Ekonomi Kesehatan – HPM FK UGM
JANUARY 2016
2015 International Proiles
of Health Care Systems
AUSTRALIA
CANADA
CHINA
DENMARK
ENGLAND
FRANCE
GERMANY
INDIA
ISRAEL
ITALY
JAPAN
NETHERLANDS
EDITED BY
Elias Mossialos and Martin Wenzl
London School of Economics and Political Science
Robin Osborn and Dana Sarnak
The Commonwealth Fund
NEW ZEALAND
NORWAY
SINGAPORE
SWEDEN
SWITZERLAND
UNITED STATES
T he C ommonwealTh F und is a private foundation that promotes a high performance health
care system providing better access, improved quality, and greater efficiency. The Fund’s work
focuses particularly on society’s most vulnerable, including low-income people, the uninsured,
minority Americans, young children, and elderly adults.
The Fund carries out this mandate by supporting independent research on health care issues
and making grants to improve health care practice and policy. An international program in
health policy is designed to stimulate innovative policies and practices in the United States
and other industrialized countries.
2015 International Proiles
of Health Care Systems
Australia, Canada, China, Denmark, England, France, Germany, India, Israel, Italy,
Japan, The Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland,
and the United States
EDITED BY
Elias Mossialos and Martin Wenzl
London School of Economics and Political Science
Robin Osborn and Dana Sarnak
The Commonwealth Fund
JA N U A RY 2 0 1 6
Abstract: This publication presents overviews of the health care systems of Australia, Canada,
China, Denmark, England, France, Germany, India, Israel, Italy, Japan, the Netherlands, New Zealand,
Norway, Singapore, Sweden, Switzerland, and the United States. Each overview covers health
insurance, public and private financing, health system organization and governance, health care
quality and coordination, disparities, efficiency and integration, use of information technology
and evidence-based practice, cost containment, and recent reforms and innovations. In addition,
summary tables provide data on a number of key health system characteristics and performance
indicators, including overall health care spending, hospital spending and utilization, health care
access, patient safety, care coordination, chronic care management, disease prevention, capacity for
quality improvement, and public views.
To learn more about new publications when they become available, visit the Fund’s website and
register to receive email alerts. Commonwealth Fund pub. 1857.
CONTENTS
Table 1. Health Care System Financing and Coverage in 18 Countries . . 6
Table 2. Selected Health System Indicators for 17 Countries . . . . . . . . . . . . 7
Table 3. Selected Health System Performance Indicators for 11 Countries . . . . .8
Table 4. Provider Organization and Payment in 18 Countries . . . . . . . . . . . . . . . 9
The Australian Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
The Canadian Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
The Chinese Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
The Danish Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
The English Health Care System, 2015. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
The French Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
The German Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
The Indian Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
The Israeli Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
The Italian Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97
The Japanese Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
The Dutch Health Care System, 2015. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
The New Zealand Health Care System, 2015. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
The Norwegian Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .133
The Singaporean Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
The Swedish Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
The Swiss Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
The U.S. Health Care System, 2015
171
Table 1. Health Care System Financing and Coverage in 18 Countries
HEALTH SYSTEM AND PUBLIC/PRIVATE INSURANCE ROLE
Government role
Public system financing
BENEFIT DESIGN
Private insurance role (core benefits; cost-sharing;
noncovered benefits; private facilities or amenities;
substitute for public insurance)
Caps on cost-sharing
Exemptions and low-income protection
Australia
Regionally administered, joint (national & state) public hospital funding;
universal public medical insurance program (Medicare)
General tax revenue; earmarked income tax
~47.3% buy complementary (e.g., private hospital and dental care,
optometry) and supplementary coverage (increased choice, faster
access for nonemergency services, rebates for selected services)
Caps for pharmaceutical OOP expenditure only,
dependent on income and total OOP expenditure in the same year
Low-income and older people: Lower cost-sharing;
lower pharmaceutical OOP cap and lower OOP maximum for 80% Medicare services rebatea
Canada
Regionally administered universal public insurance program that plans
and funds (mainly private) provision
Provincial/federal general tax revenue
~67% buy complementary coverage for noncovered benefits
(e.g., private rooms in hospitals, drugs, dental care, optometry)
No
There is no cost-sharing for publicly covered services;
protection for low-income people from cost of prescription drugs varies by region
China
Supervision by health authorities (Health and Family Planning Commissions) at the national, provincial and local levels; some direct provision
through public ownership of hospitals
There are three main publicly financed health insurance
types with local-area risk-pooling: urban employer-based
(mainly payroll taxes, for formally employed urban residents), urban resident basic (mainly government funded,
for urban nonemployed residents), and rural cooperative
medical scheme (government-funded, for rural residents)
Complementary to cover cost-sharing and gaps,
as well as better health care quality and/or higher
reimbursements. No data on coverage, but growth
has been rapid.
