Germany introduced the first national health insurance program in 1883. Other industrialized countries adopted government-funded health insurance systems in the early 20th century. Most of these programs grew extensively after World War II (1939-1945), but some have always offered more extensive coverage than others.

Many countries—such as Brazil, Mexico, Russia, and Sweden—directly employ physicians who treat patients in government-operated facilities. In other countries—such as Britain, Norway, and Spain—governments pay private physicians who may also practice outside government-funded programs.

Government-funded health insurance systems increasingly offer incentives for people to seek supplementary coverage through private insurance companies. For example, in 1998 China introduced a program designed to guarantee government-sponsored health insurance for all workers, but this program also imposes ceilings on annual reimbursements to insured individuals. To make up for the shortfall in government subsidies, employers that can afford to do so are encouraged by the government to subscribe to supplementary health insurance plans through private companies.

Australia also encourages citizens to join private health plans. The Australian government has long guaranteed basic health insurance for its citizens through its Medicare plan, but many Australians have traditionally chosen to subscribe to more comprehensive private plans. As health care costs rose in the 1980s and 1990s, however, many Australians abandoned private health insurance for Medicare. For example, in 1984 about 50 percent of Australians used the Medicare system, but by 1996 that figure had risen to 67 percent. This increased burden on public funds led to proposals in 1997 for government subsidies for low-income Australians who subscribe to private insurance.

Contributed By:
Norma L. Nielson

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