Solar Water Purification Project

Solar Water Purification Project

In 1995, EPSEA received funding through the State of Texas, State Energy Conservation Office (SECO), for a solar demonstration project. EPSEA's project demonstrated the feasibility of using solar energy to purify water. The target audience (end users) are the people who reside in colonias along the Texas/Mexico Border. A colonia is an unincorporated settlement, lacking a safe water supply and waste water treatment. EPSEA's work in solar water purification continued in colonias in Dona Ana County, New Mexico through a collaborative effort with the Southwest Technology Development Institute (SWTDI) at New Mexico State University. In 2000, EPSEA was able to install stills in Juarez, Mexico through a grant from "Border Pact". EPSEA has since received funding through the U.S. Environmental Protection Agency (EPA) to continue it's work in solar water distillation.
EPSEA has presented papers and hosted workshops at the American Solar Energy Society's (ASES) national conferences and the Mexico National Solar Energy Conferences.
The problems faced by many colonia residents include contaminated water, as well as water with very high salt content. The sources of contamination include septic systems, industrial pollution, and run off of fertilizers and pesticides. These problems are seen on both sides of the border and like the resulting sickness and diseases, know no borders. These problems are not confined to only colonias, but it is the conditions that exist in colonias which allows for the proliferation of sickness and disease. The causes of these problems can be traced to pollution, poverty, ignorance and greed.
The Marcos family, Juarez, Mexico

Solar Solutions
EPSEA's demonstration project is only a small example of the potential role for solar energy in water treatment, and disease prevention. Solar distillation is a proven technology for water disinfection. Systems can be sized for one person, up to community sized systems. They have no moving parts, relying only on the sun for energy, and should last 20 years or more. Larger disinfecting systems which generate chlorine and other gases can be operated in remote locations, using solar energy. It is hoped that through the success of our local project, these technologies will be replicated in other regions currently facing similar conditions.

click to see full photo (77k)

The heart of EPSEA's project is a basin solar still. EPSEA's research resulted in a basin still, with emphasis on ease of replication and readily available materials. The still utilizes standard patio replacement glass (34"X76"), and during the summer months produces over 3 gallons/day. Winter production is about 1/2 that amount. The still has no moving parts, uses only solar energy to operate, and is self cleaning.
Project Update
The El Paso Solar Energy Association's (EPSEA) solar water distiller projects (under an EPA grant for TX & NM, and Borderpact/Conahec for Mexico are progressing successfully. Only two more stills need to ben installed in the colonia areas of Ciudad Juarez, Mexico to complete the Borderpact project. The EPA project is just beginning Phase II which includes public community meetings and further education via energy fairs, etc., and a hands-on stills construction workshop that will be taught by Mike Cormier at the Water Festival in Columbus, NM in March. Applications are already being accepted by EPSEA from potential still recipients in the Luna, Dona Ana, and El Paso Counties of southern NM and west TX.
A selection process will be used to decide who will receive a still. A cost-share amount of $50-$100 per still (small or large, respectively) will be paid by the recipients who are chosen. A sponsorship and payment plan program is available for individuals who cannot afford the cost-share amount. A recent fundraising breakfast was held at St. Pius Church by the St. Pius Colonia Ministry to aid in achieving funds for such sponsorships.
Border Pact Presentation - PDF Document (327k)
For more information about these projects contact us at 915-772-SOLR email: webmaster@epsea.org
Final UpdateHaving completed this project, we presented a final paper to the Solar World Summit for the International Solar Energy Society in Orlando, Florida in 2005.
OPERATION
Solar energy is allowed into the collector to heat the water. The water evaporates only to condense on the underside of the glass. When water evaporates, only the water vapor rises, leaving contaminants behind. The gentle slope of the glass directs the condensate to a collection trough, which in turn delivers the water to the collection bottle.
EPSEA Still Cutaway (39k)
The still is filled each day with twice as much water as was produced. The still is fitted with overflow outlets, which allows the excess water to flush the still every day. A major advantage of the basin still is that it does not require a pressurized water supply. Colonia residents often have their drinking water delivered by truck and it is then stored in 55 gallon drums. Still recipients report that the water tastes very good and their children now drink more water than before.

Construction Cost
EPSEA material costs, with bulk purchasing, are approximately $200 per still. The cost of materials to build a single still should be less than $300. Only basic tools are required.

MINUTES FROM PROPOSAL CONFERENCE OF OCT. 10, 2001 FOR LIFE INSURANCE SOLICITATION

Introduction

The Contracting Officer welcomed all attendees, introduced the GSO Ms. Melvern Favors, COR office representative Ms. Sevin Orak and Procurement and Contracting supervisor Meral Yalhi.

Discussion of the Solicitation Package

The scope of the life insurance solicitation was conveyed as well as highlighting the following sections of the solicitation:
1. The potential offerors must bid on the main solicitation package including the base and all option years prices. Any suggestions or requested changes to this package must be offered as an alternative.
2. All the submittals listed in the cover letter must be submitted. Any deviations from these submittals will result in the offer being considered as technically unacceptable.

