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Workers? share of health care coverage to rise, survey finds Atlanta Journal Constitution,  USA - 7 hours ago By ANDY MILLER Most employers plan to lower their health care costs next year by tapping a familiar source of help: their workers. ... Majority of companies plan to increase health care costs Bizjournals.com Metro companies eyeing ways to cut health costs Newsday Workers to bear burden of rising health costs San Francisco Chronicle Hartford Courant - OverTheLimit.infoall 467 news articles

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Review panel criticizes Great Lakes health study The Associated Press - 7 hours ago (AP) ? Substandard science has hurt a federal agency's seven-year effort to document possible links between industrial pollution and health problems in the ... Great Lakes pollution can't be tied to health woes, review finds Detroit Free Press Review panel criticizes Great Lakes health study MLive.com Review panel criticizes Great Lakes health study WTTE WREX-TV - The Olympianall 315 news articles

Health Care: Will the next president fix health care? Bizjournals.com, NC - 4 hours ago The presidential election could have a profound effect on health care, who gets it, and who pays for it. There are 45.7 million uninsured people in the ... Harry and Louise are back, still worried about health care Bizjournals.com Businesses keep an eye on the workers? comp legal landscape Bizjournals.com all 109 news articles

Health is a state of physical, mental and social well-being. It involves more than just the absence of disease or infirmity. This definition was ratified during the first World Health Assembly and has not been modified since 1948.[1][2]

"" (Juvenal)

Physical fitness is good bodily health, and is the result of regular exercise, proper diet and nutrition, and proper rest for physical recovery. Physical health is how our body is functioning. If we are fit and healthy we can say we have physical health.

A strong indicator of the health of populations is height, which is generally increased by improving nutrition and health care, and is also influenced by the standard of living and quality of life. Genetics is also a major factor in people's height. The study of human growth, its regulators, and its implications is known as Auxology.

Mental health refers to a human inidual's emotional and psychological well-being. Merriam-Webster defines mental health as "A state of emotional and psychological well-being in which an inidual is able to use his or her cognitive and emotional capabilities, function in society, and meet the ordinary demands of everyday life."

According to the World Health Organization, there is no one "official" definition of mental health. Cultural differences, subjective assessments, and competing professional theories all affect how "mental health" is defined. In general, most experts agree that "mental health" and "mental illness" are not opposites. In other words, the absence of a recognized mental disorder is not necessarily an indicator of mental health.

One way to think about mental health is by looking at how effectively and successfully a person functions. Feeling capable and competent; being able to handle normal levels of stress, maintain satisfying relationships, and lead an independent life; and being able to "bounce back," or recover from difficult situations, are all signs of mental health.

Encompassing your emotional, social, and—most importantly—your mental well-being; All these aspects—emotional, physical, and social—must function together to achieve overall health.

The LaLonde report suggested that there are four general determinants of health including , , , and [3] Thus, health is maintained and improved not only through the advancement and application of health science, but also through the efforts and intelligent lifestyle choices of the inidual and society.

A major environmental factor is water quality, especially for the health of infants and children in developing countries.[4]

Achieving health and remaining healthy is an active process. Effective strategies for staying healthy and improving one's health include the following elements:

Nutrition is the science that studies how what people eat affects their health and performance, such as foods or food components that cause diseases or deteriorate health (such as eating too many calories, which is a major contributing factor to obesity, diabetes, and heart disease). The field of nutrition also studies foods and dietary supplements that improve performance, promote health, and cure or prevent disease, such as eating fibrous foods to reduce the risk of colon cancer, or supplementing with vitamin C to strengthen teeth and gums and to improve the immune system.

Personal health depends partially on the social structure of one’s life. The maintenance of strong social relationships is linked to good health conditions, longevity, productivity, and a positive attitude. This is due to the fact that positive social interaction as viewed by the participant increases many chemical levels in the brain which are linked to personality and intelligence traits. Essentially this means that positive reinforcement from a third party make one more socially adept, in control, and relaxed physically and mentally, all of which are proven to effect the nervous system(UHF).

