization

for Medicines. Despite much upheaval, there remain

more physicians per capita in Greece than in any other OECD country.

Under-the-table payments are a continuing problem.

While patients cant choose their insurer, there is a large degree of choice of provider.
57 Greece56 Global Healthcare Report

Population



65,973Total hospitals


35,000

Athens

Thessalonki Macedonia

Patras West Greece

Heraklion Crete

Larissa Thessaly

Demographics

28.42%

7.31%

1.94%

1.60%

1.51%

Attica






1

2

3

4

5
57 Greece56 Global Healthcare Report

Population





35,000

Athens

Thessalonki Macedonia

Patras West Greece

Heraklion Crete

Larissa Thessaly

Demographics

28.42%

7.31%

1.94%

1.60%

1.51%

Attica






1

2

3

4

5
59 Hungary

Hungary

Healthcare System The system is based on social health

insurance that covers virtually the entire population.

It has undergone extensive privatization and its funding is now predominantly through the Health Insurance Fund.

Municipalities are responsible for providing primary care, while responsibility for secondary and tertiary services is shared between municipalities, counties and central government.

Membership is compulsory for all those living in Hungary.

Voluntary health insurance (or top ups) exist in Hungary but only represent a negligible source of healthcare financing.

In 2011, public expenditure accounted for 65% of total healthcare expenditure.

Reimbursement Policies The National Health Insurance Fund

Administration is responsible for healthcare financing.

Healthcare is financed by health insurance contributions. Employees pay 3% of their total income, while employers pay 15% of the employees gross salary plus a lump sum tax or healthcare contribution.

In 2008, contributions constituted 71% of all revenues of the Health Insurance Fund.

Out-of-pocket payments account for about 18% of expenditure.

Public versus PrivatePublic Over 76% of hospital beds are in the

public sector. Most public hospitals are owned by

regional and local authorities; university and big hospitals for specialized treatments are still owned by the state.

Private 23% of private hospitals are not for

profit with the remainder profit making. In secondary outpatient care, many

doctors offer part-time private clinics in addition to their public sector work.

Some private polyclinics simply charge patients directly for services.

News, Developments and Notes Language: Hungarian. Regulator: National Institute of Pharmacy. Due to the low wages of medical staff,

there is also a tradition of paying gratitude money after operations or childbirth.

Patients can choose their GP.
59 Hungary

Hungary

Healthcare System The system is based on social health

insurance that covers virtually the entire population.

It has undergone extensive privatization and its funding is now predominantly through the Health Insurance Fund.

Municipalities are responsible for providing primary care, while responsibility for secondary and tertiary services is shared between municipalities, counties and central government.

Membership is compulsory for all those living in Hungary.

Voluntary health insurance (or top ups) exist in Hungary but only represent a negligible source of healthcare financing.

In 2011, public expenditure accounted for 65% of total healthcare expenditure.

Reimbursement Policies The National Health Insurance Fund

Administration is responsible for healthcare financing.

Healthcare is financed by health insurance contributions. Employees pay 3% of their total income, while employers pay 15% of the employees gross salary plus a lump sum tax or healthcare contribution.

In 2008, contributions constituted 71% of all revenues of the Health Insurance Fund.

Out-of-pocket payments account for about 18% of expenditure.

Public versus PrivatePublic Over 76% of hospital beds are in the

public sector. Most public hospitals are owned by

regional and local authorities; university and big hospitals for specialized treatments are still owned by the state.

Private 23% of private hospitals are not for

profit with the remainder profit making. In secondary outpatient care, many

doctors offer part-time private clinics in addition to their public sector work.

Some private polyclinics simply charge patients directly for services.

News, Developments and Notes Language: Hungarian. Regulator: National Institute of Pharmacy. Due to the low wages of medical staff,

there is also a tradition of paying gratitude money after operations or childbirth.

