IDEAS home Printed from https://ideas.repec.org/a/eee/hepoli/v123y2019i7p621-629.html
   My bibliography  Save this article

National Health Insurance: A conceptual framework from conflicting typologies

Author

Listed:
  • Cuadrado, Cristóbal
  • Crispi, Francisca
  • Libuy, Matías
  • Marchildon, Gregory
  • Cid, Camilo

Abstract

In the path to universal health coverage, policymakers discuss different alternative health system’s financing schemes. Classical typologies have been posited, including models such as National Health Service, Social Health Insurance and Private Health Insurance. More recently, National Health Insurance (NHI) has been suggested as a separate model. Nevertheless, there are discrepancies regarding what defines an NHI model. The purpose of this article is to propose a comprehensive definition of an NHI model, aimed to disentangle the current discrepancies in the conceptualization and the scope of this type of arrangement. Based on the previous literature we identified some common characteristics across NHI definitions, namely universal coverage, pooling in a single fund and a purchasing function based on a single-payer financing mechanism. Areas of controversy were also identified. While some authors emphasized the importance of an effective separation between the purchaser and provider functions, others highlighted the relative importance of privately-owned provision to define a system like NHI-type. Based on empirical data, we suggest that the ownership is not a critical variable to distinguish an NHI from other models, and instead, suggest that a pivotal characteristic of the NHI is the single payer mechanism that is not integrated with the health providers.

