Health Care System in the Industrialised Countries and the Role of Private Insurance

11. Conclusions

In spite of their quite different approaches in terms of service providers and sources of financing, all the health care systems of the advanced countries feature an increase in health care expenditure higher than the GDP. So far, many reforms have been put in place to curb the costs of the system, on both the demand and the supply side. In addition, prevention campaigns have been launched to promote positive lifestyles.
Although these reforms have contributed to the improvement of the system efficiency, health care spending is constantly on the rise. A further increase in expenditure is expected in the next few years: social security will have to encompass special care forms for the increasing number of non self-sufficient people, due to the ageing of population. Health care spending will also increase for the citizens’ growing demand for better quality and faster medical treatments, and especially for the increasing use of medical technology.
The health care issue is therefore a major challenge for national governments, who must strike a balance between the expectations of better services and the lack of resources. Measures aimed at increasing tax revenues through higher contributions can hardly be considered, because they would have adverse effects on the competitiveness of companies, all the more so if the highest charges weighted on the cost of labour.
Against this background, the diversification of sources of financing seems unavoidable. In terms of policy, the problem is to find the right mix of public and private mechanisms to obtain the resources necessary to provide health care services meeting the population’s requirements. It is therefore very important to define the right way and time frame to carry out the necessary changes without distorting the inspiring principle of the health care system, which in Europe is based upon the concept of solidarity.
In this context, the supply of health care services can better meet demand thanks to the wide range of solutions offered by private insurance and insurers’ ability to provide flexible and tailor-made answers. Furthermore, private insurance has made health care systems in most countries more dynamic, as individuals have the opportunity to choose the most suitable health care operators and to speed up treatment.
Policy-makers must make room for the insurers so that they can exploit their full potential and become a means to finance health care expenditure. In so doing, they must respect the freedom of action and the pursuit of the goals typical of all economic activities. However, insurance must be prevented from becoming an ineffective resource allocation tool, as well as a tool that discriminates among citizens. It won’t be easy to reconcile these goals but it is imperative to do so, if the insurer wants to contribute to the economic growth and the social development of a nation.
In this context, the Dutch and the Swiss systems must be mentioned. In these countries, insurance plays a crucial role in financing expenditure given citizens’ obligation to underwrite a policy covering health care expenses. The State regulates the supply of insurance companies and ensures a non-discriminatory access to health care by subsidizing the less well-to-do.
Undoubtedly, the insurer’s contribution could be even more significant if the subjects involved in health care manage to ‘team up’, task that must be undertaken by policy makers and cannot disregard the specific role of all subjects involved in the process. It is certainly not possible to do without the regulatory measures of the State, as the failure of health care services based on free market mechanisms has shown. It is up to the State, but not only to it, to promote greater transparency among the different parties involved, but also to widespread information so that citizens can take conscious choices and monitor how the system works.
It is also necessary to create synergies with other social security instruments, such as complementary social security that is already in place in a number of countries, albeit in a limited way. Savings accumulation meets these targets and with the passing of time it could party be transferred somewhere else to finance health and long term care coverage. Law makers should thus provide for a flexible use of accumulated capital, to meet needs that might change during the individual’s life span. People’s financial resources may be deposited on accounts that are opened to cover medical expenses. For example, some countries have set up a system of Health Care Savings Accounts which are usually coupled by a medical insurance: they cover specific services with higher financial risks often exceeding people’s economic availability.
Hopefully, in the near future the health care system will manage to harmonize goals and synergies of both the public and the private sector and place emphasis on health and wellbeing of all, while complying with the solidarity principle which is a progress indicator for countries wishing to support and promote social cohesion.

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