Sports nutrition focuses the link between dietary supplements and athletic performance. One goal of sports nutrition is to maintain glycogen levels and prevent glycogen depletion. Another is to optimize energy levels and muscle tone. An athlete's strategy for winning an event may include a schedule for the entire season of what to eat, when to eat it, and in what precise quantities (before, during, after, and between workouts and events). Participants in endurance sports such as the full-distance triathlon actually eat their races. Sports nutrition works hand-in-hand with sports medicine.

Exercise is the performance of movements in order to develop or maintain physical fitness and overall health. It is often directed toward also honing athletic ability or skill. Frequent and regular physical exercise is an important component in the prevention of some of the diseases of affluence such as cancer, heart disease, cardiovascular disease, Type 2 diabetes, obesity and back pain.

Exercises are generally grouped into three types depending on the overall effect they have on the human body:

• Flexibility exercises such as stretching improve the range of motion of muscles and joints.
• Aerobic exercises such as walking and running focus on increasing cardiovascular endurance and muscle density.
• Anaerobic exercises such as weight training or sprinting increase muscle mass and strength.

Physical exercise is considered important for maintaining physical fitness including healthy weight; building and maintaining healthy bones, muscles, and joints; promoting physiological well-being; reducing surgical risks; and strengthening the immune system.

Proper nutrition is just as, if not more, important to health as exercise. When exercising it becomes even more important to have good diet to ensure the body has the correct ratio of macronutrients whilst providing ample micronutrients; this is to aid the body with the recovery process following strenuous exercise. When the body falls short of proper nutrition, it gets into starvation mode developed through evolution and depends onto fat content for survival. Research suggest that the production of thyroid hormones can be negatively affected by repeated bouts of dieting and calorie restriction[5]. Proper rest and recovery is also as important to health as exercise, otherwise the body exists in a permanently injured state and will not improve or adapt adequately to the exercise.

The above two factors can be compromised by psychological compulsions (eating disorders such as exercise bulimia, anorexia, and other bulimias), misinformation, a lack of organization, or a lack of motivation. These all lead to a decreased state of health.

Delayed Onset Muscle Soreness can occur after any exercise, particularly if the body is in an unconditioned state relative to that exercise and the exercise involves repetitive eccentric contractions.

Hygiene is the practice of keeping the body clean to prevent infection and illness, and the avoidance of contact with infectious agents. Hygiene practices include bathing, brushing and flossing teeth, washing hands especially before eating, washing food before it is eaten, cleaning food preparation utensils and surfaces before and after preparing meals, and many others. This may help prevent infection and illness. By cleaning the body, dead skin cells are washed away with the germs, reducing their chance of entering the body.

Prolonged psychological stress may negatively impact health, such as by weakening the immune system. Stress management is the application of methods to either reduce stress or increase tolerance to stress. Certain nootropics do both. Exercising to improve physical fitness, especially cardiovascular fitness, boosts the immune system and increases stress tolerance. Relaxation techniques are physical methods used to relieve stress. Examples include , progressive relaxation, and fractional relaxation. Psychological methods include cognitive therapy, meditation, and positive thinking which work by reducing response to stress. Improving relevant skills and abilities builds confidence, which also reduces the stress reaction to situations where those skills are applicable. Reducing uncertainty, by increasing knowledge and experience related to stress-causing situations, has the same effect. Learning to cope with problems better, such as improving problem solving and time management skills, may also reduce stressful reaction to problems. Repeatedly facing an object of one's fears may also desensitize the fight-or-flight response with respect to that stimulus -- e.g., facing bullies may reduce fear of bullies.

Health care is the prevention, treatment, and management of illness and the preservation of mental and physical well being through the services offered by the medical, nursing, and allied health professions. According to the World Health Organization, health care embraces all the goods and services designed to promote health, including “preventive, curative and palliative interventions, whether directed to iniduals or to populations”.[6] The organized provision of such services may constitute a health care system. This can include a specific governmental organization such as the National Health Service in the UK, or a cooperation across the National Health Service and Social Services as in Shared Care.

