Health Insurance in Europe - Salient Features of Social Health Insurance

Salient Features of Social Health Insurance Products and Services

• Individuals who are insured are required to contribute to a health insurance fund which is based on income per annum rather than stressing upon the everpervading risks in life.
• Determination of health-status of an individual in future and not upon the ability to pay should determine access to healthcare.

• Contributions by an individual for the purpose of social insurance fund are categorised as a separate entity apart from the mandatory taxes and service charges.
• Both employers and employees should contribute towards health insurance fund.
• Government should financially, economically, socially and morally provide support to those individuals who are unable to contribute to the insurance fund.
• The options in social health insurance fund should be available to the citizens of the country with the freedom to choose the insurance products and services based on their requirements.
• Consumers should have a choice in opting for medical professionals and other healthcare service providers of their choice.
• Social health insurance is a compulsion for majority of the citizens in that economy.
• A pre-defined package of healthcare benefits is provided that may or may not vary across funds.

Salient Features of Private Health Insurance Products and Services

In European countries, private health insurance serves three distinct functions namely:-

a) First one is an alternative for mandatory social health insurance arrangements. In certain countries, citizens that are not covered under the mandatory insurance scheme can choose insurance policy cover from private insurance companies. For eg. Netherlands. In certain countries like Germany, citizens have the option of choosing between Private Health Insurance and Social Health Insurance especially when the incomes surpass the eligibility criteria.

b) The second function is to supplement statuory (public) health insurance for availing the services that are not covered under social insurance cover. Examples include alternative medical treatment, cosmetic treatment, dental treatment etc. In certain countries like Belgium, France policyholders can avail supplementary insurance with a view to cover the financial risks of co-insurance and co-payments.

c) Third salient feature of Private Health Insurance is to provide complementary coverage. Under this option, policyholders can purchase additional private insurance in addition to the existing social schemes. Such a system is found in tax-financed countries possessing a separate privately funded financial system considered parallel to the public sector.