# data[].attributes.attachment_link.readable_text
Summary

Although Japan's healthcare delivery system is highly regarded internationally, the COVID-19 pandemic has exposed its structural problems. Behind these issues lies a history of medical care provisions supported mainly by an unrestricted, "free labeling" system, and independently financed private hospitals. In addition, patients have a high degree of freedom of choice under the Japanese medical insurance system, making it difficult to provide comprehensive and continuous health management from initial diagnosis and treatment (primary care), specialized treatment, to supporting a return to home, providing nursing care and lifestyle support. As Japan becomes a "super-aged" society with individuals over 65 making up over 30% of the population, the nature of medical care will have to undergo major changes. Medical care's basic function must still be the treatment and cure of patients, but the system will also have to provide support. That means conceiving of care in a way that treats a person's life with dignity and does not sacrifice life for treatment. The implementation of a family doctor function and the clarification of the functions and roles of small and medium-sized community-based hospitals that support this function, as well as the establishment of a community comprehensive care network with multidisciplinary cooperation that goes beyond medical care, should also be set forth in future regional medical care plans.

Keywords: healthcare delivery system, medical insurance system, population ageing, medical care, Japan

Introduction

Hospitals are believed to have originated in the Middle Ages as accommodations for pilgrims. These early hospitals were mainly institutions for the nursing of the poor, sick, and stranded. The Hospice de Beaune in Beaune, France, is the world's oldest sanatorium, established in the mid-15th century.

Later, the Elizabethan Poor Law of the 16th century in England created "Contagious Hospitals" as places to care for patients in isolation. The same laws created poorhouses but these were mainly institutions where workers were treated and then sent to work again. In the 19th century, as modern medicine developed, military medicine and military hospitals developed as separate systems.

Either way, all modern hospitals in Europe for the treatment of the general public developed either as religious hospitals or public hospitals for the poor. In contrast, "clinics" have completely different origins and developed separately.

In Japan, hospitals developed in an altogether different way. As a 2013 government report (1) states:

"The difficulty of Japan's healthcare policy stems from the fact that, unlike in Western and Northern Europe, where national and municipal hospitals and other facilities are publicly owned, physicians have established medical corporations and private capital has been used to manage hospitals and other facilities (private ownership)".

"In the case of a publicly-owned system, governments can mandate reforms, such as how reforms have taken place in response to healthcare needs in some European countries recently".

"No other developed country as Japan has such a deregulated and market-dependent healthcare delivery system. In the case of Japan, publicly-owned healthcare facilities account for only 14% of all healthcare facilities and 22% of all hospital beds. Therefore, it has been difficult for Japan to do what other countries where healthcare institutions are publicly-owned can do systematically".

Characteristics of Japanese healthcare delivery system: Ownership-based medical care structure

Professor Shuhei Ikai of Hitotsubashi University, in his book "A Theory of the Hospital Century" (2), states that the Japanese healthcare delivery system is characterized by an "ownership-based medical care structure", which he defines as having the following characteristics:

i) Free access with a high degree of freedom. This leads to bloated outpatient care. It means "if you wait for three hours, you can see a doctor on the same day. There are very few countries where this type of outpatient consultation is possible.

ii) Ownership of hospital beds by physicians in a system where any licensed physician has the freedom to choose where he or she opens their business and their specialty (free labeling). The functions of large hospitals and clinics are undifferentiated, and large hospitals also have outpatient departments, creating a competitive relationship between them. General practitioners have certain specialties, and both hospitals and clinics provide both primary and secondary care, which means offerings overlap.

iii) Direct employment of physicians by hospitals. It is the physicians attached to ( i.e., employed by) the hospital who provide medical care using the hospital's medical resources. So-called open-type hospitals do not function in Japan.

iv) High ratio of private hospitals and hospital bed stock. The historical development of Japanese hospitals is unique in that private clinics became hospitals with their own beds, and then became incorporated as medical corporations.

v) Decentralized distribution of hospital beds and expensive medical equipment. As a consequence of iii) and iv), each medical institution manages its own hospitals based on its own risk and judgment in a competitive relationship. As a result, the distribution of beds among facilities is decentralized, and each institution decides how it will invest capital. making it difficult to systematically allocate beds and equipment.

vi) High specialization of general practitioners. Most general practitioners start their career through the medical office and resident physician system, then open their own practice, and many also have a specialty. This situation is quite different from that of general practitioners in other countries; in reality, Japanese general practitioners are able to provide not only primary care but also a certain level of secondary care.

vii) The lack of a family doctor (GP) system.

viii) Medical office system and egalitarian hiring. Because both resident physicians and doctors in private practice both have the same level of specialization, a system of specialized doctors does not work.

Japan's modern medical care system has taken shape since the Meiji era. This extremely stable and immutable system has come to be a defining factor for medical policy, and, as a result, medical policy has only progressed gradually.

An evaluation of Japan's healthcare system to date

Japan's healthcare system is highly regarded internationally, as the country achieved universal healthcare coverage in the 1960s. There are very few treatments that are not covered by health insurance, and services covered are provided in an extremely fair, equal, and inexpensive manner. Free-access is guaranteed, and Japan was the first in the world to establish a systematic long-term care insurance system (3).

The World Health Organization report in 2000 (4), a Newsweek feature in 2010 (5), and The Lancet in 2011 (6), international media and organizations speak highly of Japan's healthcare delivery system. On the other hand, however, the Lancet points out, for example, that Japan is facing a declining birthrate and an aging population, and there is no guarantee that the current system can be maintained in such an environment. This is a very good system, but if it is to be maintained, it must be reformed.

Issues surrounding Japan's medical care: Challenges of a "super-aged" society

Japan is already one of the world's most aged societies, its population declining by 800,000 to 1,000,000 people every year (7). There are no signs of any reversal to this decline, or to the aging of the population. Japan's population is expected to decline by about 15% by 2040 (7). On the other hand, the number of elderly people, especially those in the later stages of life, will increase, so the growth in the number of people requiring nursing care will outpace that of the overall aging of the population. Japan's elderly population will peak in 2040, and its super-elderly population in the 2060s (8), so numbers of individuals requiring care will not start to ease until after that time.

In addition, the structure of diseases will change. The number of chronic diseases will increase, pushing up treatment rates and length of treatment. The length of time people require nursing care will also increase. In other words, medical care needs per capita will increase.

Furthermore, medical technology is advancing at an ever-increasing pace, so medical care will become more sophisticated, and diseases that could not be cured before will be cured. If diseases can be cured, the average life expectancy will further increase.

An increase in medical care needs is unavoidable. Recently, Japan's fiscal authorities have argued without evidence that an increase in costs can be kept in line with gross domestic product (GDP) growth, but a look at other countries reveals that this is impossible. The Organization for Economic Co-operation and Development has published research showing that the ratio of medical care costs to GDP will increase over the next 20 years in all developed countries (8). This does not mean that nothing can be done about costs, but as long as there is a substantive increase in needs, an increase in medical care costs should be considered inevitable.

Meanwhile, the socioeconomic structure of Japan and the profile of its elderly population continue to evolve. Family and community ties are weakening, and the number of elderly living alone or in pairs will increase. Already today, most of Japan's elderly are already in single- or two-person households. This means that the point at which support is necessary is getting closer and closer to individuals. For example, a helper must be dispatched if an elderly person living alone needs something as small as a lightbulb changed. The proportion of the elderly who depend on public services will continue to increase.

Since the postwar generation will become the core of Japan's elderly population, a majority will be made up by long-time urban residents and Employees' pensioners. On the other hand, however, income disparities within the elderly population will widen.

In addition, the post-bubble generation, who were of working age during Japan's 30 years of economic stagnation, and those over 40 who struggled to find work and became contract employees, will grow old. The number of elderly people who are single, poor, and without relatives will increase. The burden on the social security system will continue to grow.