Workplace wellness programs are recognized by an increasingly large number of companies for their value in improving the health and well-being of their employees, and for increasing morale, loyalty, and productivity. Workplace wellness programs can include things like onsite fitness centers, health presentations, wellness newsletters, access to health coaching, tobacco cessation programs and training related to nutrition, weight and stress management. Other programs may include health risk assessments, health screenings and body mass index monitoring. Mostly overseen or not mentioned is a group of determinants of health which could be called coincidence, hazard, luck or bad luck. These factors are quite important determinants of health but difficult to calculate.

is "the science and art of preventing disease, prolonging life and promoting health through the organised efforts and informed choices of society, organisations, public and private, communities and iniduals." It is concerned with threats to the overall health of a community based on population health analysis. The population in question can be as small as a handful of people or as large as all the inhabitants of several continents (for instance, in the case of a pandemic). Public health has many sub-fields, but is typically ided into the categories of epidemiology, biostatistics and health services. Environmental, social and behavioral health, and occupational health, are also important fields in public health.

The focus of public health intervention is to prevent rather than treat a disease through surveillance of cases and the promotion of healthy behaviors. In addition to these activities, in many cases treating a disease can be vital to preventing it in others, such as during an outbreak of an infectious disease. Vaccination programs and distribution of condoms are examples of public health measures.

Health science is the branch of science focused on health , and it includes many subdisciplines. There are two approaches to health science: the study and research of the human body and health-related issues to understand how humans (and animals) function, and the application of that knowledge to improve health and to prevent and cure diseases.

Health research builds primarily on the basic sciences of biology, chemistry, and physics as well as a variety of multidisciplinary fields (for example medical sociology). Some of the other primarily research-oriented fields that make exceptionally significant contributions to health science are biochemistry, epidemiology, and genetics.

Applied health sciences also endeavor to better understand health, but in addition they try to directly improve it. Some of these are: biomedical engineering, biotechnology, nursing, nutrition, pharmacology, pharmacy, public health (see below), psychology, physical therapy, and medicine. The provision of services to maintain or improve people's health is referred to as health care (see above).

• Environmental health

• General fitness training
  • Physical fitness
  • List of basic exercise topics

• Health care
  • Health care delivery
  • Health education
  • Health profession

• Hygiene
  • Mental hygiene
  • Oral hygiene
  • Sleep hygiene

• Longevity
  • List of life extension related topics

• Medicine
  • Alternative medicine
  • Traditional Chinese medicine
  • Adolescent medicine

• Mental health
• Nutrition
  • Vitamins
  • Minerals
  • Healthy diet
  • List of basic nutrition topics

• Public health
  • Population health

• Reproductive health
  • Sexuality education
  • Sexually transmitted disease
  • Birth control
  • Maternal health

• World Health Organization

• WHO (1979) Health for all.
• WHO (1980) WHO Chr., 34(2)80
• WHO (1986) Concepts of Health Behavior Research, Reg. Health Paper No.13, SEARO, New Delhi
• WHO (1978) Health for all.
• UNDP, Human Development Report 1999, Oxford University Press
• UNICEF,2001 State of world's children, 2001
• WHO (1979) Health for all.
• Evang, K. (1967); In health of mankind; Ciba foundation; 100th symposium, Churchill, London
• Last, J.M (1983) A Dictionary of Epidemiology, Oxford University Press
• Raska, K (1966), WHO Chr., 20, 315

• World Health Organization
• Health On the Net Foundation
• Our Knowledge Your Health

The term health insurance is generally used to describe a form of insurance that pays for medical expenses. It is sometimes used more broadly to include insurance covering disability or long-term nursing or custodial care needs. It may be provided through a government-sponsored social insurance program, or from private insurance companies. It may be purchased on a group basis (e.g., by a firm to cover its employees) or purchased by inidual consumers. In each case, the covered groups or iniduals pay premiums or taxes to help protect themselves from high or unexpected healthcare expenses. Similar benefits paying for medical expenses may also be provided through social welfare programs funded by the government.