Questions:

Answers to the attached questions asked prior to the conference was distributed along with amendment A-002 for revision of clause C.2.2. The attached questions and answers were discussed during the conference.

Conclusion

The Pre-Proposal Conference concluded and attendees were thanked for their presence and expression of interest in serving the U.S. Government. The meeting was adjourned.



Sincerely,


Melvern Favors
Contracting Officer







Enclosure:
Questions and Answers 1 pg.

LIFE INSURANCE SOLICITATION (STU150-01-R-0822)
QUESTIONS & ANSWERS


1. How is the age that is listed in the solicitation’s attached employee lists calculated? These ages are the real ages of the individuals.
2. What is the previous benefit total given to the employees? Since there is a policy difference between the previous contract and this solicitation, this information is obsolete. The policy for benefit is based on the salary of the employee at the time of death whereas the previous contract was based on a fixed price benefit.
3. Will the beneficiary form be provided to the contractor? The contractor, Human resources office and the beneficiaries will keep copies. However, the employees are not obliged to fill out this form. For those employees who want their legal heirs to benefit, forms are not required to be filled out.
4. Although employees’ serious illnesses are listed in question no. 14, can we have the age of these employees? US Embassy does not have this information but will try to acquire it and inform the potential offerors.
5. What can be done in situations where the Duns number can not be obtained? US Government requires the Duns number and the potential offeror should do everything possible to obtain this number including inquiring the web page. But if the Duns number is not obtained, it will not be a cause of elimination of their offer.
6. Since the Turkish Treasury Ministry has issued a premium table based on gender, can the gender and age of each employee be provided? Since compiling this list will take time, the USG can provide the total number of males and females. Male: 536, Female: 143.
7. Can the position of the employees be provided? The general breakdown of the US Embassy and its missions’ work force is as follows: half are guards, a quarter is blue-collar workers and the remaining quarter is white-collar employees.
8. Can the distribution of the employees by city be provided? The total number of employees according to city – Ankara, Istanbul, Izmir, and Adana - will be provided. Yes. : Ankara:67%, Istanbul: 29%, Adana: 4%
9. On page 31, clause L.4.3.5 of the solicitation, there is a mention that cash flow statements have to be provided. For which periods does these statements have to be provided? These statements should be provided for two consecutive 6 month periods.
10. According to Turkish Insurance law, insurance companies do not have to provide invoices. Can we provide receipts instead of invoices against payments? This point has to be checked with our Washington office and informed later. In retrospect: proforma invoice will be acceptable.
11. Have any of your employees been rejected under the past life insurance policy? No, all of our employees in the work force have been covered and our aim is to have all of them covered under the new contract.
12. If the employees leave the USG, does the government require a continuation of their insurance under an individual insurance policy? No, a continuation of insurance is not required; but in order to go with prevailing practice, providing such a chance for these individuals might be discussed for future option years.
13. How is the “Plan Administration” to be demonstrated or provided by the offerors? The potential offerors should provide a general description of how they plan to implement life insurance services to the USG by stating the period the benefit payment will be made, how they maintain adequate reserves to pay these benefits, their points of contact, etc.
14. Will the USG inform the changes in their employees or in their salaries? USG will be providing the additions/deletions in their employees immediately while providing salary changes on a monthly basis.
15. According to Turkish law, the customer’s premium payment must be made according to the age and gender of each individual. Since each policy agreement has to be submitted to the approval of the Turkish Treasury Ministry, a list of the premiums for each employee based on their age and salary has to be attached to the contract. The present price charts can be used to compare offers by the USG; but the average premium rate can not be used for the actual premium calculations. The actual premium rate for any new employee has to be calculated according to their age, gender and salary if they do not meet the current premium scale. Will this pose a problem for the USG? This issue will change the whole basis of the solicitation and we will have to seek our Washington office’s guidance on this issue. The solicitation due date will have to be extended.

Medical Marijuana Requests Higher Since Obama Term Began

The rise in requests for medical marijuana has been dramatic of late. In various states where laws allow, dispensary owners recently admitted to an increase in 2009 requests for the pain reducer that ranges from 50 percent to as much as 300 percent. The high numbers seem to be implicitly linked to the stance of the Obama administration on the subject; the federal government will not interfere with state laws and patients who abide by them.

While some analysts insist the rise in medical marijuana requests pertains to the economic recession and subsequent growing number of Americans without health insurance, as they may turn to alternative and less expensive treatments for pain and disease, treatments like medical marijuana. However, most dispensary owners attribute the increase to the word from U.S. Attorney General Eric Holder that the Obama administration would not involve itself in state matters regarding medical marijuana.

The word first hit the medical marijuana community when the Obama for America campaign acknowledged its opposition to the Bush policy on the matter. A response letter to those inquiring on the subject read, in part: “Many states have laws that condone medical marijuana, but the Bush Administration is using federal drug enforcement agents to raid these facilities and arrest seriously ill people. Focusing scarce law enforcement resources on these patients who pose no threat while many violent and highly dangerous drug traffickers are at large makes no sense. Senator Obama will not continue the Bush policy when he is president.”