No
Government subsidies to low-income families for insurance contributions and OOP; emergency assistance
by local governments for specific diseases and unpaid
emergency department or other expenses
Denmark
National health care system. Regulation, central planning, and funding
by national government; provision by regional and municipal authorities.
Earmarked income tax
~39% have complementary coverage (cost-sharing, noncovered
benefits such as physiotherapy), ~26% have supplementary coverage (access to private providers)
No. Decreasing copayments with higher OOP
drug spending.
Drug OOP cap for chronically ill (DKK3,775 [USD498]);
financial assistance for low income and terminally illa
England
National health service (NHS)
General tax revenue (includes employment-related
insurance contributions)
~11% buy supplementary coverage for more rapid and convenient
access (including to elective treatment in private hospitals)
No general cap, but OOP payments almost
exclusively apply to prescription drugs and medical
appliances only. For drugs, prepayment certificate
with GBP29.10 [USD41.10] per three months or
GBP104 [USD147] per year ceiling for those needing a large number of prescription drugs.a
Drug cost-sharing exemption for low-income, older
people, children, pregnant women and new mothers,
and some disabled/chronically ill; financial assistance
with transport costs available to people with low
income; vision tests free for young people, older people,
and low-income people
France
Statutory health insurance system, with all SHI insurers incorporated into
a single national exchange
Employer/employee earmarked income and payroll tax;
general tax revenue, earmarked taxes
~95% buy or receive government vouchers for complementary
coverage (mainly cost-sharing, some noncovered benefits);
limited supplementary insurance
No. EUR50 [USD60] cap on deductibles for
consultations and servicesa
Exemption for low income, chronically ill and disabled,
and children
Germany
Statutory health insurance (SHI) system, with 124 competing SHI insurers
(“sickness funds” in a national exchange); high income can opt out for
private coverage
Employer/employee earmarked payroll tax; general
tax revenue
~11% opt out from statutory insurance and buy substitutive
coverage. Some complementary (minor benefit exclusions from
statutory scheme, copayments) and supplementary coverage
(improved amenities).
Yes. 2% of household income; 1% of income for
chronically ill.
Children and adolescents
2015 International Proiles
of Health Care Systems
AUSTRALIA
CANADA
CHINA
DENMARK
ENGLAND
FRANCE
GERMANY
INDIA
ISRAEL
ITALY
JAPAN
NETHERLANDS
EDITED BY
Elias Mossialos and Martin Wenzl
London School of Economics and Political Science
Robin Osborn and Dana Sarnak
The Commonwealth Fund
NEW ZEALAND
NORWAY
SINGAPORE
SWEDEN
SWITZERLAND
UNITED STATES
T he C ommonwealTh F und is a private foundation that promotes a high performance health
care system providing better access, improved quality, and greater efficiency. The Fund’s work
focuses particularly on society’s most vulnerable, including low-income people, the uninsured,
minority Americans, young children, and elderly adults.
The Fund carries out this mandate by supporting independent research on health care issues
and making grants to improve health care practice and policy. An international program in
health policy is designed to stimulate innovative policies and practices in the United States
and other industrialized countries.
2015 International Proiles
of Health Care Systems
Australia, Canada, China, Denmark, England, France, Germany, India, Israel, Italy,
Japan, The Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland,
and the United States
EDITED BY
Elias Mossialos and Martin Wenzl
London School of Economics and Political Science
Robin Osborn and Dana Sarnak
The Commonwealth Fund
JA N U A RY 2 0 1 6
Abstract: This publication presents overviews of the health care systems of Australia, Canada,
China, Denmark, England, France, Germany, India, Israel, Italy, Japan, the Netherlands, New Zealand,
Norway, Singapore, Sweden, Switzerland, and the United States. Each overview covers health
insurance, public and private financing, health system organization and governance, health care
quality and coordination, disparities, efficiency and integration, use of information technology
and evidence-based practice, cost containment, and recent reforms and innovations. In addition,
summary tables provide data on a number of key health system characteristics and performance
indicators, including overall health care spending, hospital spending and utilization, health care
access, patient safety, care coordination, chronic care management, disease prevention, capacity for
quality improvement, and public views.
To learn more about new publications when they become available, visit the Fund’s website and
register to receive email alerts. Commonwealth Fund pub. 1857.