Issues surrounding Japan's medical care: Challenges of human and material resources

The level of human and material resources supporting medical care in Japan is surprisingly not very high. If we reiterate the characteristics of Japan's medical care delivery system, the reasons for this become clear.

i) Japan has the most private capital-dependent healthcare delivery system of any developed country. Profits and losses of private hospitals ultimately belong to individuals (medical corporations) who manage those corporations at their own risk. Furthermore, even if the hospital is a non-profit corporation, the president of the hospital must act as a personal guarantor for any capital investment, no different from any other small business. Because they are managed by individuals who guarantee their debts, they cannot be easily reorganized and integrated.

ii) Governance of the regional healthcare provision system is not yet established. Until the revision of the Medical Service Act in 1985, it was not even possible to regulate the number of hospital beds. The allocation of human and material resources and capital investment is done by individual medical institutions based on their own judgment. In other words, they are facility-complete, and not "community-complete", in which the entire region coordinates and maintains its own facilities.

Not only private hospitals, but also public hospitals and public medical institutions, which are supposed to be well governed, duplicate functions and investments, wasting resources. In addition, medical institutions have undifferentiated functions and don't sufficiently coordinate between each other. As a result, although the number of hospital beds in Japan is high by international standards, higher functions are weak, medical care functions are inadequate, and there is no coordination with long-term care.

The number of doctors per population in Japan is not so bad, but the number of doctors per hospital bed is only one-fifth of those in the U.S. and the U.K., and less than half of those in Germany and France ( Figure 1 and Figure 2 ). In addition, the number of doctors per hospital bed in other countries is increasing significantly as medical care becomes more sophisticated. The number of doctors per hospital bed in Japan has hardly increased at all, the gap between Japan and other countries is growing wider and wider; and the same is true for nursing staff ( Figure 2 ).

This is reflected in the difference in the average length of hospital stay. Although the hospital stay in Japan has become much shorter, it is still longer than in the West. It is well known that the length of hospital stay is correlated, or rather inversely related, to the number of doctors in a hospital. In short, in Japan, hospital care has become "thin-on-the-ground medical care".

Looking at the percentage of hospitals by type of establishment ( Figure 3 ), 93% of private hospitals have 199 beds or less (9). These hospitals account for 70% of Japan's total (9). The fact that there are many medical facilities and patients can go where they choose, and that there are medical facilities close by, means that it is easy to get medical care, but the question remains as to whether this is the case from the perspective of allocating finite medical resources.

A simple calculation shows that each hospital physician is responsible for 5.5 inpatients in Japan, in other words, one doctor is in charge of 5.5 beds. In the U.S., the number is 1.1. This means that Japanese hospital physicians are responsible for five times as many patients as their American counterparts.

In the outpatient setting, the total number of outpatient visits per year by U.S. physicians is 1,538, compared to 5,333 in Japan (10). Under the Japanese healthcare system, which guarantees free access, the working environment for doctors is extremely harsh. It would be strange if reforming physicians' working environment was not on the table.

Why is this happening? Since the achievement of universal health insurance, Japan has not developed enough human and material resources to meet exploding medical needs. The history of medical care demand has been handled mainly by private medical institutions with minimal facilities and manpower. Looked at from a different perspective, the system of fee-for-service payment, may also be said to solve the problem by simply encouraging the creation of more medical institutions.

Hospital doctors and staff are chronically overworked, but unable to provide concentrated inpatient care; diagnosis responsibilities are undifferentiated and hospitals are unable to keep up with changes in the kinds of diseases that patients present. Many medical institutions don't have the facilities or the staff to provide advanced functions.

Nevertheless, since the medical care delivery system is built on the premise that medical institutions are self-financed, the entire system will collapse if reimbursement is not designed so that each medical institution can operate independently. As a consequence, various policy inducements have been made, but the remuneration system (allocation of financial resources) has largely been set up to maintain the status quo.

The problems inherent in this structure were exposed in one fell swoop with COVID-19.

What we learned in the COVID-19 pandemic

Although there are various opinions, mine is that what Japan experienced during the COVID-19 pandemic gives a glimpse of what Japan's medical care will look like 20 years from now.

Even today, 70% of hospitalized patients are already over 65 years old. Half of them are over 75 years old (11). In 20 years, most patients will require nursing care and have underlying diseases. A large percentage of them will have dementia. It will be the norm for such people to come in with infections, acute exacerbations, pneumonia, and broken bones - and there is no one at home to take care of them.

We have to think about the medical and nursing care system with such patients in mind. The plan was to get there by 2040, but this situation is now unfolding before our eyes. Remember what happened in the infectious disease ward when an elderly dementia patient was hospitalized with the coronavirus? In 2040, such situations ― while the majority of patients admitted to acute care hospitals are those in need of care with multiple underlying medical conditions at the same time ― will occur on a large scale on a daily basis.

If this is the case, medical and nursing capabilities must be thought of together. A unilinear regional care delivery system with hospitals at its core, with the hospital upstream and the home care system downstream, will no longer be possible. Acute care hospitals must also consider having medical and long-term care capabilities, and chronic care hospitals must be able to provide at least secondary emergency care in order to support the community.

Nursing homes, as well, cannot skimp on medical care capabilities. The entire home care provision system will literally break down if a comprehensive and coherent care network is not implemented.

These things have been discussed for a long time, but unless they are seriously implemented now, we will not be able to survive in the future society. The pandemic forced this realization upon Japan by exposing structural problems in its healthcare delivery system.

Of course, a pandemic is a one-off, large-scale disaster that does not happen every day. In that sense, it is correct to consider Japan's "contingency response". At the same time, the situation that occurred - the so-called "collapse of medical care" - should be viewed as the manifestation of structural problems that were inherent in the system during normal times, and as an opportunity to solve structural problems in the current healthcare delivery system itself.

The reasons that Japan's system of delivering medical care is functionally undifferentiated, inefficient, "thinly spread", and lacking in spare capacity is precisely because medical care has been delivered mainly by independently-financed private hospitals in an unrestricted medical system where doctors can freely select their own medical specialties and disclose them to the public (free labeling). Cooperation and collaboration among medical institutions is not the default, and any cooperation among doctors and medical institutions is basically left to the resourcefulness and actions of individual doctors and medical institutions on the frontline.

Furthermore, under a free-access medical insurance system with a high degree of freedom of choice on the part of patients, there is no institutional control of patient flow. In Japan's free access system, patients are entirely responsible for deciding whether or not to go to a doctor, which doctor to go to, and which department to go to, without any advice or assistance from professional medical personnel. In other words, the system is not designed to objectively provide timely and appropriate medical care or to provide necessary medical care when needed. If this is the case, it is difficult to create a system for comprehensive and continuous health management, a flow of prevention and health management, initial diagnosis and treatment (primary care), specialized treatment, return home, and nursing care and lifestyle support. In other words, neither the supply, nor the demand side can be controlled.

Despite this situation, the system has managed to function to date. However, the frontline healthcare workers who support medical care shoulder a heavy burden. As mentioned above, the number of inpatients per physician in Japan is five times that of the U.S., and the total number of outpatients per year is 3.5 times that of the U.S. As the recent pandemic has made clear, Japan's healthcare system is fragile and can easily collapse if there is two much pressure put on one specific point.

Will medicine really be able to sustain itself for the next 15 to 20 years in Japan? Even now, there are cases of emergency patients being shunted around from hospital to hospital and individuals who are unable to access medical care and nursing care. The lack of coordination and networking on the provider side has led to blockages here and there, and there have been many cases of families running around looking for a facility to stay in.

Now that the pandemic has brought the problem to the fore, perhaps now is the time for reform.

What is required of medical care in a super-aged society

In the long-term care world, it's already common understanding that the goal of elderly care should be to enable people to live with dignity at home, in their community, for as long as possible (12). The role of long-term care service is to support lives and lifestyles. In a super-aged society, regular medical practitioners need to also start thinking this way.