Though Holder has not always held the same view, he has changed course since his appointment as the Attorney General. And despite Drug Enforcement Administration raids that happened as Obama took office in late 2008 as a continuation of the Bush policy, which stated that federal law overrode that of the states, those have since been ordered to an end. Holder stated in February of 2009, “What the president said during the campaign, you’ll be surprised to know, will be consistent with what we’ll be doing in law enforcement… What he said during the campaign is now American policy.”

According to Colorado clinic numbers, applications for medical marijuana have risen significantly. As December 2008 came to a close, there were 4,720 applications on file, as compared to the 6,796 by February 28, 2009. While this certainly does not indicate that doctors are willing to authorize all of the new patients for marijuana use, the requests are difficult to ignore. And to accommodate, some dispensaries are paying doctors to be on staff and provide the oversight to patients whose own doctors are unwilling to sign off on the applications.

And more states are looking to provide the medical marijuana service for their residents, as a growing number of studies show that the drug is a safe and highly effective alternative to prescription medicines like morphine, in addition to being a form of miracle drug for cancer patients dealing with the effects of chemotherapy. New Hampshire and North Carolina are two states in the process of debating laws that would add them to the thirteen-state list of states already supportive of the medicinal qualities of marijuana. Those states are Alaska, California, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont, and Washington.

With that said, some states are still involved in complicated and expensive court battles due to the Bush administration’s crackdown and blurring of the lines between federal and state laws. California, the first state to legalize medical marijuana 13 years ago, has lost every court battle with the federal government thus far but seeks to avenge those losses in a current appeals process.

Americans for Safe Access, an organization promoting the safe and legal access to marijuana for therapeutic use and research, recently sued the federal government on the basis that law prohibits the government from disseminating inaccurate information, such as that about the actual benefits of marijuana. In its most recent hearing in the U.S. 9th Circuit Court of Appeals, lawyers for Safe Access argued that the government must update its data and rely on current information.

Director of Safe Access Steph Sherer told the Los Angeles Times, “The science to support medical marijuana is overwhelming. It’s time for the federal government to acknowledge the efficacy of medical marijuana and stop holding science hostage to politics.”

If the Obama administration has anything to say about it, science will prevail over politics, as evidenced by President Obama’s strong stand on stem cell research. But it may take some time for the medical marijuana advocacy organizations to make their case on a federal level. In the meantime, the absence of federal government intervention in state laws regarding marijuana is a start. Patients who can find some peace in the face of chronic and overwhelming medical conditions may be able to rest or recover a bit easier without the fear of federal agents appearing at their local dispensary or their own front doors.

Health insurance

Health insurance is insurance that pays for medical expenses. It is sometimes used more broadly to include insurance covering disability or long-term nursing or custodial care needs. It may be provided through a government-sponsored social insurance program, or from private insurance companies. It may be purchased on a group basis (e.g., by a firm to cover its employees) or purchased by individual consumers. In each case, the covered groups or individuals pay premiums or taxes to help protect themselves from high or unexpected healthcare expenses. Similar benefits paying for medical expenses may also be provided through social welfare programs funded by the government.

By estimating the overall risk of healthcare expenses, a routine finance structure (such as a monthly premium or annual tax) can be developed, ensuring that money is available to pay for the healthcare benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity. [1]
Contents
[hide]

* 1 History and evolution
* 2 How it works
o 2.1 Health plan vs. health insurance
o 2.2 Comprehensive vs. scheduled
o 2.3 Inherent problems with multiple insurance funds and optional insurance
+ 2.3.1 Adverse selection
+ 2.3.2 Moral hazard
o 2.4 Other factors affecting insurance prices
* 3 Comparison
o 3.1 Australia
o 3.2 Canada
o 3.3 France
o 3.4 Netherlands
o 3.5 United Kingdom
o 3.6 United States
* 4 See also
* 5 Notes and references

[edit] History and evolution
Main article: History of insurance

The concept of health insurance was proposed in 1694 by Hugh the Elder Chamberlen from the Peter Chamberlen family. In the late 19th century, "accident insurance" began to be available, which operated much like modern disability insurance.[2].This payment model continued until the start of the 20th century in some jurisdictions (like California), where all laws regulating health insurance actually referred to disability insurance.[3]

Accident insurance was first offered in the United States by the Franklin Health Assurance Company of Massachusetts. This firm, founded in 1850, offered insurance against injuries arising from railroad and steamboat accidents. Sixty organizations were offering accident insurance in the US by 1866, but the industry consolidated rapidly soon thereafter. While there were earlier experiments, the origins of sickness coverage in the US effectively date from 1890. The first employer-sponsored group disability policy was issued in 1911.[4]

Before the development of medical expense insurance, patients were expected to pay all other health care costs out of their own pockets, under what is known as the fee-for-service business model. During the middle to late 20th century, traditional disability insurance evolved into modern health insurance programs. Today, most comprehensive private health insurance programs cover the cost of routine, preventive, and emergency health care procedures, and also most prescription drugs, but this was not always the case.

