Healthcare in Kiravia

An operating room in Virsūkirtik, Elegia.

The Kiravian Federacy has a multipayer healthcare finance system, in which healthcare costs are met by contributions from government sources (federal and state/territorial), private nonprofit health mutuals, commercial health insurance plans, and out-of-pocket payments by individuals. Health services are predominantly provided by non-governmental entities, such as institutional hospitals and private medical practices.

Health outcomes and the efficacy of the Kiravian system are uneven across dimensions such as geography, income level, and social background, with wide divergences between "First Kirav" (growing metropolitan areas of high-income developed coastal states) and "Third Kirav" (economically stagnant areas, particularly rural, of inland states and South Kirav). Major public health challenges in Kiravia include the effects of rampant alcohol and tobacco overconsumption, infectious disease transmission in dense urban areas, the lingering effects of industrial pollution from previous eras, poor diets across much of the country, and unique challenges to transfusion medicine posed by the abundance of rare blood types among the Kiravian population.

Average life expectancy in Kiravia remains lower than most countries with comparable per capita GDP, though this gap has reliably narrowed annually since the completion of the post-Kirosocialist economic transition and is projected to close for women by 2032 AD.

History

Local plague doctor → Mostly church and manorial institutions → Previous + growing number of independent/semi-public institutional hospitals → Kirosocialism, full state takeover → Reprivatisation. Some states have not fully reprivatised. Federal “Transitional Medicaid” is still in effect for unemployed and low-income people in certain states that aren’t handling the economic transition well. It is federally financed but administered by the states and gets cut more and more annually.

Public financing of healthcare developed separately in the kirosocialist Kiravian Union and the Federalist rump state centred on Æonara. The Sydona Islands (which embraced the Kiravian Union but maintained a significant degree of autonomy in economic planning) were the first part of Kiravia to fully socialise the health system, with all health services provided by the People's Health Service, a government agency, and funded out of the general budget. In mainland Great Kirav and other territories under Kirosocialist rule, a single-payer finance model was adopted and hospitals were brought under state control (though in many cases not fully nationalised), but many *de facto* independent practitioners continued to operate, particularly outside of the cities, as nominal public contractors.

In the Rump Republic, a Bismarckian healthcare regime was implemented in [YEAR].

Financing

The public contribution to healthcare finance varies by federal subject, but generally speaking, different state and territorial governments will pay for different percentages of different classes of medical procedures/services. As an example, for an income-sufficient household in Hiterna, the state will cover 60% of the fee for primary care services, 35-55% of the fee for specialist services, and 25% of the fee for behavioural health services. The exact percentage covered for a particular service may vary according to the particulars of state policy and the nature of the service. Additional programmes may cover certain percentages of different allied health services and prescription drug costs, but few provide any form of public dental coverage. Most developed states have programmes to cover higher percentages of health costs for their low-income citizens, and may cover 100% of primary care services delivered at county health clinics for eligible patients. Some states have implemented universal catastrophic care schemes. Populous, highly developed coastal states tend to cover more health costs, while more sparsely populated, less-developed, and inland/island states and territories tend to cover less.^{[this may not actually be true]} Some states, such as Fariva and Sydona, are moving towards statewide public health insurance to cover ~100% of costs for working households.

The remainder of healthcare funding comes from private sources, including xyzlódrisāv (“health mutuals”), union- and employer-backed commercial health policies, individual supplemental insurance, and patients themselves. Xyzlódrisāv are non-profit mutual funds, the management of which is elected by and accountable to policyholders.

Differences in public healthcare coverage across federal subjects have been subject to criticism. In addition to the predictable complaints from peripheral and less-developed regions, humanitarians, and political progressives, economic liberals have posited this arrangement for hindering labour mobility and the seamlessness of the internal market. The One Kiravia Institute has produced studies demonstrating that working-class families are to a significant extent inhibited from moving from a state that provides more extensive public health coverage to a state that provides less.^{[citation needed]}

Providers

Hospitals

With the exception of county, rural, and island health clinics, the Veterans’ Hospital Network, and the Urom Health Service (which serves certain economically deprived Urom communities), the vast majority of healthcare providers in Kiravia are private or semiprivate entities. Religious institutions are prominent in this sector, with about half of Kiravian hospitals having some form of religious affiliation. Hospitals under the auspices of the Catholic Church serve the most patients each year, though the Coscivian Orthodox Church oversees a larger number of hospital sites. The Insular Apostolic Church, various Islamic waqfs, the Reformed Orthodox Church, and Wesleyan Federated Health System, the Lutheran Hospital Union also have a nationwide presence in healthcare. Most other hospitals are commercial (for-profit), though some are classified as “other institutional”, being associated with nonsectarian universities or private foundations, or operating as standalone non-profit entities.

Public health challenges

Grain alcohol