Risk pooling and universal health coverage – Prof. Monika Steffen EUHEALTH
Summary
TLDRCe script aborde les systèmes de santé en Allemagne, en France et dans d'autres pays européens. Il explique comment l'Allemagne a résolu le problème de solidarité en créant un fonds national pour la compensation des risques. La France a réformé son système en intégrant l'assurance maladie universelle pour les pauvres dans l'assurance maladie sociale. Les Pays-Bas ont opté pour une approche mixte en privatisant leurs assurances maladie tout en mettant en place un fonds national pour la redistribution des risques. La Suisse a adopté une approche similaire. L'essentiel pour garantir un accès universel à la santé est une assurance maladie obligatoire pour tous les résidents, avec une mutualisation des risques entre les organismes d'assurance.
Takeaways
- 🇩🇪 L'Allemagne possède un système d'assurance maladie privée historique, principalement utilisé par les fonctionnaires et les très riches, qui représente environ 11% de la population.
- 🏥 En Allemagne, les assureurs privés paient en fonction de l'âge, de l'état de santé et du nombre de personnes à charge, offrant des tarifs avantageux aux jeunes professionnels sans famille.
- 🔄 Ceux qui rejoignent l'assurance privée en Allemagne et dont le revenu diminue ne peuvent plus revenir à l'assurance publique, ce qui peut entraîner des coûts élevés avec l'âge et les problèmes de santé.
- 🏛️ L'Allemagne a créé un fonds national pour la compensation des risques, permettant une répartition plus équitable des contributions entre les différents régimes d'assurance maladie.
- 🇫🇷 En France, l'assurance maladie est devenue individuelle en 2016 avec la réforme de la Protection Universelle Maladie (PUMA), éliminant ainsi les co-assurés familiaux.
- 🆓 En France, les personnes ayant un faible revenu sont affiliées gratuitement à l'assurance maladie et bénéficient également d'une couverture privée complémentaire.
- 🤝 La France a fusionné l'assurance maladie complémentaire avec l'assurance maladie sociale, offrant ainsi des droits et des prestations identiques à tous les affiliés.
- 👩⚕️ Les soins de santé en France ne sont pas soumis à des limitations d'âge ou de ressources pour les personnes âgées ou gravement malades, contrairement à d'autres systèmes de santé.
- 💊 Les co-paiements dans les systèmes de santé européens sont généralement faibles ou inexistants pour les personnes aux revenus les plus faibles et pour les maladies chroniques.
- 🌐 L'accès universel à la santé est garanti par une assurance maladie obligatoire pour tous les résidents, avec une mutualisation des risques entre les organismes d'assurance, ce qui est essentiel pour assurer un financement équitable.
Q & A
德国的私人健康保险是如何形成的?
-德国的私人健康保险最初是由公务员之间形成的私人组织,这发生在俾斯麦创建社会健康保险之前。因此,即使在公共健康保险制度建立后,这部分人仍然保留了他们的私人保险。
在德国,什么情况下可以选择退出公共健康保险系统加入私人健康保险?
-在德国,如果个人月收入超过一定数额(例如5000欧元),可以选择退出公共健康保险系统,加入私人健康保险。
德国私人健康保险的费用是如何决定的?
-德国私人健康保险的费用取决于多个因素,包括加入者的年龄、健康状况以及是否有家庭成员共同参保。年轻人、健康状况良好且没有家庭负担的人可能会获得较低的费率。
德国的健康保险改革包括哪些重要措施?
-德国的健康保险改革包括创建了一个国家风险补偿基金(Australis Fund),所有健康保险基金必须加入这个基金,通过风险评级系统来重新分配资金,以消除不同保险之间的不平衡。
法国的健康保险系统有哪些特点?
-法国的健康保险系统通过CMU(全民医疗保障)为低收入人群提供免费或补贴的健康保险。此外,2016年的PUMA改革将CMU纳入法定健康保险体系,实现了个体化参保,取消了家庭成员共同保险的做法。
在法国,如何确保所有人都能获得必要的医疗服务?
-法国通过CMU(全民医疗保障)确保低收入人群能够获得免费的医疗服务。此外,对于在法国境内居住三个月以上的移民,也可以免费加入健康保险。
荷兰的健康保险系统是如何运作的?
-荷兰的健康保险系统通过将所有健康保险公司私有化,并要求所有居民都必须参保。保险费用分为社区评级部分和国家风险池部分,后者根据风险指数重新分配资金。政府对保险公司的活动进行严格监管,确保所有人都能获得医疗服务。
瑞士的健康保险系统有哪些特点?
