of hospitalization. this can include complementary medicine, routine dental treatment and private ward hospitalization, which are not covered by the compulsory insurance. as far as the compulsory health insurance is concerned, the insurance companies cannot set any conditions relating to age, sex or state of health for coverage. although the level of premium can vary from one company to another, they must be identical within the same company for all insured persons of the same age group and region, regardless of sex or state of health. this does not apply to complementary insurance, where premiums are risk-based. switzerland has an infant mortality rate of about 3.6 out of 1,000. the general life expectancy in 2012 was for men 80.5 years compared to 84.7 years for women. these are the world's best figures. united kingdom main article: national health service the uk's national health service (nhs) is a publicly funded healthcare system that provides coverage to everyone normally resident in the uk. it is not strictly an insurance system because (a) there are no premiums collected, (b) costs are not charged at the patient level and (c) costs are not pre-paid from a pool. however, it does achieve the main aim of insurance which is to spread financial risk arising from ill-health. the costs of running the nhs (est. £104 billion in 2007–8) are met directly from general taxation. the nhs provides the majority of health care in the uk, including primary care, in-patient care, long-term health care, ophthalmology, and dentistry. private health care has continued parallel to the nhs, paid for largely by private insurance, but it is used by less than 8% of the population, and generally as a top-up to nhs services. there are many treatments that the private sector does not provide. for example, health insurance on pregnancy is generally not covered or covered with restricting clauses. typical exclusions for bupa schemes (and many other insurers) include: aging, menopause and puberty; aids/hiv; allergies or allergic disorders; birth control, conception, sexual problems and sex changes; chronic conditions; complications from excluded or restricted conditions/ treatment; convalescence, rehabilitation and general nursing care ; cosmetic, reconstructive or weight loss treatment; deafness; dental/oral treatment (such as fillings, gum disease, jaw shrinkage, etc.); dialysis; drugs and dressings for out-patient or take-home use† ; experimental drugs and treatment; eyesight; hrt and bone densitometry; learning difficulties, behavioural and developmental problems; overseas treatment and repatriation; physical aids and devices; pre-existing or special conditions; pregnancy and childbirth; screening and preventive treatment; sleep problems and disorders; speech disorders; temporary relief of symptoms. († = except in exceptional circumstances) there are a number of other companies in the united kingdom which include, among others, chubb limited, axa, aviva, bupa, groupama healthcare, wpa and vitalityhealth. similar exclusions apply, depending on the policy which is purchased. in 2009, the main representative body of british medical physicians, the british medical association, adopted a policy statement expressing concerns about developments in the health insurance market in the uk. in its annual representative meeting which had been agreed earlier by the consultants policy group (i.e. senior physicians) stating that the bma was "extremely concerned that the policies of some private healthcare insurance companies are preventing or restricting patients exercising choice about (i) the consultants who treat them; (ii) the hospital at which they are treated; (iii) making top up payments to cover any gap between the funding provided by their insurance company and the cost of their chosen private treatment." it went in to "call on the bma to publicise these concerns so that patients are fully informed when making choices about private healthcare insurance." the practice of insurance companies deciding which consultant a patient may see as opposed to gps or patients is referred to as open referral. the nhs offers patients a choice of hospitals and consultants and does not charge for its services. the private sector has been used to increase nhs capacity despite a large proportion of the british public opposing such involvement. according to the world health organization, government funding covered 86% of overall health care expenditures in the uk as of 2004, with private expenditures covering the remaining 14%. nearly one in three patients receiving nhs hospital treatment is privately insured and could have the cost paid for by their insurer. some private schemes provide cash payments to patients who opt for nhs treatment, to deter use of private facilities. a report, by private health analysts laing and buisson, in november 2012, estimated that more than 250,000 operations were performed on patients with private medical insurance each year at a cost of £359 million. in addition, £609 million was spent on emergency medical or surgical treatment. private medical insurance does not normally cover emergency treatment but subsequent recovery could be paid for if the patient were moved into a private patient unit. united states main articles: health insurance in the united states and health care in the united states short term health insurance on the 1st of august, 2018 the dhhs issued a final rule which made federal changes to short-term, limited-duration health insurance (stldi) which lengthened the maximum contract term to 364 days and renewal for up to 36 months. this new rule, in combination with the expiration of the penalty for the individual mandate of the affordable care act, has been the subject of independent analysis. the united states health care system relies heavily on private health insurance, which is the primary source of coverage for most americans. as of 2018, 68.9% of american adults had private health insurance, according to the center for disease control and prevention. the agency for healthcare research and quality (ahrq) found that in 2011, private insurance was billed for 12.2 million u.s. inpatient hospital stays and incurred approximately $112.5 billion in aggregate inpatient hospital costs (29% of the total national aggregate costs). public programs provide the primary source of coverage for most senior citizens and for low-income children and families who meet certain eligibility requirements. the primary public programs are medicare, a federal social insurance program for seniors and certain disabled individuals; and medicaid, funded jointly by the federal government and states but administered at