The basic function of medicine - providing treatment to cure - will not change, but in addition to that, it will be important to heal and support. In other words, what will be required is medical care that supports the dignity of people's lives, and does not sacrifice life for the sake of treatment. Medical care will exist as a part of life.

"Healing and support" cannot be achieved by medical care alone, unless a comprehensive regional care network, provided by medical care and long-term care together, with the cooperation of many different professions that support patients, is created.

As is already the case in the world of social service and, outreach to patients/users in close proximity will also be required of medical care. House calls will become more important, and asynchronous, remote medical care, such as telemedicine, will become an important weapon in the future, especially when considering the limited human and material resources available to support local medical care. There have been remarkable advances in medical digital transformation and other home healthcare support technologies, and it is already technically possible to perform a considerable amount of diagnostic procedures remotely (13). These technological innovations will contribute to reducing the burden on both patients and medical personnel, and should be actively implemented.

In order for this system to work, IT infrastructure to centralize patient health information and share information, is an indispensable prerequisite. "Tooling" such as medical IT, IoT, and digital transformation must be standard, and should be prioritized as essential to support home medical care and community comprehensive and coherent care networks.

Medical care challenges faced by a super-aged society

The functions of hospitals in a super-aged society will be divided into two major approaches. On one hand will be highly-specialized, acute care hospitals that provide intensive acute care, on the other, community-based hospitals that provide medical care for healing and support (3).

While there has been a lot of discussion about rethinking regional medical care, we should further promote functional differentiation of hospital beds, selection and concentration, strengthening of acute care functions, and concentrated investment of resources (efficient use of hospital beds by reducing the number of hospital beds). At the same time, we should also clearly set a direction for strengthening regional medical care and home medical care. As I have emphasized in this paper, if home medical care is not strengthened, the burden on hospitals and emergency medical services will increase, and the entire medical care delivery system will break down.

In this sense, the implementation of primary care physician function and the clarification of the functions and roles of small and medium-sized community-based hospitals that support this function, as well as the establishment of a regional comprehensive and coherent care network with multidisciplinary cooperation that transcends medical care, should also be pillars of regional medical care.

Regional medical care impacts the overall medical care delivery system. Although debate tends to focus on reducing the number of hospital beds, the original purpose of regional medical care is to reallocate and reorganize human and physical resources to "efficiently meet the future medical (and nursing care) needs of the region with the existing human and physical resources".

The realization of better regional medical care will lead to better resource allocation and the optimization of overall medical care costs. Reforming how care is delivered is the most realistic and effective way to optimize costs.

Long-term care becomes more important in a super-aging society

Finally, I would like to share some interesting data. As you may recall, all elderly people aged 65 and over are enrolled in Medicare in the US. In other words, all medical costs for the US population after the age of 65 are reflected in the Medicare database.

One study (14) compares the cumulative amount of medical and long-term care expenses spent by those aged 65 or older who are enrolled in Medicare up to the time of their death, segmented by age at death. The data shows that the longer a person lives, the more his/her lifetime medical expenses increase until they peak out at around age 90-95. In other words, the lifetime medical costs of someone who lives to be 100 or and someone who lives to be 110 years old are not very different. It follows, then, that if average life expectancy were to increase to 90 or 100 years, medical costs would gradually start to peak out as people lived longer healthy lives.

The data for long-term care costs shows a different picture. The lifetime cost of long-term care increases with the age at death, and exceeds the lifetime cost of medical care for those over age 95. This means that as more people age in a super-aged society, the relationship between cumulative medical costs and cumulative long-term care costs by the time of death is reversed.

In other words, aging (increase in life expectancy) will be a factor in increasing lifetime medical costs until about the age of the 90s, but long-term care (long-term care) will continue to grow without peaking out.

In conclusion, The COVID-19 disaster revealed structural weaknesses in Japan's healthcare delivery system. We should take this as an important warning: this is only the beginning. Looking ahead to the year 2040, it is inevitable that Japan will need to streamline and optimize its healthcare delivery system given its limited resources. This will depend on a reform of the entire regional medical care delivery system, and a move towards a more community approach to medical care. Only this shift will allow Japan to more efficiently use resources and give patients better care - and a shot at a better quality of life - overall.

Funding

None.

Conflict of Interest

The author has no conflicts of interest to disclose.

References

2. Shuhei Ikai. A Theory of the Hospital Century. Yuhikaku Publishing, Tokyo, Japan. 2010. [ Google Scholar]

13. Takao H. Digital Medicine - Current ability and future. Nikkei BP, Tokyo, Japan, 2022. (in Japanese). [ Google Scholar]

14. Spillman BC, Lubitz J. The effect of longevity on spending for acute and long-term care. N Engl J Med. 2000; 342:1409-1415. [[ PubMed] Google Scholar]

Articles from Global Health & Medicine are provided here courtesy of National Center for Global Health and Medicine, Japan

# data[].attributes.attachment_link.title
Japan's healthcare delivery system: From its historical evolution to the challenges of a super-aged society

# data[].attributes.attachment_link.description
Although Japan's healthcare delivery system is highly regarded internationally, the COVID-19 pandemic has exposed its structural problems. Behind these issues lies a history of medical care provisions supported mainly by an unrestricted, "free labeling" ...

# data[].attributes.attachment_link.readable_text
Learn about Canada's health care system, including Medicare, funding, accessing health care services and delivery.

On this page

About Medicare

Medicare is a term that refers to Canada's publicly funded health care system. Instead of having a single national plan, we have 13 provincial and territorial health care insurance plans. Under this system, all Canadian residents have reasonable access to medically necessary hospital and physician services without paying out-of-pocket.

Roles and responsibilities for health care services are shared between provincial and territorial governments and the federal government.

The provincial and territorial governments are responsible for the management, organization and delivery of health care services for their residents.

The federal government is responsible for:

Canada Health Act

Provincial and territorial health care insurance plans must meet the standards described in the Canada Health Act. This is necessary to get their full payment under the Canada Health Transfer.

These standards include:

public administration

comprehensiveness

universality

portability

accessibility

Public administration

The provincial and territorial plans must be administered and operated on a non profit basis by a public authority.

Comprehensiveness

The provincial and territorial plans must insure all medically necessary services provided by:

hospitals

physicians

dentists, when the service must be performed in a hospital

Medically necessary services are not defined in the Canada Health Act. The provincial and territorial health care insurance plans consult with their respective physician colleges or groups. Together, they decide which services are medically necessary for health care insurance purposes.

If a service is considered medically necessary, the full cost must be covered by the public health care insurance plan.

Universality

The provincial and territorial plans must cover all residents.

Portability

The provincial and territorial plans must cover all residents when they travel within Canada. Limited coverage is also required for travel outside the country.

When a resident moves to another province, they can continue to use their original health care insurance card for 3 months. This gives them enough time to register for the new plan and receive their new health insurance card.

Accessibility

The provincial and territorial plans must provide all residents reasonable access to medically necessary services. Access must be based on medical need and not the ability to pay.

Federal funding for health care

The federal government provides health care funding to the provinces and territories through the Canada Health Transfer.

Provinces and territories receive additional federal funding support through other fiscal transfers.

Delivering health care services to specific groups

We provide certain direct health care services to some population groups, including:

First Nations people living on reserves

Inuit

serving members of the Canadian Forces

eligible veterans

inmates in federal penitentiaries

some groups of refugee claimants

Other federal health-related functions

We are responsible for the regulation of products, such as:

food

consumer products

pharmaceuticals

cosmetics

chemicals

pesticides

medical devices

radiation-emitting devices like cellphones

The federal government also supports:

health research

health promotion and protection

disease monitoring and prevention

The government also provides tax support for health-related costs:

tax credits for:

disability

medical expenses

caregivers and disabled dependents

tax rebates to public institutions for health services

deductions for private health insurance premiums for the self-employed

Accessing health care services

Canadians most often turn to primary health care services as their first point of contact with the health care system.

