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Many countries have some form a government purchaser/funder or health insurance arrangements,
Kosovo is a long way from establishing the basic building blocks for health insurance as discussed
earlier, but can take some practical steps to improve arrangements such as a purchaser/provider
split within the government funded system, as discussed earlier. The box below describes the health
insurance arrangements in some countries. 9
Box 3.1 - Legal Status of Health Insurance in European Countries
Germany has statutory health funds and private health insurance companies that also act as
purchasers of health care. Health funds are corporatist, nongovernmental organizations, operating
on a not-for-profit basis. German law requires professional management of funds.
France has a main health insurance scheme (régime général) with a network of 16 regional offices
that are not for profit organizations with their own boards and a degree of managerial autonomy.
They are supervised by the national fund organization.
Lithuania has a single statutory HIF that is a governmental budgetary institution largely financed by
general taxation.
The Estonia Health Insurance Fund (EHIF) is an autonomous public organization Hungarv’s
National Health Insurance Fund Administration (NHIFA) is a not for profit organization closely
supervised by the MOH In February 2008 the Parliament approved the creation of 22 insurance
companies with 49 percent of stakes owned by private investors.
Health insurers in the Netherlands are private not for profit organizations In Switzerland, insurers
can be incorporated under public oi private law and take various legal forms including associations
not for profit stock company and mutuality.
The Czech Republic has nine HIFs and one national fund (General Fund) Insurers are public not for
profit organizations that have a degree of autonomy from the government.
Slovakia has two public health insurers and four private for profit health insurance companies that
until recently were allowed to pay dividends to their shareholders.
Source a Schweizerisches Bundes esetz fuer die Krankenversischerung 1994 Stand 2005 Art 11 12
9 Ibid., page 23.
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