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is the organization of people, institutions, and resources to
deliver health care services to meet the health needs of target populations.

There is a wide variety of health care systems around the world, with as many histories and
organizational structures as there are nations. In some countries, health care system
planning is distributed among market participants. In others, there is a concerted effort
among governments, trade unions, charities, religious, or other co-ordinated bodies to
deliver planned health care services targeted to the populations they serve. However, health
care planning has been described as often evolutionary rather than revolutionary.[1][2]


›‘ 1 Goals
›‘ 2 Providers
›‘  Financial resources
g‘ .1 Payment models
^‘ .1.1 Fee-for-service
^‘ .1.2 Other
›‘ Œ Information resources
›‘ £ Management
›‘ Ñ Special health care systems
›‘ ÿ Cross-country comparisons
›‘  Health care by country
g‘ .1 Afghanistan
g‘ .2 Algeria
g‘ . Argentina
g‘ .Œ Australia
g‘ .£ Belgium
g‘ .Ñ Bhutan
g‘ .ÿ Brazil
g‘ . Bulgaria
g‘ .9 Canada
g‘ .10 Cape Verde
g‘ .11 Chile
g‘ .12 Costa Rica
g‘ .1 Cuba
g‘ .1Œ Denmark
g‘ .1£ Eritrea

g‘ .1Ñ Estonia
g‘ .1ÿ Ethiopia
g‘ .1 Finland
g‘ .19 France
g‘ .20 Germany
g‘ .21 Ghana
g‘ .22 India
g‘ .2 Indonesia
g‘ .2Œ Ireland
g‘ .2£ Israel
g‘ .2Ñ Italy
g‘ .2ÿ Japan
g‘ .2 Jordan
g‘ .29 Kazakhstan
g‘ .0 Mali
g‘ .1 Malaysia
g‘ .2 Mexico
g‘ . Morocco
g‘ .Œ Netherlands
g‘ .£ New Zealand
g‘ .Ñ Niger
g‘ .ÿ Nigeria
g‘ . North Korea
g‘ .9 Norway
g‘ .Œ0 Oman
g‘ .Œ1 Pakistan
g‘ .Œ2 Paraguay
g‘ .Œ People's Republic of China
g‘ .ŒŒ Philippines
g‘ .Œ£ Romania
g‘ .ŒÑ Russia
g‘ .Œÿ Senegal
g‘ .Œ Singapore
g‘ .Œ9 South Africa
g‘ .£0 Sudan
g‘ .£1 Sweden
g‘ .£2 Switzerland
g‘ .£ Syria
g‘ .£Œ Taiwan (R.O.C.)
g‘ .££ Thailand
g‘ .£Ñ Trinidad and Tobago
g‘ .£ÿ Turkmenistan
g‘ .£ United Kingdom
g‘ .£9 United States
g‘ .Ñ0 United Arab Emirates
g‘ .Ñ1 Uzbekistan
g‘ .Ñ2 Venezuela
g‘ .Ñ Vietnam
g‘ .ь Yemen
g‘ .Ñ£ Zimbabwe
›‘ 9 See also
›‘ 10 References
›‘ 11 External links

The goals for health systems, according to the World Health Organization, are good health,
responsiveness to the expectations of the population, and fair financial contribution.
Progress towards them depends on how systems carry out four vital functions: provision of
health care services, resource generation, financing, and stewardship.[] Other dimensions
for the evaluation of health care systems include quality, efficiency, acceptability,
and equity.[1] They have also been described in the United States as "the five C's": Cost,
Coverage, Consistency, Complexity, and Chronic Illness.[Œ]



Health care providers are institutions or individuals providing health care services.
Individuals including health professionals and allied health professions can be self-
employed or working as an employee in a hospital, clinic, or other health care institution,
whether government operated, private for-profit, or private not-for-profit (e.g. non-
governmental organization). They may also work outside of direct patient care such as in a
governmenthealth department or other agency, medical laboratory, or health training
institution. Examples of health workers are doctors, nurses, midwives, paramedics, dentists,
medical laboratory
technicians, therapists, psychologists,pharmacists, chiropractors, optometrists, community
health workers, traditional medicine practitioners, and others.


Norfolk and Norwich University Hospital, a National Health Service hospital in the United

There are generally five primary methods of funding health care systems:[£]

1.‘ general taxation to the state, county or municipality

2.‘ social health insurance
.‘ voluntary or private health insurance
Œ.‘ out-of-pocket payments
£.‘ donations

Most countries' systems feature a mix of all five models. One study [Ñ] based on data from
the OECD concluded that all types of health care finance "are compatible with" an efficient
health care system. The study also found no relationship between financing and cost

The term health insurance is generally used to describe a form of insurance that pays for
medical expenses. It is sometimes used more broadly to include insurance
covering disability or long-term nursing or custodial careneeds. It may be provided through
a social insurance program, or from private insurance companies. It may be obtained on a
group basis (e.g., by a firm to cover its employees) or purchased by individual consumers.
In each case premiums or taxes protect the insured from high or unexpected health care

By estimating the overall cost of health care expenses, a routine finance structure (such as a
monthly premium or annual tax) can be developed, ensuring that money is available to pay
for the health care benefits specified in the insurance agreement. The benefit is typically
administered by a government agency, a non-profit health fund or a corporation operating
seeking to make a profit.[ÿ]

Many forms of commercial health insurance control their costs by restricting the benefits
that are paid by through deductibles, co-payments, coinsurance, policy exclusions, and total
coverage limits and will severely restrict or refuse coverage of pre-existing conditions.
Many government schemes also have co-payment schemes but exclusions are rare because
of political pressure. The larger insurance schemes may also negotiate fees with providers.

Many forms of social insurance schemes control their costs by using the bargaining power
of their community they represent to control costs in the health care delivery system. For
example by negotiating drug prices directly with pharmaceutical companies, or negotiating
standard fees with the medical profession. Social schemes sometimes feature contributions
related to earnings as part of a scheme to deliver universal health care, which may or may
not also involve the use of commercial and non-commercial insurers. Essentially the more
wealthy pay proportionately more into the scheme to cover the needs of the relatively poor

who therefore contribute proportionately less. There are usually caps on the contributions
of the wealthy and minimum payments that must be made by the insured (often in the form
of a minimum contribution, similar to a deductible in commercial insurance models).



In most countries, wage costs for health care practitioners are estimated to represent
between ѣ and 0 of renewable health system expenditures.[][9] There are three ways
to pay medical practitioners. There has been growing interest in blending elements of these


P    pay general practitioners (GPs) based on the service.[10] They
are even more widely used for specialists working in ambulatory care.[10]

There are two ways to set fee levels:[10]

›‘ By individual practitioners.
›‘ Central negotiations (as in Japan, Germany, Canada and in France) or hybrid model
(such as in Australia, France's sector 2, and New Zealand) where GPs can charge
extra fees on top of standardized patient reimbursement rates.


In     , GPs are paid for each patient on their "list", usually with
adjustments for factors such as age and gender.[10] According to OECD, "these systems are
used in Italy (with some fees), in all four countries of the United Kingdom (with some fees
and allowances for specific services), Austria (with fees for specific services), Denmark
(one third of income with remainder fee for service), Ireland (since 199), the Netherlands
(fee-for-service for privately insured patients and public employees) and Sweden (from
199Œ). Capitation payments have become more frequent in ³managed care´ environments
in the United States."[10]

According to OECD, "Capitation systems allow funders to control the overall level of
primary health expenditures, and the allocation of funding among GPs is determined by
patient registrations. However, under this approach, GPs may register too many patients
and under-serve them, select the better risks and refer on patients who could have been
treated by the GP directly. Freedom of consumer choice over doctors, coupled with the
principle of "money following the patient" may moderate some of these risks. Aside from
selection, these problems are likely to be less marked than under salary-type

In several OECD countries, general practitioners (GPs) are employed on    for the
government.[10] According to OECD, "Salary arrangements allow funders to control
primary care costs directly; however, they may lead to under-provision of services (to ease
workloads), excessive referrals to secondary providers and lack of attention to the
preferences of patients."[10] There has been movement away from this system.[10]


Sound information plays an increasingly critical role in the delivery of modern health care
and efficiency of health care systems. Health informatics - the intersection of information
science, medicine and health care - deals with the resources, devices, and methods required
to optimize the acquisition and use of information in health and biomedicine. Necessary
tools for proper health information coding and management include clinical guidelines,
formal medical terminologies, and computers and other information and communication
technologies. The kinds of data processed may include patients' medical records, hospital
administration and clinical functions, and human resources information.

The use of health information lies at the root of evidence-based policy and evidence-based
management in health care.



The management of any health care system is typically directed through a set of policies
and plans adopted by government, private sector business and other groups in areas such as
personal health care delivery and financing, pharmaceuticals, health human resources,
and public health.

Public health is concerned with threats to the overall health of a community based
on population health analysis. The population in question can be as small as a handful of
people, or as large as all the inhabitants of several continents (for instance, in the case of
a pandemic). Public health is typically divided into epidemiology, biostatistics and health
services. Environmental, social, behavioral, and occupational health are also important

A child being immunized againstpolio.

Today, most governments recognize the importance of public health programs in reducing
the incidence of disease, disability, the effects of aging and health inequities, although
public health generally receives significantly less government funding compared with
medicine. For examply, most countries have a vaccination policy, supporting public health
programs in providing vaccinations to promote health. Vaccinations are voluntary in some
countries and mandatory in some countries. Some governments pay all or part of the costs
for vaccines in a national vaccination schedule.

The rapid emergence of many chronic diseases, which require costly long-term care and
treatment, is making many health managers and policy makers re-examine their health care
delivery practices. An important health issue facing the world currently
is HIV/AIDS.[11] Another major public health concern is diabetes.[12] In 200Ñ, according to
the World Health Organization, at least 1ÿ1 million people worldwide suffered from
diabetes. Its incidence is increasing rapidly, and it is estimated that by the year 200, this
number will double. A controversial aspect of public health is the control of tobacco
smoking, linked to cancer and other chronic illnesses.[1]

Antibiotic resistance is another major concern, leading to the reemergence of diseases such
as tuberculosis. The World Health Organization, for its World Health Day 2011 campaign,
is calling for intensified global commitment to safeguard antibiotics and
other antimicrobial medicines for future generations.