Patients can choose their GP.
61 Hungary60 Global Healthcare Report

Population

9,908,798 Area size




71,343

Budapest

Debrecen Hajd- Bihar

Szeged Csongrd

Miskolc Borsod- Abaj- Zempln

Pcs Baranya

Demographics

17.56%

2.10%

1.72%

1.68%

1.58%

Budapest






1

2

3

4

5
61 Hungary60 Global Healthcare Report

Population

9,908,798 Area size




71,343

Budapest

Debrecen Hajd- Bihar

Szeged Csongrd

Miskolc Borsod- Abaj- Zempln

Pcs Baranya

Demographics

17.56%

2.10%

1.72%

1.68%

1.58%

Budapest






1

2

3

4

5
63 India

India

Healthcare System The healthcare system in India is

overseen by the Ministry of Health and Family Welfare.

While India does have a universal healthcare system, it is dominated by private healthcare providers.

Less than 15% of the Indian population is covered under some form of health insurance, including government-supported schemes.

The National Rural Health Mission was set up to provide accessible, affordable and good-quality healthcare to the rural population, which makes up 72% of the population yet only has access to one-third of the beds.

Health insurance only covers hospitalization and emergency costs.

Only 31% of total health expenditure was funded by public sources in 2011.

Reimbursement Policies In 2006, out-of-pocket expenditures

accounted for over 75% of the total healthcare spend.

The cost of treatment at private healthcare facilities is between two and nine times higher than at public facilities.

Public versus PrivatePublic In 2006, out-of-pocket expenditures



Private 70% of households in urban areas and

63% in rural areas rely on the private medical sector.

75% of physicians in both urban and rural settings are in the private sector.

Nearly three out of four hospital beds are in private, urban hospitals.

Most of the private facilities are confined to the state capitals or Tier I cities. Few providers have made inroads in Tier II and Tier III cities.

News, Developments and Notes Language: Hindi, English (plus 21 additional

official languages). Regulator: Central Drugs Standard Control

Organization. India has one of the lowest doctor per

capita ratios in the world. There is currently a bill going through

Parliament seeking to amend the Drug and Cosmetics Act and set up a Central Drugs Authority.

The healthcare system includes Ayurvedic hospitals.

Private hospitals have a bed quota that they must reserve to treat poor patients.
63 India

India

Healthcare System The healthcare system in India is

overseen by the Ministry of Health and Family Welfare.

While India does have a universal healthcare system, it is dominated by private healthcare providers.

Less than 15% of the Indian population is covered under some form of health insurance, including government-supported schemes.

The National Rural Health Mission was set up to provide accessible, affordable and good-quality healthcare to the rural population, which makes up 72% of the population yet only has access to one-third of the beds.

Health insurance only covers hospitalization and emergency costs.

Only 31% of total health expenditure was funded by public sources in 2011.

Reimbursement Policies In 2006, out-of-pocket expenditures



Public versus PrivatePublic In 2006, out-of-pocket expenditures



Private 70% of households in urban areas and

63% in rural areas rely on the private medical sector.

75% of physicians in both urban and rural settings are in the private sector.

Nearly three out of four hospital beds are in private, urban hospitals.

Most of the private facilities are confined to the state capitals or Tier I cities. Few providers have made inroads in Tier II and Tier III cities.

News, Developments and Notes Language: Hindi, English (plus 21 additional

official languages). Regulator: Central Drugs Standard Control

Organization. India has one of the lowest doctor per

capita ratios in the world. There is currently a bill going through

Parliament seeking to amend the Drug and Cosmetics Act and set up a Central Drugs Authority.

The healthcare system includes Ayurvedic hospitals.

Private hospitals have a bed quota that they must reserve to treat poor patients.
65 India64 Global Healthcare Report

Population

1,210,193,422 Area size




576,793

Mumbai

Delhi Delhi

Bangalore Karnataka

Hyderabad Andhra Pradesh

Ahmedabad Gujarat

Demographics

1.03%

0.91%

0.70%

0.56%

0.46%

Maharashtra






1

2

3

4

5
65 India64 Global Healthcare Report

Population

1,210,193,422 Area size




576,793

Mumbai

Delhi Delhi

Bangalore Karnataka

Hyderabad Andhra Pradesh

Ahmedabad Gujarat

Demographics

1.03%

0.91%

0.70%

0.56%

0.46%

Maharashtra






1

2

3

4

5
67 Ireland

Ireland

Healthcare System Ireland has a comprehensive, government-

funded public healthcare system. Delivered by the Health Service Executive

(HSE), it is available to all but not free to all. Anyone who has lived in Ireland for at

least one year has either full eligibility (Category 1) or limited eligibility (Category 2) for health services.