Health insurance works by estimating the overall risk of healthcare expenses and developing a routine finance structure (such as a monthly premium or annual tax) that will ensure that money is available to pay for the healthcare benefits specified in the insurance agreement. The benefit is administered by a central organization, most often either a government agency or a private or not-for-profit entity operating a health plan.[1]

The concept of health insurance was proposed in 1694 by Hugh the Elder Chamberlen from the Peter Chamberlen family. In the late 19th century, "accident insurance" began to be available, which operated much like modern insurance.[2].This payment model continued until the start of the 20th century in some jurisdictions (like California), where all laws regulating health insurance actually referred to disability insurance.[3]

Accident insurance was first offered in the United States by the Franklin Health Assurance Company of Massachusetts. This firm, founded in 1850, offered insurance against injuries arising from railroad and steamboat accidents. Sixty organizations were offering accident insurance in the US by 1866, but the industry consolidated rapidly soon thereafter. While there were earlier experiments, the origins of sickness coverage in the US effectively date from 1890. The first employer-sponsored group disability policy was issued in 1911.[4]

Before the development of medical expense insurance, patients were expected to pay all other health care costs out of their own pockets, under what is known as the fee-for-service business model. During the middle to late 20th century, traditional disability insurance evolved into modern health insurance programs. Today, most comprehensive private health insurance programs cover the cost of routine, preventive, and emergency health care procedures, and also most prescription drugs, but this was not always the case.

Hospital and medical expense policies were introduced during the first half of the 20th century. During the 1920s, inidual hospitals began offering services to iniduals on a pre-paid basis, eventually leading to the development of Blue Cross organizations.[4] The predecessors of today's Health Maintenance Organizations (HMOs) originated beginning in 1929, through the 1930s and on during World War II.[5][6]

A Health insurance policy is a contract between an insurance company and an inidual. The contract can be renewable annually or monthly. The type and amount of health care costs that will be covered by the health plan are specified in advance, in the member contract or Evidence of Coverage booklet. The inidual policy-holder's payment obligations may take several forms[7]:

• Premium: The amount the policy-holder pays to the health plan each month to purchase health coverage.
• Deductible: The amount that the policy-holder must pay out-of-pocket before the health plan pays its share. For example, a policy-holder might have to pay a $500 deductible per year, before any of their health care is covered by the health plan. It may take several doctor's visits or prescription refills before the policy-holder reaches the deductible and the health plan starts to pay for care.
• Copayment: The amount that the policy-holder must pay out of pocket before the health plan pays for a particular visit or service. For example, a policy-holder might pay a $45 copayment for a doctor's visit, or to obtain a prescription. A copayment must be paid each time a particular service is obtained.
• Coinsurance: Instead of paying a fixed amount up front (a copayment), the policy-holder must pay a percentage of the total cost. For example, the member might have to pay 20% of the cost of a surgery, while the health plan pays the other 80%. Because there is no upper limit on coinsurance, the policy-holder can end up owing very little, or a significant amount, depending on the actual costs of the services they obtain.
• Exclusions: Not all services are covered. The policy-holder is generally expected to pay the full cost of non-covered services out of their own pocket.
• Coverage limits: Some health plans only pay for health care up to a certain dollar amount. The policy-holder may be expected to pay any charges in excess of the health plan's maximum payment for a specific service. In addition, some plans have annual or lifetime coverage maximums. In these cases, the health plan will stop payment when they reach the benefit maximum, and the policy-holder must pay all remaining costs.
• Out-of-pocket maximums: Similar to coverage limits, except that in this case, the member's payment obligation ends when they reach the out-of-pocket maximum, and the health plan pays all further covered costs. Out-of-pocket maximums can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.
• Capitation: An amount paid by an insurer to a health care provider, for which the provider agrees to treat all members of the insurer.
• In-Network Provider: A health care provider on a list of providers preselected by the insurer. The insurer will offer discounted coinsurance or copayments, or additional benefits, to a plan member to see an in-network provider. Generally, providers in network are providers who have a contract with the insurer to accept rates further discounted from the "usual and customary" charges the insurer pays to out-of-network providers.

