Social Health Insurance
This option aims to diversify the public financing stream and generate additional revenue for the Canadian healthcare system to cover the non-CHA services. Social health insurance (SHI) is one of the principal methods of health financing globally. SHI involves compulsory membership among all of the population. Unlike national insurance (NI) systems (Medicare), where revenue is raised through general taxation, most social health insurance schemes are funded by combining allocated payroll and pension contributions (from both employer and employees). In addition, governments often contribute on behalf of people who otherwise would not be able to pay, such as unemployed people and low-income informal economy workers. Contributions to the social insurance fund are kept separate from other government mandated taxes and charges.
SHI uses private-sector providers, but payment comes from a government-run insurance program that every citizen pays into. Member’s contribution is based on income rather than reflecting his/her risk of illness. Since there’s no need for marketing, no financial motive to deny claims and no profit, these universal insurance programs tend to be cheaper and much simpler administratively. The single-payer tends to have considerable market power to negotiate for lower prices.
Under social insurance, everyone in the contributory regime group must enroll and pay the specified premium or contribution. It pools low- and high-risk people, avoids adverse selection and people’s failure to address risks, and allows enrollees to contribute based on their ability to pay. SHI is transparent a...
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...l soon deplete their accounts, and would have to depend on other sources to meet their bills.
3. The service is not seen as necessary (for example, to avoid the adverse health and fiscal consequences of not using preventive services or managing chronic diseases).
Very few services meet the three criteria. MSAs represent high costs for minimal benefit, particularly as they exclude both the most expensive services and those most important to improving health. Therefore, MSAs do not appear to be a valuable addition to financing Canadian healthcare.
Most research has assessed the ability of mandatory MSAs to increase revenue and accessibility and have not assessed the value of non-mandatory MSAs. Research should explore whether supplementing the existing public healthcare system with non-mandatory MSAs would improve accessibility of non-medicare (and medicare) services.
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