In general, primary health care:

delivers first-contact health care services

coordinates patients' health care services to support:

continuity of care, which means receiving high quality care from diagnosis to recovery

ease of movement across the health care system when more specialized services are needed from specialists or in hospitals

The provinces and territories also provide supplemental coverage to certain groups of people, such as:

seniors

children

social assistance recipients

This helps pay for health care services that are not generally covered under the publicly funded health care system. These services include:

vision care

dental care

prescription drugs

ambulance services

independent living (home care)

Those who do not qualify for supplementary benefits under government plans pay for these services through:

out-of-pocket payments

private health insurance plans

# data[].attributes.attachment_link.description
Learn about Canada's health care system, including Medicare, funding, accessing health care services and delivery.

# data[].attributes.body
https://www.gov.uk/government/publications/ecuador-hospitalisation-information-pack/ecuador-hospitalisation-pack

# data[].attributes.body
https://www.gov.uk/foreign-travel-advice/mauritius/health

# data[].attributes.body
https://eurohealthobservatory.who.int/countries/monaco

# data[].attributes.body
https://www.rvo.nl/sites/default/files/2021/11/Zorgsector%20Denemarken%20marktrapport%202021.pdf

# data[].attributes.attachment_link.description
Understanding the healthcare system in Spain - information for tourists and expats on costs, finding a doctor, prescription costs and more.

# data[].attributes.body
https://rho.emro.who.int/sites/default/files/Profiles-briefs-files/IRA-Health-System-Profiles-2018.pdf

# data[].attributes.attachment_link.description
This is a best prospect industry sector for this country. Includes a market overview and trade data.

# data[].attributes.body
https://www.undp.org/kazakhstan/news/undp-supports-kazakhstans-healthcare-system

# data[].attributes.body
https://www.health.gov.au/about-us/the-australian-health-system

# data[].attributes.attachment_link.readable_text
If you're planning on moving to China to live, work or study, you'll want to know a bit about how the healthcare system in China works. Making sure you have adequate health cover for your personal needs is an essential no matter where in the world you are. Use this China healthcare system overview to figure out what you need to do to stay healthy, and avoid unforeseen bills if you have an illness or accident while you're there.

As well as an introduction to the medical system in China, this guide covers a brief explanation of the China healthcare system vs United States healthcare provision, so you can understand the differences.

We'll also touch on how expats living abroad can save money with Wise and the Wise Multi-currency Account. Hold, send and spend money in dozens of currencies, and get the mid-market exchange rate no matter where in the world you are.
Learn more about Wise
China healthcare system: overview

China's healthcare system has developed enormously in recent years, and many aspects of the way medical care works are still under review in order to make further strides. Chinese citizens can access universal health care through one of a range of government supported or mandated health insurance plans. There are also a wide range of private healthcare options available, and supplementing public health insurance with private cover is possible.

Let's start with a run through of the key public and private health insurance options available under the healthcare system in China¹:

Type of coverage

Funding, eligibility and entitlements

How does China's healthcare system work?

Most Chinese citizens can choose to take up government supported public health insurance through one of the schemes laid out above. However, aside from the UEMBI program, cover is not mandatory, which means that some people still need to pay out of pocket for all medical expenses.

Government funding for public health and hospital care varies based on the location. There are differences at a regional level, with additional government support in place for low income and rural areas. Insurance premiums for individuals are generally fairly low to allow more citizens to access these schemes if possible. However, even with public insurance, there are some copay requirements at the point of accessing some care. We'll look at these in more detail a little later.

Does China have a universal health care system?

The Chinese government has created ways for all citizens to access public health insurance. However, there are fees and insurance premiums to pay, and the schemes are not necessarily mandatory for individuals. This means that not everyone is able to take up the opportunity of public healthcare.

Is healthcare free in China?

Even for Chinese citizens with public health insurance, there may be some fees for care and medication. However, these costs are subsidised heavily, to make care within the reach of as many people as possible.

Copay for care and medication depends on the type of public insurance you have, the healthcare needs you have, the type of hospital you visit and a range of other factors. However, the Commonwealth Fund report the following as typical costs:

Wondering how much it would cost you in China's local currency? Check out the handy calculator below

Not all medication is reimbursed, or there may be limits to the amount patients can claim for some medications. However, discounts on some care exist for retirees. Government support is also available for some people who can not cover copay costs, or who are uninsured. However, this only typically reaches a very small fraction of the population.

Health care for foreigners and expats

As a foreigner in China you'll almost certainly need to take out private health insurance as you are unlikely to be covered by a government subsidised health insurance scheme. Private health insurance can be used to provide care and also cover deductibles and copay requirements³. The Chinese government is encouraging the development of the private health insurance market to allow both foreigners and higher income Chinese citizens to have a broader range of health care choices.

Private hospitals are available throughout the country, with a bigger choice in the large cities and provincial capitals. There are a reported 21,000+ different private hospitals, excluding community and village private facilities, throughout China.

Is healthcare free in China for foreigners?

Healthcare in China is free for Chinese citizens and Chinese permanent residents. If you're a foreigner with permanent resident status you may be able to access government supported public health insurance. If not, you'll need private health cover.

Paying for medical expenses abroad? Try Wise

If you're living or taking a trip abroad and need to pay a medical bill in a different currency, choose Wise.

Pay your bills in CNY or dozens of other currencies for up to 3x less than using your regular bank. You can arrange your payment online or using your smartphone, for fast and secure international transfers no matter where you are.

If you're a regular traveler or an expat, why not open for free an online Wise Multi-currency Account to get currency conversion which uses the mid-market exchange rate and low, transparent fees. You'll get a linked debit card to spend and make ATM withdrawals all around the world (additional charges may occur from independent ATM networks), and your own receiving accounts for 10 major world currencies. Make sending, spending and receiving money in foreign currencies easy, with Wise.
Create a Wise account Please see Terms of Use for your region or visit Wise Fees & Pricing for the most up to date pricing and fee information.
China healthcare system vs. United States

US citizens traveling to China - and Chinese citizens headed to the US - are often surprised by the differences in the way healthcare is set up.

Here are some of the key differences between China's healthcare system vs United States healthcare:

95%+ of Chinese citizens have public health insurance - significantly higher than in the US. However, even with public insurance, patients in China need to pay some fees and copay costs

US health costs per capita in 2018 hit 10,586 USD, while the equivalent in China was only 688 USD. For reference, the OECD average was 3,994 USD⁴

In the US there are 2 doctors, and 11.9 nurses per 1,000 inhabitants - in China, those figures are 2.6 doctors, and 2.7 nurses⁴, reflecting the differences in how healthcare is accessed and administered across the countries

Getting a specialist care appointment in the US can involve a significant wait. In Chinese public hospitals, the process can be faster, and patients may be able to pay more for faster care - either officially or through less formal channels²

If you don't have the right insurance or cover for your health needs in either China or the US, you could find you have high medical bills. It's also important to note that private health care is more consistently available in Chinese cities compared to rural areas. No matter whether you're in the US, China, or anywhere else in the world, getting to know your healthcare options is important, to make sure you can access the care you need, when you need it.

Important information

Emergency number
Call 120 for an ambulance

Note: there may be a significant delay in remote or rural areas. You're advised to have a Chinese speaker call for you, to check the likely arrival time

The healthcare system in China is developing at a rapid pace and has already helped to transform the country in many ways. Further reforms are ongoing, which aim to help all citizens access the care they need, as well as giving additional choices and care options to higher income citizens and residents.