Eligibility is means tested rather than relying on social insurance contributions or tax payments.

Over 30% of the population are Category 1 patients and they receive a medical card allowing them to access free services.

Category 2 patients must contribute towards most services.

50% of the population has voluntary health insurance to gain more immediate access to some hospital interventions.

In 2011, 67% of total health expenditure was in the public sector.

Reimbursement Policies The primary source of healthcare

funding is general taxation, accounting for 75% of expenditure.

13% of expenditure is on out-of-pocket payments for primary care services such as GP visits, drugs and private hospital treatment.

Pay-Related Social Insurance (PRSI) constitutes only 1% of healthcare financing in Ireland.

In 2011, an income-led, healthcare-related tax called Universal Social Charge was imposed of between 4% and 7%; those earning less than 10,036 are exempt.

Public versus Private There are three types of hospital: HSE

hospitals (owned and funded by the state), voluntary public hospitals (run by private bodies and mostly funded by the government) and fully private hospitals.

Public In 2011, there were at least 57 acute

hospitals and 28 voluntary public hospitals including university teaching hospitals.

Private 21 private hospitals. Approximately 50% of the Irish population

has private health insurance cover. Some of the beds in acute public hospitals

are designated for use by private patients.

News, Developments and Notes Language: Irish Gaelic/English. Regulator: Irish Medicines Board. Following the economic crisis, Ireland

saw a significant reduction in the public share of health funding. This was brought about, in part, by measures introduced to increase out-of-pocket costs, including increases in the share of direct payments for prescribed medicines.
67 Ireland

Ireland

Healthcare System Ireland has a comprehensive, government-

funded public healthcare system. Delivered by the Health Service Executive

(HSE), it is available to all but not free to all. Anyone who has lived in Ireland for at

least one year has either full eligibility (Category 1) or limited eligibility (Category 2) for health services.

Eligibility is means tested rather than relying on social insurance contributions or tax payments.

Over 30% of the population are Category 1 patients and they receive a medical card allowing them to access free services.

Category 2 patients must contribute towards most services.

50% of the population has voluntary health insurance to gain more immediate access to some hospital interventions.

In 2011, 67% of total health expenditure was in the public sector.

Reimbursement Policies The primary source of healthcare

funding is general taxation, accounting for 75% of expenditure.

13% of expenditure is on out-of-pocket payments for primary care services such as GP visits, drugs and private hospital treatment.

Pay-Related Social Insurance (PRSI) constitutes only 1% of healthcare financing in Ireland.

In 2011, an income-led, healthcare-related tax called Universal Social Charge was imposed of between 4% and 7%; those earning less than 10,036 are exempt.

Public versus Private There are three types of hospital: HSE

hospitals (owned and funded by the state), voluntary public hospitals (run by private bodies and mostly funded by the government) and fully private hospitals.

Public In 2011, there were at least 57 acute

hospitals and 28 voluntary public hospitals including university teaching hospitals.

Private 21 private hospitals. Approximately 50% of the Irish population

has private health insurance cover. Some of the beds in acute public hospitals

are designated for use by private patients.

News, Developments and Notes Language: Irish Gaelic/English. Regulator: Irish Medicines Board. Following the economic crisis, Ireland

saw a significant reduction in the public share of health funding. This was brought about, in part, by measures introduced to increase out-of-pocket costs, including increases in the share of direct payments for prescribed medicines.
69 Ireland68 Global Healthcare Report

Population

6,399,115 Area size

Global Healthcare Report 2014 Edition

Documents

Transcript of Global Healthcare Report 2014 Edition