Prescription drug plans are a form of insurance offered through some employer benefit plans in the US, where the patient pays a copayment and the prescription drug insurance part or all of the balance for drugs covered in the formulary of the plan.

Some, if not most, health care providers in the United States will agree to bill the insurance company if patients are willing to sign an agreement that they will be responsible for the amount that the insurance company doesn't pay. The insurance company pays out of network providers according to "reasonable and customary" charges, which may be less than the provider's usual fee. The provider may also have a separate contract with the insurer to accept what amounts to a discounted rate or capitation to the provider's standard charges. It generally costs the patient less to use an in-network provider.

Historically, HMOs tended to use the term "health plan", while commercial insurance companies used the term "health insurance". A health plan can also refer to a subscription-based medical care arrangement offered through health maintenance organization, HMO, PPO, or POS plan. These plans are similar to pre-paid dental, pre-paid legal, and pre-paid vision plans. Pre-paid health plans typically pay for a fixed number of services (for instance, $300 in preventive care, a certain number of days of hospice care or care in a skilled nursing facility, a fixed number of home health visits, a fixed number of spinal manipulation charges, etc.) The services offered are usually at the discretion of a utilization review nurse who is often contracted through the managed care entity providing the subscription health plan. This determination may be made either prior to or after hospital admission (concurrent utilization review).

Comprehensive health insurance pays a percentage (may be 100, 90, 80, 70, 60, 50, percent) of the cost of hospital and physician charges after a deductible (usually applies to hospital charges) or a co-pay (usually applies to physician charges, but may apply to some hospital services) is met by the insured. These plans are generally expensive because of the high potential benefit payout — $1,000,000 to 5,000,000 is common — and because of the vast array of covered benefits.[8]

Scheduled health insurance plans are not meant to replace a traditional comprehensive health insurance plans and are more of a basic policy providing access to day-to-day health care such as going to the doctor or getting a prescription drug. In recent years, these plans have taken the name mini-med plans or association plans. These plans may provide benefits for hospitalization and surgical, but these benefits will be limited. Scheduled plans are not meant to be effective for catastrophic events. These plans cost much less then comprehensive health insurance. They generally pay limited benefits amounts directly to the service provider, and payments are based upon the plan's "schedule of benefits". Annual benefits maximums for a typical scheduled health insurance plan may range from $1,000 to $25,000.[9]

Insurance systems must typically deal with two inherent challenges: adverse selection, which affects any voluntary system, and ex-post moral hazard, which affects any insurance system in which a third party bears major responsibility for payment, whether that is an employer or the government. Some national systems with compulsory insurance utilize systems such as risk equalization and community rating to overcome these inherent problems.

Insurance companies use the term "adverse selection" to describe the tendency for only those who will benefit from insurance to buy it. Specifically when talking about health insurance, unhealthy people are more likely to purchase health insurance because they anticipate large medical bills. On the other side, people who consider themselves to be reasonably healthy may decide that medical insurance is an unnecessary expense; if they see the doctor once a year and it costs $250, that's much better than making monthly insurance payments of $40. (example figures).

The fundamental concept of insurance is that it balances costs across a large, random sample of iniduals (see risk pool). For instance, an insurance company has a pool of 1000 randomly selected subscribers, each paying $100 per month. One person becomes very ill while the others stay healthy, allowing the insurance company to use the money paid by the healthy people to pay for the treatment costs of the sick person. However, when the pool is self-selecting rather than random, as is the case with iniduals seeking to purchase health insurance directly, adverse selection is a greater concern.[10] A disproportionate share of health care spending is attributable to iniduals with high health care costs. In the US the 1% of the population with the highest spending accounted for 27% of aggregate health care spending in 1996. The highest-spending 5% of the population accounted for more than half of all spending. These patterns were stable through the 1970s and 1980s, and some data suggest that they may have been typical of the mid-to-early 20th century as well.[11][12] A few iniduals have extremely high medical expenses, in extreme cases totaling a half million dollars or more.[13] Adverse selection could leave an insurance company with primarily sick subscribers and no way to balance out the cost of their medical expenses with a large number of healthy subscribers.