-瑞士的健康保险系统虽然以私人健康保险为主,但也引入了公共元素,通过风险池化和强制性保险来确保所有人都能获得医疗服务。
在欧洲,如何避免健康保险中的“风险选择”问题?
-在欧洲,为了避免健康保险中的“风险选择”问题,许多国家引入了风险池化机制,确保不同保险公司之间可以共享风险,从而避免年轻健康人群被特定保险公司吸引,导致保险系统的不平衡。
为什么说强制性健康保险对于实现全民健康覆盖至关重要?
-强制性健康保险确保了所有居民都必须参保,这样可以在健康人群中分散风险,为生病的人提供足够的资金支持。如果没有强制性保险,可能会导致部分人群无法获得必要的医疗服务,或者形成贫富差距明显的双层医疗体系。
Outlines
🇩🇪 Assurance maladie privée en Allemagne
Le premier paragraphe explique l'existence d'un système d'assurance maladie privée en Allemagne, principalement utilisé par les fonctionnaires et les très riches. Il est basé sur des critères tels que le revenu et l'âge des affiliés. Les jeunes professionnels et les personnes sans famille peuvent bénéficier de tarifs avantageux. Cependant, une fois que l'on a choisi l'assurance privée et que le revenu diminue, il est impossible de revenir au système public. L'Allemagne a créé un fonds national pour la compensation des risques afin de répartir les contributions de manière équilibrée entre les différentes caisses d'assurance maladie.
🏥 Réforme de l'assurance maladie en France
Le deuxième paragraphe décrit la réforme de l'assurance maladie en France, qui a créé le CMU (Couverture Maladie Universelle) pour les personnes aux revenus modestes. Ce système garantit un accès universel à l'assurance maladie, y compris pour les complémentaires. La réforme a également introduit la couverture individuelle, mettant fin au système de co-assurance familiale, et a élargi les droits aux soins pour les femmes et aux enfants majeurs.
🌍 Accès aux soins pour les migrants en Europe
Le troisième paragraphe traite de l'accès aux soins de santé pour les migrants en Europe. Il explique que la plupart des pays européens offrent un certain niveau de couverture médicale aux migrants, même s'ils ne sont pas titulaires de papiers. En France, par exemple, les migrants qui peuvent prouver qu'ils se trouvent sur le territoire français pendant trois mois sont affiliés gratuitement à l'assurance maladie. Il y a également une aide médicale d'urgence pour les personnes sans papiers.
🏘️ Réforme de l'assurance maladie aux Pays-Bas
Le quatrième paragraphe explique comment les Pays-Bas ont réformé leur système d'assurance maladie en le privatisant, tout en imposant une loi qui exige que tous les citoyens soient affiliés à une assurance maladie. Les contributions sont divisées entre les caisses d'assurance privées et un fonds national de partage des risques. Cette réforme a permis de maintenir l'accès universel aux soins et de subventionner les personnes aux revenus faibles.
💊 Frais de participation et soins de santé en Europe
Le cinquième paragraphe discute des frais de participation dans les systèmes de santé européens, en soulignant que les pays européens ont généralement peu ou pas de frais de participation pour les personnes aux revenus modestes et pour les maladies chroniques. Les frais de participation sont généralement limités et ne concernent pas les soins essentiels. La France a récemment introduit des soins dentaires, des lunettes et des prothèses auditives gratuites pour tous, même si la qualité est standardisée.
🌐 L'accès universel à l'assurance maladie
Le sixième paragraphe conclut que l'accès universel à la santé ne peut être garanti que par une assurance maladie obligatoire pour tous les résidents, avec une mutualisation des risques entre les organismes d'assurance. Il souligne que les systèmes d'assurance maladie sont plus efficaces pour assurer la couverture universelle que les systèmes de service de santé national, car ils permettent une meilleure répartition des risques et des ressources.
Mindmap
Keywords
💡Assurance maladie privée
💡Solidarité
💡Assurance maladie sociale
💡Répartition des risques
💡Assurance complémentaire
💡Tarif
💡Couverture universelle
💡Co-paiement
💡Assurance maladie nationale
💡Migrants
Highlights
In Germany, there is a unique private health insurance system primarily used by public servants due to historical reasons.
Individuals in Germany earning over 5000 euros a month can opt for private health insurance.
