The pressures on existing healthcare financing systems are multi-layered. In Europe, pay-as-you-go social insurance schemes are creaking under the weight of demographic change; in the US, the costs of corporate retiree healthcare commitments are increasingly challenging large employers. Demand for and expectations of healthcare services and the cost of meeting them are rising all the time and across most territories.
Reform is on the agenda and, to varying degrees, systems are undergoing change. Very similar pressures can be recognized around the world but the health insurance industry - the focus of this report - has a more national orientation than most businesses, an inevitable consequence of the close links that exist between social policy and the role of health insurance. Policymakers in each country will make their own choices and the great variety of financing systems in different countries suggests that the choices available are wide.