NHI – NATIONAL HEALTH INSURANCE | POLICY & IMPLEMENTATION VERIFIED
EXAM SOLUTIONS - COMPREHENSIVE QUESTIONS AND ANSWERS - CURRENT
VERSION (2026/2027)
Q1 What is National Health Insurance (NHI)?
NHI is a single-payer, publicly funded health system designed to
ensure that all citizens and eligible residents receive access to
A quality healthcare services regardless of their employment status,
income, or social standing. It pools health funds from various
sources to provide universal coverage.
Q2 What is the primary goal of NHI?
The primary goal of NHI is to achieve Universal Health Coverage
(UHC) — ensuring every person can access needed health services
A
(prevention, promotion, treatment, rehabilitation, and palliation)
without suffering financial hardship.
Which country pioneered the concept of a National Health
Q3
Service?
The United Kingdom pioneered the concept with the establishment
A of the National Health Service (NHS) in 1948, providing free
healthcare to all residents funded through general taxation.
Q4 What are the key principles underpinning NHI?
Key principles include universality (coverage for all), equity (fair
A distribution of services and financial burden), social solidarity
(pooling of risk across the population), quality (provision of
Page 1
, comprehensive, evidence-based care), and sustainability (long-term
financial viability of the system).
Q5 How does NHI differ from private health insurance?
NHI is publicly funded, non-profit, and provides coverage to all
eligible individuals as a right. Private insurance is voluntary, profit-
A driven, risk-rated, and may exclude pre-existing conditions. NHI
pools risk across the entire population, whereas private insurance
segments it.
Q6 What is the 'single-payer' model in the context of NHI?
In a single-payer model, one entity — typically the government —
collects health contributions from various sources and pays
A
healthcare providers on behalf of all beneficiaries, eliminating
fragmentation and reducing administrative costs.
Q7 What does Universal Health Coverage (UHC) mean?
UHC means that all people and communities can use promotive,
A preventive, curative, rehabilitative, and palliative health services
they need, of sufficient quality, without financial hardship.
What role does the World Health Organization (WHO) play in
Q8
NHI globally?
The WHO sets the global agenda for UHC, provides technical
guidance on health financing frameworks, tracks country progress
A toward UHC targets under the Sustainable Development Goals
(SDG 3.8), and supports governments in designing and
implementing NHI schemes.
Q9 What are the three dimensions of the UHC cube?
The three dimensions are: (1) population coverage — who is
covered; (2) service coverage — which services are covered; and
A
(3) financial coverage — what proportion of the cost is covered,
reducing out-of-pocket payments.
Page 2
, What is the Sustainable Development Goal (SDG) related to
Q10
UHC?
SDG 3.8 specifically targets the achievement of UHC, including
financial risk protection, access to quality essential health services,
A
and access to safe, effective, quality, and affordable essential
medicines and vaccines for all.
Q11 What is a benefit package in NHI?
A benefit package is the defined set of health services and
interventions that are covered under the NHI scheme. It outlines
A what conditions are treated, which procedures are included, and
the level of care (primary, secondary, tertiary) that beneficiaries are
entitled to.
Q12 What is meant by 'social solidarity' in health financing?
Social solidarity means that healthy individuals contribute to
covering the costs of sick individuals, and wealthier members
A subsidize care for poorer members. Risk and financial burden are
shared across the entire insured population rather than borne
individually.
Q13 What is an out-of-pocket payment in health systems?
An out-of-pocket payment is a direct payment made by patients at
the point of care that is not covered by any insurance or
A
reimbursement scheme. High out-of-pocket costs are a major
barrier to healthcare access and can cause financial catastrophe.
Q14 What constitutes 'catastrophic health expenditure'?
Catastrophic health expenditure occurs when a household's out-of-
pocket health spending exceeds a defined threshold (often 10–
A
25% of total household expenditure or income), pushing families
into poverty or financial hardship.
Page 3
, What is the difference between a Bismarckian and
Q15
Beveridgean health system model?
The Bismarckian model (Germany, France) is funded by payroll
contributions from employers and employees through social health
A insurance. The Beveridgean model (UK NHS) is funded through
general taxation and provides free care at point of use to all
citizens.
Q16 What is health financing?
Health financing refers to the mechanisms by which funds are
raised to pay for health services. It covers revenue collection, fund
A pooling, and purchasing of services. Effective health financing
ensures adequate resources for the health system while protecting
individuals from financial risk.
Q17 What are the three functions of health financing?
The three functions are: (1) Revenue collection — generating funds
from taxes, payroll contributions, premiums, etc.; (2) Pooling —
A accumulating prepaid funds to share financial risk across a
population; and (3) Purchasing — paying providers on behalf of the
population.
Q18 What is a capitation payment model?
Capitation is a payment model in which a provider is paid a fixed
amount per registered patient per period (e.g., per month),
A
regardless of the number of services actually used. It incentivizes
preventive care and cost control.
Q19 What is fee-for-service (FFS) payment?
Fee-for-service is a payment model where providers are paid for
A each individual service or procedure they deliver. It incentivizes
volume of care but can lead to over-servicing and increased costs.