Because of adverse selection, insurance companies employ medical underwriting, using a patient's medical history to screen out those whose pre-existing medical conditions pose too great a risk for the risk pool. Before buying health insurance, a person typically fills out a comprehensive medical history form that asks whether the person smokes, how much the person weighs, whether the person has been treated for any of a long list of diseases and so on. In general, those who present large financial burdens are denied coverage or charged high premiums to compensate.[14] One large US industry survey found that roughly 13 percent of applicants for comprehensive, inidually purchased health insurance who went through the medical underwriting in 2004 were denied coverage. Declination rates increased significantly with age, rising from 5 percent for iniduals 18 and under to just under a third for iniduals aged 60 to 64.[15] Among those who were offered coverage, the study found that 76% received offers at standard premium rates, and 22% were offered higher rates.[16] On the other side, applicants can get discounts if they do not smoke and are healthy.[17]

Moral hazard occurs when an insurer and a consumer enter into a contract under symmetric information, but one party takes action, not taken into account in the contract, which changes the value of the insurance. A common example of moral hazard is third-party payment—when the parties involved in making a decision are not responsible for bearing costs arising from the decision. An example is where doctors and insured patients agree to extra tests which may or may not be necessary. Doctors benefit by avoiding possible malpractice suits, and patients benefit by gaining increased certainty of their medical condition. The cost of these extra tests is borne by the insurance company, which may have had little say in the decision. Co-payments, deductibles, and less generous insurance for services with more elastic demand attempt to combat moral hazard, as they hold the consumer responsible.

A recent study by PriceWaterhouseCoopers examining the drivers of rising health care costs in the US pointed to increased utilization created by increased consumer demand, new treatments, and more intensive diagnostic testing, as the most significant driver.[18] People in developed countries are living longer. The population of those countries is aging, and a larger group of senior citizens requires more intensive medical care than a young healthier population. Advances in medicine and medical technology can also increase the cost of medical treatment. Lifestyle-related factors can increase utilization and therefore insurance prices, such as: increases in obesity caused by insufficient exercise and unhealthy food choices; excessive alcohol use, smoking, and use of street drugs. Other factors noted by the PWC study included the movement to broader-access plans, higher-priced technologies, and cost-shifting from Medicaid and the uninsured to private payers.[18]

The public health system is called Medicare. It ensures free universal access to hospital treatment and subsidised out-of-hospital medical treatment. It is funded by a 1.5% tax levy.

The private health system is funded by a number of private health insurance organisations. The largest of these is Medibank Private, which is government-owned, but operates as a government business enterprise under the same regulatory regime as all other registered private health funds. The Coalition Howard government had announced that Medibank would be privatised if it won the 2007 election, however they were defeated by the Australian Labor Party under Kevin Rudd which had already pledged that it would remain in government ownership.

Some private health insurers are 'for profit' enterprises, and some are non-profit organizations such as HCF Health Insurance. Some have membership restricted to particular groups, but the majority have open membership.

Most aspects of private health insurance in Australia are regulated by the .

The private health system in Australia operates on a "community rating" basis, whereby premiums do not vary solely because of a person's previous medical history, current state of health, or (generally speaking) their age (but see Lifetime Health Cover below). Balancing this are waiting periods, in particular for pre-existing conditions (usually referred to within the industry as PEA, which stands for "pre-existing ailment"). Funds are entitled to impose a waiting period of up to 12 months on benefits for any medical condition the signs and symptoms of which existed during the six months ending on the day the person first took out insurance. They are also entitled to impose a 12-month waiting period for benefits for treatment relating to an obstetric condition, and a 2-month waiting period for all other benefits when a person first takes out private insurance. Funds have the discretion to reduce or remove such waiting periods in inidual cases. They are also free not to impose them to begin with, but this would place such a fund at risk of "adverse selection", attracting a disproportionate number of members from other funds, or from the pool of intending members who might otherwise have joined other funds. It would also attract people with existing medical conditions, who might not otherwise have taken out insurance at all because of the denial of benefits for 12 months due to the PEA Rule. The benefits paid out for these conditions would create pressure on premiums for all the fund's members, causing some to drop their membership, which would lead to further rises, and a vicious cycle would ensue.