If you're an expat in China it's worth understanding the local medical system, even though you're likely to access care through private insurance and hospitals. Use this guide to help you build a picture of China's healthcare system, and don't forget - if you're paying out of pocket for your medical expenses in China, you'd be better off with a Wise Multi-currency Account. Use Wise to cut the fees for currency exchange in China - or on payments to 70+ other countries around the world.
Sources:

1. Commonwealth Fund - China

2. SUP China - Healthcare compare: US vs China

3. CBBC - How China's healthcare system actually works

4. USC - Healthcare in the US and China

Sources checked on 10.11.2021
*Please see terms of use and product availability for your region or visit Wise fees and pricing for the most up to date pricing and fee information.

This publication is provided for general information purposes and does not constitute legal, tax or other professional advice from Wise Payments Limited or its subsidiaries and its affiliates, and it is not intended as a substitute for obtaining advice from a financial advisor or any other professional.

We make no representations, warranties or guarantees, whether expressed or implied, that the content in the publication is accurate, complete or up to date.

# data[].attributes.attachment_link.description
Wondering how the Chinese healthcare system works? Find everything you need to know in this comprehensive guide.

# data[].attributes.body
https://www.internationalinsurance.com/health/systems/russia.php

# data[].attributes.body
Jaylinio

# data[].attributes.attachment_link.provider_name
FOD Buitenlandse Zaken - Buitenlandse Handel en Ontwikkelingssamenwerking

# data[].attributes.attachment_link.description
Informatie over gezondheid en hygiëne in Suriname

# data[].attributes.attachment_link.readable_text
It is strongly recommended that tourists and other short-term travelers to Italy and who are not from any EU member country have travel insurance, which includes medical coverage. Although tourists occasionally report being treated for minor disorders in hospitals for no cost, this is an exception rather than a rule. If travelers to Italy need diagnostic tests, hospital admission, or surgical care, they can expect to receive a large bill.

If a visitor's travel time in Italy includes adventure activities or extreme sports, such as hiking and climbing in The Alps or scuba diving in the south then they must ensure they are appropriately insured.
Extreme Sports Travel Medical Coverage:

# data[].attributes.attachment_link.description
Learn about Italy's public health system. Check if you need private health insurance in Italy as an expat or traveler.

# data[].attributes.attachment_link.readable_text
Does Italy have a national health service?

The Italian Healthcare System is a great matter of pride for Italian citizens. Healthcare in Italy is public and accessible to everyone, without any discrimination based on income, gender or age.

The Italian Healthcare System was first introduced on December 23, 1978 with Law No. 833. The founding principles of Italian healthcare are universality, solidarity of financing - through general taxation - and equitable access to services. All the laws that regulate the Italian NHS ( Servizio Sanitario Nazionale) are made in compliance with art. 32 of the Italian Constitution.

Below you will find everything you need to know about public health insurance in Italy, how you can access and the differences with private healthcare.

How does health insurance work in Italy?

The healthcare system in Italy is based on 3 guiding principles of "universality, equality and solidarity". The aim is to achieve uniform levels of care throughout national territory, equitable access to services for all citizens and fiscal solidarity as the fundamental way of financing the health system.

This is an extraordinary societal achievement and a key indicator of a country's social and democratic development.

Only a minority of countries around the world deliver this type of healthcare to all citizens, without any discrimination.

The Italian NHS provides high-quality healthcare to all citizens for hospital care, emergency care and primary care provided by general practitioners and paediatricians. In addition, the NHS covers a wide range of pharmaceuticals and all the hospital and diagnostic services essential for health.

Moreover, healthcare in Italy is managed at a regional level by local authorities - Azienda Sanitaria Locale (ASL) - that supply healthcare services.

Regional Health Authorities may have different names, depending on the region. For instance, in Emilia-Romagna is called AUSL - Azienda Unità Sanitaria Locale.

How to get health insurance in Italy?

Italian citizens residing in Italy are entitled to free health care registration with the NHS.

This right is extended to certain categories of residents abroad, if they are in possession of appropriate documentation, as determined by bilateral agreements on health care, in force between the various States.

A specific procedure applies in the case of Italian citizens accessing healthcare abroad in countries that do not have an agreement with Italy.

In addition, EU workers and their dependents are entitled to free health care registration, as well as non-EU citizens holding specific residence permits.

Foreigners who are legally residing in Italy but not entitled to free healthcare can apply for voluntary enrolment into the NHS.

Such voluntary enrolment is done through the payment of an annual contribution, as determined by Article 1, paragraph 240 of Low No. 213 of December 30, 2023.

Enrollment procedure for the Italian Healthcare

The enrollment in the National Health Service offers access to hospitals and medical examinations. Enrollment is mandatory for all Italian citizens.

When citizens enroll in the NHS, they are also granted a family doctor. Family doctors are particularly useful when in need of prescriptions for drugs and/or medical examination.

In fact, citizens need a prescription for booking an appointment with a specific specialist. In this case, a small fee applies. Moreover, each specialist doctor has a waiting list that varies based on the type of examination.

As regards the prescription of drugs, this is mandatory for specific categories (i.e. antibiotics), but not for others (i.e. paracetamol).

How much does it cost to go to hospital in Italy?

Access to the healthcare in Italy is public. This means that anytime citizens need a medical examination, therapy or surgery, they can go to a public hospital and access the service through a relatively low fee.

With "relatively" we mean that obviously the perception of the fee service changes based on the individual. However, with "low" fee we mean a true difference in price, as opposed to other health services abroad.

Ticket is the term used in Italy that refers to the fee payment to access the medical examination. The ticket depends on the citizen's income.

For the treatment of serious and chronic diseases, the Italian NHS offers drugs free of charge, including last-generation innovative medicines.

Cost of Italian Healthcare for children

Italy is one of the few countries in Europe that allows families to choose their paediatrician at no cost to them for all children aged 0 to 14 years.

When do you lose the right to healthcare in Italy?

Italian citizens who transfer their residence to a foreign state may lose their right to healthcare upon cancellation from the Italian registry office, with their AIRE registration.

However, in some specific cases it is possible to continue availing from healthcare while living abroad.

Do I need medical insurance for travel to Italy?

If you are a foreigner visiting Italy as a tourist, you may decide to purchase private medical insurance, to cover potential risks during your stay.

Having a private health insurance becomes a mandatory requirement, when applying for certain types of Italian visas.

Italian health insurance card

What is the health ID card in Italy?

The Italian Revenue Agency issues the National Health Card ( Tessera Sanitaria Nazionale) to all Italian residents that have the right to receive health assistance by the NHS.

The Card is also valid in all the EU Member States.

Is tessera sanitaria health insurance?

The Italian Health Insurance Card includes the tax code issued by the Italian Revenue Agency. Citizens mainly use it to see doctors and to buy medicines. It may be also useful anytime residents have to show their tax code.

Before it expires, the Italian Revenue Agency automatically sends Italian residents a new Insurance Card.

In general, the Card validity is usually of 6 years but may be shorter in specific cases (i.e. for foreigners with a limited residence permit).

In June 2022, through Resolution No. 25/E, the Revenue Agency provided clarification regarding the assignment of a tax code to undocumented and unaccompanied foreign minors, for the purpose of their registration with the National Health System.

Do I need an EHIC card for Italy?

The back of the Italian Insurance Card represents the  European Health Insurance Card (EHIC)

The Italian EHIC card is used to take advantage of health care services in Europe, specifically to access medically necessary treatment, if that is provided by the country of destination.

Specifically, coverage is provided in the 27 EU Member States, as well as in Iceland, Liechtenstein, Norway and Switzerland.

For more information about the coverage, please check our article dedicated to the EHIC.

Private healthcare in Italy

Unfortunately, sometimes the waiting lists to access Italian public health services are quite long. Therefore, more and more people decide to turn to the private healthcare, which can be really expensive because citizens have to pay for the entire fee.

Regardless of the cost, Italian private healthcare is highly considered. For this reason, an increasing number of people choose to stipulate a private health insurance in Italy. Private healthcare insurance grants easier access to private hospitals or clinics.