Suggested Citation

  • Cuadrado, Cristóbal & Crispi, Francisca & Libuy, Matías & Marchildon, Gregory & Cid, Camilo, 2019. "National Health Insurance: A conceptual framework from conflicting typologies," Health Policy, Elsevier, vol. 123(7), pages 621-629.
    • Handle: RePEc:eee:hepoli:v:123:y:2019:i:7:p:621-629
    DOI: 10.1016/j.healthpol.2019.05.013
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0168851019301307
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.healthpol.2019.05.013?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Toth, Federico, 2016. "Classification of healthcare systems: Can we go further?," Health Policy, Elsevier, vol. 120(5), pages 535-543.
    2. Lee, Sang-Yi & Chun, Chang-Bae & Lee, Yong-Gab & Seo, Nam Kyu, 2008. "The National Health Insurance system as one type of new typology: The case of South Korea and Taiwan," Health Policy, Elsevier, vol. 85(1), pages 105-113, January.
    3. Michiel Bijlsma & Viktoria Kocsis & Victoria Shestalova & Gijsbert Zwart, 2008. "Vertical foreclosure: a policy framework," CPB Document 157, CPB Netherlands Bureau for Economic Policy Analysis.
    4. Londono, Juan-Luis & Frenk, Julio, 1997. "Structured pluralism: towards an innovative model for health system reform in Latin America," Health Policy, Elsevier, vol. 41(1), pages 1-36, July.
    5. Wagstaff, Adam & van Doorslaer, Eddy & van der Burg, Hattem & Calonge, Samuel & Christiansen, Terkel & Citoni, Guido & Gerdtham, Ulf-G & Gerfin, Mike & Gross, Lorna & Hakinnen, Unto, 1999. "Equity in the finance of health care: some further international comparisons1," Journal of Health Economics, Elsevier, vol. 18(3), pages 263-290, June.
    6. Hussey, P. & Anderson, G. F., 2003. "A comparison of single- and multi-payer health insurance systems and options for reform," Health Policy, Elsevier, vol. 66(3), pages 215-228, December.
    7. Rothgang, Heinz & Cacace, Mirella & Grimmeisen, Simone & Wendt, Claus, 2005. "9 The changing role of the state in healthcare systems," European Review, Cambridge University Press, vol. 13(S1), pages 187-212, March.
    8. Chiang, Tung-liang, 1997. "Taiwan's 1995 health care reform," Health Policy, Elsevier, vol. 39(3), pages 225-239, March.
    9. Pablo Gottret & George Schieber, 2006. "Health Financing Revisited : A Practitioner's Guide," World Bank Publications - Books, The World Bank Group, number 7094, December.
    10. Böhm, Katharina & Schmid, Achim & Götze, Ralf & Landwehr, Claudia & Rothgang, Heinz, 2013. "Five types of OECD healthcare systems: Empirical results of a deductive classification," Health Policy, Elsevier, vol. 113(3), pages 258-269.
    11. Sado, Lantona & Spaho, Alma & Hotchkiss, David R., 2014. "The influence of women's empowerment on maternal health care utilization: Evidence from Albania," Social Science & Medicine, Elsevier, vol. 114(C), pages 169-177.
    12. Kutzin, Joseph, 2001. "A descriptive framework for country-level analysis of health care financing arrangements," Health Policy, Elsevier, vol. 56(3), pages 171-204, June.
    13. Terris, M. & Cornely, P.B. & Daniels, H.C. & Kerr, L.E., 1977. "The case for a national health service," American Journal of Public Health, American Public Health Association, vol. 67(12), pages 1183-1185.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Espinosa-González, Ana Belén & Delaney, Brendan C. & Marti, Joachim & Darzi, Ara, 2021. "The role of the state in financing and regulating primary care in Europe: a taxonomy," Health Policy, Elsevier, vol. 125(2), pages 168-176.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Lee, Sang-Yi & Chun, Chang-Bae & Lee, Yong-Gab & Seo, Nam Kyu, 2008. "The National Health Insurance system as one type of new typology: The case of South Korea and Taiwan," Health Policy, Elsevier, vol. 85(1), pages 105-113, January.
    2. Matthias Klumpp & Dominic Loske & Silvio Bicciato, 2022. "COVID-19 health policy evaluation: integrating health and economic perspectives with a data envelopment analysis approach," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(8), pages 1263-1285, November.
    3. Espinosa-González, Ana Belén & Delaney, Brendan C. & Marti, Joachim & Darzi, Ara, 2021. "The role of the state in financing and regulating primary care in Europe: a taxonomy," Health Policy, Elsevier, vol. 125(2), pages 168-176.
    4. Fu, Hwai-Hui & Tsai, Hsien-Tang & Lin, Ching-Wei & Wei, Duan, 2004. "Application of a single sampling plan for auditing medical-claim payments made by Taiwan National Health Insurance," Health Policy, Elsevier, vol. 70(2), pages 185-195, November.
    5. Adam Wagstaff, 2010. "Social health insurance reexamined," Health Economics, John Wiley & Sons, Ltd., vol. 19(5), pages 503-517, May.
    6. Bonasia, Mariangela & Kounetas, Konstantinos & Oreste, Napolitano, 2020. "Assessment of regional productive performance of European health systems under a metatechnology framework," Economic Modelling, Elsevier, vol. 84(C), pages 234-248.
    7. Mohammed Khaled Al-Hanawi & Omar Alsharqi & Saja Almazrou & Kirit Vaidya, 2018. "Healthcare Finance in the Kingdom of Saudi Arabia: A Qualitative Study of Householders’ Attitudes," Applied Health Economics and Health Policy, Springer, vol. 16(1), pages 55-64, February.
    8. Cavagnero, Eleonora, 2008. "Health sector reforms in Argentina and the performance of the health financing system," Health Policy, Elsevier, vol. 88(1), pages 88-99, October.
    9. Purcel, Alexandra-Anca & Dragos, Cristian Mihai & Mare, Codruța & Dragos, Simona Laura, 2023. "Voluntary health insurance and out-of-pocket payments in European OECD countries," Economic Modelling, Elsevier, vol. 120(C).
    10. Mohammad Hajizadeh & Hong Nghiem, 2011. "Out-of-pocket expenditures for hospital care in Iran: who is at risk of incurring catastrophic payments?," International Journal of Health Economics and Management, Springer, vol. 11(4), pages 267-285, December.
    11. Böhm, Katharina & Schmid, Achim & Götze, Ralf & Landwehr, Claudia & Rothgang, Heinz, 2012. "Classifying OECD healthcare systems: A deductive approach," TranState Working Papers 165, University of Bremen, Collaborative Research Center 597: Transformations of the State.
    12. Hussey, P. & Anderson, G. F., 2003. "A comparison of single- and multi-payer health insurance systems and options for reform," Health Policy, Elsevier, vol. 66(3), pages 215-228, December.
    13. Galina Besstremyannaya & Jaak Simm, 2014. "Multi-payer health insurance systems in Central and Eastern Europe: lessons from the Czech Republic, Slovakia, and Russia," Working Papers w0203, Center for Economic and Financial Research (CEFIR).
    14. Toshiyuki Sueyoshi & Youngbok Ryu & Ji-Young Yun, 2021. "COVID-19 Response and Prospects of Clean/Sustainable Energy Transition in Industrial Nations: New Environmental Assessment," Energies, MDPI, vol. 14(4), pages 1-30, February.
    15. World Bank, 2005. "Azerbaijan : Health Sector Review Note, Volume 2, Background papers," World Bank Publications - Reports 8691, The World Bank Group.
    16. Sanmarchi Francesco & Esposito Francesco & Golinelli Davide & Bucci Andrea & Toscano Fabrizio, 2021. "Association between Economic Growth, Mortality, and Healthcare Spending in 31 High-Income Countries," Forum for Health Economics & Policy, De Gruyter, vol. 24(2), pages 101-118, December.
    17. World Bank, 2008. "Kosovo : Health Financing Reform Study," World Bank Publications - Reports 8121, The World Bank Group.
    18. Böhm, Katharina & Schmid, Achim & Götze, Ralf & Landwehr, Claudia & Rothgang, Heinz, 2013. "Five types of OECD healthcare systems: Empirical results of a deductive classification," Health Policy, Elsevier, vol. 113(3), pages 258-269.
    19. Alvaro S Almeida, 2016. "The Role Of Private Non-Profit Healthcare Organizations In Nhs Systems: Implications For The Portuguese Hospital Devolution Program," FEP Working Papers 577, Universidade do Porto, Faculdade de Economia do Porto.
    20. Joana Cima & Alvaro S Almeida, 2018. "Health Expenditure, GDP Growth and the Financial Crisis: A Panel Data Analysis for OECD European Countries," FEP Working Papers 602, Universidade do Porto, Faculdade de Economia do Porto.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:123:y:2019:i:7:p:621-629. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu or the person in charge (email available below). General contact details of provider: http://www.elsevier.com/locate/healthpol .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.