*The Advantage of Single-Payer National Insurance DOI: http://dx.doi.org/10.5772/intechopen.105692*

#### *Health Insurance*


*\*Coverage of essential health services (defined as the average coverage of essential services based on tracer interventions that include reproductive, maternal, newborn and child health, infectious diseases, non-communicable diseases and service capacity and access, among the general and the most disadvantaged population). The indicator is an index reported on a unitless scale of 0 to 100.*

#### **Table 2.**

*Comparison of Public Finance as % GDP and IMR of Some Developed Countries with different health financing Schemes 2011–2018. Processed from World Bank Data and UHC Monitor 2021.*

administrative expenses compared to CHI, which can absorb up to 25% of the total premium income. The administrative costs of NHI in Asia ranged from 1.8% in Taiwan to about 4% in Indonesia. Most Medicare programs in the US, Canada, and Australia also consume less than 4% of revenue. The average administrative expenses of the German's sickness funds were also around 4% of the total revenues. 8.When the NHI already reaches its maturity, providing quality health care to all populations with no catastrophic health spending, the NHI can be national pride.

If we consider tax-funded NHS as also a single payer with the government as the payer, this single-payer system or tax-funded system also has the above advantages. Evidence shows that countries applying NHS model, such as the UK, Nordic countries, Italy, and Spain, spent less than 10% of their GDP to achieve universal health coverage. In contrast, the US with dominance CHI has spent above 16% of its GDP in the last 10 years with relatively similar health outcomes with those developed countries with NHS or single-payer NHI.

As an illustration, in **Figure 1** we plot the index of health expenditures and infant mortality rates of three countries using 2011 as the base (index =1) and trend of decreasing IMR up to 2017. We use the World Bank data to illustrate the correlation between changes in health expenditures per capita and changes in IMR of Germany (blue dots), Japan (green dots), and the USA (orange dots). The figure illustrates that a virtual (quasi) single-payer health financing system in Japan had better performance in decreasing IMR with the same increase (change of index) from 2011 to 2017. Although this figure may not depict causal relationship, we can see the correlation is noted to be explored more.

We also provide **Table 2** illustrating the same level of UHC Index of high-income countries, public health spending as % GDP, and IMR per 1000 live births from 2011 to 2017. Data from the World Bank and the UHC Monitoring is used to develop this table.