Hospital and medical expense policies were introduced during the first half of the 20th century. During the 1920s, individual hospitals began offering services to individuals on a pre-paid basis, eventually leading to the development of Blue Cross organizations.[4] The predecessors of today's Health Maintenance Organizations (HMOs) originated beginning in 1929, through the 1930s and on during World War II.[5][6]

[edit] How it works

A health insurance policy is a contract between an insurance company and an individual or his sponsor (e.g. an employer). The contract can be renewable annually or monthly. The type and amount of health care costs that will be covered by the health insurance company are specified in advance, in the member contract or "Evidence of Coverage" booklet. The individual insurered person's obligations may take several forms[7]:

* Premium: The amount the policy-holder or his sponsor (e.g. an employer) pays to the health plan each month to purchase health coverage.
* Deductible: The amount that the insured must pay out-of-pocket before the health insurer pays its share. For example, a policy-holder might have to pay a $500 deductible per year, before any of their health care is covered by the health insurer. It may take several doctor's visits or prescription refills before the insured person reaches the deductible and the insurance company starts to pay for care.
* Copayment: The amount that the insured person must pay out of pocket before the health insurer pays for a particular visit or service. For example, an insured person might pay a $45 copayment for a doctor's visit, or to obtain a prescription. A copayment must be paid each time a particular service is obtained.
* Coinsurance: Instead of, or in addition to, paying a fixed amount up front (a copayment), the co-insurance is a percentage of the total cost that insured person may also pay. For example, the member might have to pay 20% of the cost of a surgery over and above a co-payment, while the insurance company pays the other 80%. If there is an upper limit on coinsurance, the policy-holder could end up owing very little, or a great deal, depending on the actual costs of the services they obtain.
* Exclusions: Not all services are covered. The insured person is generally expected to pay the full cost of non-covered services out of their own pocket.
* Coverage limits: Some health insurance policies only pay for health care up to a certain dollar amount. The insured person may be expected to pay any charges in excess of the health plan's maximum payment for a specific service. In addition, some insurance company schemes have annual or lifetime coverage maximums. In these cases, the health plan will stop payment when they reach the benefit maximum, and the policy-holder must pay all remaining costs.
* Out-of-pocket maximums: Similar to coverage limits, except that in this case, the insured person's payment obligation ends when they reach the out-of-pocket maximum, and the health company pays all further covered costs. Out-of-pocket maximums can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.
* Capitation: An amount paid by an insurer to a health care provider, for which the provider agrees to treat all members of the insurer.
* In-Network Provider: (U.S. term) A health care provider on a list of providers preselected by the insurer. The insurer will offer discounted coinsurance or copayments, or additional benefits, to a plan member to see an in-network provider. Generally, providers in network are providers who have a contract with the insurer to accept rates further discounted from the "usual and customary" charges the insurer pays to out-of-network providers.
* Prior Authorization: A certification or authorization that an insurer provides prior to medical service occurring. Obtaining an authorization means that the insurer is obligated to pay for the service, assume it matches what was authorized. Many smaller, routine services do not require authorization[8]
* Explanation of Benefits: A document sent by an insurer to a patient explaining what was covered for a medical service, and how they arrived at the payment amount and patient responsibility amount[9]

Prescription drug plans are a form of insurance offered through some employer benefit plans in the US, where the patient pays a copayment and the prescription drug insurance part or all of the balance for drugs covered in the formulary of the plan.

Some, if not most, health care providers in the United States will agree to bill the insurance company if patients are willing to sign an agreement that they will be responsible for the amount that the insurance company doesn't pay. The insurance company pays out of network providers according to "reasonable and customary" charges, which may be less than the provider's usual fee. The provider may also have a separate contract with the insurer to accept what amounts to a discounted rate or capitation to the provider's standard charges. It generally costs the patient less to use an in-network provider.

[edit] Health plan vs. health insurance

Historically, HMOs tended to use the term "health plan", while commercial insurance companies used the term "health insurance". A health plan can also refer to a subscription-based medical care arrangement offered through HMOs, preferred provider organizations, or point of service plans. These plans are similar to pre-paid dental, pre-paid legal, and pre-paid vision plans. Pre-paid health plans typically pay for a fixed number of services (for instance, $300 in preventive care, a certain number of days of hospice care or care in a skilled nursing facility, a fixed number of home health visits, a fixed number of spinal manipulation charges, etc.) The services offered are usually at the discretion of a utilization review nurse who is often contracted through the managed care entity providing the subscription health plan. This determination may be made either prior to or after hospital admission (concurrent utilization review).

