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The Single-Payer model came in for criticism mainly because of long waiting lines, patients’ rights to
avail quality healthcare, doctors’ and healthcare providers’ right to get the best price and serious quality
concerns. In the 1980s, market-led initiatives changed the market dynamics in many countries. India also
created publicly managed markets for private health insurance, popularly known as mediclaim policies.

The private capital can control both the demand and supply side. It can influence the healthcare
arena by managing the entire delivery or supply side by owning healthcare services and goods or the
demand side by purchasing healthcare services and goods.

6. Universal Health Coverage, Role of Health Insurance and Experience

As per Glover (2016), “Universal Health coverage in Australia is through Medicare, financed through
general tax revenue - the national tax system and a government levy. Citizens enrolled receive free public
hospital care and substantial coverage for physician services, pharmaceuticals, and other services. Many
Australians buy private supplementary insurance for private hospital care, dental services, and other
services. Private health insurance covers hospital care, general treatment, or ambulance services. The
broad treatment coverage, often capped, provides dental, physiotherapy, chiropractic, podiatry, home
nursing, and optometry services. Private health insurance is encouraged through tax rebates, and a Medicare
Levy surcharge is slapped on high-income individuals and families for not purchasing private insurance”.
Allin et al. (2019) state, “Canada has slowly adopted the two-tier system. Canadian Medicare is
Canada’s universal, publicly funded healthcare system, with all beneficiaries receiving medically necessary
hospital and physician services free at the point of use. 67% of Canadians have private insurance for
services that Medicare does not cover, like vision and dental care, outpatient prescription drugs,
rehabilitation services, and private hospital rooms. Specialists are paid primarily on a fee-for-service
basis. Hospitals are a mix of public and private, predominantly not-for-profit organizations; however,
some clinics operate for profit”.

China goes about its Universal Health Care Coverage through two major schemes: Urban Employee
Basic Medical Insurance, which is compulsory for urban residents with formal jobs; Urban and Rural Resident
Basic Medical Insurance (URRBMI) offered to rural and urban residents without formal jobs, including
children, older people, and the self-employed, China seeks universal coverage by providing publicly funded
basic medical insurance. The basic medical insurance plans cover primary, speciality, hospital, mental health
care, prescription drugs, physical therapy, emergency care, and traditional Chinese medicine. It also covers
in-patient hospital care in selected cities. Despite the high share of health care in GDPs ( 6.6% in 2018), the
share of Out of Pocket expenses at 28% of the total healthcare expenses in 2018 is indicative that China also
banks on private health insurance, which is making inroads by covering deductibles, co-payments, other
cost-sharing, and expensive services not paid for by public insurance. The co-payments are applicable in
Outpatient physician services, drugs, and inpatient admissions. The primary healthcare services with village
clinics and doctors form the backbone of the Chinese healthcare system. Deductibles, co-payments, and
reimbursement ceilings apply. There is no annual cap on out-of-pocket spending. Complementary private
health insurance helps cover cost-sharing and coverage gaps (Fang, 2018). One study finds that the integrated
URRBMI scheme enhanced the probability of obtaining benefits and the degree of benefits for outpatient
care, with evident treatment effects also seen in outpatient benefits for rural patients( Ren et al., 2022)