I.

Introduction

National Health Insurance, government-operated system of insurance that provides financial benefits and medical services to persons disabled by sickness or accident. National health insurance systems are found in many countries, particularly in Europe. In the United States, health insurance has traditionally been provided by private enterprise on a voluntary basis. National health insurance bills were introduced in the Congress of the United States in the 1930s and 1940s but were not enacted. The Social Security Amendments of 1965, however, created a governmental health insurance program known as Medicare, which is intended primarily for the aged. In 1993 President Bill Clinton introduced a plan for universal health care coverage. However, a compromise could not be reached with opponents in Congress and the bill died. See Health Insurance; Medicare and Medicaid.

Systems of national health insurance frequently are coordinated with other national programs of social insurance, such as pension programs, programs of unemployment insurance, and workers’ compensation.

II.

History of National Health Insurance

The first country to provide health insurance on a national scale was Germany. The German chancellor Prince Otto von Bismarck obtained passage of a compulsory sickness-insurance law in 1883, which was financed by a state subsidy. Various types of national health insurance were adopted by other European countries, including Austria-Hungary later in the 19th century, Norway in 1909, Sweden in 1910, and Britain and Russia in 1911. After World War II (1939-1945) the growth of national systems of health insurance in Europe was extensive, although the amount of benefits, conditions of eligibility, treatment of dependents, and provisions for maternity care varied widely.

III.

National Health Insurance in the United Kingdom

The British system of national health insurance, comprising social security and the National Health Service, was thoroughly reorganized after World War II and is one of the most comprehensive systems in operation. National health insurance is under the jurisdiction of the Department of Health and Social Security, which administers the payment of cash benefits for sickness and maternity. All employed and self-employed people up to the age of 65 are eligible for benefits, and the funds for the program are derived from weekly contributions by employers and employees. Sickness benefits are payable up to pensionable age if a sufficient number of weekly contributions have been made. Maternity benefits include weekly allowances, before and after confinement, to women who ordinarily work, as well as certain cash grants.

The National Health Service administers the National Health Service Act, which went into effect in 1948. The cost of the program is met largely from public funds. Benefits, which are of unlimited duration, include hospital services, general medical services outside of hospitals, and local health services. Hospital services are provided in general and special hospitals, for inpatient, outpatient, and day-patient care, including the services of specialists. General medical services include those of general practitioners and dental, pharmaceutical, and ophthalmic services. The local health services include maternity and child-welfare services, domiciliary nursing care, aftercare, immunization, and some mental-health services.

A person may use all the facilities of the National Health Service, or only a part of the service. He or she may, for example, make private arrangements with a practitioner for medical care and apply for free hospitalization. Practitioners are not required to participate in the program. Those who participate and work outside of hospitals receive a fee for each patient as well as a basic practice allowance. Participating physicians may also engage in private practice. Almost all of the hospitals in Britain are administered by the National Health Service.