[edit] Comprehensive vs. scheduled

Comprehensive health insurance pays a percentage of the cost of hospital and physician charges after a deductible (usually applies to hospital charges) or a co-pay (usually applies to physician charges, but may apply to some hospital services) is met by the insured. These plans are generally expensive because of the high potential benefit payout — $1,000,000 to 5,000,000 is common — and because of the vast array of covered benefits.[10]

Scheduled health insurance plans are not meant to replace a traditional comprehensive health insurance plans and are more of a basic policy providing access to day-to-day health care such as going to the doctor or getting a prescription drug. In recent years, these plans have taken the name mini-med plans or association plans. These plans may provide benefits for hospitalization and surgical, but these benefits will be limited. Scheduled plans are not meant to be effective for catastrophic events. These plans cost much less than comprehensive health insurance. They generally pay limited benefits amounts directly to the service provider, and payments are based upon the plan's "schedule of benefits". Annual benefits maximums for a typical scheduled health insurance plan may range from $1,000 to $25,000.[11]

[edit] Inherent problems with multiple insurance funds and optional insurance

The basic concept of insurance is population solidarity. There are inherent risks in a population but the population absorbs the cost of risks to an individual by spreading the impact of incurred costs amongst the insured population. However, if the population is split into insured and uninsured groups, or into selectively groups (as with private insurance with pre-insurance selection either by the insurance company or the insured) the concept of population solidarity breaks down. Insurance systems must then typically deal with two inherent challenges: adverse selection and ex-post moral hazard.

Some national systems with compulsory insurance utilize systems such as risk equalization and community rating to overcome these inherent problems. Proponents of single-payer health care in the United States aim to provide the population of the country with health care from a single fund and thus avoid problems and costs associated with adverse selection, moral hazard, and private profiteering from insurance.

[edit] Adverse selection

Insurance companies use the term "adverse selection" to describe the tendency for only those who will benefit from insurance to buy it. Specifically when talking about health insurance, unhealthy people are more likely to purchase health insurance because they anticipate large medical bills. On the other side, people who consider themselves to be reasonably healthy may decide that medical insurance is an unnecessary expense; if they see the doctor once a year and it costs $250, that's much better than making monthly insurance payments of $40. (example figures).

The fundamental concept of insurance is that it balances costs across a large, random sample of individuals (see risk pool). For instance, an insurance company has a pool of 1000 randomly selected subscribers, each paying $100 per month. One person becomes very ill while the others stay healthy, allowing the insurance company to use the money paid by the healthy people to pay for the treatment costs of the sick person. However, when the pool is self-selecting rather than random, as is the case with individuals seeking to purchase health insurance directly, adverse selection is a greater concern.[12] A disproportionate share of health care spending is attributable to individuals with high health care costs. In the US the 1% of the population with the highest spending accounted for 27% of aggregate health care spending in 1996. The highest-spending 5% of the population accounted for more than half of all spending. These patterns were stable through the 1970s and 1980s, and some data suggest that they may have been typical of the mid-to-early 20th century as well.[13][14] A few individuals have extremely high medical expenses, in extreme cases totaling a half million dollars or more.[15] Adverse selection could leave an insurance company with primarily sick subscribers and no way to balance out the cost of their medical expenses with a large number of healthy subscribers.

Because of adverse selection, insurance companies employ medical underwriting, using a patient's medical history to screen out those whose pre-existing medical conditions pose too great a risk for the risk pool. Before buying health insurance, a person typically fills out a comprehensive medical history form that asks whether the person smokes, how much the person weighs, whether the person has been treated for any of a long list of diseases and so on. In general, those who present large financial burdens are denied coverage or charged high premiums to compensate.[16] One large US industry survey found that roughly 13 percent of applicants for comprehensive, individually purchased health insurance who went through the medical underwriting in 2004 were denied coverage. Declination rates increased significantly with age, rising from 5 percent for individuals 18 and under to just under a third for individuals aged 60 to 64.[17] Among those who were offered coverage, the study found that 76% received offers at standard premium rates, and 22% were offered higher rates.[18] On the other side, applicants can get discounts if they do not smoke and are healthy.[19]

[edit] Moral hazard
Main article: Moral hazard

Moral hazard occurs when an insurer and a consumer enter into a contract under symmetric information, but one party takes action, not taken into account in the contract, which changes the value of the insurance. A common example of moral hazard is third-party payment—when the parties involved in making a decision are not responsible for bearing costs arising from the decision. An example is where doctors and insured patients agree to extra tests which may or may not be necessary. Doctors benefit by avoiding possible malpractice suits, and patients benefit by gaining increased certainty of their medical condition. The cost of these extra tests is borne by the insurance company, which may have had little say in the decision. Co-payments, deductibles, and less generous insurance for services with more elastic demand attempt to combat moral hazard, as they hold the consumer responsible.