# data[].attributes.attachment_link.description
Introduction to Healthcare in Italy. Learn accessibility conditions, differences with private healthcare and more.

# data[].attributes.body
Jaylinio

# data[].attributes.attachment_link.readable_text
Overview of the Mexican Healthcare System

Overall, the healthcare system in Mexico offers good standards and operates efficiently. Healthcare is affordable and large cities, in particular, have superb hospitals and clinics. A large number of Mexican doctors go to medical school or do extra training in the United States or Europe. As such, there is a high percentage of doctors who speak excellent English. And, remarkably, many still perform house visits, a rarity in modern medicine. However, there are still a large number of people who cannot afford more than the most basic care. As well, the Mexican government has one of the lowest per capita healthcare expenditures of all OECD countries.

The Healthcare System in Mexico: 3 Tiers

The health care in Mexico is delivered via a 3-tier system.

The Mexican social security program, known as the IMSS, covers employees in the private and public sectors. In short, if you work for a Mexican company, you directly quality for medical coverage under the IMSS. The employee's portion of the costs comes directly off from their paycheck. Workplace HR staff do all the paperwork, making participation in the IMSS very easy. The cost of the coverage through IMSS is very affordable, costing approximately US$500 per year.

A second option for participating in the country's public health insurance system is the Seguro Popular program. The Seguro Popular was set up to provide for those who don't qualify for the IMSS tier, either due to financial reasons or because of pre-existing conditions. Those covered by Seguro Popular are primarily the unemployed, the homeless, and those with exclusionary medical conditions. Theoretically, between Seguro Popular and IMSS, everyone in Mexico should be covered through the public system at a price they can afford.

The final tier in Mexico's health care system is provided through private insurance. This is a desirable option for many people as the private healthcare system offers greater comfort and privacy. However, it is very expensive compared to the public system.

Who is Eligible for the IMSS - Health Care in Mexico

In theory, at least, signing up for healthcare in Mexico is easy for citizens and legal permanent residents. For most people, to be eligible for the IMSS you have to be fully (and formally) employed in Mexico. As such, your employer makes the necessary arrangements with paperwork and to set up paycheck deductions.

Alternatively, if you aren't formally employed you can also still join through voluntary enrollment. This is an option open to those who aren't employed but still meet the requirements of being a legal resident, such as expat retirees.

Mexican citizens who grew up with the IMSS are familiar with the system and it feels natural to them. For expats in Mexico, however, the IMSS is entirely new. Without the support of a formal employer, voluntary enrollment might seem intimidating. You begin the application process by visiting a local IMSS office in your community and filling out multiple forms. Unless you read and write excellent Spanish, bring along a local friend, or hire an interpreter to help you with the formalities. Occasionally, applying might require you to revisit the office on several occasions to supply the staff with all the paperwork they need.

Costs of the Mexican Healthcare System

The healthcare system in Mexico is part of the national social security program. It's funded in part by employees and employers who contribute to the IMSS each month. It's further augmented by funding from the federal government, which is raised through general taxation.

A simple doctor's office visit costs about 400 pesos or roughly US$20. Diagnostic tests can cost up to a third less in Mexico compared to the United States or Canada. However, costs can quickly add up for more complicated procedures. Tourists and expats should be aware that certain healthcare facilities in areas with large international tourist populations have been known to inflate medical charges. Even short term travelers should carry comprehensive insurance.

Related:

The Differences Between Private and Public Care

Like many countries, there's a gap in the quality of care found in rural areas versus urban areas. Public hospitals are often crowded and the primary language spoken will be Spanish, especially in rural areas. Private hospital rooms, a greater range of specialists, and shorter waiting times are some of the perks you can expect to enjoy if you supplement your coverage. While it's generally not a problem to find an English speaking doctor, private health insurance all but guarantees it, along with private rooms in more comfortable and modern facilities. This difference in standards of coverage is a primary motivator for people to carry supplemental health insurance.

Healthcare Options for Expats and Foreigners in Mexico

For expats, the IMSS is fantastic for offering comprehensive healthcare insurance at a low price. However, it has one major drawback. Pre-existing conditions preclude participation. Such conditions include but are not limited to cancer, diabetes, heart disease, and addictions. A full list of exclusions can be found here. As such, private health insurance coverage is a more comprehensive option. If you're not able to get coverage through your job, compare private health care plans to choose one that offers the best value and coverage.

Tourists and other short term foreign visitors aren't eligible for any public health insurance coverage and thus should travel with their own travel medical insurance and emergency coverage.

It's a smart idea for all visitors to keep a reserve of cash on hand in your bank. In many cases, clinics and hospitals in Mexico don't participate in direct billing programs for international insurance. Patients have to pay before leaving the hospital and submit the relevant paperwork in for reimbursement. And, in some cases, you're even required to pay before you are treated.

Special Information About Pharmacies

Pharmacies in Mexico have a unique set up that's not found anywhere else. There are two classes of pharmacies in Mexico - and it's not the same as the usual pharmacy versus drug store distinction found in many other countries.

In Mexico, pharmacies are broken into two basic groups: Segunda Clase and Primera Clase. Segunda class pharmacies are incredibly common, both in big cities and small towns. However, this group isn't allowed to sell regulated medicines. Think of it as a kind of 'pharmacy-lite'. Common antibiotics and other everyday drugs like cholesterol medication and allergy treatments are available there. However, regulated medications that pose a high risk of abuse aren't found at a Segunda Clase pharmacy. The Primera Clase pharmacy, which is a bit harder to find, has no restrictions at all. You can get any medication you have a prescription for, including pain killers and other drugs that are potentially addictive. Hopefully, you will never be so ill to required this class of medication but, if you are, ask for your doctor for directions to the closest Primera Clase pharmacy.

Author: Joe Cronin, Founder and President of International Citizens Insurance. Mr. Cronin, a former expat, is an authority in the areas of international travel, and global health, life, and travel insurance, with expertise in advising individuals and groups on benefits for today's global workforce. Follow him on LinkedIn or Twitter.
Related Articles

# data[].attributes.attachment_link.description
Understanding the healthcare system in Mexico, including who is eligible for the IMSS and what insurance Foreigners and tourists need While in Mexico.

# data[].attributes.attachment_link.readable_text
This health policy is in line with the Gambia National Development Plan (2018 - 2021) to achieve the SDG health related goals of a three-quarter decline in maternal mortality and a two-third decline in mortality among children under five; to halt and reverse the spread of HIV/AIDS and to provide special assistance to orphans and put the country on a strong footing to attaining the Vision of the Government.

The theme, "Building Partnerships for Quality Health Care for All," is the current philosophy which our national health policy is hinged upon. The mission of the Ministry of Health is to provide quality, affordable and equitable healthcare for the population within the context of Primary Health Care. This is aimed at reducing out-of-pocket healthcare expenditure and to ensure that no one suffers financial hardship (catastrophic expenditure) because of ill-health.

# data[].attributes.attachment_link.title
National Health Policy of The Gambia, 2021-2030

# data[].attributes.attachment_link.description
This health policy is in line with the Gambia National Development Plan (2018 - 2021) to achieve the SDG health related goals of a three-quarter decline in maternal mortality and a two-third decline in mortality among children under five; to halt and reverse the spread of HIV/AIDS and to provide special assistance to orphans and put the country on a strong footing to attaining the Vision of the Government.

# data[].attributes.body
Jaylinio

# data[].attributes.attachment_link.readable_text
South Africa's Healthcare System: What Expats Should Know

South Africa is a hugely popular travel destination for expats and tourists alike. Whether you're traveling for a safari or relocating to start a new career, you'll probably want to know about South Africa's healthcare system. On the plus side, South Africa has the best hospitals and medical infrastructure in southern Africa. However, there is much room for improvement.

According to the 2020 Global Healthcare Index, South Africa's healthcare system ranks 49th out of 89 countries. Health care accessibility remains poor in rural areas and there are problems retaining physicians in the public system. Furthermore, only an estimated 27% of patients who need mental healthcare receive it. That said, South Africa's healthcare system is slowly and steadily improving overall.

