Social health insurance is an insurance program which meets at least one
of the following three conditions:
- participation in the program is compulsory either by law or by the conditions of employment
- the program is operated on behalf of a group and restricted to group members
- an employer makes a contribution to the program on behalf of an employee.
Insured individuals make regular, mostly income-related contributions which are not tied to the cost of the services they use.
The contributions are administered by one or more quasi-independent public body(ies), normally with “statutory” responsibilities (usually called “sickness funds”), which act as the payers/purchasers of care.
The actual collection of the contributions can also be organized through a governmental institution.
If social health insurance is mandated by government, it is also called statutory health insurance.
World Health Organization. European Observatory on Health Systems and Policies. Glossary. 2009.