Private health insurance in Germany is based on age and health status, with higher premiums for older or less healthy individuals.
About 11% of the German population is on private health insurance, including functionaries and high-income earners.
Once individuals switch to private health insurance in Germany, they cannot revert to the public system.
Germany has a national fund for risk compensation to balance the financial burden across different health insurance funds.
France introduced the CMU (Universal Medical Coverage) to provide free health insurance to low-income individuals.
In France, health insurance membership is now individual, ending the concept of co-insured family members.
The French health system, post-PUMA reform, ensures universal health protection without institutional differences between payers.
Migrants in France are entitled to free health insurance if they can prove a three-month stay in the country.
The Netherlands transitioned from social to private health insurances while maintaining universal access and risk sharing.
Switzerland, known for its liberal policies, adopted a system similar to the Netherlands with mandatory health insurance and risk pooling.
National Health Service systems can control costs more directly than health insurance systems.
Co-payments in European health systems are generally low or nonexistent for the underprivileged and those with chronic conditions.
France recently introduced free spectacles, hearing aids, and dental implants for all citizens, regardless of income.
Compulsory health insurance with risk mutualization is essential for achieving universal health coverage.
Transcripts
and there's a second problem in germany
which most people don't know what's
interesting for historical reasons there
is a
completely private health insurance in
germany most of the affiliated people
are
public servants from the government the
reason is they had this health insurance
between them as a private organization
long before bismarck created his social
health insurances so they were there
first and they wanted to
to remain they didn't want to die so
they were maintained and today you can
enter in germany you can leave the
public system of the social health
insurance
and join private health insurance
completely private
uh if you earn more than 5000 euros a
month it's not exactly the figure but i
made it a round figure 5 000.
uh
these people once you earn more than 5
000 you can opt out of the public system
and join a private one or don't drown
anything just keep without
if you think you're rich enough to pay a
big bill one day
um
it concerns about 11 of the population
it's functionaries because of historical
reasons and it's a state who pays a
contribution so it's not really them
and very rich people and
what else
what artists so people like this with a
quite high income
so eleven percent of the population
and their contribution to this private
health insurance which takes all your
service it's not complementary it's it's
a supplementary one who replaces the
other social health insurance
they pay on age the age you have when
you enter the more you are aged the more
you repay and then your health status
they will examine you from ted to to to
bottom to see whether you're in good or
bad health and every little illness you
have you have to pay more
and the number of co-insured family
members so if you have three children or
ten children or you're just just alone
you report more or less so this private
health insurance is very interesting for
young professionals who are not yet
married to earn a lot of money more than
5 000 euros and have no family under
good heads they will get a very good
tariff they will pay much less than in
the public health insurance
the problem is
if they change jobs
and they earn less than five thousand
they will have normally the choice to go
back to the public
one or stay in the
in the in the
in this private one
and eventually if they earn just a
little bit less
the public one will be more expensive
than the private one and from the
private one they get more benefits
as they are still young um and not
charged with family they will probably
want to stay in the private one but
there's a problem afterwards once you
opted for the private one and your
salary drops again and you should go
back to the public one and you don't
from that moment on you will have to
stay all your life in the private health
insurance you can never ever go back to
the public one and when you are 80 years
old
and very ill you will pay a lot of money
for this private health insurance so
there is a stop the government joined in
so to make the people think if really
they want to stay in a private health
insurance
anyway this is the traditional problem
germany had a breach
of solidarity between of the social
health insurances
tradition
because they were constructed like this
so they could reform this and they did
and this inheritance of the past with
this 11 of the population that private
health insurance nobody would do that
today such an insurance but they can't
stop it because these insurances their
own buildings their own hospitals
there's a legal problem you cannot
abolish it it's very difficult otherwise
i would do it so what was done in
germany i put it in red because this is
important
all this
the government made to reform that all
these social health insurances
they have to join a national fund for
risk compensation
and it's very easy that is the german
word australis fund there is a national
fund which collects now all the
contributions for all these 250 funds so
you don't send your money anymore to
this fund to your own health insurance
you send it to this national fund
and the national fund
they collect all this money
and they have risk
risk how would you call this risk
rating so they look into each of these
funds what are the affiliates what is
their age
the average age what is the health
status on about 40 or 60 illnesses
they know it because they have the
reimbursement figures so they know what
the illness of the people is so what is
the average chronic illnesses and and