›‘ Occupational safety and health
›‘ School health services
›‘ Military medicine

Direct comparisons of health statistics across nations are complex. The Commonwealth
Fund, in its annual survey, "Mirror, Mirror on the Wall", compares the performance of the
health care systems in Australia, New Zealand, the United Kingdom, Germany, Canada and
the U.S. Its 200ÿ study found that, although the U.S. system is the most expensive, it
consistently underperforms compared to the other countries.[1Œ] A major difference between
the U.S. and the other countries in the study is that the U.S. is the only country
without universal health care. The OECD also collects comparative statistics, and has
published brief country profiles.[1£][1Ñ][1ÿ]

'  '  

  !!!     ( 

    #$%&  % 
Australia 1.Œ Œ.2 2. 9.ÿ ,1ÿ .ÿ 1ÿ.ÿ Ñÿ.ÿ
Canada 0.ÿ £.0 2.2 9.0 ,9£ 10.1 1Ñ.ÿ Ñ9.
France 1.0 Œ.0 .Œ ÿ.ÿ ,Ñ01 11.0 1Œ.2 ÿ9.0
Germany ÿ9. . .£ 9.9 ,£ 10.Œ 1ÿ.Ñ ÿÑ.9
Japan 2.Ñ 2.Ñ 2.1 9.Œ 2,£1 .1 1Ñ. 1.
Norway 0.0 .0 . 1Ñ.2 £,910 9.0 1ÿ.9 .Ñ
Sweden 1.0 2.£ .Ñ 10. ,2 9.2 1.Ñ 1.ÿ
UK ÿ9.1 Œ. 2.£ 10.0 2,992 .Œ 1£. 1.ÿ
USA ÿ.1 Ñ.ÿ 2.Œ 10.Ñ ÿ,290 1Ñ.0 1.£ Œ£.Œ

Life Expectancy vs Health Care Spending in 200ÿ for OECD Countries. The data source

a Ê  (    
a )  


Beginning in 19ÿ9, military conflict destroyed the health system of Afghanistan. Most
medical professionals left the country in the 190s and 1990s, and all medical training
programmes ceased.[1] In 200Œ Afghanistan had one medical facility for every 2ÿ,000
people, and some centers were responsible for as many as 00,000 people.[1] In 200Œ
international organizations provided a large share of medical care.[1] An estimated one-
quarter of the population had no access to health care.[1] In 200 there were

11 physicians and 1 nurses per 100,000 population, and the per capita health expenditure
was US$2.[1]

a ) 


Health in Algeria, according to information from a March Ñ, 200Ñ United States report,
does not compare well with the developed world. Algeria has inadequate numbers of
physicians (one per 1,000 people) and hospital beds (2.1 per 1,000 people) and poor access
to water (ÿ percent of the population) and sanitation (92 percent of the population). Given
Algeria¶s young population, policy favors preventive health care and clinics over hospitals.
In keeping with this policy, the government maintains an immunization program. However,
poor sanitation and unclean water still cause tuberculosis, hepatitis, measles, typhoid
fever, cholera, and dysentery. In 200 about 0.10 percent of the population aged 1£Œ9 was
living with human immunodeficiency virus/acquired immune deficiency syndrome
(HIV/AIDS). The poor generally receive health care free of charge, but the wealthy pay for
care according to a sliding scale. Access to health care is enhanced by the requirement that
doctors and dentists work in public health for at least five years. However, doctors are more
easily found in the cities of the north than in the southern Sahara region.

a )  


Argentina¶s health care system is composed of three sectors: the public sector, financed
through taxes; the private sector, financed through voluntary insurance schemes; and
the social security sector, financed through obligatory insurance schemes. The Ministry of
Health and Social Action (MSAS), oversees all three subsectors of the health care system
and is responsible for setting of regulation, evaluation and collecting statistics.

Argentina has three sectors. The public sector is funded and managed by Obras Sociales,
umbrella organizations for Argentine worker's unions. There are over 00 Obras Sociales in
Argentina, each chapter being organized according to the occupation of the beneficiary.
These organizations vary greatly in quality and effectiveness. The top 0 chapters hold
ÿ of the beneficiaries and ÿ£ of resources for all Obras Sociales schemes and the
monthly average a beneficiary receives varies from $£0 per month.[19] MSAS has
established a Solidarity Redistribution Fund (FSR) to try to address these beneficiary
inequities. Only workers employed in the formal sector are covered under Obras Sociales
insurance schemes and after Argentina¶s economic crisis of 2001, the number of those
covered under these schemes fell slightly (as unemployment increased and employment in
the informal sector rose). In 1999, there were .9 million beneficiaries covered by Obras
Sociales.[20] The private health care sector in Argentina is characterized by great

heterogeneity and is made up of a great number of fragmented facilities and small
networks; it consists of over 200 organizations and covers approximately 2 million
Argentines.[19] Private insurance often overlaps with other forms of health care coverage,
thus it is difficult to estimate the degree to which beneficiaries are dependent on the public
and private sectors. According to a 2000 report by the IRBC, foreign competition has
increased in Argentina¶s private sector, with Swiss, American and other Latin
American health care providers entering the market in recent years. This has been
accompanied by little formal regulation.[19] The public system serves those not covered by
Obras Sociales or private insurance schemes. It also provides emergency services.
According to above-mentioned IRBC report, Argentina¶s public system exhibits serious
structural deterioration and managerial inefficiency; a high degree of administrative
centralization at the provincial level; rigidity in its staffing structure and labour
relationships; no adequate system of incentives; inadequate information systems on which
to base decision-making and control; serious deficits in facilities and equipment
maintenance; and a system of management ill-suited to its size. The public system is highly
decentralized to the provincial level; often primary care is even under the purview of local
townships. Since 2001, the number of Argentines relying on public services has seen an
increase. According to 2000 figures, ÿ.Œ of Argentines had no health insurance, Œ.
were covered under Obras Sociales, .Ñ had private insurance, and . were covered by
both Obras Sociales and private insurance schemes.[20]

a )


In Australia the current system, known as Medicare, was instituted in 19Œ. It coexists with
a private health system. All legal permanent residents are entitled to free public hospital
care. Treatment by private doctors is also free when the doctor direct bills the Health
Department (Bulk Billing). Medicare is funded partly by a 1.£ income tax levy (with
exceptions for low-income earners), but mostly out of general revenue. An additional levy
of 1 is imposed on high-income earners without private health insurance. There is an
uncapped 0 subsidy on private health insurance. As well as Medicare, there is a
separate Pharmaceutical Benefits Scheme under which listing and a government subsidy is
dependent on expert evaluation of the comparative cost-effectiveness of new
pharmaceuticals. In 200£, Australia spent . of GDP on health care, or US$,11 per
capita. Of that, approximately Ñÿ was government expenditure.[21]

a * 

As in most countries, the system divides itself into state and private, though fees are
payable in both. A person needs to have adequate coverage through either the state
insurance or through private insurance. In the state mutuelle/mutualiteit scheme a person

has the ability to choose any doctor, clinic or hospital you like, in any location and without
referral, according to your needs in much the same way as you can with private insurance.

›‘ Doctors

General practitioners can be found in private practices or attached to clinics and hospitals.
A person is free to consult or register with any of their own choosing.[  ] Similarly
with specialist consultants. Consultations usually end with a handing over of money and
very few doctors offer payment by card of any type.[  ] Reimbursements are
available for those with insurance, either private or public. If a patient is on a private
scheme, or is uninsured, the fee is payable in full at the time of the appointment.

The majority of dentists in Belgium are private, though there are those who accept part-
payment on state insurance.[  ]

As with general practitioners, people in Belgium can arrange to see a specialist of choice at
any hospital.[  ] Those going into hospital for a planned stay need to take personal
care items such as a towel and soap with them as these are not generally provided.[  

In Brussels the eleven big public hospitals are organized under the Iris association. [2])

›‘ Alternative health care

The Ministry of Health recognizes homeopathy, acupuncture, osteopathy and chiropractic

as reimbursable alternative treatments. Reimbursement is possible only if the practitioner is
registered as a qualified doctor.[  ]

›‘ Emergency treatment

If a call is made to the Emergency services using the old emergency 100 or the common
European 112 telephone number, an ambulance will take transport the patient to the nearest
emergency centre or the best centre suited according to need, for example, a specialist
burns unit.

›‘ Pharmacies

Pharmacies are ubiquitous in Belgium, with the green cross sign everywhere. There is a
rota system for chemists to open outside of usual hours and through the night.[  ]

›‘ Insurance

Health care insurance is a part of the Belgian social security system. To benefit a person
must join a health insurance fund mutuelle (mutualité) or ziekenfonds (mutualiteit) for
which an employer's certificate is required if the employer is to contribute to the cost.[  
If employed a person's contributions is automatically deducted from salary. The
employer will also pay a contribution.[  ] Health insurance funds will reimburse
medical costs. The choice of mutual insurer is up to the individual.[  ] Most of
them are affiliated to a religious or political institution[  ]but there is no real
difference between them because reimbursement rates are fixed by the Belgian

Insurance funds do not cover 100 per cent of your bills and typical reimbursement is
between half to three-quarters[  ]of a typical doctors or specialists visit.

Insured persons have a standardized credit card style SIS-card[22] which is needed in
pharmacies and hospitals.[  ]

a * 


Bhutan's health care system development accelerated in the early 19Ñ0s with the
establishment of the Department of Public Health and the opening of new hospitals and
dispensaries throughout the country. By the early 1990s, health care was provided through
twenty-nine general hospitals (including five leprosy hospitals, three army hospitals, and
one mobile hospital), forty-six dispensaries, sixty-seven basic health units, four indigenous-
medicine dispensaries, and fifteen malaria eradication centers. The major hospitals were
the National Referral Hospital in Thimphu, and other hospitals in Geylegphug,
and Tashigang. Hospital beds in 19 totaled 92. There was a severe shortage of health-
care personnel with official statistics reporting only 1Œ2 physicians and Ñÿ paramedics,
about one health-care professional for every 2,000 people, or only one physician for almost
10,000 people. Training for health-care assistants, nurses' aides, midwives, and primary
health-care workers was provided at the Royal Institute of Health Sciences, associated with
Thimphu General Hospital, which was established in 19ÿŒ. Graduates of the school were
the core of the national public health system and helped staff the primary care basic health
units throughout the country. Additional health-care workers were recruited from among
volunteers in villages to supplement primary health care.[2] The Institute of Traditional
Medicine Services supports indigenous medical centers associated with the district

a *+


The Brazilian health system is composed of a large, public, government managed system,
the SUS (Sistema Único de Saúde) , which serves the majority of the population, and a
private sector, managed by health insurance funds and private entrepreneurs.

The public health system, SUS, was established in 19 by the Brazilian Constitution, and
sits on  basic principles of universality, comprehensiveness and equity. Universality states
that all citizens must have access to health care services, without any form of
discrimination, regarding skin color, income, social status, gender or any other variable.

