to further rises in premiums, and a vicious cycle of higher premiums-leaving members would ensue. the australian government has introduced a number of incentives to encourage adults to take out private hospital insurance. these include: lifetime health cover: if a person has not taken out private hospital cover by 1 july after their 31st birthday, then when (and if) they do so after this time, their premiums must include a loading of 2% per annum for each year they were without hospital cover. thus, a person taking out private cover for the first time at age 40 will pay a 20 percent loading. the loading is removed after 10 years of continuous hospital cover. the loading applies only to premiums for hospital cover, not to ancillary (extras) cover. medicare levy surcharge: people whose taxable income is greater than a specified amount (in the 2011/12 financial year $80,000 for singles and $168,000 for couples) and who do not have an adequate level of private hospital cover must pay a 1% surcharge on top of the standard 1.5% medicare levy. the rationale is that if the people in this income group are forced to pay more money one way or another, most would choose to purchase hospital insurance with it, with the possibility of a benefit if they need private hospital treatment – rather than pay it in the form of extra tax as well as having to meet their own private hospital costs. the australian government announced in may 2008 that it proposes to increase the thresholds, to $100,000 for singles and $150,000 for families. these changes require legislative approval. a bill to change the law has been introduced but was not passed by the senate. an amended version was passed on 16 october 2008. there have been criticisms that the changes will cause many people to drop their private health insurance, causing a further burden on the public hospital system, and a rise in premiums for those who stay with the private system. other commentators believe the effect will be minimal. private health insurance rebate: the government subsidises the premiums for all private health insurance cover, including hospital and ancillary (extras), by 10%, 20% or 30%, depending on age. the rudd government announced in may 2009 that as of july 2010, the rebate would become means-tested, and offered on a sliding scale. while this move (which would have required legislation) was defeated in the senate at the time, in early 2011 the gillard government announced plans to reintroduce the legislation after the opposition loses the balance of power in the senate. the alp and greens have long been against the rebate, referring to it as "middle-class welfare". canada main article: health care in canada as per the constitution of canada, health care is mainly a provincial government responsibility in canada (the main exceptions being federal government responsibility for services provided to aboriginal peoples covered by treaties, the royal canadian mounted police, the armed forces, and members of parliament). consequently, each province administers its own health insurance program. the federal government influences health insurance by virtue of its fiscal powers – it transfers cash and tax points to the provinces to help cover the costs of the universal health insurance programs. under the canada health act, the federal government mandates and enforces the requirement that all people have free access to what are termed "medically necessary services," defined primarily as care delivered by physicians or in hospitals, and the nursing component of long-term residential care. if provinces allow doctors or institutions to charge patients for medically necessary services, the federal government reduces its payments to the provinces by the amount of the prohibited charges. collectively, the public provincial health insurance systems in canada are frequently referred to as medicare. this public insurance is tax-funded out of general government revenues, although british columbia and ontario levy a mandatory premium with flat rates for individuals and families to generate additional revenues - in essence, a surtax. private health insurance is allowed, but in six provincial governments only for services that the public health plans do not cover (for example, semi-private or private rooms in hospitals and prescription drug plans). four provinces allow insurance for services also mandated by the canada health act, but in practice, there is no market for it. all canadians are free to use private insurance for elective medical services such as laser vision correction surgery, cosmetic surgery, and other non-basic medical procedures. some 65% of canadians have some form of supplementary private health insurance; many of them receive it through their employers. private-sector services not paid for by the government account for nearly 30 percent of total health care spending. in 2005, the supreme court of canada ruled, in chaoulli v. quebec, that the province's prohibition on private insurance for health care already insured by the provincial plan violated the quebec charter of rights and freedoms, and in particular, the sections dealing with the right to life and security, if there were unacceptably long wait times for treatment, as was alleged in this case. the ruling has not changed the overall pattern of health insurance across canada, but has spurred on attempts to tackle the core issues of supply and demand and the impact of wait times. china main articles: healthcare reform in the people's republic of china and pharmaceutical industry in the people's republic of china cyprus in 2020 in cyprus it was introduced the general healthcare system (ghs, also known as gesy) which is an independent insurance fund through which clinics, private doctors, pharmacists, laboratories, microbiological laboratories, and physiotherapists will be paid so that they can offer medical care to permanent residents of cyprus who will be paying contributions to this fund. in addition to gesy, more than 12 local and international insurance companies (e.g. bupa, aetna, cigna, metlife) provide individual and group medical insurance plans. the plans are divided into two main categories plans providing coverage from inpatient expenses (i.e. hospitalization, operations) and plans covering inpatient and outpatient expenses (such as doctor visits, medications, physio-therapies). france main article: health care in france the national system of health insurance was instituted in 1945, just after the end of the second world war. it was a compromise between