[edit] Other factors affecting insurance prices

A recent study by PriceWaterhouseCoopers examining the drivers of rising health care costs in the US pointed to increased utilization created by increased consumer demand, new treatments, and more intensive diagnostic testing, as the most significant driver.[20] People in developed countries are living longer. The population of those countries is aging, and a larger group of senior citizens requires more intensive medical care than a young healthier population. Advances in medicine and medical technology can also increase the cost of medical treatment. Lifestyle-related factors can increase utilization and therefore insurance prices, such as: increases in obesity caused by insufficient exercise and unhealthy food choices; excessive alcohol use, smoking, and use of street drugs. Other factors noted by the PWC study included the movement to broader-access plans, higher-priced technologies, and cost-shifting from Medicaid and the uninsured to private payers.[20]

[edit] Comparison
See also: Health care systems

The Commonwealth Fund, in its annual survey, "Mirror, Mirror on the Wall", compares the performance of the health care systems in Australia, New Zealand, the United Kingdom, Germany, Canada and the U.S. Its 2007 study found that, although the U.S. system is the most expensive, it consistently under-performs compared to the other countries.[21] One difference between the U.S. and the other countries in the study is that the U.S. is the only country without universal health insurance coverage.

[edit] Australia
Main article: Health care in Australia

The public health system is called Medicare. It ensures free universal access to hospital treatment and subsidised out-of-hospital medical treatment. It is funded by a 1.5% tax levy.

The private health system is funded by a number of private health insurance organisations. The largest of these is Medibank Private, which is government-owned, but operates as a government business enterprise under the same regulatory regime as all other registered private health funds. The Coalition Howard government had announced that Medibank would be privatised if it won the 2007 election, however they were defeated by the Australian Labor Party under Kevin Rudd which had already pledged that it would remain in government ownership.

Some private health insurers are 'for profit' enterprises, and some are non-profit organizations such as HCF Health Insurance and GMHBA Health Insurance. Some have membership restricted to particular groups, but the majority have open membership.

Most aspects of private health insurance in Australia are regulated by the Private Health Insurance Act 2007.

The private health system in Australia operates on a "community rating" basis, whereby premiums do not vary solely because of a person's previous medical history, current state of health, or (generally speaking) their age (but see Lifetime Health Cover below). Balancing this are waiting periods, in particular for pre-existing conditions (usually referred to within the industry as PEA, which stands for "pre-existing ailment"). Funds are entitled to impose a waiting period of up to 12 months on benefits for any medical condition the signs and symptoms of which existed during the six months ending on the day the person first took out insurance. They are also entitled to impose a 12-month waiting period for benefits for treatment relating to an obstetric condition, and a 2-month waiting period for all other benefits when a person first takes out private insurance. Funds have the discretion to reduce or remove such waiting periods in individual cases. They are also free not to impose them to begin with, but this would place such a fund at risk of "adverse selection", attracting a disproportionate number of members from other funds, or from the pool of intending members who might otherwise have joined other funds. It would also attract people with existing medical conditions, who might not otherwise have taken out insurance at all because of the denial of benefits for 12 months due to the PEA Rule. The benefits paid out for these conditions would create pressure on premiums for all the fund's members, causing some to drop their membership, which would lead to further rises, and a vicious cycle would ensue.

There are a number of other matters about which funds are not permitted to discriminate between members in terms of premiums, benefits or membership - these include racial origin, religion, sex, sexual orientation, nature of employment, and leisure activities. Premiums for a fund's product that is sold in more than one state can vary from state to state, but not within the same state.

The Australian government has introduced a number of incentives to encourage adults to take out private hospital insurance. These include:

* Lifetime Health Cover: If a person has not taken out private hospital cover by the 1st July after their 30th birthday, then when (and if) they do so after this time, their premiums must include a loading of 2% per annum. Thus, a person taking out private cover for the first time at age 40 will pay a 20 per cent loading. The loading continues for 10 years. The loading applies only to premiums for hospital cover, not to ancillary (extras) cover.

* Medicare Levy Surcharge: People whose taxable income is greater than a specified amount (currently $70,000 for singles and $140,000 for couples) and who do not have an adequate level of private hospital cover must pay a 1% surcharge on top of the standard 1.5% Medicare Levy. The rationale is that if the people in this income group are forced to pay more money one way or another, most would choose to purchase hospital insurance with it, with the possibility of a benefit in the event that they need private hospital treatment - rather than pay it in the form of extra tax as well as having to meet their own private hospital costs.
o The Australian government announced in May 2008 that it proposes to increase the thresholds, to $100,000 for singles and $150,000 for families. These changes require legislative approval. A bill to change the law has been introduced but was not passed by the Senate.[22] A changed version was passed on 16 October 2008. There have been criticisms that the changes will cause many people to drop their private health insurance, causing a further burden on the public hospital system, and a rise in premiums for those who stay with the private system. Other commentators believe the effect will be minimal.[23]

* Private Health Insurance Rebate: The government subsidises the premiums for all private health insurance cover, including hospital and ancillary (extras), by 30%, 35% or 40%.