There are a number of other matters about which funds are not permitted to discriminate between members in terms of premiums, benefits or membership - these include racial origin, religion, sex, sexual orientation, nature of employment, and leisure activities. Premiums for a fund's product that is sold in more than one state can vary from state to state, but not within the same state.

The Australian government has introduced a number of incentives to encourage adults to take out private hospital insurance. These include:

• Lifetime Health Cover : If a person has not taken out private hospital cover by the 1st July after their 30th birthday, then when (and if) they do so after this time, their premiums must include a loading of 2% per annum. Thus, a person taking out private cover for the first time at age 40 will pay a 20 per cent loading. The loading continues for 10 years. The loading applies only to premiums for hospital cover, not to ancillary (extras) cover.

• Medicare Levy Surcharge : People whose taxable income is greater than a specified amount (currently $50,000 for singles and $100,000 for families) and who do not have an adequate level of private hospital cover must pay a 1% surcharge on top of the standard 1.5% Medicare Levy. The rationale is that if the people in this income group are forced to pay more money one way or another, most would choose to purchase hospital insurance with it, with the possibility of a benefit in the event that they need private hospital treatment - rather than pay it in the form of extra tax as well as having to meet their own private hospital costs.
  • The Australian government announced in May 2008 that it proposes to increase the thresholds, to $100,000 for singles and $150,000 for families. These changes require legislative approval. A bill to change the law has been introduced but has not yet been passed.[19] There have been criticisms that this proposed change will cause many people to drop their private health insurance, causing a further burden on the public hospital system, and a rise in premiums for those who stay with the private system. Other commentators believe the effect will be minimal.[20]

• Private Health Insurance Rebate : The government subsidises the premiums for all private health insurance cover, including hospital and ancillary (extras), by 30%, 35% or 40%.

Most health insurance in Canada is administered by each province, under the Canada Health Act, which requires all people to have free access to basic health services. Collectively, the public provincial health insurance systems in Canada are frequently referred to as Medicare. Private health insurance is allowed, but the provincial governments allow it only for services that the public health plans do not cover; for example, semi-private or private rooms in hospitals and prescription drug plans. Canadians are free to use private insurance for elective medical services such as laser vision correction surgery, cosmetic surgery, and other non-basic medical procedures. Some 65% of Canadians have some form of supplementary private health insurance; many of them receive it through their employers.[21] Private-sector services not paid for by the government account for nearly 30 percent of total health care spending.[22]

In 2005, the Supreme Court of Quebec ruled, in Chaoulli v. Quebec, that the province's prohibition on private insurance for health care already insured by the provincial plan could constitute an infringement of the right to life and security if there were long wait times for treatment as happened in this case. Certain other provinces have legislation which financially discourages but does not forbid private health insurance in areas covered by the public plans. The ruling has not changed the overall pattern of health insurance across Canada but has spurred on attempts to tackle the core issues of supply and demand and the impact of wait times.[23]

In the Netherlands in 2006, a new system of health insurance came into force. All insurance companies have to provide at least one policy which meets a government set minimum standard level of cover and all adult residents are obliged by law to purchase this cover from an insurance company of their choice.

The new system avoids the two pitfalls of adverse selection and moral hazard associated with traditional forms of health insurance.

