Single-payer healthcare is a type of universal healthcare, in which the costs of essential healthcare for all residents are covered by a single public system (hence "single-payer"). Single-payer systems may contract for healthcare services from private organizations (as is the case in Canada) or may own and employ healthcare resources and personnel (as is the case in the United Kingdom). "Single-payer" describes the mechanism by which healthcare is paid for by a single public authority, not a private authority, nor a mix of both.
Description Within single-payer healthcare systems, a single government or government-related source pays for all covered healthcare services. In 2010, the World Health Organization's member countries adopted universal healthcare as a goal; this goal was also adopted by the United Nations General Assembly in 2015 as part of the 2030 Agenda for Sustainable Development. A single-payer health system establishes a single risk pool, consisting of the entire population of a geographic or political region. It also establishes a single set of rules for health care rationing, services offered, reimbursement rates, drug prices, and minimum standards for required services. Health care rationing can include cost–utility analysis and waiting lists. In wealthy nations, single-payer healthcare is typically available to all citizens. Examples include the United Kingdom's National Health Service, Australia's Medicare, Canada's Medicare, Spain's National Health System, Taiwan's National Health Insurance and Italy's National Health System (SSN Servizio Sanitario Nazionale).
History of the term The term was coined in the 1990s to characterize the differences between the Canadian healthcare system with those such as the United Kingdom's NHS. In the Canadian healthcare system, the government pays private agencies to provide healthcare for qualifying individuals. In other systems, the government both funds and delivers care. Typically, "single-payer healthcare" refers to health insurance provided as a public service and offered to citizens and legal residents; it does not usually refer to delivery of healthcare services. The fund can be managed by the government directly or as a publicly owned and regulated agency. Single-payer contrasts with other funding mechanisms like "multi-payer" (multiple public and/or private sources), "two-tiered" (defined either as a public source with the option to use qualifying private coverage as a substitute, or as a public source for catastrophic care backed by private insurance for common medical care), and "insurance mandate" (citizens are required to buy private insurance which meets a national standard and which is generally subsidized). Some systems combine elements of these four funding mechanisms. In contrast to the standard usage of the term, some writers describe all publicly administered systems as "single-payer plans", and others have described any system of healthcare which intends to cover the entire population, such as voucher plans, as "single-payer plans", although these usages generally do not meet strict definitions of the term.
Regions with single-payer systems
Several nations worldwide have single-payer health insurance programs. These programs generally provide some form of universal health care, which is implemented in a variety of ways. In some cases doctors are employed and hospitals are run by the government, such as in the UK or Spain. Alternatively, the government may purchase healthcare services from outside organizations, such as the approach taken in Canada.
Canada
Healthcare in Canada is delivered through a publicly funded health care system, which is mostly free at the point of use and has most services provided by private entities. The system was established by the provisions of the Canada Health Act of 1984. The government assures the quality of care through federal standards. The government does not participate in day-to-day care or collect any information about an individual's health, which remains confidential between a person and their physician. Canada's provincially based Medicare systems show administrative simplicity, every doctor handles the insurance claim against the provincial insurer. There is no need for the person who accesses healthcare to be involved in billing and reclaim. In general, costs are paid through funding from income taxes. A health card is issued by the Provincial Ministry of Health to each individual who enrolls for the program and everyone receives the same level of care. There is no need for a variety of plans because virtually all essential basic care is covered, including maternity and infertility problems. Depending on the province, dental and vision care may not be covered but are often insured by employers through private companies. In some provinces, private supplemental plans are available for those who desire private rooms if they are hospitalized. Cosmetic surgery and some forms of elective surgery are not considered essential care and are generally not covered. These can be paid out-of-pocket or through private insurers. Health coverage is not affected by loss or change of jobs, and there are no lifetime limits or exclusions for pre-existing conditions. Pharmaceutical medications are covered by public funds, privately out-of-pocket or through employment-based private insurance. Drug prices are negotiated with suppliers by the federal government to control costs. Family physicians (often known as general practitioners or GPs in Canada) are chosen by individuals. If a patient wishes to see a specialist or is counseled to see a specialist, a referral can be made by a GP. Canadians do wait for some treatments and diagnostic services. The median wait time for diagnostic services such as MRI and CAT scans is two weeks, with 86.4% waiting less than three months. The median wait time for surgery is four weeks, with 82.2% waiting less than three months. While physician income initially boomed after the implementation of a single-payer program, a reduction in physician salaries followed, which many feared would be a long-term result of government-run healthcare. However, by the beginning of the 21st century, medical professionals were again among Canada's top earners.
Taiwan
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