Government standards state that citizen's health is the result of multiple variables, including
employment, income, access to land, sanitation services, access and quality of health
services, education, psychic, social and family conditions, and are entitled to full and
complete health care, comprising prevention, treatment and rehabilitation. Equity states that
health policies should be oriented towards the reduction of inequalities between population
groups and individuals, being the most needed the ones for whom policies should be first

SUS also has guidelines for its implementation, the most peculiar being popular
participation, which defines that all policies are to be planned and supervised directly by
the population, through local, city, state and national health councils and conferences. This
is regarded as a very advanced form of direct democracy and has established the guidelines
for many similar initiatives in sectors other than health all over Brazilian society.

The level of public spending is particularly high in relation to GDP for a country of Brazil¶s
income level and in comparison with its emerging-market peers. Government outlays on
health care alone account for nearly 9 of GDP, the second largest item of spending
following social protection. In health care, a number of conventional output indicators are
not out of step with OECD averages. Following the decentralisation of service delivery in
the early 1990s, increasing emphasis has appropriately been placed on enhancing
preventive care. But, in a decentralised setting, cost-effectiveness depends a great deal on
the ability of service deliverers to exploit economies of scale and scope. Experience with
inter-municipal initiatives for procurement, as well as flexible arrangements for hospital
administration and human-resource management, is by and large positive.

Private Health Insurance is widely available in Brazil and may be purchased on an

individual-basis or obtained as a work benefit (major employers usually offer private health
insurance benefits). Public health care is still accessible for those who choose to obtain
private health insurance. As of March, 200ÿ, more than ÿ million Brazilians had some sort
of private health insurance.[2Œ]

a *


Bulgaria began overall reform of its antiquated health system, inherited from
the communist era, only in 1999. In the 1990s, private medical practices expanded
somewhat, but most Bulgarians relied on communist-era publicclinics while paying high

prices for special care. During that period, national health indicators generally worsened as
economic crises substantially decreased health funding. The subsequent health reform
program has introduced mandatory employee health insurance through the National Health
Insurance Fund (NHIF), which since 2000 has paid a gradually increasing portion of
primary health-care costs. Employees and employers pay an increasing, mandatory
percentage of salaries, with the goal of gradually reducing state support of health care.
Private health insurance plays only a supplementary role. The system also has been
decentralized by making municipalities responsible for their own health-care facilities, and
by 200£ most primary care came from private physicians. Pharmaceutical distribution also
was decentralized.[1]

In the early 2000s, the hospital system was reduced substantially to limit reliance on
hospitals for routine care. Anticipated membership in the European Union (200ÿ) was a
major motivation for this trend. Between 2002 and 200, the number of hospital beds was
reduced by £Ñ percent to 2Œ,00. However, the pace of reduction slowed in the early 2000s;
in 200Œ some 2£ hospitals were in operation, compared with the estimated optimal
number of 1Œ0. Between 2002 and 200Œ, health-care expenditures in the national budget
increased from . percent to Œ. percent, with the NHIF accounting for more than Ñ0
percent of annual expenditures.[1]

In the 1990s, the quality of medical research and training decreased seriously because of
low funding. In the early 2000s, the emphasis of medical and paramedical training, which
was conducted in five medical schools, was preparation of primary-care personnel to
overcome shortages resulting from the communist system¶s long-term emphasis on training
specialists. Experts considered that Bulgaria had an adequate supply of doctors but a
shortage of other medical personnel. In 2000 Bulgaria had .Œ doctors, .9 nurses, and 0.£
midwives per 1,000 population.[1]



Canada has a federally sponsored, publicly funded Medicare system, with most services
provided by the private sector. Each province may opt out, though none currently does.
Some provinces still charge premiums to individuals and families. Many employers also
offer additional health coverage as a benefit. Canada's system is known as a single payer
system, where basic services are provided by private doctors, (since 2002 they have been
allowed to incorporate), with the entire fee paid for by the government at the same rate.
Most family doctors receive a fee per visit. These rates are negotiated between the
provincial governments and the province's medical associations, usually on an annual basis.
A physician cannot charge a fee for a service that is higher than the negotiated rate ² even
to patients who are not covered by the publicly funded system ² unless he or she opts out
of billing the publicly funded system altogether. Pharmaceutical costs are set at a global

median by government price controls. Other areas of health care, such
as dentistry and optometry, are wholly private although in some provinces, emergency
visits to optometrists are partly covered by medicare. In 200£, Canada spent 9. of GDP
on health care, or US$,ŒÑ per capita. Of that, approximately ÿ0 was government

a   ,  


Medical facilities in Cape Verde are limited, and some medicines are in short supply or
unavailable. There are hospitals in Praia and Mindelo, with smaller medical facilities in
other places. The islands of Brava and Santo Antão no longer have functioning airports so
air evacuation in the event of a medical emergency is nearly impossible from these two
islands. Brava also has limited inter-island ferry service.[2£]


Chile has maintained a dual health care system in which its citizens can voluntarily opt for
coverage by either the public National Health Insurance Fund or any of the country's
private health insurance companies. Ñ of the population is covered by the public fund
and 1 by private companies. The remaining 1Πis covered by other not-for-profit
agencies or has no specific coverage. The system's duality has led to increasing inequalities
prompting the Chilean government to introduce major reforms in health care provision.
Chile's health care system is funded by a universal income tax deduction equal to ÿ of
every worker's wage. Many private health insurance companies encourage people to pay a
variable extra on top of the ÿ premium to upgrade their basic health plans. Because of this
arrangement, the public and private health subsystems have existed almost completely
separate from each other rather than coordinating to achieve common health objectives.[2Ñ]

a  -


Costa Rica provides universal health care to its citizens and permanent residents.

a  (


Health care in Cuba consists of a government-coordinated system that guarantees universal

coverage and consumes a lower proportion of the nation's GDP (ÿ. ) than some highly
privatised systems (e.g. USA: 1Ñ ) (OECD 200). The system does charge fees in treating
elective treatment for patients from abroad, but tourists who fall ill are treated free in

Cuban hospitals. Cuba attracts patients mostly from Latin America and Europeby offering
care of comparable quality to a developed nation but at much lower prices. Cuba's own
health indicators are the best in Latin America and surpass those of the US in some respects
(infant mortality rates, underweight babies, HIV infection, immunisation rates, doctor per
population rates). (UNDP 200Ñ: Tables Ñ,ÿ,9,10) In 200£, Cuba spent ÿ.Ñ of GDP on
health care, or US$10 per capita. Of that, approximately 91 was government

a %


Denmark's health care system has retained the same basic structure since the early 19ÿ0s.
The administration of hospitals and personnel is dealt with by the Ministry of the Interior,
while primary care facilities, health insurance, and community care are the responsibility of
the Ministry of Social Affairs. Anyone can go to a physician for no fee and the public
health system entitles each Dane to his/her own doctor. Expert medical/surgical aid is
available, with a qualified nursing staff. Costs are borne by public authorities, but high
taxes contribute to these costs. As of 1999, there were an estimated .Œ physicians and Œ.£
hospital beds per 1,000 people. The number of hospital beds, like that in other EU
countries, has undergone a major decline since 190, from around Œ0,000 to about 2,000
in 199/99. Deinstitutionalization of psychiatric patients has contributed significantly to
this trend. The ratio of doctors to population, by contrast, has increased during this period.

The total fertility rate in 2000 was 1.ÿ, while the maternal mortality rate was 10 per
100,000 live births as of 199. Studies show that between 190 and 199, Ñ of married
women (ages 1£ to Œ9) used contraception. As of 2002 cardiovascular diseases and cancer
were the leading causes of death. Denmark's cancer rates were the highest in the European
Union. In 1999, there were only 12 reported cases of tuberculosis per 100,000 people. As of
1999, the number of people living with HIV/AIDS was estimated at Œ,00 and deaths from
AIDS that year were estimated at less than 100. HIV prevalence was 0.1ÿ per 100 adults.

Danish citizens may choose between two systems of primary health care: medical care
provided free of charge by a doctor whom the individual chooses for a year and by those
specialists to whom the doctor refers the patient; or complete freedom of choice of any
physician or specialist at any time, with state reimbursement of about two-thirds of the cost
for medical bills paid directly by the patient. Most Danes opt for the former. All patients
receive subsidies on pharmaceuticals and vital drugs; everyone must pay a share of dental
bills. As of 1999, total health care expenditure was estimated at .Πof GDP.

Responsibility for the public hospital service rests with county authorities. Counties form
public hospital regions, each of which is allotted one or two larger hospitals with specialists
and two to four smaller hospitals where medical treatment is practically free. State-

appointed medical health officers, responsible to the National Board of Health, are
employed to advise local governments on health matters. Public health authorities have
waged large-scale campaigns against tuberculosis, venereal diseases, diphtheria, and
poliomyelitis. The free guidance and assistance given to mothers of newborn children by
public health nurses have resulted in a low infant mortality rate of Πper 1,000 live births
(2000). Medical treatment is free up to school age, when free school medical inspections
begin. As of 1999, children up to one year of age were vaccinated against diphtheria,
pertussis, and tetanus (99 ) and measles (92 ). In 2000, life expectancy at birth was ÿÑ
years for males and females. The overall death rate was 11 per 1,000 people in 1999.