Overview of South Africa's Healthcare System

Healthcare in South Africa is administered by the Department of Health. However, South Africa does not have a system of universal healthcare. Instead, it has two parallel systems. A private healthcare system and a public healthcare system operate in tandem with one another.

The majority of the public, up to 80% of the population, relies on the public system for their care. The public system is subsidized by the government. In general, it is underfunded and poorly managed. There are more than 400 public hospitals in South Africa. Large, regional hospitals are managed by provincial health departments. Smaller hospitals and primary care clinics are managed at the municipal level.

On the other side, an estimated 80% of doctors work in the private system, serving just 20% or so of the population, primarily middle class and upper-class families, as well as expats. As such, the public system is constantly short of resources, while the private system is very strong.

Costs of the Healthcare System

South African public healthcare is funded by the government by taxation, as well as through point-of-care spending from patients.

Public healthcare in South Africa is subsidized by up to 40%. The system uses the Uniform Patient Fee Schedule or UPFS to regulate patient billings and physician payments. Patient charges are based on income and family size and the UPFS uses three categories of patients to determine the cost of different visits and procedures.

Full paying patients are either being treated by a private physician, are externally funded, or are non-citizens. This would apply to expats, who are eligible to use public facilities but must pay the highest billing category.

Partially subsidized patients are eligible to have the cost of their care partially covered on the basis of their income. Finally, fully subsidized patients are those who are referred to a hospital by the Primary Healthcare Services. This mostly applies to people who have a lower income.

Additionally, there are also some occasions in which certain medical services are free. For instance, there are nearly 3,500 clinics that provide free healthcare to pregnant women and children under the age of six.

The Differences Between Private and Public Care in South Africa

As a general rule, public hospitals in South Africa are underfunded and understaffed. Patients are frustrated by long waiting times, a lack of privacy, and serious overcrowding. A significant source of the problems is that public hospitals aren't given adequate resources. As such, they cannot update their equipment, pay competitive wages to keep top doctors working locally, or even stock their pharmacies. To say that the staff of public hospitals are overworked would be an understatement. The situation is further complicated by mismanagement and corruption.

Johannesburg and Cape Town are both well known for their excellent public hospitals. Additionally, public hospitals that are associated with major universities offer a high standard of care. However, everyone knows this and the waiting times at university hospitals are extensive for all their services. Residents are really in a tough situation. They can go to a busy popular hospital and wait to receive the best quality of care. The other choice is to go to a poorly rated facility in hopes of being seen more quickly.

Fortunately, South Africa has excellent private healthcare. Patients who use the private healthcare system can expect short wait times and modern facilities. There is greater privacy and hospital stays are more comfortable. South Africa's private hospitals are also home to the country's best doctors. These facilities can offer higher wages and better benefits from the public system hospitals.

Who is Eligible For Care

South Africa's constitution guarantees that everyone has access to healthcare services. This includes expats, refugees, and asylum seekers. Therefore, just by living in South Africa, expats are able to receive public healthcare. In the case of refugees and asylum seekers, there is no need for a permit or South African identification documents to have access to free antiretroviral treatment for HIV/AIDS. However, all foreign nationals must subscribe to a health insurance plan in order to access public or private health care services in order to demonstrate that they won't be a drain on the public system.

South African Healthcare Options for Expats and Foreigners

For the best possible care, expats should carry private global medical insurance in South Africa. The quality of healthcare can vary dramatically between regions in South Africa. Even in the best public hospitals, patients can face long waits and crowded conditions. This allows patients to minimize wait times, have access to the widest range of specialists, and be treated in more private and comfortable facilities.

Best Private Global Medical Insurance in South Africa for Expats

US Citizens in South Africa: Best Health Insurance

Alternative Medicine in South Africa

Alternative medicine is extremely important to South Africans. An estimated 80% of South Africans rely on the services of a traditional practitioner to some degree. This figure rises to more than 90% in rural areas. Alternative and traditional medicine, while widely used, isn't without controversy. For instance, some practitioners have claimed they can treat or even cure HIV/AIDS, one of South Africa's most serious health problems, which greatly frustrates those practicing standard medicine. However, much progress has been made and collaborative programs are developing.

The roles of healers and alternative practitioners (including homeopathy, osteopathy, chiropractic medicine, and naturopathy) are regulated professions in South Africa. People in these fields are required to be licensed and registered. They must also have specific qualifications from their applicable governing bodies.

Traditional and alternative medicine isn't included in most private insurance packages. If this kind of treatment is important to you, you most likely will have to pay out of pocket for care.

Looking Forward To The Future

South Africa's healthcare system is on the verge of some serious changes. The government is working to establish a national health insurance system. The goals of this system are to improve the nation's health, make healthcare more affordable for everyone, and address inequalities between different socio-economic groups. However, discussions about implementing such a system are still in their infancy and will take a long time to develop.

Related:

Author: Joe Cronin, Founder and President of International Citizens Insurance. Mr. Cronin, a former expat, is an authority in the areas of international travel, and global health, life, and travel insurance, with expertise in advising individuals and groups on benefits for today's global workforce. Follow him on LinkedIn or Twitter.

# data[].attributes.attachment_link.title
Understanding South Africa's Healthcare System

# data[].attributes.attachment_link.description
Learn about South Africa's healthcare system and what it means for expats, visitors and international citizens.

# data[].attributes.body
https://welcome.uw.edu.pl/healthcare-in-poland/

# data[].attributes.body
Rida angola https://www.trade.gov/country-commercial-guides/angola-healthcare

# data[].attributes.body
https://en.m.wikipedia.org/wiki/Healthcare_in_Egypt

# data[].attributes.body
Mohammed Belal

# data[].attributes.attachment_link.readable_text
An Overview of Healthcare in Thailand

Thailand has a healthcare system that is one of the world's best . The country started its universal coverage program , which opened up universal health coverage to all citizens. Most Thais receive health coverage through that universal coverage scheme. However, civil servants and their family members receive healthcare coverage via the civil service welfare system. And private employees are often covered by a social security system that is supported by payroll contributions . Foreigners and expatriates who hold private sector jobs in Thailand may be eligible for this coverage.

For visitors and residents of Thailand who don't qualify for any of the above systems, you'll need private health insurance. Fortunately, there are many affordable plans available. Plus private insurance coverage is often accepted by Thailand's top-tier private hospitals. These facilities provide such excellent care that medical tourists from all over the world visit for treatments.

Mandated Insurance for Thai Visitors

To get a long-stay non-immigrant O-A visa for Thailand, the country you purchase an insurance policy with coverage of at least 40,000 Baht ($1340) outpatient and 400,000 Baht ($13,400) inpatient costs. Following the COVID-19 pandemic, visitors to Thailand also must have a health insurance policy that will cover at least $100,000 in COVID-related medical treatment. This applies to tourists and other short-term visitors, as well as those making longer stays. Some policies will meet this requirement while also offering you insurance for other medical situations.

How Good Is Healthcare in Thailand?

Thai healthcare is so good that numerous non-Thai citizens come from Europe, America, and other parts of Asia to receive medical treatment in Thailand. Thailand's medical tourism industry is known for serving patients in areas that include cancer treatment, fertility assistance, orthopedics, cardiovascular medicine, and dentistry. These treatments cost, on average, about of what their prices would be in the United States or Europe. Here are some approximate costs for care in Thailand (prices noted in $USD):

MRI scan: $190

Hip replacement: $13,000

Knee replacement: $11,500

Doctors in Thailand are trained in the latest medical procedures. They also have access to quality equipment, particularly in private hospitals. There are more than 60 Thai hospitals and healthcare institutions that have received certification from the respected Joint Commission International (JCI).

