National Health Insurance: A conceptual framework from conflicting typologies.

Area of Science:

• Health Policy
• Health Economics
• Healthcare Financing

Background:

• Policymakers explore various health financing schemes for universal health coverage.
• Existing typologies include National Health Service, Social Health Insurance, and Private Health Insurance.
• National Health Insurance (NHI) is increasingly recognized as a distinct model, but definitions vary.

Purpose of the Study:

• To propose a comprehensive definition of the National Health Insurance (NHI) model.
• To clarify discrepancies in the conceptualization and scope of NHI arrangements.
• To provide a clear framework for understanding NHI in global health policy.

Main Methods:

• Literature review to identify common characteristics and areas of controversy in NHI definitions.
• Analysis of empirical data to assess critical defining variables.
• Comparative analysis of different health financing models.

Main Results:

• Common NHI characteristics include universal coverage, single fund pooling, and a single-payer purchasing function.
• Controversies exist regarding the separation of purchaser-provider functions and the role of private provision.
• Empirical data suggests provider ownership is not critical; a non-integrated single-payer mechanism is pivotal.

Conclusions:

• A clear definition of NHI is crucial for effective health system policy and achieving universal health coverage.
• The single-payer mechanism, independent of provider ownership, is the defining feature of NHI.
• Distinguishing NHI from other models requires focusing on its core financing and purchasing functions.