National health insurance.

INSURANCE Health is described as a state of complete physical, social, and mental wellbeing. In order to ensure that the population of a given nation remains at or achieves a good health status, health expenditures must be financed. Health care expenditures are the total amount of spending for personal health care, administration, research, construction, and other expenses that are directly related to patient care. Although insurance coverage is not the sole determinant of health, timely access to quality care does play a key role in maintaining and improving health. Many developed nations have a system of national health insurance to finance health care for their citizens. Though these plans vary, all provide national health insurance and take into account the political, historical, and social factors of the given society. Variations in national health insurance plans may relate to the organization of the health care system in a given country, or to the provisions of the plan. Many plans guarantee minimal national health insurance to all constituents; others provide insurance to all who meet low income standards, and yet others provide national health insurance with provisions that allow citizens to purchase supplemental private insurance. Countries that have national health insurance plans include Australia, Japan, China, Sweden, Russia, the United Kingdom, Germany, the Netherlands, Austria, Sri Lanka, Chile, and Canada, to name a few. These national health insurance plans have limitations and differing levels of effectiveness. The Canadian national health insurance plan is one of the most impressive and historically established plans among developed nations. Initially developed in 1968, this plan is funded by federal and provincial tax revenues, as well as insurance premiums paid by all taxpaying citizens. Consequently, Canada ranks high on indicators that suggest the health of a society. Infant mortality, for example, is low in Canada, and the life expectancy of Canada’s citizens is high. Despite this success, some have criticized Canada’s system for a decrease in the professional authority of physicians and the rationing of health care. Critics of Canada’s national health care system argue that in theory the system provides everyone with health care, but not necessarily superior health care. In contrast, Sri Lanka, a peripheral or developing nation, instituted a national health insurance plan in 1992. The Sri Lankan government provides health care to its civilians mostly free of cost. The Sri Lankan government split the management of health care between provinces and administrative divisions. Provincial levels of government are responsible for the management of all health care institutions; divisions, which include medical officers, are responsible for administering health care. Though the national health insurance plan of Sri Lanka is not as well established as Canada’s, health indicators for this country are good. Like Canada, Sri Lanka boasts a relatively low infant mortality rate (59.6 per 100,000 births), and life expectancy has been increasing. Although it is too early to assess the limitations of Sri Lanka’s national health insurance plan, the plan includes provisions for development and change. The Sri Lankan Ministry of Health is responsible for the formulation of health policy; the ministry monitors the performance of the country’s health organizations, and moderates and changes policy when necessary. The United States stands as one of the world’s developed nations that does not have a comprehensive national health insurance plan. Despite the lack of such a plan, the United States spends a larger percentage of its gross domestic product (the nation’s total economic output) on health care expenditures than any other country, including countries that provide national health insurance coverage. Many American citizens have no insurance. The American health care system can be characterized as heavily influenced by such political action committees (PACs) as the American Medical Association (AMA), the American Hospital Association (AHA), the American Pharmacists Association (formerly the American Pharmaceutical Association, APA), and other special interest groups. The American health care system is also based upon a profit incentive, and health care expenditures are funded through numerous sources. These factors have contributed to vast inequalities in who receives health insurance and health care. These factors also explain why there is no national health insurance system in the United States, and the emergence of categories of Americans who are characterized as underinsured and uninsured. The U.S. medical-industrial complex—the rapidly growing industry that supplies health care services for profit—is the result of the AMA’s and APA’s professional and political efforts during the nineteenth century to establish accredited medical training and unfavorable views of holistic medical practices. These historical efforts led to a great increase in the power of these and other special interest groups associated with American health care. While changes to existing insurance standards and policies are the responsibility of the U.S. government, the corporations that make up the medical-industrial complex employ PACs to influence congressional decisions regarding health care. Failures in efforts during the 1990s to implement a national health insurance system illustrate the strength of the influence of the medical industry. In November 1993 the administration of President Bill Clinton announced a national health insurance plan called managed competition. This plan would have provided national health coverage and was designed to account for problems related to both access to and the cost of health care. But the aforementioned special interest