After implementing universal coverage, Thailand can boast that of its residents are insured (only 75% were insured in 2000). There is even a system to provide low-cost health coverage to non-Thai migrants in low-skill jobs.

Thailand's actions to expand healthcare have resulted in increased life expectancy, decreased infant mortality, and improved medical care in rural settings. Today Thailand has a strong public health system. There are around 1 million community health workers to support the population.

Is Healthcare in Thailand Free?

Initially, the healthcare program that took Thailand to universal coverage required a small copayment of 30 baht to receive care. For this reason, the universal coverage scheme was sometimes called the 30-baht scheme , or the 30-baht project.

This minimal copayment for treatment was removed in 2006. Therefore, Thai citizens can now access many healthcare services with no out-of-pocket costs. Healthcare is primarily funded by tax revenues. The government provides hospital funding and pays the salaries of many staff members. A range of pharmaceutical drugs are produced inside Thailand and are therefore available at relatively low costs.

However, unless a foreigner or expat is eligible for coverage through their Thai employer, they should expect to pay for a private insurance plan and related costs while in Thailand. These insurance policies should not be unreasonably expensive - there are multiple plans offering a range of coverage options for you to choose from - but they will not be free.

Read: Hospitals in Thailand for Visitors and Foreigners

Private Care Vs. Public Care in Thailand

Thailand's healthcare system includes both private and public healthcare settings. Whether you go to a private hospital or a public one, you'll have to show your to receive medical care.

There are many private hospitals in Thailand, particularly in urban parts of the country. Private hospitals in Bangkok maintain around 60% of all available hospital beds. These private institutions offer shorter waiting times and newer medical equipment to patients. Though there is no guarantee you will have a doctor who speaks English or another foreign language during the course of a visit to a public facility, in private settings many staff members are multilingual and interpreter services can be provided.

Most doctors in Thailand do not work in just one location. They might be employed at multiple hospitals, or work in a public hospital while also reporting for hours at a private clinic. This system means you could see multiple physicians over the course of your treatment.

In almost every situation, going to a private hospital is going to be more expensive than seeking care at a public location. This includes mental health treatment. Checking into a private psychiatric hospital can be very expensive. Public mental health institutions are often overcrowded.

How to Access and Receive Healthcare in Thailand

How does the Thai healthcare system work if you need medical treatment? You first need to decide whether to seek care at a public or private hospital.

Private vs. Public Hospitals in Thailand

Before leaving your home, check on a private hospital's website to see if that facility accepts your insurance plan. If your medical situation isn't pressing, it can pay to check the websites of different hospitals to compare prices beforehand. Going to a website may also give you the chance to schedule an appointment. You can even purchase treatment packages ahead of time, such as these coronary health options at Bumrungrad International Hospital.

Visiting a public hospital or clinic can save you money, though expats may owe slightly higher fees than Thai nationals. When going to a public facility, you need to be prepared for long wait times and crowded waiting areas. In contrast, you can often walk into private settings and receive care quickly, even without an appointment. In addition, while private facilities will often have staff who speak English and other foreign languages, you will most likely have to communicate in Thai at a public hospital. If your Thai isn't good, you might want to bring a Thai-speaking friend or family member who can translate for you. They can also keep you company while you wait!

Physicians in Thailand are well-trained and should be familiar with the latest developments and treatments in medicine. Whether you visit a public or private hospital, you will be taken care of. However, public hospitals may not have the same kind of technology available as private ones. You may also find challenges in receiving certain procedures. For example, abortion in the first 12 weeks of pregnancy has been in Thailand, though some doctors are still reluctant to perform abortions.

Pharmaceuticals in Thailand

As overseen by the Government Pharmaceutical Organization , Thailand manufactures many pharmaceutical drugs. These are available at a much lower cost than in many other countries. For example, Lipitor (Atorvastatin) was sold for 41 cents (the generic version cost 29 cents). Xanax (Alprazolam) costs 5 cents per 1mg dose (2 cents for the generic). To get prescription medication, you will first need to visit a physician. Once your medicine has been prescribed, you can go to a pharmacy. Prices at non-hospital pharmacies may be more affordable.

Thailand legalized the use of medical marijuana in 2018, though recreational use is still prohibited.

Carry Your Passport - And Money

Wherever you receive care, you will need to show your passport. If you don't have insurance, you may also be asked to pay for all of your medical treatment before leaving a hospital. Costs for healthcare in Thailand will vary. Some factors that affect prices are if you're visiting a public or private facility and if you're in a rural or urban location.

What If You Need Emergency Care in Thailand?

If you or someone in your vicinity experiences a medical emergency, you can telephone 1669, the emergency number in Thailand, at no cost. Operators who respond have the ability to connect with Tourist Police if they can't understand your language.

The emergency responders who arrive to assist you may be volunteers. Thailand also has professional responders who travel to scenes as needed. You can be charged if a private hospital dispatches an ambulance.

There are three levels of first responder medical assistance in Thailand. Most volunteers are categorized under the level of FR, or first responder. The second is BLS, or basic life support. The third is ALS, or advanced life support. In general, FR volunteers only receive 24 hours of training.

Healthcare Options for Expats and Foreigners

How does the Thai healthcare system work for expats and foreigners? If you have a job with a private company in Thailand, you may be eligible for health insurance via the country's social security program. This coverage is paid for via payroll contributions. Please note, it does not cover dependents, so your loved ones would need private insurance.

Expats and foreigners are not able to access healthcare in Thailand via the country's universal health program. Therefore, if you don't have a job that offers health coverage you will need private insurance. While Thailand delivers excellent healthcare for prices that are much lower in comparison to other countries, private insurance will provide an important layer of protection. You don't know when you could fall down a flight of stairs, or when illness might strike. Getting medical treatment in Thailand for an extended period can result in large bills, particularly if you seek care at a private hospital.

Thai Insurance Requirements for Visitors

For short-term visitors like tourists to Thailand , travel medical insurance will keep you from being overwhelmed by medical expenses. The COVID-19 pandemic also prompted a change in visitor insurance requirements. To enter Thailand you must now have a policy that will cover at least $100,000 in COVID-related medical treatment. The right policy can also ensure that you will be treated in private facilities where you will have access to cutting-edge equipment. Your care providers at private hospitals will likely speak English and other foreign languages.

Best Travel Insurance With COVID-19 Coverage for Visitors to Thailand

If you want to get a long-stay non-immigrant O-A visa for Thailand, the country requires you to have an insurance policy with coverage of at least 40,000 Baht ($1340) outpatient and 400,000 Baht ($13,400) inpatient costs.

To have your non-immigrant O-A visa extended each year, your health policy must come from a Thai insurance company that's been approved to provide coverage. These policies are generally written in Thai and don't offer coverage for motorcycle accidents and a number of other issues. In order to be fully covered, many expats also purchase a global health plan which will cover them in Thailand as well as any country they travel to.

Global Health Insurance for Expats in Thailand

Global Health Insurance for US Citizens in Thailand

The Future of Healthcare in Thailand

No matter how good healthcare is in Thailand right now, the country will have to prepare for the future. Like many countries, increasing costs in the healthcare sector are an issue in Thailand, particularly as the population ages.

Thailand's cities, especially Bangkok, are home to world-class hospitals, research facilities, and specialty care clinics. This is not necessarily the case in rural areas. The government has worked to improve healthcare in Thailand's rural areas , with initiatives such as recruiting medical students from rural locations, instituting mandatory rural service periods, and offering financial incentives. Additional focus on this issue will further promote parity in health services in rural areas.

Related:

# data[].attributes.attachment_link.title
Understanding the Healthcare System in Thailand

# data[].attributes.attachment_link.description
Thailand has a healthcare system that is one of the world's best . The country started its universal coverage program , which opened up universal health coverage to all citizens. Most Thais receive health coverage through that universal coverage scheme. However, civil servants and their family members receive healthcare coverage via the civil service welfare system.