Page 4
EXAM SOLUTIONS - COMPREHENSIVE QUESTIONS AND ANSWERS - CURRENT
VERSION (2026/2027)
Q1 What is National Health Insurance (NHI)?
NHI is a single-payer, publicly funded health system designed to
ensure that all citizens and eligible residents receive access to
A quality healthcare services regardless of their employment status,
income, or social standing. It pools health funds from various
sources to provide universal coverage.
Q2 What is the primary goal of NHI?
The primary goal of NHI is to achieve Universal Health Coverage
(UHC) — ensuring every person can access needed health services
A
(prevention, promotion, treatment, rehabilitation, and palliation)
without suffering financial hardship.
Which country pioneered the concept of a National Health
Q3
Service?
The United Kingdom pioneered the concept with the establishment
A of the National Health Service (NHS) in 1948, providing free
healthcare to all residents funded through general taxation.
Q4 What are the key principles underpinning NHI?
Key principles include universality (coverage for all), equity (fair
A distribution of services and financial burden), social solidarity
(pooling of risk across the population), quality (provision of
Page 1
, comprehensive, evidence-based care), and sustainability (long-term
financial viability of the system).
Q5 How does NHI differ from private health insurance?
NHI is publicly funded, non-profit, and provides coverage to all
eligible individuals as a right. Private insurance is voluntary, profit-
A driven, risk-rated, and may exclude pre-existing conditions. NHI
pools risk across the entire population, whereas private insurance
segments it.
Q6 What is the 'single-payer' model in the context of NHI?
In a single-payer model, one entity — typically the government —
collects health contributions from various sources and pays
A
healthcare providers on behalf of all beneficiaries, eliminating
fragmentation and reducing administrative costs.
Q7 What does Universal Health Coverage (UHC) mean?
UHC means that all people and communities can use promotive,
A preventive, curative, rehabilitative, and palliative health services
they need, of sufficient quality, without financial hardship.
What role does the World Health Organization (WHO) play in
Q8
NHI globally?
The WHO sets the global agenda for UHC, provides technical
guidance on health financing frameworks, tracks country progress
A toward UHC targets under the Sustainable Development Goals
(SDG 3.8), and supports governments in designing and
implementing NHI schemes.
Q9 What are the three dimensions of the UHC cube?
The three dimensions are: (1) population coverage — who is
covered; (2) service coverage — which services are covered; and
A
(3) financial coverage — what proportion of the cost is covered,
reducing out-of-pocket payments.
Page 2
, What is the Sustainable Development Goal (SDG) related to
Q10
UHC?
SDG 3.8 specifically targets the achievement of UHC, including
financial risk protection, access to quality essential health services,
A
and access to safe, effective, quality, and affordable essential
medicines and vaccines for all.
Q11 What is a benefit package in NHI?
A benefit package is the defined set of health services and
interventions that are covered under the NHI scheme. It outlines
A what conditions are treated, which procedures are included, and
the level of care (primary, secondary, tertiary) that beneficiaries are
entitled to.
Q12 What is meant by 'social solidarity' in health financing?
Social solidarity means that healthy individuals contribute to
covering the costs of sick individuals, and wealthier members
A subsidize care for poorer members. Risk and financial burden are
shared across the entire insured population rather than borne
individually.
Q13 What is an out-of-pocket payment in health systems?
An out-of-pocket payment is a direct payment made by patients at
the point of care that is not covered by any insurance or
A
reimbursement scheme. High out-of-pocket costs are a major
barrier to healthcare access and can cause financial catastrophe.
Q14 What constitutes 'catastrophic health expenditure'?
Catastrophic health expenditure occurs when a household's out-of-
pocket health spending exceeds a defined threshold (often 10–
A
25% of total household expenditure or income), pushing families
into poverty or financial hardship.
Page 3
, What is the difference between a Bismarckian and
Q15
Beveridgean health system model?
The Bismarckian model (Germany, France) is funded by payroll
contributions from employers and employees through social health
A insurance. The Beveridgean model (UK NHS) is funded through
general taxation and provides free care at point of use to all
citizens.
Q16 What is health financing?
Health financing refers to the mechanisms by which funds are
raised to pay for health services. It covers revenue collection, fund
A pooling, and purchasing of services. Effective health financing
ensures adequate resources for the health system while protecting
individuals from financial risk.
Q17 What are the three functions of health financing?
The three functions are: (1) Revenue collection — generating funds
from taxes, payroll contributions, premiums, etc.; (2) Pooling —
A accumulating prepaid funds to share financial risk across a
population; and (3) Purchasing — paying providers on behalf of the
population.
Q18 What is a capitation payment model?
Capitation is a payment model in which a provider is paid a fixed
amount per registered patient per period (e.g., per month),
A
regardless of the number of services actually used. It incentivizes
preventive care and cost control.
Q19 What is fee-for-service (FFS) payment?
Fee-for-service is a payment model where providers are paid for
A each individual service or procedure they deliver. It incentivizes
volume of care but can lead to over-servicing and increased costs.
Page 4