accident rates and and heart attack
rates in the people from the people who
are insured in fund x egreg and said
and then they put it all together on a
computer program and what comes out is a
risk ratio
redistribution so the fund collected all
this money
the informatics system work and then
gives back the money to each of these
funds for each of its uh member to get
all the money back for me who is insured
in one of these funds it's not really
true but that's an example but it will
be more money for me or less according
to what is the risk rating for my fund
i hope this is clear
so they have a sort of risk rating for
all these different funds and then they
upgrade or under grade the money they
give back to this fund that all the
funds have the same
sort of contribution for each of the
members according to the risk of of
expenditure they have
so this eliminates completely the
inequal
um imbalance between these different
insurances and the result is this reform
was done
so what i said here you know creation of
this fund and then the fund
redistributes the collected
contributions
to the individual individual funds
corrected by risk index that's the right
word the risk index the national risk
index which is constantly renewed also
they always rework on it every year
so the result 20 years later is
if you have public opinion polls now
about people being able to afford care
or not germany reports today after this
reform with risk equilibrium
europe's lowest level of unmet health
needs
people don't say anymore i can't go and
see the doctor because i like the money
or the doctor is too far away or
whatever
almost none
declares unmet health needs for
financial reasons or other reasons
neither in the lowest income clinton
this is really an achievement because if
you do the same inquiries in france
about 20 of the people who say they have
unmet unmet health risks they can't pay
for the doctors
despite very high health expenditure in
floods and the very big
solidarity in the system so this seems
to have been a very very intelligent
technical solution
risk equilibrium between the different
health insurances
well this is between the public ones but
you can also include the private ones if
you want
it depends on the law so france has a
system for um we had the same problem in
france because we had a social health
insurance system with different branches
and people dropped out of the system
because too long unemployed or because
divorced and
not working anymore and the husband used
to
co-ensure the ladies and now it's it's
finished
so france had a very old law on medical
assistance a law that dated from 1800
and something
and it was abolished it was more than
100 years old the local law
local mayor had to pay for the medical
expenditure for the for the poor people
this functions of course very very badly
because it was very old and not adopted
so in 2000 that they abolished this law
replaced it by what they called the
universal medical coverage cmu
and made it a legal right for everybody
who earns less than a certain sum or so
three short income three short if you
have less income per month and according
to your family members of course it's
all counted you are entitled to get
this cmu
right which means
you can you will be affiliated with the
health insurance for free you don't pay
contributions anymore you are just free
affiliated and you have the same rights
than any other person who pays the same
rights and i have who pay
and so the same benefits like the paying
affiliates
but there's an income tree short it is
relatively low it is a little bit lower
than the three sort for getting social
assistance
so in addition as france has
social health insurance who never
completely reimburse the expenditure
only sort of 70 percent everybody has a
complimentary private health insurance
in france so we all insured twice
once in the mainstream public health
insurance the social one
and one complementary private health
insurance
so
these poor people who are under the tree
short they are affiliated without paying
also to the complementary private health
insurance
so there is a law about this the
government organized it all and the
private health insurance has to accept
the people who want to join because
there are several no
they're not entitled to look how
expensive you will be how ill you are
they have to accept you when they say
when you say i want to go to your your
insurance
so if they are just a little bit above
the tree sold you know 30 percent above
they get to voucher
uh some money from the government to
help them buy themselves such a
complimentary private health insurance
so the poor
people with poor income they get free
affiliation or a supple subject uh how
do you say a subsidized subsidized
subscription this is a basic format in
in france so um
and in 2016
this
uh
all this what was created in 2000
was murdered in another reform with the
main health insurance so all these
things about same uh doesn't don't exist
anymore we merged it into the normal
health insurance a big one
so there's no difference now anymore
institutionally between the people who
are free and short or those who pay you
all have the same health insurance the
difference i pay and other people don't
and we get the same service and go to
the same hospitals
so we call this the puma reform puma is
for universal health protection
there was another interesting the cmu
for the poor people was merged into the
statute statutory more the legal social
health insurance and another very
interesting point in this reform
concerns mainly women not only
membership is now individual you are in
the french health insurance
we don't know since 2016 any co-insured
family members anymore doesn't exist
anymore
so let's say you have the same couple mr
egreg and his wife
mrs egreg
and only mr egreg works and she looks
after the house and the children
so what will happen to her
by nothing
formally she was co-insured with him and
when they got divorced or separated or
when he would die she was without
insurance and she had to run around
many offices to get the right papers to
be reinsured as a widower