In the Dutch system, insurance companies are compensated for taking on high risk iniduals because they receive extra funding for them. This funding comes from an insurance equalization pool run by a regulator which collects salary based contributions from employers (about 45% of all health care funding) and funding from the government for people whose means are such that they cannot afford health care (about 5% of all funding). Thus insurance companies find that insuring high risk iniduals becomes an attractive proposition. All insurance companies receive from the pool, but those with more high risk iniduals will receive more from the fund. The remaining 45% of health care funding comes from insurance premiums paid by the public. Insurance companies compete for this money on price alone. The insurance companies are not allowed to set down any co-payments or caps or deductibles. Neither are they allowed to deny coverage to any person applying for a policy or charge anything other than their nationally set and internet published standard policy premiums. Every person buying insurance from that company will pay the same price as everyone else buying that policy. And every person will get the minimum level of coverage. Children under 18 are insured for free (the funding coming from the equalization pool).

In addition to this minimum level, companies are free to sell extra insurance for additional coverage over the national minimum, but extra risks for this are not covered from the insurance pool and must therefore be priced accordingly.

The UK's National Health Service (NHS) is a publicly funded healthcare system that provides coverage to everyone normally resident in the UK. It is not strictly insurance system because (a) there are no premiums collected, (b) costs are not charged at the patient level and (c) costs are not pre-paid from a pool. However, it does achieve the main aim of insurance which is to spread financial risk arising from ill-health. The costs of running the NHS (est. £104 billion in 2007-8)[24] are met directly from general taxation.

Private health care has continued parallel to the NHS, paid for largely by private insurance, but it is used by less than 8% of the population, and generally as a top-up to NHS services.

The NHS provides the majority of health care in the UK, including primary care, in-patient care, long-term health care, ophthalmology and dentistry. Recently the private sector has been increasingly used to increase NHS capacity despite a large proportion of the British public opposing such involvement.[25]. According to the World Health Organization, government funding covered 86% of overall health care expenditures in the UK as of 2004, with private expenditures covering the remaining 14%.[26]

The US market-based health care system relies heavily on private and not-for-profit health insurance, which is the primary source of coverage for most Americans. According to the United States Census Bureau, approximately 84% of Americans have health insurance; some 60% obtain it through an employer, while about 9% purchase it directly. Various government agencies provide coverage to about 27% of Americans (there is some overlap in these figures).[27]

Public programs provide the primary source of coverage for most seniors and for low-income children and families who meet certain eligibility requirements. The primary public programs are Medicare, a federal social insurance program for seniors and certain disabled iniduals, Medicaid, funded jointly by the federal government and states but administered at the state level, which covers certain very low income children and their families, and SCHIP, also a federal-state partnership that serves certain children and families who do not qualify for Medicaid but who cannot afford private coverage. Other public programs include military health benefits provided through TRICARE and the Veterans Health Administration and benefits provided through the Indian Health Service. Some states have additional programs for low-income iniduals.[28]

In 2006, there were 47 million people in the United States (16% of the population) who were without health insurance for at least part of that year.[27] About 37% of the uninsured live in households with an income over $50,000.[27]

In 2004, US health insurers directly employed almost 470,000 people at an average salary of $61,409.[29] (As of the fourth quarter of 2007, the total US labor force stood at 153.6 million, of whom 146.3 million were employed. Employment related to all forms of insurance totaled 2.3 million.[30] Mean annual earnings for full-time civilian workers as of June 2006 were $41,231; median earnings were $33,634.)[31] The insurance industry also represents a significant lobbying group in the US. For the 2007-2008 election cycle insurance was the 8th among industries in political contributions to members of Congress, giving $13,411,561, of which 56% was given to Democrats (lawyers and law firms were number 1, giving $59,205,616, of which 80% went to Democrats). The top recipient of insurance industry contributions was Senator Christopher Dodd (D-CT).[32] The leading contributor from the insurance industry — as measured by total political contributions — was AFLAC, Inc., which contributed $907,150 in 2007.[33].

• Injury cover
• Economic capital
• Government ownership
• Health economics
• Health maintenance organization
• Healthcare reform
• Self-funded health care
• List of insurance topics
• Physicians for a National Health Program
• Public health
• Social health insurance
• Social security
• Social welfare
• Health care
• Health care politics
• Philosophy of Healthcare

• Navigating your health benefits for dummies. Charles M Cutler MD Tracey A Baker CFP (c)2006 ISBN-13:978-0-470-08354-3