CONTENTS
Table 1. Health Care System Financing and Coverage in 18 Countries . . 6
Table 2. Selected Health System Indicators for 17 Countries . . . . . . . . . . . . 7
Table 3. Selected Health System Performance Indicators for 11 Countries . . . . .8
Table 4. Provider Organization and Payment in 18 Countries . . . . . . . . . . . . . . . 9
The Australian Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
The Canadian Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
The Chinese Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
The Danish Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
The English Health Care System, 2015. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
The French Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
The German Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
The Indian Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
The Israeli Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
The Italian Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97
The Japanese Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
The Dutch Health Care System, 2015. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
The New Zealand Health Care System, 2015. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
The Norwegian Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .133
The Singaporean Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
The Swedish Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
The Swiss Health Care System, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
The U.S. Health Care System, 2015
171
Table 1. Health Care System Financing and Coverage in 18 Countries
HEALTH SYSTEM AND PUBLIC/PRIVATE INSURANCE ROLE
Government role
Public system financing
BENEFIT DESIGN
Private insurance role (core benefits; cost-sharing;
noncovered benefits; private facilities or amenities;
substitute for public insurance)
Caps on cost-sharing
Exemptions and low-income protection
Australia
Regionally administered, joint (national & state) public hospital funding;
universal public medical insurance program (Medicare)
General tax revenue; earmarked income tax
~47.3% buy complementary (e.g., private hospital and dental care,
optometry) and supplementary coverage (increased choice, faster
access for nonemergency services, rebates for selected services)
Caps for pharmaceutical OOP expenditure only,
dependent on income and total OOP expenditure in the same year
Low-income and older people: Lower cost-sharing;
lower pharmaceutical OOP cap and lower OOP maximum for 80% Medicare services rebatea
Canada
Regionally administered universal public insurance program that plans
and funds (mainly private) provision
Provincial/federal general tax revenue
~67% buy complementary coverage for noncovered benefits
(e.g., private rooms in hospitals, drugs, dental care, optometry)
No
There is no cost-sharing for publicly covered services;
protection for low-income people from cost of prescription drugs varies by region
China
Supervision by health authorities (Health and Family Planning Commissions) at the national, provincial and local levels; some direct provision
through public ownership of hospitals
There are three main publicly financed health insurance
types with local-area risk-pooling: urban employer-based
(mainly payroll taxes, for formally employed urban residents), urban resident basic (mainly government funded,
for urban nonemployed residents), and rural cooperative
medical scheme (government-funded, for rural residents)
Complementary to cover cost-sharing and gaps,
as well as better health care quality and/or higher
reimbursements. No data on coverage, but growth
has been rapid.
No
Government subsidies to low-income families for insurance contributions and OOP; emergency assistance
by local governments for specific diseases and unpaid
emergency department or other expenses
Denmark
National health care system. Regulation, central planning, and funding
by national government; provision by regional and municipal authorities.
Earmarked income tax
~39% have complementary coverage (cost-sharing, noncovered
benefits such as physiotherapy), ~26% have supplementary coverage (access to private providers)
No. Decreasing copayments with higher OOP
drug spending.
Drug OOP cap for chronically ill (DKK3,775 [USD498]);
financial assistance for low income and terminally illa
England
National health service (NHS)
General tax revenue (includes employment-related
insurance contributions)
~11% buy supplementary coverage for more rapid and convenient
access (including to elective treatment in private hospitals)
No general cap, but OOP payments almost
exclusively apply to prescription drugs and medical
appliances only. For drugs, prepayment certificate
with GBP29.10 [USD41.10] per three months or
GBP104 [USD147] per year ceiling for those needing a large number of prescription drugs.a
Drug cost-sharing exemption for low-income, older
people, children, pregnant women and new mothers,
and some disabled/chronically ill; financial assistance
with transport costs available to people with low
income; vision tests free for young people, older people,
and low-income people
France
Statutory health insurance system, with all SHI insurers incorporated into
a single national exchange
Employer/employee earmarked income and payroll tax;
general tax revenue, earmarked taxes
~95% buy or receive government vouchers for complementary
coverage (mainly cost-sharing, some noncovered benefits);
limited supplementary insurance
No. EUR50 [USD60] cap on deductibles for
consultations and servicesa
Exemption for low income, chronically ill and disabled,
and children
Germany
Statutory health insurance (SHI) system, with 124 competing SHI insurers
(“sickness funds” in a national exchange); high income can opt out for
private coverage
Employer/employee earmarked payroll tax; general
tax revenue
~11% opt out from statutory insurance and buy substitutive
coverage. Some complementary (minor benefit exclusions from
statutory scheme, copayments) and supplementary coverage
(improved amenities).
Yes. 2% of household income; 1% of income for
chronically ill.
Children and adolescents