The Design of Health Care Financing Schemes in Different Countries

Abstract

In this chapter, the conceptual analysis developed in the previous chapter is applied to the following countries: Australia, Belgium, France, Germany, Ireland, Israel, the Netherlands, Switzerland and the United States. In particular, we discuss the conformity of the actual design of these OECD countries’ health care financing schemes with the economic arguments for mandatory cross-subsidies and for mandatory coverage. We observe that several countries (e.g. Australia, Belgium, France and Israel) opted for the introduction of universal mandatory coverage for a comprehensive and uniform package of services. As discussed in Chap. 2 this measure is not per se necessary and proportionate to achieve an affordable access to (the coverage of) health care services for vulnerable groups. Alternatively, governments could rely either on the two-option scheme or the single-option scheme with voluntary income-related deductibles. Although the latter scheme is likely to be preferable from an economic perspective, it is not implemented in any of the considered countries. Only the Netherlands and Switzerland come close to this scheme given that they have implemented a single-option scheme with traditional deductibles (fixed amounts) for curative health care services. However, the fixed deductible levels may be too high for low-income people and too low for high-income individuals. In addition, long-term care services are covered by a universal single-option scheme with mandatory income-related copayments in the Netherlands (AWBZ). As far as the two-option scheme is concerned, it is implemented in Germany and Ireland. Nevertheless, the high-option scheme for low-income people seems to be too broad in Germany and too small in Ireland.