Healthcare in Urcea

Urcea has a universal multi-payer health care system paid for by a combination of statutory, state-funded health insurance officially called King's Health Aid (KHA) and private health-insurance. The system, which provides a public health insurance option, sees approximately 65% of citizens using the KHA System and the remaining percent using private health insurance plans. In the 2014-15 fiscal year, expenditures on the King's Health Aid was approximately $4.3 trillion dollars, or around 6% of the GDP and around $3,024 per capita.

In 2020, Urcea ranked highly in the world in life expectancy (80.5 years for men). It had a very low infant mortality rate (4.1 per 1,000 live births), and it ranked highly in the number of practicing physicians, at 3.7 per 1,000 persons. While outcomes, hospital wait times, and quality of care in Urcea are all considered to be "very good", the nation's healthcare system at times has come under criticism for its adherence to Catholic social teaching, and LGBT advocates as well as pro-choice advocates ranked it the "Most Regressive Healthcare System in the World" in 2021 due to the illegality of abortion and contraceptives, among other practices.

History
Prior to the enactment of the King's Health Aid Act of 2007, Urcea's healthcare system relied primarily on private health-insurance and a series of safety net health insurance programs for the poor and elderly. Healthcare coverage was provided through a combination of private health insurance and this public health coverage system. Guilds made up the largest share of private insurers, but a minority of guilds had the requisite members and funding to self-insure. Despite the emphasis on private coverage, in 2003, 64% of health spending was paid for by the government, and funded via programs as mentioned in addition to the Children's Health Insurance Program, and the Veterans' Health Department. People aged under 65 typically acquired insurance via their or a family member's employer, by purchasing health insurance on their own, or were uninsured. Health insurance for public sector employees was primarily provided by the government in its role as employer. Healthcare was a major issue within the context of the politics of Urcea, with the National Pact supporting deregulating and market-based solutions in order to drive down costs, and the Commonwealth Union supporting a universal single-payer system. The ascension of Michael Witte to Commonwealth Union leadership and, eventually, the office of Procurator brought about a major change in the political discussion, as Witte supported a multi-payer system with the "public option" government insurance joining the myriad of private insurers in order to create the "best of both worlds".

The Witte administration crafted, and managed to pass through the Concilium Daoni, the King's Health Aid Act of 2007. The bill combined all previous government health insurance programs into the King's Health Aid Administration, and dramatically expanded its funding in order to have it be a functioning competitor within the insurance marketplace. The Act came into effect in 2010, by which time a slim majority of Urceans had enrolled. A 2012 report issued by the Royal Administration called the program an "unmitigated success", improving healthcare outcomes and dramatically reducing the government economic impact and cost to the average patient. Enrollment in the program reached 60% of Urceans in 2014, and reached 65% by 2015. The availability of public healthcare lead to some guilds eliminating their self-insurance program, but 10.4% of Urceans were covered under their guild's health insurance program in 2015.