UHCS

Union Health and Care Service

Anning Helþ ond Cær Þæning (AHCÞ)
UHCS (AHCÞ) logo, since 2006
Service overview
Formed	2 October 1906 (1906-10-02)
Jurisdiction	Esthursia
Employees	4,331,000 FTE
Annual budget	$573 billion (2024)
Minister responsible	Sian Holt, Reeve for Health and Care
Service executive	Irmen Eftby, Chairperson
Parent department	Redery of Health and Care
Website	ahcþ.org.et (Atlish)

The Union Health and Care Service, or UHCS, (Atlish: Anning Helþ ond Cær Þæning; AHCÞ) is the publicly-funded universal healthcare system serving Esthursia, with Cordane operating a similar model under the Cordane Health Agency. Established in 1911 under the guise of National Health Insurance (NHI, AHS) - a public insurance programme - it was renamed to the Union Health and Care Service and expanded heavily in the following decades - particularly under George Asmont and Tanja Olsen - to provide virtually all healthcare provision through the state. It is increasingly an umbrella term, and is often conflated to include the CHA of Cordane, as well as both the Helmark and Osynstry and the West branches of the UHCS, which have somewhat diverged thanks to devolved administrations in recent decades. All UHCS services provide a wide range of healthcare services without charge to those ordinarily resident within Esthursia.

Notable for being entirely publicly funded and its wide breadth of service provision, it ensures that all citizens have equal access to healthcare services without any cost at the point of service; since the late-2010s, the UHCS has shifted to "self-supply" models and reverted from trust systems to local authority control. The UHCS is managed by its executive board, as well as local authorities and the Redery for Health and Care.

History

Origins

The history of the idea of universal healthcare in Esthursia can be traced back as early as the 1880s, when the Workers' Union narrowly missed out on winning the 1884 election running on a slate of "pro-health and anti-wealth" campaigns, which heavily influenced successive governments' actions on sanitation, health regulation and economic affairs.

In both elections of 1905, the Liberal party under its leader Islwyn Torcall promised to institute a "universal health dividend". Following an inconclusive result in January 1905, which left the Conservative Union under Winthrop Fowler still the largest party but with no ability to pass legislation, the Liberals campaigned on "life issues" - pensions, healthcare, poverty and housing. By December 1905, after a slew of by-election losses pushed the Conservative Union below any ability to meaningfully pass legislation, the House of Ministers called a vote of no confidence, and the ensuing landslide delivered in favour of the "Liberal future" gave Islwyn Torcall a significant mandate.

The National Health Insurance programme was first founded in October 1906, making it compulsory for all citizens to pay into a health dividend which covered all emergency costs, set up an independent body for medicine pricing and out-of-plan prices, and regulated the practice of private healthcare provision more strictly. The Liberal government also built a series of non-profit hospitals which were rented out to private providers, and gradually decreased the caps over time to make it more accessible for the poor, as well as installing means-testing for "the destitute to be freed from the vice of illness-skjeld (illness debt)."

The Conservative and Liberal governments which followed made slight changes to this following the departure of Islwyn Torcall in 1911 - mainly concerning the Salisbury and Grey governments' "ping-pong" over price caps and the means-tested health funding - carried on the tradition of this social market model for Esthursian healthcare, however the 1920s saw the Forethaneship of James Thorne heavily cut back healthcare provision in Esthursia. Although still remaining a programme, Thorne rerouted most health funding to the war effort in Scalvia as well as education, tax cuts and wider defence spending - this included the scrappage of means-testing guarantees, the end to building public hospitals (and subsequent sale of nearly all public-owned hospitals permanently), and the removal of the guarantee to cover all private health costs, causing a sudden explosion in healthcare costs due to both corporate profit-seeking and an increase in the price of pharmaceutical goods and labour.

Reformation

The Workers' Union came to government in April 1926, following the landslide defeat of incumbent Conservative Forethane James Thorne over a number of issues - particularly war and economic divides - and immediately began drawing up plans for the "postwar groundlay (foundation)". The Workers' Union sought to solve the "vices of society", which they saw as:

• Poverty
• Cramptness - unsatisfactory, dirty and uncomfortable (often but not exclusively slum) housing
• Hunger (starvation)
• Wanþekking - lit. "in want of knowledge/study", unsatisfactory and inequal education
• Unevenness - economic and social inequality in income, wealth and industrial power, and by detachment berþrihtwelþ (inherited wealth and power)
• Illness
• Ondersheddingslawen - discriminatory law and application therewith against groups with less power (women and the poor in particular)