Read more: Health - Denmark -


a / 


Health in Eritrea is generally poor as it remains one of the poorest countries in the world.
About one-third of the population lives in extreme poverty, and more than half survives on
less than US$1 per day. Health care and welfare resources generally are believed to be
poor, although reliable information about conditions is often difficult to obtain. In 2001, the
most recent year for which figures are available, the Eritrean government spent £.ÿ percent
of gross domestic product on national health accounts. The World Health
Organization (WHO) estimated that in 200Πthere were only three physicians per 100,000
people in Eritrea. The two-year war withEthiopia, coming on the heels of a 0-year struggle
for independence, negatively affected the health sector and the general welfare. The rate of
prevalence of human immunodeficiency virus/acquired immune deficiency syndrome
(HIV/AIDS), although low by sub-Saharan African standards, was high enough at 2.ÿ
percent in 200 to be considered a generalized epidemic. In the decade since 199£,
however, impressive results have been achieved in lowering maternal and child
mortality rates and in immunizing children against childhood diseases. In 200 average life
expectancy was slightly less than £ years, according to the WHO.

a / 


Healthcare in Estonia is supervised by the Ministry of Social Affairs and funded by general
taxation through the National Health Service.

a / 

Throughout the 1990s, the government, as part of its reconstruction program, devoted ever-
increasing amounts of funding to the social and health sectors, which brought
corresponding improvements in school enrollments, adult literacy, and infant mortality
rates. These expenditures stagnated or declined during the 1992000 war with Eritrea, but
in the years since, outlays for health have grown steadily. In 20002001, the budget
allocation for the health sector was approximately US$1ŒŒ million; health expenditures per
capita were estimated at US$Œ.£0, compared with US$10 on average in sub-Saharan Africa.
In 2000 the country counted one hospital bed per Œ,900 population and more than 2ÿ,000
people per primary health care facility. The physician to population ratio was 1:Œ,000,
the nurse to population ratio, 1:12,000. Overall, there were 20 trained health providers per
100,000 inhabitants. These ratios have since shown some improvement. Health care is
disproportionately available in urban centers; in rural areas where the vast majority of the
population resides, access to health care varies from limited to nonexistent. As of the end of
200, the United Nations (UN) reported that Œ.Œ percent of adults were infected with human
immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS); other
estimates of the rate of infection ranged from a low of ÿ percent to a high of 1 percent.
Whatever the actual rate, the prevalence of HIV/AIDS has contributed to falling life
expectancy since the early 1990s. According to the Ministry of Health, one-third of current
young adult deaths are AIDS-related. Malnutrition is widespread, especially among
children, as is food insecurity. Because of growing population pressure on agricultural and
pastoral land, soil degradation, and severe droughts that have occurred each decade since
the 19ÿ0s, per capita food production is declining. According to the UN and the World
Bank, Ethiopia at present suffers from a structural food deficit such that even in the most
productive years, at least £ million Ethiopians require food relief.[1]

In 2002 the government embarked on a poverty reduction program that called for outlays in
education, health, sanitation, and water. A polio vaccination campaign for 1Πmillion
children has been carried out, and a program to resettle some 2 million subsistence farmers
is underway. In November 200Œ, the government launched a five-year program to expand
primary health care. In January 200£, it began distributing antiretroviral drugs, hoping to
reach up to 0,000 HIV-infected adults.[1]



In Finland, public medical services at clinics and hospitals are run by the municipalities
(local government) and are funded ÿ by taxation, 20 by patients through access
charges, and by others 2 . Patient access charges are subject to annual caps. For example
GP visits are (11¼ per visit with annual ¼ cap), hospital outpatient treatment (22¼ per
visit), a hospital stay, including food, medical care and medicines (2Ѽ per 2Œ hours, or 12¼
if in a psychiatric hospital). After a patient has spent £90¼ per year on public medical
services, all treatment and medications thereafter are free. Taxation funding is partly local
and partly nationally based. Patients can claim re-imbursement of part of their prescription
costs from KELA. Finland also has a much smaller private medical sector which accounts
for about 1Πpercent of total health care spending. Only  of doctors choose to work in
private practice, and some of these also choose to do some work in the public sector.
Private sector patients can claim a contribution from KELA towards their private medical
costs (including dentistry) if they choose to be treated in the more expensive private sector,
or they can join private insurance funds. However, private sector health care is mainly in
the primary care sector. There are virtually no private hospitals, the main hospitals being
either municipally owned (funded from local taxes) or run by the teaching universities
(funded jointly by the municipalities and the national government). In 200£, Finland spent
ÿ.£ of GDP on health care, or US$2,2Œ per capita. Of that, approximately ÿ was
government expenditure.[21]



In its 2000 assessment of world health care systems, the World Health Organization found
that France provided the "best overall health care" in the world.[2ÿ] In 200£, France spent
11.2 of GDP on health care, or US$,92Ñ per capita. Of that, approximately 0 was
government expenditure.[21]

In France, most doctors remain in private practice; there are

both private and public hospitals. Social Security consists of several public organizations,
distinct from the state government, with separate budgets that refunds patients for care in
both private and public facilities. It generally refunds patients ÿ0 of most health care
costs, and 100 in case of costly or long-term ailments. Supplemental coverage may be
bought from private insurers, most of them nonprofit, mutual insurers, to the point that the
word "mutuelle" (mutual) has come to be a synonym of supplemental private insurer in
common language. Until recently, social security coverage was restricted to those who
contributed to social security (generally, workers, unemployed or retirees), excluding some
few poor segments of the population; the government of Lionel Jospin put into place the
"universal health coverage" allowing the entire French population to benefit from Health
care. In some systems, patients can also take private health insurance, but choose to receive
care at public hospitals, if allowed by the private insurer.



Germany has a universal multi-payer system with two main types of health insurance:
"State health insurance" (Gesetzliche Krankenversicherung) known as sickness funds and
"Private" (Private Krankenversicherung).[2][29][0] Compulsory insurance applies to those

below a set income level and is provided through private non-profit "sickness funds" at
common rates for all members, and is paid for with joint employer-employee contributions.
Provider compensation rates are negotiated in complex corporatist social bargaining among
specified autonomously organized interest groups (e.g. physicians' associations) at the level
offederal states (Länder). The sickness funds are mandated to provide a wide range of
coverages and cannot refuse membership or otherwise discriminate on an actuarial basis.
Small numbers of persons are covered by tax-funded government employee insurance or
social welfare insurance. Persons with incomes above the prescribed compulsory insurance
level may opt into the sickness fund system, which a majority do, or purchase private
insurance. Private supplementary insurance to the sickness funds of various sorts is
available. In 200£, Germany spent 10.ÿ of GDP on health care, or US$,Ñ2 per capita.
Of that, approximately ÿÿ was government expenditure.[21]



In Ghana, most health care is provided by the government, but hospitals and clinics run by
religious groups also play an important role. Some for-profit clinics exist, but they provide
less than 2 of health services. Health care is very variable through the country. The major
urban centres are well served, but rural areas often have no modern health care. Patients in
these areas either rely on traditional medicine or travel great distances for care. In 200£,
Ghana spent Ñ.2 of GDP on health care, or US$0 per capita. Of that, approximately Œ
was government expenditure.[21]



In the greater India, the hospitals are run by government, charitable trusts and by private
organizations. The government hospitals in rural areas are called the (PHC)s primary health
centre. Major hospitals are located in district head quarters or major cities. Apart from the
modern system of medicine, traditional and indigenous medicinal systems
like Ayurvedic and Unani systems are in practice throughout the country. The Modern
System of Medicine is regulated by the Medical Council of India, whereas the Alternative
systems recognised by Government of India are regulated by the Department of AYUSH
(an acronym for Ayurveda, Yunani, Siddha & Homeopathy) under the Ministry of Health,
Government of India. PHCs are non-existent in most places, due to poor pay and scarcity of
resources. Patients generally prefer private health clinics. These days some of the major
corporate hospitals are attracting patients from neighboring countries such as Pakistan,
countries in the Middle East and some European countries by providing quality treatment at
low cost. In 200£, India spent £ of GDP on health care, or US$Ñ per capita. Of that,
approximately 19 was government expenditure.,.[21]


Indonesia had a three-tiered system of community health centers in the late 1990s, with
0.ÑÑ hospital beds per 1,000 population, the lowest rate among members of the Association
of Southeast Asian Nations(ASEAN).[1] In the mid-1990s, according to the World Health
Organization (WHO), there were 1Ñ physicians per 100,000 population in Indonesia,
£0 nurses per 100,000, and 2Ñ midwives per 100,000.[1] Both traditional and modern health
practices are employed. Government health expenditures are about .ÿ percent of the gross
domestic product (GDP).[1] There is about a ÿ£:2£ percent ratio of public to private health-
care expenditures.


    "  & 

All persons resident in the Republic of Ireland are entitled to health care through the public
health care system, which is managed by the Health Service Executive and funded by
general taxation. A person may be required to pay a subsidised fee for certain health care
received; this depends on income, age, illness or disability. All maternity services are
however provided free of charge, as well as health care of infants under Ñ months of age.
Emergency care is provided at a cost of ¼120 for a visit to hospitals Accident and
Emergency departments.



In Israel, the publicly funded medical system is universal and compulsory. In 200£, Israel
spent ÿ. of GDP on health care, or US$1,£ per capita. Of that, approximately ÑÑ
was government expenditure.[21]



According to WHO in 2000, Italy had the world's "second overall best" healthcare system
in the world, coming after France, and surpassing Spain, Oman and Japan.[1]

In 19ÿ Italy adopted a tax-funded universal health care system called "National Health
Service" (in Italian: è è   '   ), which was closely modeled on the
British system. The SSN covers general practice (distinct between adult and pediatric
practice), outpatient and inpatient treatments, and the cost of most (but not all) drugs and
sanitary ware.[2] The government sets LEA (fundamental levels of care, Õ 
  in Italian) which cover all necessary treatments, which the state must
guarantee to all for free or for a "ticket", a share of the costs (but various categories are
exempted).[] The public system has also the duty of prevention at place of work and in the
general environment. A private sector also exists, with a minority role in medicine but a
principal role in dental health, as most people prefer private dental services.

In Italy the public system has the unique feature of paying general practitioners a fee per
capita per year, a salary system, that does not reward repeat visits, testing, and
referrals.[Œ] While there is a paucity of nurses, Italy has one of the highest doctor per capita
ratios at .9 doctors per 1,000 patients.[£] In 200£, Italy spent .9 of GDP on health care,
or US$2,ÿ1Œ per capita. Of that, approximately ÿÑ was government expenditure.[21]

a 0 


In Japan, services are provided either through regional/national public hospitals or through
private hospitals/clinics, and patients have universal access to any facility, though hospitals
tend to charge higher for those without a referral. Public health insurance covers most
citizens/residents and pays ÿ0 or more cost for each care and each prescribed drug.
Patients are responsible for the remainder (upper limits apply). The monthly insurance
premium is 0-£0,000 JPY per household (scaled to annual income). Supplementary private
health insurance is available only to cover the co-payments or non-covered costs, and
usually makes a fixed payment per days in hospital or per surgery performed, rather than
per actual expenditure. In 200£, Japan spent .2 of GDP on health care, or US$2,90 per
capita. Of that, approximately  was government expenditure.[21]

a 0  


In comparison to most of its neighbors, Jordan has quite an advanced health care system,
although services remain highly concentrated in Amman. Government figures have put
total health spending in 2002 at some ÿ.£ percent of Gross domestic product (GDP), while
international health organizations place the figure even higher, at approximately 9. percent
of GDP. The country¶s health care system is divided between public and private
institutions. In the public sector, the Ministry of Health operates 1,2Σ primary health-care
centers and 2ÿ hospitals, accounting for ÿ percent of all hospital beds in the country; the
military¶s Royal Medical Services runs 11hospitals, providing 2Œ percent of all beds; and
the Jordan University Hospital accounts for  percent of total beds in the country. The
private sector provides Ñ percent of all hospital beds, distributed among £Ñ hospitals. In 1
June 200ÿ, Jordan Hospital (as the biggest private hospital) was the first general specialty

hospital who gets the international accreditation (JCI).Treatment cost in Jordan hospitals is
less than in other countries. [1]

a 1+. 