now she will be insured on her own name
and as she doesn't have any income she
will be free and short without paying
and if she gets divorced or her husband
dies it doesn't change anything she will
still be insured in your own name
without paying any contributions and
today she finds work and she starts
working she will have to contribute
so this is just a sort of
simplification administratively but it's
a big help for women
it really is to protect women for months
and months without insurance for just
administrative reasons
and it also works for grown-up children
once they reach the age that they can't
be
reinsured with the parents anymore they
are individually insured and as
generally their students or they don't
earn money they will be free and short
so there are quite a lot of people now
who benefit from this reform just being
free free and
free and short so there's a long history
behind and it was solved in the way you
merge it with the normal health
insurance and you have three short
income
and individual membership
now you may be curious about migrants
but all the people who migrate around in
europe and come to france if they can
prove that they are in the territory of
france for three months
they will be free affiliated to this
puma
thing to the normal health insurance but
they have to prove that they are there
for three months if they are less than
three months
they can still go to the public hospital
there is a special service in each
public hospital for people who need
medical help who don't have papers who
don't want to give their name because
they are afraid of the police because
they're illegal migrants you can even go
there without giving your name and you
will get the care you need
there is a state medical emergency aid
scheme that's a
money fund
government gives some money in this fund
and this fund will then pay for these
people to the hospital
and you have of course humanitarian
medical associations who will help so
basically everybody is covered it's just
to give you an example of
different types of coverage
in germany this works more or less the
same way the european countries they
consult each other and they all have
plans for migrants they all have plans
for these
people who earn very little and they're
more or less sort of the same but they
have to fit into their institutional
makeup architecture of the system
concerning migrants of course in europe
many countries have different policies
poland for instance in hungary are not
very friendly to migrants and they will
probably not be
so
ready to give them medical care but then
they just need to go to another country
next door
and they will get to what they don't get
in hungary or because
free movement in europe so that's no
problem quite a lot of people in france
who come from other countries just
because they need medical care and they
can't get it in the other country
so
netherlands uh you had some reading
about it just to summarize netherlands
had um
traditionally social health insurances
just like germany
and for all sorts of reason um
money-wise and it was not very efficient
it was very bureaucratic cost control
and so on they decided to privatize all
them they made them just private
we just declared now you're a private
organization you can recruit the manager
you want you just have to watch your own
budget
your private now
and
then the government of course regulated
very strongly their activity
and especially that they would keep
universal access
and ensure all the people who don't have
money also so in fact they do this
private
by privatization they did the same thing
than others did by risk materialization
of the french by
free affiliation so they made a law at
the same time
the dutch saying all citizens all the
people who are in the dutch territory
must be affiliated to health insurance
and as they all privatize now it means
to a private health insurance and the
private health insurance must accept
those who apply to them
the contribution this is interesting
is divided into two parts
one part of the contribution to that
private health insurance is community
rated that means probably according to
age groups and professions and things
like this you have a little bit
different tariffs
and that money goes directly to that
health insurance
and part of the income goes to a
national pooling fund they call it
that redistributes the money according
to risk index to the different
insurances so it's the same thing than
the germans did but the germans did it
for all the insurances for all the
contributions on the national level and
the dutch did it for half of the
contributions
and the other half continues on the
basis of more or less private ideas so
the community rated contributions
it's not your individual health status
but your status may be by age or the
region you live for the profession you
have
so there is a little bit of risk
in it
and all poor people are free and sure
the government subsidizes their
affiliation so if people don't earn
money they can still join these health
insurances although they're private and
the government will subsidize i will
send
a fixed sum for each member to each of
these insurances that they get some
money back and switzerland who is such a
free neoliberal country they adopted
more or less the same system they used
to have only private health insurances
and they they nationalized them they
made them public and introduced more or
less the same
things in holland so you can see the
combination between public and private
is not really important anymore what's
which is important is that you have risk
pooling between your insurances that
everybody in the country must be insured
and that the very poor people are
insured free
these are the sort of basis for
uh universal access as we see it in
europe so we can
summarize a few points the national
health service systems are easier to
monitor and regulate than health
insurance systems because government has
direct control over all the three
functions you remember the nice temple
we saw regulation funding and
distribution
the government in these in this national
health care system health systems can