The issue of illness was seen as an essentially solvable one, with Forethane George Asmont promising to "end mass preventable illness", in that it could be naturally lessened by prevention and cure. Asmont quickly reformed the now essentially-scrapped National Health Insurance system into a fully-fledged Union Health and Care System in January 1927, and began construction of hundreds of publicly-owned hospitals as well as the prioritisation of medical degrees and production in Esthursia. Scientific curriculums in schools were reformed to make a "leap to healthcare more like a stroll", the Esthursian Medical Association (EMA) became key advisors to the government - who shared the socialists' ambition for a state-driven healthcare sector - and 20th century theory often speculated that the cost of healthcare provision would naturally go down as people lived longer and healthier. Although this proved incorrect, Esthursia's healthcare system has proven resilient, cost-effective and increased Esthursian productivity markedly.

The crux of the reform was that not only would funding be public - as was the case before the Scalvian War, a model that political theory in Esthursia more associated with the Liberal party - but also provision and supply of goods would be nationalised. Local authorities were given sweeping powers over administration, with government funding moved straight to these sectors, while virtually all medical issues - including prescriptions - were to be provided free-at-the-point-of-access. Esthursia's Workers' Union compromised with its moderate faction in not totally banning private healthcare, which Asmont considered a "leech on the blood of the nation", but a sweeping programme of nationalisations essentially relegated the private health sector to irrelevance in Esthursia from the late 1920s onwards.

The Fascist Wars and transition of the Workers' Union into a more actively progressive socialist party under Tanja Olsen in the 1940s brought the issue of prevention closer to the forefront - the government set up a rudimentary childcare programme to link with the war effort and the UHCS, while the UHCS (by now a fully-fledged universal healthcare system) focused on expanding its capacity in Cordane, the only area of Esthursia where fighting took place in the 1940s.

The average person's life expectancy went from approximately 49 in 1925 to 73 in 1955, while the UHCS increased productivity in the economy markedly along with the Workers' Union other postwar societal reforms, causing the Esthursian economic miracle to develop between 1930 and 1950.

Mid-century

The government of Olafn Arbjern, though distasting of its more socialist heritage, believed that the Esthursian healthcare system could be touted as a national heritage piece - his rebranding of it colloquially as the Esthursian Health Service, and later control of public expression from its workers (who leant left politically and thus were highly critical of him openly), masked a larger acceptance of the UHCS. This stood out as one of the few consensus issues between the far-left Workers' Union and far-right Nationalist Party, as other issues such as public welfare, women's rights, homosexuality and education proved more divisive.

The Liberal government of Edith Newell phased out its self-supply model gradually in the 1960s for "non-essential goods"; despite an effort by the subsequent Social Democratic governments under James Seddon and David Holmfirth to renationalise supply, the Greenwood administration privatised the UHCS supply infrastructure, while giving it significant independence from local authorities with a trusts system. The last term of Greenwood's government floated the notion of introducing private healthcare into public funding nets, however staunch opposition on the centrist wing of the party and the decline of the party's fortunes in the late 1980s saw these plans never enter fruition.

Modern history

The governments of Mark Willesden (Social Democratic) and Isaac Harding (Conservative), as well as Tharbjorn Einarsson (Conservative) to a lesser extent, saw the UHCS undergo a period of private "entryism" - whereby private companies increasingly provided UHCS services and received contracts - while the wider UHCS budget underwent a period of relative stagnation.

Eligibility

The UHCS provides for free-at-the-point-of-use treatment for all "mainstay dwellers" of Esthursia - the term "mainstay dweller" referring to anyone ordinarily resident in Esthursia, including non-citizens "normally finding Esthursia their home at the time" - and payment plans for those not applicable to this category capped at 150% of the "real price" of the treatment. All Esthurs pay into a social care fund, which accumulates over the course of their life, to a set amount - those who are incapable of paying receive the payment from the Chancellory.

The Union Health and Care Service was once free for all with no criteria for residency, however the issue of health tourism was a long-held problem felt by the Conservative Union, who in the 2000s instituted the "mainstay dweller" status for wider welfare programmes. George Asmont spoke out against the criteria, calling it a "wedge to hold the door of costly healthcare open with," and was a key campaigner in his old age against the Greenwood government's plans to institute a similar idea in the 1980s.

Performance

Esthursia's healthcare system consistently ranks in the highest rungs of the world's healthcare systems, especially for efficiency, health outcomes and protection of lower-income groups. Its performance receded slightly in the late 2000s and early 2010s thanks to the effect of reduced capital and stagnating funding, however the post-recession period has seen its performance return to - in some respects, also exceeding - pre-austerity performance levels.

Hospital beds

There were approximately 278,000 hospital beds in Esthursia as of 2020.