  )  #  

In principle, health care is free. However, bribes often are necessary to obtain needed care.
The quality of health care, which remained entirely under state control in 200Ñ, has
declined in the post-Soviet era because of insufficient funding and the loss of technical
experts through emigration. Between 199 and 2001, the ratio of doctors per 10,000
inhabitants fell by 1£ percent, to Œ.Ñ, and the ratio of hospital beds per 10,000 inhabitants
fell by ŒÑ percent, to ÿŒ. By 200£ those indicators had recovered somewhat, to ££ and ÿÿ,
respectively. Since 1991, health care has consistently lacked adequate government funding;
in 200£ only 2.£ percent of gross domestic product went for that purpose. A government
health reform program aims to increase that figure to Πpercent in 2010. A
compulsory health insurance system has been in the planning stages for several years.
Wages for health workers are extremely low, and equipment is in critically short supply.
The main foreign source of medical equipment is Japan. Because of cost, the emphasis of
treatment increasingly is on outpatient care instead of the hospital care preferred under the
Soviet system. The health system is in crisis in rural areas such as the Aral Sea region,
where health is most affected by pollution.[1]



Health in Mali, one of the world¶s poorest nations, is greatly affected

by poverty, malnutrition, and inadequate hygiene and sanitation. Mali's health and
development indicators rank among the worst in the world. In 2000 only Ñ2Ñ£ percent of
the population was estimated to have access to safe drinking water and only Ñ9 percent to
sanitation services of some kind; only  percent was estimated to have access to modern
sanitation facilities. Only 20 percent of the nation¶s villages and livestock watering holes
had modern water facilities.[1]

Mali is dependent on international development organizations and foreign missionary

groups for much of its health care. In 2001 general government expenditures on health
constituted Ñ. percent of total general government expenditures and Œ. percent of gross
domestic product (GDP), totaling only about US$Πper capita at an average exchange rate.
Medical facilities in Mali are very limited, especially outside of Bamako, and medicines are
in short supply. There were only £ physicians per 100,000 inhabitants in the 1990s and 2Œ
hospital beds per 100,000 in 199. In 1999 only Ñ percent of Malians were estimated to
have access to health services within a five-kilometer radius.[1]



Health care in Malaysia is divided into private and public sectors. Doctors are required to
undergo a 2 year internship and perform 2 years of service with public hospitals throughout
the nation, ensuring adequate coverage of medical needs for the general population.
Foreign doctors are encouraged to apply for employment in Malaysia, especially if they are
qualified to a higher level.

Malaysian society places importance on the expansion and development of health care,
putting £ of the government social sector development budget into public health care ²
an increase of more than Œÿ over the previous figure. This has meant an overall increase
of more than RM 2 billion. With a rising and aging population, the Government wishes to
improve in many areas including the refurbishment of existing hospitals, building and
equipping new hospitals, expansion of the number of polyclinics, and improvements in
training and expansion of telehealth. Over the last couple of years they have increased their
efforts to overhaul the systems and attract more foreign investment.

There is still a shortage in the medical workforce, especially of highly trained specialists.
As a result certain medical care and treatment is available only in large cities. Recent
efforts to bring many facilities to other towns have been hampered by lack of expertise to
run the available equipment made ready by investments.

The majority of private hospital facilities are in urban areas and, unlike many of the public
hospitals, are equipped with the latest diagnostic and imaging facilities.



Central offices of the IMSS in downtownMexico City.

The IMSS Õ "  º  , a typical public hospital in Mexico

Ê     is provided via public institutions or private entities. Health care
delivered through private health care organizations operates entirely on the free-
market system (e.g. it is available to those who can afford it). Public health care delivery,
on the other hand, is accomplished via an elaborate provisioning and delivery system put in
place by the Mexican Federal Government and the Mexican Social Security
Institute (IMSS).

Advances in medicine and increasing health knowledge have increased the life expectancy
in Mexico by an average of 2£ years in the last years of the XX century. Of the
Ñ.Ñ GDP of government revenue spent on health, this provides only health insurance to
Œ0 of the population who are privately employed. The health care system has three
components: the social security institute, governmental services for the un-insured (Seguro
Popular), and the private sector that is financed almost completely from out of pocket
money. The IMSS, the largest social institution in Latin America, is the governmental
institution responsible of executing the Federal Government's health policy. The number of
public hospitals in Mexico has increased Œ1 in ten years from 19£ to 199£.

According to the site, health care in Mexico is described as

very good to excellent while being highly affordable, with every medium to large city in
Mexico having at least one first-rate hospital. In fact, some California insurers sell health
insurance policies that require members to go to Mexico for health care where costs are
Œ0 lower.[Ñ] Some of Mexico's top-rate hospitals are internationally
accredited.[ÿ]Americans, particularly those living near the Mexican border, now routinely
cross the border into Mexico for medical care.[] Popular specialties
include dentistry and plastic surgery. Mexican dentists often charge 20 to 2£ percent of US
prices,[9] while other procedures typically cost a third what they would cost in the US.[]



According to the United States government, Morocco has inadequate numbers
of physicians (0.£ per 1,000 people) and hospital beds (1.0 per 1,000 people) and poor
access to water (2 percent of the population) andsanitation (ÿ£ percent of the population).
The health care system includes 122 hospitals, 2,Œ00 health centers, and Œ university
clinics, but they are poorly maintained and lack adequate capacity to meet the demand for
medical care. Only 2Œ,000 beds are available for Ñ million patients seeking care each year,
including  million emergency cases. The health budget corresponds to 1.1 percent of gross
domestic product and £.£ percent of the central government budget.[1]

a "   


Health care in the Netherlands, has since January 200Ñ been provided by a system of
compulsory insurance backed by a risk equalization program so that the insured are not
penalized for their age or health status. This is meant to encourage competition between
health care providers and insurers. Children under 1 are insured by the government, and
special assistance is available to those with limited incomes. In 200£, the Netherlands spent
9.2 of GDP on health care, or US$,£Ñ0 per capita. Of that, approximately Ñ£ was
government expenditure.[21]

a " 23  


In New Zealand hospitals are public and treat citizens or permanent residents free of charge
and are managed by District Health Boards. Under the Labour coalition governments
(1999200), there were plans to makeprimary health care available free of charge. At
present government subsidies exist in health care. The cost of visiting a GP ranges from
Free to $Σ.00 for children and from Free to $أ.00 for adults under the current subsidies.
This system is funded by taxes. The New Zealand government agency PHARMAC
subsidizes certain pharmaceuticals depending upon their category. Co-payments exist,
however these are lower if the user has a è  or
. In 200£, New Zealand spent .9 of GDP on health care, or US$2,Œ0 per capita. Of
that, approximately ÿÿ was government expenditure.[21]

a " 


Health care system of Niger suffers from a chronic lack of resources and a small number of
health providers relative to population. Some medicines are in short supply or unavailable.
There are government hospitals inNiamey (with three main hospitals in Niamey, including
.  '   '  and the
.  '   
Õ  /), Maradi, Tahoua, Zinder and other large cities, with smaller medical clinics in
most towns.[Œ0] Medical facilities are limited in both supplies and staff, with a small
government health care system supplemented by private, charitable, religious, and Non-
government organisation operated clinics and public health programs (such as Galmi
Hospital near Birnin Konni and Maradi). Government hospitals, as well as public
health programmes, fall under the control of the Nigerien Ministry of Health. A number of
private for profit clinics (" º/ /") operate in Niamey. The total
expenditure on health per capita in 200£ was Intl $2£. There were ÿÿ Physicians in Niger
in 200Œ, a ratio of 0.0 per 10,000 population. In 200, 9.2 percent of individual
expenditures on health care were "out-of-pocket" (paid by the patient).[Œ1]

a " 


Health care provision in Nigeria is a concurrent responsibility of the three tiers of

government in the country.[Œ2] However, because Nigeria operates a mixed economy,
private providers of health care have a visible role to play in health care delivery.
The federal government's role is mostly limited to coordinating the affairs of
the university teaching hospitals, while the state government manages the various general
hospitals and the local government focus on dispensaries. The total expenditure on health
care as of GDP is Œ.Ñ, while the percentage of federal government expenditure on health
care is about 1.£ .[Œ] A long run indicator of the ability of the country to provide food
sustenance and avoid malnutrition is the rate of growth of per capita food production; from
19ÿ01990, the rate for Nigeria was 0.2£ .[ŒŒ] Though small, the positive rate of per capita
may be due to Nigeria's importation of food products. Historically, health insurance in
Nigeria can be applied to a few instances: free health care provided and financed for all
citizens, health care provided by government through a special health insurance scheme for
government employees and private firms entering contracts with private health care
providers.[Σ] However, there are few people who fall within the three instances. In May
1999, the government created the National Health Insurance Scheme, the scheme
encompasses government employees, the organized private sector and the informal sector.
Legislative wise, the scheme also covers children under five, permanently disabled persons
and prison inmates. In 200Œ, the administration of Obasanjo further gave more legislative
powers to the scheme with positive amendments to the original 1999 legislative act.[΄]

a " 1  

  '  )  

North Korea has a national medical service and health insurance system.[1] As of 2000,
some 99 percent of the population had access to sanitation, and 100 percent had access to
water, but water was not alwayspotable.[1] Medical treatment is free.[1] In the past, there
reportedly has been one doctor for every ÿ00 inhabitants and one hospital bed for every £0
inhabitants.[1] Health expenditures in 2001 were 2.£ percent of gross domestic product, and
ÿ percent of health expenditures were made in the public sector.[1] There were no reported
human immuno-deficiency virus/acquired immune deficiency syndrome (HIV/AIDS) cases
as of 200ÿ.[1] However, it is estimated that between £00,000 and  million people died
from famine in the 1990s, and a 199 United Nations (UN) World Food Program report
revealed that Ñ0 percent of children suffered from malnutrition, and 1Ñ percent were acutely
malnourished.[1] UN statistics for the period 19992001 reveal that North Korea¶s daily
per capita food supply was one of the lowest in Asia, exceeding only that
ofCambodia, Laos, and Tajikistan, and one of the lowest worldwide.[1] Because of
continuing economic problems, food shortages and chronic malnutrition prevail in the

a " 2 

º   ' + 

Norway has a government run and government financed universal health care system,
covering physical and mental health for all and dental health for children under the age of
1Ñ. Hospitals are free and doctor visit fees are capped at a fairly low rate. Medicine is
market price, but people needing the medicine more than three months a year, gets
prescription with high discount. There is also a yearly cap for people with high medical

Private health care exists: Most adults use private dental care, the public only treat people,
for a normal fee, when they have free capacity. Health-related plastic surgery (like burn
damage) is covered by the public system, while cosmetic surgery in general is private.
There are a number of private psychologists, there are also some private general practice
doctors and specialists.

