Healthcare Disparities and Health Equity-An Overview through International Health Insurance

Blendon reported a high proportion of citizen being dissatisfied with the healthcare systems in Australia, Canada, New Zealand, United Kingdom, and United States in 2001-2. Low-income U.S. citizens reported more problems getting care than did their counterparts in other countries. The first annual report on healthcare disparities in 2003 by the agency of healthcare research and quality, a part of the U.S. department of health and human services, demonstrates that disparities exist despite highest health expenditure and improvement is possible. Healthcare disparity became a socioeconomic issue after industrialization. Demolishing healthcare disparity by social insurance operated health insurance was implemented in Germany and extends globally in the early 20th century. Although in 1992 Weil praised Germany healthcare with universal access, comprehensive high-quality services, but responding to a $5.7 billion deficit the German parliament imposed mandatory global budgets in 1993. Excessive supply of healthcare resources has driven prices higher to 11.1% in 2003. From 1 January 2004 the insured of the statutory health insurance have to copay a quarterly €10 per ambulance visit, €10 per emergency visit, and 10% of the drug price in Germany. The regulation on medical practice, hospital stay, fees, medications and equipments, physician supply, and liberalization of changing fund were introduced to decrease the supply and enhance competition between funds. The annual health care expenditure in Japan increased to reach 7.9% of GDP in 2002 plus 1% of GDP on long term care. Although the Japanese were remodeling their country to social welfare by reallocating the social welfare expenditure since late 1980, but the Japanese still have to copay 20% since a health reform in 1997, and it climbed to 30% in 2003 and the continuation of some drug copayment since 2002. Both the Japanese and German are trying to integrate the health insurances into a universal one. The contribution rate half paid by the employee in Taiwan is 2.5% of the wage, in comparison to 6.3% to 7.5% in Germany, and 4.1% in Japan with another half paid by the employer in 2005. There is no statistical difference of visit per year between the upper quintile and the lower quintile income families in 2005. Our healthcare system is still very efficient, good accessible without disparities in 2005, but no regulation on the insured part and incapable to control unnecessary services in the provider part are diluting our quality and allowing extra payment is hazardous to health equity now.

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