[edit] Canada
Main article: Health care in Canada

Most health insurance in Canada is administered by each province, under the Canada Health Act, which requires all people to have free access to basic health services. Collectively, the public provincial health insurance systems in Canada are frequently referred to as Medicare. Private health insurance is allowed, but the provincial governments allow it only for services that the public health plans do not cover; for example, semi-private or private rooms in hospitals and prescription drug plans. Canadians are free to use private insurance for elective medical services such as laser vision correction surgery, cosmetic surgery, and other non-basic medical procedures. Some 65% of Canadians have some form of supplementary private health insurance; many of them receive it through their employers.[24] Private-sector services not paid for by the government account for nearly 30 percent of total health care spending.[25]

In 2005, the Supreme Court of Quebec ruled, in Chaoulli v. Quebec, that the province's prohibition on private insurance for health care already insured by the provincial plan could constitute an infringement of the right to life and security if there were long wait times for treatment as happened in this case. Certain other provinces have legislation which financially discourages but does not forbid private health insurance in areas covered by the public plans. The ruling has not changed the overall pattern of health insurance across Canada but has spurred on attempts to tackle the core issues of supply and demand and the impact of wait times.[26]

[edit] France
Main article: Health care in France

The French model of health insurance has been ranked by the World Health Organization as the best in the world, because it permits a high quality of care and nearly total patient freedom. The national system of health insurance was instituted in 1945, just after the end of the Second World War. It was a compromise between Gaullist and Communist representatives in the French parliament. The Conservative Gaullists were opposed to a state-run healthcare system, while the Communists were supportive of a complete nationalisation of health care along a British Beveridge model.

The resulting programme was profession-based : all people working were required to pay a portion of their income to a health insurance fund, which mutualised the risk of illness, and which reimbursed medical expenses at varying rates. Children and spouses of insured people were eligible for benefits, as well. Each fund was free to manage its own budget and reimburse medical expenses at the rate it saw fit.

The government has two responsibilities in this system.

* The first government responsibility is the fixing of the rate at which medical expenses should be negotiated, and it does this in two ways: The Ministry of Health directly negotiates prices of medicine with the manufacturers, based on the average price of sale observed in neighboring countries. A board of doctors and experts decides if the medicine provides a valuable enough medical benefit to be reimbursed (note that most medicine is reimbursed, including homeopathy). In parallel, the government fixes the reimbursment rate for medical services : this means that a doctor is free to charge the fee that he wishes for a consultation or an examination, but the social security system will only reimburse it at a pre-set rate. These tariffs are set annually through negotiation with doctors' representative organisations.
* The second government responsibility is oversight of the health-insurance funds, to ensure that they are correctly managing the sums they receive, and to ensure oversight of the public hospital network.

Today, this system is more-or-less intact. All citizens and legal foreign residents of France are covered by one of these mandatory programs, which continue to be funded by worker participation. However, since 1945, a number of major changes have been introduced. Firstly, the different health-care funds (there are five : General, Independent, Agricultural, Student, Public Servants) now all reimburse at the same rate. Secondly, since 2000, the government now provides health care to those who are not covered by a mandatory regime (those who have never worked and who are not students, meaning the very rich or the very poor). This regime, unlike the worker-financed ones, is financed via general taxation and reimburses at a higher rate than the profession-based system for those who cannot afford to make up the difference. Finally, to counter the rise in health-care costs, the government has installed two plans, (in 2004 and 2006), which require insured people to declare a referring doctor in order to be fully reimbursed for specalist visits, and which installed a mandatory co-pay of 1 € (about $1.45) for a doctor visit, 0,50 € (about 80 ¢) for each box of medicine prescribed, and a fee of 16-18 € (20-25 $) per day for hospital stays and for expensive procedures.

An important element of the French insurance system is solidarity : the more ill a person becomes, the less they pay. This means that for people with serious or chronic illnesses, the insurance system reimburses them 100 % of expenses, and waives their co-pay charges.

Finally, for fees that the mandatory system does not cover, there is a large range of private complementary insurance plans available. The market for these programs is very competitive, and often subsidised by the employer, which means that premiums are usually modest. 85% of French people benefit from complementary private health insurance.

[27][28]

[edit] Netherlands
Main article: Health care in the Netherlands

In 2006, a new system of health insurance came into force in the Netherlands. This new system avoids the two pitfalls of adverse selection and moral hazard associated with traditional forms of health insurance by using a combination of regulation and an insurance equalization pool. Moral hazard is avoided by mandating that insurance companies provide at least one policy which meets a government set minimum standard level of coverage, and all adult residents are obliged by law to purchase this coverage from an insurance company of their choice. All insurance companies receive funds from the equalization pool to help cover the cost of this government-mandated coverage. This pool is run by a regulator which collects salary-based contributions from employers, which make up about 50% of all health care funding, and funding from the government to cover people who cannot afford health care, which makes up an additional 5%.

The remaining 45% of health care funding comes from insurance premiums paid by the public, for which companies compete on price, though the variation between the various competing insurers is only about 5%. However, insurance companies are free to sell additional policies to provide coverage beyond the national minimum. These policies do not receive funding from the equalization pool, but cover additional treatments, such as dental procedures and physiotherapy, which are not paid for by the mandatory policy.

