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Table 1 Background on the health care systems of seven countries

From: Discourse on medicine: meditative and calculative approaches to ethics from an international perspective

  Structure of health care system Private vs. Government Waiting lists Medical insurance
Canada Universal health care system whereby any Canadian can access essential health services, including medical visits and hospital stays, free of charge. About 30% of Canadians' health care is paid for through the private sector. There are private clinics that offer some of the same services as the public system. Universal health care results in waiting lists for certain types of specialists and procedures (although urgent cases are seen quickly). Many Canadians have private insurance, often through their employer. Private health insurance that could cover procedures in the private sector is not legal.
India There is government health care free of charge for those in the lowest economic strata. Those from higher strata are charged proportionally to their income. The central government funds and oversees the universal health policies whereas state governments implement policies at the levels of primary, secondary and tertiary care. There is also a flourishing expensive private medical system. Waiting lists are rarely encountered, as it is a walk-in system rather than appointments. In the private system, elective procedures are done swiftly (possible due to the competitive market of private health care system). Medical insurance is not popular – the majority of the population cannot afford it and they have free access to government health care.
Primary health care facilities are part of a tiered system that funnels more difficult cases into hospitals while providing routine care in the countryside.
Ireland The Health Service Executive (HSE) is responsible for the provision of healthcare. Free healthcare is provided for those who earn below a certain income. Currently, free universal GP health care for children under 6 yrs of age is being planned and there is the intention that this will be followed by free universal GP healthcare for persons over 70. Health care is typically delivered in a mix of private and public systems with most infrastructures being in private hands. “One per cent of the Irish population is now on a hospital waiting list… The government has already committed £Ir2m this year on its waiting list initiative, but more than 34000 patients are still awaiting reatment…It also pointed out that new statistics show that bed occupancy rates in Irish hospitals were now the highest in the European Union, and, in terms of per capita spending on health among countries in the Organisation for Economic Cooperation and Development, Ireland comes near the bottom, just ahead of Portugal and Greece” [4] A number of companies offer voluntary private health insurance in Ireland.
The major provider is the Voluntary Health Insurance Board (VHI) and it is a statutory body whose board is appointed by the Minister for Health. There are also a number of long-established health insurance providers that deal only with particular groups of employees; membership is confined to employees and retired employees and their dependants. These schemes are known as restricted membership schemes.
The Health Insurance Authority administers a Risk Equalisation Fund which pays health credits to the insurance company for people over 60 to help to meet their higher claims costs. The health credits vary by age, gender and by level of cover. These credits are funded by a community rating health insurance levy paid by health insurers.
Japan Japan has universal health coverage at a reasonable cost for every citizen. Fees for services are covered by national insurance and public expenditure. The patients pay utmost 30% of the total fee. The financing system is regulated by nationally uniform schedule. In the Japanese health care system, national and local governments provide healthcare services (including free screening examinations for particular diseases, prenatal care, and infectious disease control). Reported by the OECD study (2003) to be one of eight countries where the waiting times were low. People without insurance through employers can participate in a national health insurance program. Since 1973, all elderly persons have been covered by government-sponsored insurance.
Thailand Thailand has Nation Health Security Policy to ensure that every Thai person can access any essential health services from the local health care center. They are charged a token amount per visit. Health insurance in Thailand is for profit. Difficult cases cannot always be treated in local health care centers. Because tertiary health centers are usually located in large provinces or universities, patients might have financial strains when having been referred to these centres. There are few insurance companies (catering to the needs of expatriates), so competition between companies is hardly present resulting in high prices.
South Korea Universal health care service is provided under government’s supervision. Any Korean can visit a local hospital or public health clinic for a small of fee for essential medical service. There are many small private clinics and hospitals as well as public hospitals, but all are supervised by government, and provide similar services. Essential health care costs are same at anywhere. Waiting lists are very short if any. Doctors in large hospitals are generally overloaded by too many patients. All insurance is governed and controlled by the government. Private insurance exists only for more excessive health care costs. Insurance fee varies by each individual’s income or wealth. Generally, the employer pays 50% of insurance. However, some high-cost diseases are not fully covered by the insurance. Government pays full healthcare cost for low-income population.
China There are two main medical insurance policies for non-agricultural population and farm population. The former pay more than latter for their medical insurance, however, the latter receives less coverage for their medical services. Most of medical institutions are public. Private medical institutions are profit-based. It is a walk-in system rather than appointment-based in most health care facilities. Appointments may or may not be requested depend on the number of available positions. Main medical insurance is provided by local governments. There are few commercial insurance.