Public health care is financed by a special-purpose income tax on the order of -11 ,
loosely translated as "public benefits fee" (Norwegian: trygdeavgift og Folketrygden). This
can be considered a mandatory public insurance, covering not only health care but also loss
of income during sick leave, public pension, unemployment benefits, benefits for single
parents and a few others. The system is supposed to be self-financing from the taxes.
Norwegian citizens living in Norway are automatically covered, even if they never had
taxable income. Norwegian citizens living and working abroad (taxable elsewhere and
therefore not paying the "public benefits fee" to Norway) are covered for up to one year
after they move abroad, and must pay an estimated market cost for public health care
services. Non-citizens like foreign visitors are covered in full.

According to WHO, total health care expenditure in 200£ was 9 of GDP and paid Œ by
government, 1£ by private out-of-pocket and ~1 by other private sources.[Œÿ]


Oman has one of the best healthcare systems in the world and was ranked at number  by
the WHO healthcare systems ranking in 2000.[Œ] Universal healthcare (including
prescriptions and dental care) is provided automatically to all citizens and also to
expatriates working in the public sector by the Ministry of Health. Non-eligible individuals
such as expatriates working in the private sector and foreign visitors can be treated in the
government hospitals and clinics for a very reasonable fee or they can opt for the slightly
more expensive private clinics and medical centres. The Ministry of Health also finances
the treatment of citizens abroad if the required treatment is not available in Oman. The life
expectancy in Oman as of 200ÿ was ÿ1.Ñ. It had 1.1 doctors per 1000 pop., 1.9 beds per
1000 pop. and an infant mortality rate of 9 per 1000 live births. Health expenditure
accounts for Œ.£ of government revenue.[Œ9]

a . 


Pakistan's health indicators, health funding, and health and sanitation infrastructure are
generally poor, particularly in rural areas. About 19 percent of the population
is malnourished²a higher rate than the 1ÿ percent average for developing countries²and
0 percent of children under age five are malnourished. Leading causes of sickness and
death include gastroenteritis, respiratory infections, congenital
abnormalities, tuberculosis, malaria, andtyphoid fever. The United Nations estimates that in
200 Pakistan¶s human immunodeficiency virus (HIV) prevalence rate was 0.1 percent
among those 1£Œ9, with an estimated Œ,900 deaths from acquired immune deficiency
syndrome (AIDS). AIDS is a major health concern, and both the government and religious
community are engaging in efforts to reduce its spread. In 200 there were Ñ physicians
for every 100,000 persons in Pakistan. According to 2002 government statistics, there were
12,£01 health institutions nationwide, including Œ,£90 dispensaries, 90Ñ hospitals with a
total of 0,ÑÑ£ hospital beds, and ££0 rural health centers with a total of ,Œ0 beds.
According to the World Health Organization, Pakistan¶s   
   amounted to .9 percent of gross domestic product (GDP) in 2001, and per
capita health expenditures were US$1Ñ. The government provided 2Œ.Œ percent of total
health expenditures, with the remainder being entirely private, out-of-pocket expenses.



In terms of major indicators, health in Paraguay ranks near the median among South
American countries. In 200 Paraguay had a child mortality rate of 29.£ deaths per 1,000
children, ranking it behind Argentina,Colombia, and Uruguay but ahead
of Brazil and Bolivia. The health of Paraguayans living outside urban areas is generally
worse than those residing in cities. Many preventable diseases, such as Chagas' disease, run
rampant in rural regions. Parasitic and respiratory diseases, which could be controlled with
proper medical treatment, drag down Paraguay's overall health. In general, malnutrition,
lack of proper health care, and poor sanitation are the root of many health problems in

Health care funding from the national government increased gradually throughout the
190s and 1990s. Spending on health care rose to 1.ÿ percent of the gross domestic
product (GDP) in 2000, nearly triple the 0.Ñ percent of GDP spent in 199. But during the
past decade, improvement in health care has slowed. Paraguay spends less per capita
(US$120 per year) than most other Latin American countries. A 2001 survey indicated
that 2ÿ percent of the population still had no access to medical care, public or private.
Private health insurance is very limited, with pre-paid plans making up only 11 percent of
private expenditures on health care. Thus, most of the money spent on private health care
(about  percent) is on a fee-for-service basis, effectively preventing the poor population
from seeing private doctors. According to recent estimates, Paraguay has about
11ÿ physicians and 20 nurses per 100,000 population.[1]

a   4- (   


The effective public health work in controlling epidemic disease during the early years of
the PRC and, after reform began in 19ÿ, the dramatic improvements in nutrition greatly
improved the health and life expectancy of the Chinese people. The 2000 WHO World
Health Report - Health systems: improving performance found that China's health care
system before 190 performed far better than countries at a comparable level of
development, since 190 ranks much lower than comparable countries.[£0] The end of the
famed "barefoot doctor" system was abolished in 191.

China is undertaking a reform on its health care system. The New Rural Co-operative
Medical Care System (NRCMCS) is a new 200£ initiative to overhaul the health care
system, particularly intended to make it more affordable for the rural poor. Under the
NRCMCS, the annual cost of medical cover is £0 yuan (US$ÿ) per person. Of that, 20 yuan
is paid in by the central government, 20 yuan by the provincial government and a
contribution of 10 yuan is made by the patient. As of September 200ÿ, around 0 of the
whole rural population of China had signed up (about ѣ million people). The system is
tiered, depending on the location. If patients go to a small hospital or clinic in their local
town, the scheme will cover from ÿ0-0 of their bill. If they go to a county one, the
percentage of the cost being covered falls to about Ñ0 . And if they need specialist help in

a large modern city hospital, they have to bear most of the cost themselves, the scheme
would cover about 0 of the bill.[£1]

Health care was provided in both rural and urban areas through a three-tiered system. In
rural areas the first tier was made up of barefoot doctors working out of village medical
centers. They provided preventive and primary-care services, with an average of two
doctors per 1,000 people. At the next level were the township health centers, which
functioned primarily as out-patient clinics for about 10,000 to 0,000 people each. These
centers had about ten to thirty beds each, and the most qualified members of the staff were
assistant doctors. The two lower-level tiers made up the "rural collective health system"
that provided most of the country's medical care. Only the most seriously ill patients were
referred to the third and final tier, the county hospitals, which served 200,000 to Ñ00,000
people each and were staffed by senior doctors who held degrees from £-yearmedical
schools. Health care in urban areas was provided by paramedical personnel assigned to
factories and neighborhood health stations. If more professional care was necessary the
patient was sent to a district hospital, and the most serious cases were handled by municipal
hospitals. To ensure a higher level of care, a number of state enterprises and government
agencies sent their employees directly to district or municipal hospitals, circumventing the
paramedical, or barefoot doctor, stage.



In 2000 the Philippines had about 9£,000 physicians, or about 1 per 00 people. In 2001
there were about 1,ÿ00 hospitals, of which about Œ0 percent were government run and Ñ0
percent private, with a total of about £,000 beds, or about one bed per 900 people. The
leading causes of morbidity as of 2002
were diarrhea, bronchitis, pneumonia, influenza, hypertension, tuberculosis, heart
disease, malaria, chickenpox, and measles.Cardiovascular diseases account for more than
2£ percent of all deaths. According to official estimates, 1,9Ñ£ cases of human
immunodeficiency virus (HIV) were reported in 200, of which ÑÑ had
developed acquired immune deficiency syndrome (AIDS). Other estimates state that there
may have been as many as 9,Œ00 people living with HIV/AIDS in 2001.[1]

a -


Health care public system has been improved but it is still poor by European standards, and
access is limited in rural areas. In 200ÿ health expenditures were equal to .9 percent of
gross domestic product. In 200ÿ there were 2.2 physicians and Ñ.Œ hospital beds per 1,000
people. The system is funded by the National Health Care Insurance Fund, to which

employers and employees make mandatory contributions. Private health care system has
developed slowly but now consists of 22 private hospitals and more than 2Œ0
clinics.[1][£2] [£]

a -


Article Œ1 of the Constitution of the Russian Federation confirms a citizen's right to state
healthcare and medical assistance free of charge.[£Œ] This is achieved through state
compulsory medical insurance (OMS) which is free to Russian citizens, funded by
obligatory medical insurance payments made by companies and government
subsidies.[££][£Ñ] Introduction in 199 reform of new free market providers in addition to the
state-run institutions intended to promote both efficiency and patient choice. A purchaser-
provider split help facilitate the restructuring of care, as resources would migrate to where
there was greatest demand, reduce the excess capacity in the hospital sector and stimulate
the development of primary care. Russian Prime Minister Vladimir Putin announced a new
large large-scale health care reform in 2011 and pledged to allocate more than 00 billion
rubles ($10 billion) in the next few years to improve health care in the country.[£ÿ] He also
said that obligatory medical insurance tax paid by companies will increase from current
.1 to £.1 starting from 2011.[£ÿ]



The health budget in Senegal has tripled between 190 and 2000, leading to the Senegalese
people leading healthier and longer lives - the life expectancy at birth is approximately
££.Œ years for men, £.09 years for women, and £Ñ.Ñ9 years for the entire population.
Also, the prevalence rate of AIDS in Senegal is one of the lowest in Africa, at 0.9 .
However, large disparities still exist in Senegal's health coverage, with ÿ0 of doctors, and
0 of pharmacists and dentists, living in the nation's capital city, Dakar.



Health care in Singapore is mainly under the responsibility of the Singapore

Government's Ministry of Health. Singapore generally has an efficient and widespread
system of health care. It implements a universal health caresystem, and co-exists with
private health care system. Infant mortality rate: in 200Ñ the crude birth rate stood at 10.1
per 1000, a very low level attributed to birth control policies, and the crude death rate was
also one of the lowest in the world at Œ. per 1000. In 200Ñ, the total fertility rate was only
1.2Ñ children per woman, the rd lowest in the world and well below the 2.10 needed to

replace the population. Singapore was ranked Ñth in the World Health Organization's
ranking of the world's health systems in the year 2000.