gaullist and communist representatives in the french parliament. the conservative gaullists were opposed to a state-run healthcare system, while the communists were supportive of a complete nationalisation of health care along a british beveridge model. the resulting programme is profession-based: all people working are required to pay a portion of their income to a not-for-profit health insurance fund, which mutualises the risk of illness, and which reimburses medical expenses at varying rates. children and spouses of insured people are eligible for benefits, as well. each fund is free to manage its own budget, and used to reimburse medical expenses at the rate it saw fit, however following a number of reforms in recent years, the majority of funds provide the same level of reimbursement and benefits. the government has two responsibilities in this system. the first government responsibility is the fixing of the rate at which medical expenses should be negotiated, and it does so in two ways: the ministry of health directly negotiates prices of medicine with the manufacturers, based on the average price of sale observed in neighboring countries. a board of doctors and experts decides if the medicine provides a valuable enough medical benefit to be reimbursed (note that most medicine is reimbursed, including homeopathy). in parallel, the government fixes the reimbursement rate for medical services: this means that a doctor is free to charge the fee that he wishes for a consultation or an examination, but the social security system will only reimburse it at a pre-set rate. these tariffs are set annually through negotiation with doctors' representative organisations. the second government responsibility is oversight of the health-insurance funds, to ensure that they are correctly managing the sums they receive, and to ensure oversight of the public hospital network. today, this system is more or less intact. all citizens and legal foreign residents of france are covered by one of these mandatory programs, which continue to be funded by worker participation. however, since 1945, a number of major changes have been introduced. firstly, the different health care funds (there are five: general, independent, agricultural, student, public servants) now all reimburse at the same rate. secondly, since 2000, the government now provides health care to those who are not covered by a mandatory regime (those who have never worked and who are not students, meaning the very rich or the very poor). this regime, unlike the worker-financed ones, is financed via general taxation and reimburses at a higher rate than the profession-based system for those who cannot afford to make up the difference. finally, to counter the rise in health care costs, the government has installed two plans, (in 2004 and 2006), which require insured people to declare a referring doctor in order to be fully reimbursed for specialist visits, and which installed a mandatory co-pay of €1 for a doctor visit, €0.50 for each box of medicine prescribed, and a fee of €16–18 per day for hospital stays and for expensive procedures. an important element of the french insurance system is solidarity: the more ill a person becomes, the less the person pays. this means that for people with serious or chronic illnesses, the insurance system reimburses them 100% of expenses, and waives their co-pay charges. finally, for fees that the mandatory system does not cover, there is a large range of private complementary insurance plans available. the market for these programs is very competitive, and often subsidised by the employer, which means that premiums are usually modest. 85% of french people benefit from complementary private health insurance. germany main article: healthcare in germany germany has the world's oldest national social health insurance system, with origins dating back to otto von bismarck's sickness insurance law of 1883. beginning with 10% of blue-collar workers in 1885, mandatory insurance has expanded; in 2009, insurance was made mandatory on all citizens, with private health insurance for the self-employed or above an income threshold. as of 2016, 85% of the population is covered by the compulsory statutory health insurance (shi) (gesetzliche krankenversicherung or gkv), with the remainder covered by private insurance (private krankenversicherung or pkv). germany's health care system was 77% government-funded and 23% privately funded as of 2004. while public health insurance contributions are based on the individual's income, private health insurance contributions are based on the individual's age and health condition. reimbursement is on a fee-for-service basis, but the number of physicians allowed to accept statutory health insurance in a given locale is regulated by the government and professional societies. co-payments were introduced in the 1980s in an attempt to prevent over utilization. the average length of hospital stay in germany has decreased in recent years from 14 days to 9 days, still considerably longer than average stays in the united states (5 to 6 days). part of the difference is that the chief consideration for hospital reimbursement is the number of hospital days as opposed to procedures or diagnosis. drug costs have increased substantially, rising nearly 60% from 1991 through 2005. despite attempts to contain costs, overall health care expenditures rose to 10.7% of gdp in 2005, comparable to other western european nations, but substantially less than that spent in the u.s. (nearly 16% of gdp). germans are offered three kinds of social security insurance dealing with the physical status of a person and which are co-financed by employer and employee: health insurance, accident insurance, and long-term care insurance. long-term care insurance (gesetzliche pflegeversicherung) emerged in 1994 and is mandatory. accident insurance (gesetzliche unfallversicherung) is covered by the employer and basically covers all risks for commuting to work and at the workplace. greece the national health system in greece covers both out and in-patient treatment. the out-patient treatment is carried out by social administrative structures as following: eoppy (national organization for the provision of health services): contracted private healthcare providers pedy (national primary healthcare network) units: public healthcare state hospitals, rural and regional medical units, health centers of the esy (national health system) private health professionals: medical professionals and services not contracted with eopyy. the