Funding from the equalization pool is distributed to insurance companies for each person they insure under the required policy. However, high-risk individuals get more from the pool, and low-income persons and children under 18 have their insurance paid for entirely. Because of this, insurance companies no longer find insuring high risk individuals an unappealing proposition, avoiding the potential problem of adverse selection.

Insurance companies are not allowed to have co-payments, caps, or deductibles, or to deny coverage to any person applying for a policy, or to charge anything other than their nationally set and published standard premiums. Therefore, every person buying insurance will pay the same price as everyone else buying the same policy, and every person will get at least the minimum level of coverage.

[edit] United Kingdom
Main article: National Health Service

The UK's National Health Service (NHS) is a publicly funded healthcare system that provides coverage to everyone normally resident in the UK. It is not strictly an insurance system because (a) there are no premiums collected, (b) costs are not charged at the patient level and (c) costs are not pre-paid from a pool. However, it does achieve the main aim of insurance which is to spread financial risk arising from ill-health. The costs of running the NHS (est. £104 billion in 2007-8)[29] are met directly from general taxation. The NHS provides the majority of health care in the UK, including primary care, in-patient care, long-term health care, ophthalmology and dentistry.

Private health care has continued parallel to the NHS, paid for largely by private insurance, but it is used by less than 8% of the population, and generally as a top-up to NHS services. There are many treatments that the private sector does not provide. For example, health insurance on pregnancy is generally not covered or covered with restricting clauses.[30] One of the major insurers, BUPA, excludes many forms of treatment and care that most people will need during their lifetime or specialist care most of which are freely available from the NHS. These include:-

ageing, menopause and puberty; AIDS/HIV; allergies or allergic disorders; birth control, conception, sexual problems and sex changes; chronic conditions; complications from excluded or restricted conditions/ treatment; convalescence, rehabilitation and general nursing care ; cosmetic, reconstructive or weight loss treatment; deafness; dental/oral treatment (such as fillings, gum disease, jaw shrinkage, etc); dialysis; drugs and dressings for out-patient or take-home use† ; experimental drugs and treatment; eyesight; HRT and bone densitometry; learning difficulties, behavioural and developmental problems; overseas treatment and repatriation; physical aids and devices; pre-existing or special conditions; pregnancy and childbirth; screening and preventive treatment; sleep problems and disorders; speech disorders; temporary relief of symptoms[31] († = except in exceptional circumstances)

BUPA's competitors include, among others, AXA, Aviva, Groupama Healthcare and Pru Health.

Recently the private sector has been used to increase NHS capacity despite a large proportion of the British public opposing such involvement.[32]. According to the World Health Organization, government funding covered 86% of overall health care expenditures in the UK as of 2004, with private expenditures covering the remaining 14%.[33]

[edit] United States
Main articles: Health insurance in the United States and Health care in the United States

The US market-based health care system relies heavily on private and not-for-profit health insurance, which is the primary source of coverage for most Americans. According to the United States Census Bureau, approximately 84% of Americans have health insurance; some 60% obtain it through an employer, while about 9% purchase it directly. Various government agencies provide coverage to about 27% of Americans (there is some overlap in these figures).[34]

Public programs provide the primary source of coverage for most seniors and for low-income children and families who meet certain eligibility requirements. The primary public programs are Medicare, a federal social insurance program for seniors and certain disabled individuals, Medicaid, funded jointly by the federal government and states but administered at the state level, which covers certain very low income children and their families, and SCHIP, also a federal-state partnership that serves certain children and families who do not qualify for Medicaid but who cannot afford private coverage. Other public programs include military health benefits provided through TRICARE and the Veterans Health Administration and benefits provided through the Indian Health Service. Some states have additional programs for low-income individuals.[35]

In 2006, there were 47 million people in the United States (16% of the population) who were without health insurance for at least part of that year.[34] About 37% of the uninsured live in households with an income over $50,000.[34]

In 2004, US health insurers directly employed almost 470,000 people at an average salary of $61,409.[36] (As of the fourth quarter of 2007, the total US labor force stood at 153.6 million, of whom 146.3 million were employed. Employment related to all forms of insurance totaled 2.3 million.[37] Mean annual earnings for full-time civilian workers as of June 2006 were $41,231; median earnings were $33,634.)[38] The insurance industry also represents a significant lobbying group in the US. For 2008 insurance was the 8th among industries in political contributions to members of Congress, giving $28,654,121, of which 51% was given to Democrats and 49% to Republicans, with the top recipient of insurance industry contributions being Senator John McCain (R-AZ).[39] The leading contributor from the insurance industry — as measured by total political contributions — was AFLAC, Inc., which contributed $907,150 in 2007.[40].

[edit] See also

* Injury cover
* Economic capital
* Health economics
* Health maintenance organization
* Healthcare reform
* Self-funded health care
* List of insurance topics
* Public health
* Social health insurance
* Social security
* Social welfare
* Health care
* Health care politics
* Philosophy of Healthcare
* Single-payer health care