limit capacities well the battery the
bed the manpower and the equipment
so it has all the power and the result
is waiting list age limits for heavy
heavy uh care
and in france this doesn't exist
oh we have some waiting lists but
they're not really very long
and uh
to decide whether a very old person of
80 should have a new hip
or of of 90 it's a doctor decides it's
not the government it's not the health
insurance so
uh hospitals get money for the work they
do so they're always interested in doing
work so they will give you a new hip
even if you are 90. they will just look
whether it's reasonably on a medical
stage so that if they think you will be
better afterwards because there is a
principle in
in
medicine which is
important in france they keep to their
traditional principles prima non-nursery
so a doctor should never do something
which makes you
afterwards worse so if you have some
chance of being better with your new hip
even if you're 100 years old that will
give you a new hip and they won't bother
at all about the cost
but that would be a bit different in
britain
because there's more control over what
should be paid and not paid
social health insurances germany
netherlands and austria and so on they
invented new efficient tools to avoid
risk skimming by private health
insurances taking all the young people
and correcting the traditional
solidarity breach of the social health
insurance so that means they introduced
risk mutualization even if you have a
thousand different health insurances
half of them private you can mutualize
the risk
by the risk ratio factor which you
use for redistributing the contributions
i hope this was clear it may be a bit
difficult for indians to understand this
even americans would find it difficult
so a few words about co-payments uh we
have seen in our statistics that there
are quite a lot of co-payment in the
poorer eastern european health care
systems
but i lined up a little bit general
general statements
in general in the european countries
even the poorer ones you have no
co-payments or very little for people
under income three shorts and they're
very very little money and generally
they are freed from co-payments
out-of-pocket payments are generally
unrelated for chronic disease
let's say somebody has a chronic heart
disease or cancer
chronic which comes back and back they
won't pay you out of pocket it will be
undulated because they always need care
or for very long and expensive illness
in several countries also there are no
out-of-pocket payments for children
under 18 or under 16.
most countries
also limits the out-of-pocket payments
which you can sort of accumulate during
a year year and it should not
outpass a certain amount in a year so
people who need a lot of care they will
not be penalized for the fact that they
need all the time to see a doctor and
have a little co-payment for this
sorry
uh
it always runs away so in france the
limit is six euros a year once you have
co-paid
one euro here and six euros here and
three euros here when you have reached
the 60 euros the health insurance
doesn't take any co-payment anymore
out of pocket
so uh
countries did different rules about
co-payments generally the out-of-pocket
payments are concentrated on
non-essential medicines
and on things like spectacles hearing
aids and dental implants
more expensive things but which are not
vital
except france they introduced just
recently in 21 in september it's very
new you can get totally free without any
penny to pay whatever is your income
even a millionaire
free spectacles free hearing aids and
free dental implants
without any out of pocket for everybody
but you have to take a standard model
for a standard quality so the government
negotiated with this with a specialist
for instance with the eye the eye
doctors what type of spectacles needs
this and this and this in this case and
what in average would they cost and they
made a list of about i don't know you
have a choice maybe about 10 different
spectacles
and which are all good for you for your
for your eyes and the glasses are okay
but it will be sort of average quality
and average sort of aesthetics
it's okay it's fine
i must admit i tried for my last
spectacles i start i tried the standard
models but i could see much better with
a more expensive model so i paid it
myself
but it helps many people who just
couldn't pay it i mean you get
reasonable quality uh are tested by
specialists and you can have it all for
free so afterwards the choice you make
you want a new car or you want good
spectacles
okay
i will finish with this after having
said all i said there's only one way to
universal access in its full sense and
that is a compulsory health insurance
for all residents in one country
with health insurance bodies that are
share risk mutualization there's no
other way because otherwise you can't
finance it
health insurance is like any insurance
if you want to have a good insurance you
have to have lots of people who pay and
very little who take the money out so if
you ensure the entire population that
most people are healthy you will get
enough money to pay for all the people
who are ill but if you don't have
compulsory insurance or let part of the
people get away with private insurances
who don't share the risk
afterwards
then you can't ensure universal health
care
for all or you have a two class system
you will have this sheep or medicine for
the poor people free of charge
the good doctors won't work there they
will work in other private clinics so
you have to decide one day or the other
if you want a universal access for
everybody according to the rules of
dignity of every human being
and in that case the technical way to
get there is compulsory health insurance
for all residents without exception
paid according to income not according
to risk
and that all the bodies who ensure the
risk share risk mutualization to avoid
to have poor and rich health insurances
with different care baskets
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Consumptie_Module6_Verzekeringen_FR
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