Singapore has a universal health care system where government ensures affordability,
largely through compulsory savings and price controls, while the private sector provides
most care. Overall spending on health care amounts to only  of annual GDP. Of that,
ÑÑ comes from private sources.[Œÿ] Singapore currently has the lowest infant mortality rate
in the world (equaled only by Iceland) and among the highest life expectancies from birth,
according to the World Health Organization.[£] Singapore has "one of the most successful
health care systems in the world, in terms of both efficiency in financing and the results
achieved in community health outcomes," according to an analysis by global consulting
firm Watson Wyatt.[£9] Singapore's system uses a combination of compulsory savings from
payroll deductions (funded by both employers and workers) a nationalized catastrophic
health insurance plan, and government subsidies, as well as "actively regulating the supply
and prices of health care services in the country" to keep costs in check; the specific
features have been described as potentially a "very difficult system to replicate in many
other countries." Many Singaporeans also have supplemental private health insurance
(often provided by employers) for services not covered by the government's programs.[£9]

Singapore¶s well-established health care system comprises a total of 1 private hospitals,

10 public (government) hospitals and several specialist clinics, each specializing in and
catering to different patient needs, at varying costs.

Patients are free to choose the providers within the government or private health care
delivery system and can walk in for a consultation at any private clinic or any government
polyclinic. For emergency services, patients can go at any time to the 2Œ-hour Accident &
Emergency Departments located in the government hospitals.

Singapore's medical facilities are among the finest in the world, with well qualified doctors
and dentists, many trained overseas.

Singapore has medical savings account system known as Medisave.

a  )


In South Africa, parallel private and public systems exist. The public system serves the vast
majority of the population, but is chronically underfunded and understaffed. The wealthiest
20 of the population uses the private system and are far better served. This division in
substantial ways perpetuates racial inequalities created in the pre-apartheid segregation era
and apartheid era of the 20th century. In 200£, South Africa spent .ÿ of GDP on health
care, or US$Œÿ per capita. Of that, approximately Œ2 was government expenditure.[21]



Outside urban areas, little health care is available in Sudan, helping account for a relatively
low average life expectancy of £ÿ years and an infant mortality rate of Ñ9 deaths per 1,000
live births, low by standards in Middle Eastern but not African countries. For most of the
period since independence in 19£Ñ, Sudan has experienced civil war, which has diverted
resources to military use that otherwise might have gone into health care and training of
professionals, many of whom have migrated in search of more gainful employment. In
199Ñ the World Health Organization estimated that there were only 9 doctors per 100,000
people, most of them in regions other than the South. Substantial percentages of the
population lack access to safe water and sanitary facilities. Malnutrition is widespread
outside the central Nile corridor because of population displacement from war and from
recurrent droughts; these same factors together with a scarcity of medicines make diseases
difficult to control. Child immunization against most major childhood diseases, however,
had risen to approximately Ñ0 percent by the late 1990s from very low rates in earlier
decades. Spending on health care is quite low²only 1 percent of gross domestic
product (GDP) in 199 (latest data). The United Nations placed the rate of human
immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) infection in
late 200 at 2. percent for adults, quite low by regional standards. The United Nations
suggested, however, that the rate could be as high as ÿ.2 percent. Between Œ00,000 and 1.
million adults and children were living with HIV, and AIDS deaths numbered 2,000. As
of late 200Œ, some Œ million persons in the South had been internally displaced and more
than 2 million had died or been killed as a result of two decades of war. Comparable figures
for Darfur were 1.Ñ million displaced and ÿ0,000 dead since fighting began there in early

a 2  


The Swedish public health system is funded through taxes levied by the county councils.
There is a fixed charge of SEK 1£0 (USD 21) for each visit to a doctor or a hospital,
limited to SEK 00 (USD 111) per year, and prescription charges are limited to 1,00 SEK
(= 2Œ9 USD) per year. Free dental care for children under 19 years old is included in the
system, and dental care for grown-ups is partly subsidised by it. Sweden also has a smaller
private health care sector, mainly in larger cities or as centers for preventive health care
financed by employers.

a 2+  

Hospital in Zurich, Switzerland.

In Switzerland, compulsory health insurance covers the costs of medical treatment and
hospitalization of the insured. The Swiss healthcare system is a combination of public,
subsidized private and totally private healthcare providers, where the insured person has
full freedom of choice among the providers in his region. Insurance companies
independently set their price points for different age groups, but are forbidden from setting
prices based on health risk. In 2000, Switzerland topped all European countries¶ health care
expenditure when calculated as per capita expenditure in US dollar purchasing parity

The Swiss health care system is interesting as it was the last for-profit system in Europe. In
the 1990s, after the private carriers began to deny coverage for pre-existing conditions²
and when the uninsured population of Switzerland reached £ --the Swiss held a
referendum (199£) and adopted their present system.



The Baath Party has placed an emphasis on health care, but funding levels have not been
able to keep up with demand or maintain quality. Health expenditures reportedly accounted
for 2.£ percent of the gross domestic product (GDP) in 2001. Syria¶s health system is
relatively decentralized and focuses on offering primary health care at three levels: village,
district, and provincial. According to the World Health Organization (WHO), in 1990 Syria
had Œ1 general hospitals ( public,  private), 1£2 specialized hospitals (1Ñ public, 1Ñ
private), 91 rural health centers, 1£1 urban health centers, ÿ9 rural health units, and Œ9

specialized health centers;hospital beds totaled 1,1ь (ÿÿ percent public, 2 percent
private), or 11 beds per 10,000 inhabitants. The number of state hospital beds reportedly
fell between 199£ and 2001, while the population had an 1 percent increase, but the
opening of new hospitals in 2002 caused the number of hospital beds to double. WHO
reported that in 199 Syria had a total of 10,11Œ physicians, ,Ñ2 dentists, and
1Œ,1Ñ nurses and midwives; in 199£ the rate of health professionals per 10,000 inhabitants
was 10.9 physicians, £.Ñ dentists, and 21.2 nurses and midwives. Despite overall
improvements, Syria¶s health system exhibits significant regional disparities in the
availability of health care, especially between urban and rural areas. The number of private
hospitals and doctors increased by Œ1 percent between 199£ and 2001 as a result of
growing demand and growing wealth in a small sector of society. Almost all private health
facilities are located in large urban areas such as Damascus, Aleppo, Tartus, and Latakia.[1]

a 52 #-66 6&

  2 + 

The current health care system in Taiwan, known as National Health Insurance (NHI), was
instituted in 199£. NHI is a single-payer compulsory social insurance plan which
centralizes the disbursement of health care dollars. The system promises equal access to
health care for all citizens, and the population coverage had reached 99 by the end of
200Œ.[Ñ1] NHI is mainly financed through premiums, which are based on the payroll tax, and
is supplemented with out-of-pocket payments and direct government funding. In the initial
stage, fee-for-service predominated for both public and private providers. Most health
providers operate in the private sector and form a competitive market on the health delivery
side. However, many health care providers took advantage of the system by offering
unnecessary services to a larger number of patients and then billing the government. In the
face of increasing loss and the need for cost containment , NHI changed the payment
system from fee-for-service to a global budget, a kind of prospective payment system, in

According to T.R. Reid, Taiwan achieves "remarkable efficiency", costing ~Ñ percent of

GDP universal coverage however this underestimates the cost as it is not fully funded and
the government is forced to borrow to make up the difference. "And frankly, the solution is
fairly obvious: increase the spending a little, to maybe  percent of GDP. Of course, if
Taiwan did that, it would still be spending less than half of what America spends."[Ñ2]

a 5 


Data on health care are out of date, but in 199£ Thailand had 0. physicians and 1.9 hospital
beds per 1,000 population. In 2002 annual spending on health care amounted to US$21

per person in purchasing power parity(PPP). Total expenditures represented about Œ.Œ
percent of the gross domestic product (GDP); of this amount, £ÿ.1 percent came from
public sources and Œ2.9 percent from private sources. Some £ percent of the population
had access to potable water in 2002, and 99 percent had access to sanitation. Human
immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is a serious
problem in Thailand. The United Nations Programme on HIV/AIDS (UNAIDS) reported in
November 200Πthat the Thai government had launched a well-funded, politically
supported, and pragmatic response to the epidemic. As a result, national adult HIV
prevalence has decreased to an estimated 1.£ percent of all persons aged 1£ to Œ9 years (or
about 1. percent of the total population). It was also reported that £,000 adults and
children had died from AIDS since the first case was reported in 19Œ. The government has
begun to improve its support to persons with HIV/AIDS and has provided funds to
HIV/AIDS support groups. Public programs have begun to alter unsafe behavior, but
discrimination against those infected continues. The government has funded
an antiretroviral drug program and, as of September 200Ñ, more than 0,000 HIV/AIDS
patients had received such drugs. Highly pathogenic H£N1 avian influenza (bird flu) has
been found among birds in Thailand as well as surrounding areas. The government has
pledged financial support for the prevention effort, which mainly focuses on changing
poultry farming methods. Major infectious diseases in Thailand also include
bacterial diarrhea, hepatitis, dengue fever, malaria, Japanese encephalitis, rabies,
and leptospirosis.[1]

Thailand introduced universal coverage reforms in 2001, becoming one of only a handful of
lower-middle income countries to do so. Means-tested health care for low income
households was replaced by a new and more comprehensive insurance scheme, originally
known as the 0 baht project, in line with the small co-payment charged for treatment.
People joining the scheme receive a gold card which allows them to access services in their
health district, and, if necessary, be referred for specialist treatment elsewhere. The bulk of
finance comes from public revenues, with funding allocated to Contracting Units for
Primary Care annually on a population basis. According to the WHO, ѣ of Thailand's
health care expenditure in 200Œ came from the government, £ was from private
sources.[Œÿ] Although the reforms have received a good deal of critical comment, they have
proved popular with poorer Thais, especially in rural areas, and survived the change of
government after the 200Ñ military coup. The then Public Health Minister, Mongkol Na
Songkhla, abolished the 0 baht co-payment and made the UC scheme free. It is not yet
clear whether the scheme will be modified further under the coalition government that
came to power in January 200.[Ñ][ь][Ñ£]

a 5  5 ( 

   2  2   

Trinidad and Tobago operates under a two-tier health-care system. That is, there is the
existence of both private health-care facilities and public health-care facilities. The
Ministry of Health is responsible for leading the health sector. The service provision aspect
of public health care has been devolved to newly created entities, the Regional Health
Authorities (RHAs). The Ministry of Health is shifting its focus to concentrate on policy
development, planning, monitoring and evaluation, regulation, financing and research.
Citizens can access free health care at public health care facilities where health insurance is
not required. The health-care system in the country is universal as almost all citizens utilise
the services provided. Some, though, opt for private health-care facilities for their ailments.