the state level, which covers certain very low income children and their families. together, medicare and medicaid accounted for approximately 63 percent of the national inpatient hospital costs in 2011. schip is a federal-state partnership that serves certain children and families who do not qualify for medicaid but who cannot afford private coverage. other public programs include military health benefits provided through tricare and the veterans health administration and benefits provided through the indian health service. some states have additional programs for low-income individuals. in the late 1990s and early 2000s, health advocacy companies began to appear to help patients deal with the complexities of the healthcare system. the complexity of the healthcare system has resulted in a variety of problems for the american public. a study found that 62 percent of persons declaring bankruptcy in 2007 had unpaid medical expenses of $1000 or more, and in 92% of these cases the medical debts exceeded $5000. nearly 80 percent who filed for bankruptcy had health insurance. the medicare and medicaid programs were estimated to soon account for 50 percent of all national health spending. these factors and many others fueled interest in an overhaul of the health care system in the united states. in 2010 president obama signed into law the patient protection and affordable care act. this act includes an 'individual mandate' that every american must have medical insurance (or pay a fine). health policy experts such as david cutler and jonathan gruber, as well as the american medical insurance lobby group america's health insurance plans, argued this provision was required in order to provide "guaranteed issue" and a "community rating," which address unpopular features of america's health insurance system such as premium weightings, exclusions for pre-existing conditions, and the pre-screening of insurance applicants. during 26–28 march, the supreme court heard arguments regarding the validity of the act. the patient protection and affordable care act was determined to be constitutional on 28 june 2012. the supreme court determined that congress had the authority to apply the individual mandate within its taxing powers. history and evolution main articles: health insurance in the united states § history, and managed care in the late 19th century, "accident insurance" began to be available, which operated much like modern disability insurance. this payment model continued until the start of the 20th century in some jurisdictions (like california), where all laws regulating health insurance actually referred to disability insurance. accident insurance was first offered in the united states by the franklin health assurance company of massachusetts. this firm, founded in 1850, offered insurance against injuries arising from railroad and steamboat accidents. sixty organizations were offering accident insurance in the u.s. by 1866, but the industry consolidated rapidly soon thereafter. while there were earlier experiments, the origins of sickness coverage in the u.s. effectively date from 1890. the first employer-sponsored group disability policy was issued in 1911. before the development of medical expense insurance, patients were expected to pay health care costs out of their own pockets, under what is known as the fee-for-service business model. during the middle-to-late 20th century, traditional disability insurance evolved into modern health insurance programs. one major obstacle to this development was that early forms of comprehensive health insurance were enjoined by courts for violating the traditional ban on corporate practice of the professions by for-profit corporations. state legislatures had to intervene and expressly legalize health insurance as an exception to that traditional rule. today, most comprehensive private health insurance programs cover the cost of routine, preventive, and emergency health care procedures. they also cover or partially cover the cost of certain prescription and over-the-counter drugs. insurance companies determine what drugs are covered based on price, availability, and therapeutic equivalents. the list of drugs that an insurance program agrees to cover is called a formulary. additionally, some prescriptions drugs may require a prior authorization before an insurance program agrees to cover its cost. the numbers of americans lacking health insurance and the uninsured rate from 1987 to 2008 hospital and medical expense policies were introduced during the first half of the 20th century. during the 1920s, individual hospitals began offering services to individuals on a pre-paid basis, eventually leading to the development of blue cross organizations. the predecessors of today's health maintenance organizations (hmos) originated beginning in 1929, through the 1930s and on during world war ii. the employee retirement income security act of 1974 (erisa) regulated the operation of a health benefit plan if an employer chooses to establish one, which is not required. the consolidated omnibus budget reconciliation act of 1985 (cobra) gives an ex-employee the right to continue coverage under an employer-sponsored group health benefit plan. through the 1990s, managed care insurance schemes including health maintenance organizations (hmo), preferred provider organizations, or point of service plans grew from about 25% us employees with employer-sponsored coverage to the vast majority. with managed care, insurers use various techniques to address costs and improve quality, including negotiation of prices ("in-network" providers), utilization management, and requirements for quality assurance such as being accredited by accreditation schemes such as the joint commission and the american accreditation healthcare commission. employers and employees may have some choice in the details of plans, including health savings accounts, deductible, and coinsurance. as of 2015, a trend has emerged for employers to offer high-deductible plans, called consumer-driven healthcare plans which place more costs on employees, while employees benefit by paying lower monthly premiums. additionally, having a high-deductible plan allows employees to open a health savings account, which allows them to contribute pre-tax savings towards future medical needs. some employers will offer multiple plans to their employees. russia the private health insurance market, known in russian as "voluntary health insurance" (russian: добровольное медицинское страхование, дмс) to distinguish it from state-sponsored mandatory medical insurance, has experienced sustained levels of growth. it was introduced in october 1992.