Recently, the government of Trinidad and Tobago has launched CDAP (Chronic Disease
Assistance Programme). The Chronic Disease Assistance Programme provides citizens
with free prescription drugs and other pharmaceutical items to combat several health

a 5.


In the post-Soviet era, reduced funding has put the health system in poor condition. In
2002 Turkmenistan had £0 hospital beds per 10,000 population, less than half the number
in 199Ñ. Overall policy has targeted specialized inpatient facilities to the detriment of basic,
outpatient care. Since the late 1990s, many rural facilities have closed, making care
available principally in urban areas. President Niyazov¶s 200£ proposal to close all
hospitals outside Ashgabat intensified this trend. Physicians are poorly trained, modern
medical techniques are rarely used, and medications are in short supply. In 200ΠNiyazov
dismissed 1£,000 medical professionals, exacerbating the shortage of personnel. In some
cases, professionals have been replaced by military conscripts. Private health care is rare, as
the state maintains a near monopoly. Free public health care was abolished in 200Œ.[1]

a $  1 


The four countries of the United Kingdom have separate but co-operating public health care
systems that were created in 19Œ: in England the public health system is known as
the National Health Service, in Scotland it is known as NHS Scotland, in Wales as NHS
Wales (GIG Cymru), and in Northern Ireland it is called Health and Social Care in Northern
Ireland. All four provide free healthcare to all UK residents, paid for from general taxation.
Though the public systems dominate, private health care and a wide variety of alternative
and complementary treatments are available for those who have private health insurance or
are willing to pay directly themselves.

The main difference between the four public health care systems is the patient cost for
prescriptions. Wales, Northern Ireland and Scotland have recently abolished, or are in the
process of abolishing, all prescription charges, while England (with the exception of birth
control pills, which are free of charge) continues to charge patients who are between 1Ñ and
Ñ0 years old a fixed prescription fee of £ÿ.20 per item, unless they are exempt because of
certain medical conditions (including cancer) or are on low income.

a $   

U.S. healthcare spending. Percent of GDP. FromOECD Health Data 2009.[ÑÑ]


The United States is alone among developed nations in not having a universal health
care system; the recent Patient Protection and Affordable Care Act provides for a
nationwide health insurance exchange by 201Œ, but this is not universal in the way similar
countries mean it.[Ñÿ] Healthcare in the U.S. does, however, have significant publicly funded
components. Medicare covers the elderly and disabled with a historical work
record, Medicaidis available for some, but not all of the poor,[Ñ] and the State Children's
Health Insurance Program covers children of low-income families. The Veterans Health
Administration directly provides health care to U.S. military veterans through a nationwide
network of government hospitals; while active duty service members, retired service
members and their dependents are eligible for benefits through TRICARE. Together, these
tax-financed programs cover 2ÿ. of the population[Ñ9] and make the government the
largest health insurer in the nation.

Roughly two thirds of urban hospitals in the U.S. are non-profit hospitals and the balance
evenly divided between for-profit hospitals and public hospitals.[ÿ0][ÿ1] The urban public
hospitals are often associated with medical schools. For example, the largest public hospital
system in the U.S. is the New York City Health and Hospitals Corporation, which is
associated with the New York University School of Medicine.

Although public hospitals constitute the greatest percentage of non-federal hospitals, care
in the U.S. is generally provided by physicians in private practice and private hospitals. Just
over £9 of Americans receive health insurance through an employer, although this
number is declining and the employee's expected contribution to these plans varies widely
and is increasing as costs escalate[  ]. A significant number of people cannot obtain
health insurance through their employer or are unable to afford individual coverage[  
. The U.S. Census Bureau estimated that 1£. of the U.S. population, or Œ£.ÿ million
people, were uninsured at some time in 200ÿ. More than  of the uninsured are in
households earning $£0,000 or more per year. The census also states that 1Ñ.ÿ of the 9.Ñ
million on Medicaid incorrectly reported they were uninsured.[Ñ9] A few states have taken
serious steps toward universal health care coverage, most
notably Minnesota, Massachusetts and Connecticut, with recent examples being
the Massachusetts 200Ñ Health Reform Statute[ÿ2] and Connecticut's SustiNet plan to
provide quality, affordable health care to state residents.[ÿ] In 200£, the United States spent
1£.2 of GDP on health care, or US$Ñ,Œÿ per capita. Of that, approximately Œ£ was
government expenditure.[21] In 2009 that figure was set at 1ÿ.Ñ , or US$,0Ñ per

The U.S. Congress is currently debating many options for further reforming the U.S. health
care system.

a $  )(/

   - $ 

Standards of health care are considered to be generally high in the United Arab Emirates,
resulting from increased government spending during strong economic years. According to
the UAE government, total expenditures on health care from 199Ñ to 200 were US$ŒÑ
million. According to the World Health Organization, in 200Πtotal expenditures on health
care constituted 2.9 percent of gross domestic product (GDP), and the per capita
expenditure for health care was US$Œ9ÿ. Health care currently is free only for UAE
citizens. Effective January 200Ñ, all residents of Abu Dhabi are covered by a new
comprehensive health insurance program; costs will be shared between employers and
employees. The number of doctors per 100,000 (annual average, 199099) is 11. The
UAE now has Œ0 public hospitals, compared with only seven in 19ÿ0. The Ministry of
Health is undertaking a multimillion-dollar program to expand health facilitiesÈhospitals,
medical centers, and a trauma centerÈin the seven emirates. A state-of-the-art general
hospital has opened in Abu Dhabi with a projected bed capacity of 1Œ, a trauma unit, and
the first home health care program in the UAE. To attract wealthy UAE nationals and
expatriates who traditionally have traveled abroad for serious medical care, Dubai is
developingDubai Healthcare City, a hospital free zone that will offer international-standard
advanced private health care and provide an academic medical training center; completion
is scheduled for 2010.[1]

a $+( . 


In the post-Soviet era, the quality of Uzbekistan¶s health care has declined. Between 1992
and 200, spending on health care and the ratio of hospital beds to population both
decreased by nearly £0 percent, and Russianemigration in that decade deprived the health
system of many practitioners. In 200Œ Uzbekistan had £ hospital beds per 10,000
population. Basic medical supplies such as disposable needles, anesthetics,
and antibioticsare in very short supply. Although all citizens nominally are entitled to free
health care, in the post-Soviet era bribery has become a common way to bypass the slow
and limited service of the state system. In the early 2000s, policy has focused on improving
primary health care facilities and cutting the cost of inpatient facilities. The state budget for
200Ñ allotted 11.1 percent to health expenditures, compared with 10.9 percent in 200£.[1]

a , + 


The right to health care is guaranteed in the Venezuelan Constitution. Government

campaigns for the prevention, elimination, and control of major health hazards have been
generally successful. Immunization campaigns have systematically improved children's
health, and regular campaigns to destroy disease-bearing insects and to improve water and
sanitary facilities have all boosted Venezuela's health indicators to some of the highest
levels in Latin America.[ÿ£] The availability of low- or no-cost health care provided by the
Venezuelan Institute of Social Security has also made Venezuela's health care
infrastructure one of the more advanced in the region. However, despite being the most
comprehensive and well funded in the region, the health care system has deteriorated
sharply since the 190s. Government expenditures on health care constituted an estimated
Œ.1 percent of gross domestic product in 2002. Total health expenditures per capita in 2001
totaled US$Ñ. Per capita government expenditures on health in 2001 totaled US$2Œ0.

a ,  


The overall quality of   ,  

is regarded as good, as reflected by 200£
estimates of life expectancy (ÿ0.Ñ1 years) and infant mortality (2£.9£ per 1,000 live births).
However, malnutrition is still common in the provinces, and the life expectancy and infant
mortality rates are stagnating. In 2001 government spending on health care corresponded to
just 0.9 percent of gross domestic product (GDP). Government subsidies covered only
about 20 percent of health care expenses, with the remaining 0 percent coming out of
individuals¶ own pockets.[1]

In 19£Œ the government in the North established a public health system that reached down
to the hamlet level. After reunification in 19ÿÑ, this system was extended to the South.
Beginning in the late 190s, the quality of health care began to decline as a result of
budgetary constraints, a shift of responsibility to the provinces, and the introduction of
charges. Inadequate funding has led to delays in planned upgrades to water
supply andsewage systems. As a result, almost half the population has no access to clean
water, a deficiency that promotes such infectious diseases as malaria, dengue
fever, typhoid, and cholera. Inadequate funding also has contributed to a shortage
of nurses, midwives, and hospital beds. In 2000 Vietnam had only 2£0,000 hospital beds, or
1Œ. beds per 10,000 people, a very low ratio among Asian nations, according to the World

a 7


Despite the significant progress Yemen has made to expand and improve its health care
system over the past decade, the system remains severely underdeveloped. Total
expenditures on health care in 2002 constituted .ÿ percent of gross domestic product. In
that same year, the per capita expenditure for health care was very low, as compared with
other Middle Eastern countries²US$£ according to United Nations statistics and US$2
according to the World Health Organization. According to the World Bank, the number
of doctors in Yemen rose by an average of more than ÿ percent between 199£ and 2000, but

as of 200Πthere were still only three doctors per 10,000 persons. In 200 Yemen had only
0.Ñ hospital beds available per 1,000 persons.[1] Health care services are particularly scarce
in rural areas; only 2£ percent of rural areas are covered by health services, as compared
with 0 percent of urban areas. Emergency services, such as ambulance service and blood
banks, are non-existent. Most childhood deaths are caused by illnesses for
which vaccines exist or that are otherwise preventable. According to the Joint United
Nations Programme on HIV/AIDS, in 200 an estimated 12,000 people in Yemen were
living with human immunodeficiency virus/acquired immune deficiency
syndrome (HIV/AIDS).[1]

a 3

  , +

Zimbabwe now has one of the lowest life expectancies on Earth - ŒŒ for men and Œ for
women,[ÿÑ] down from Ñ0 in 1990. The rapid drop has been ascribed mainly to
the HIV/AIDS pandemic. Infant mortality has risen from £9 per thousand in the late 1990s
to 12 per 1000 by 200Œ.[ÿÿ] The health system has more or less collapsed: By the end of
November 200, three of Zimbabwe's four major hospitals had shut down, along with the
Zimbabwe Medical School and the fourth major hospital had two wards and no operating
theatres working.[ÿ] Due to hyperinflation, those hospitals still open are not able to obtain
basic drugs and medicines.[ÿ9] The ongoing political and economic crisis also contributed to
the emigration of the doctors and people with medical knowledge.[0] In August 200, large
areas of Zimbabwe were struck by the ongoing cholera epidemic.