Unified Healthcare Services

The Unified Healthcare Services (UHS) is the umbrella organisation to which the various publicly funded healthcare systems of the Republic of Énqusqó (RCE) belong. The first of these services to be funded out of general taxation of the public came in 1953, shortly after the signing of the Treaty of Póo Mín Tsetli, however the modern UHS wasn't created until 1969. The need for public healthcare was quickly extrapolated from the rights and freedoms declared under the treaty - healthcare was to be universal, comprehensive and gratuitous. None of the constituent health services are officially known under the "UHS" name, however, they are all referred to as such colloquially. In the wake of the Third World War and the growing integration of the United Cities (UC) during the 1960s, the various public healthcare services of the newly founded RCE were unified under one central healthcare service. All UHS organisations provide a wide array of health services, including dental, mental and optical health, free of charge at the point of use to all who are resident within the RCE. In many of the southern city-states, patients pay for their prescriptions, although national legislation exempts some populations from such charges.

The sum total of the 36 healthcare services under the UHS have a large purchasing power in the drugs market and often the UHS uses this power, based on its own assessments of the fair price of drugs, to influence global pricing. This usually maintains a lower global price of drugs. Several other countries within the RCE's sphere of influence have taken to copying the UHS model, with some services being dependent on the UHS's assessment of drug prices. Moreover, as there is a growing pharmaceutical industry in the RCE, the UHS capitalises on the development and distribution of several drugs and hospitals across the UHS are becoming globally renowned sites of medical research.

In 2019-2020, the UHS employed around 500,000 people across the RCE with a budget of ꤊ90.3 billion. It is one of the biggest employers in the world and is the [ORDINAL] largest non-military public organisation in the world.

History
Under the UC, all participant member states had some means of public healthcare, although the direct method of achieving this varied from state to state, with the most common strategies being public health insurance and funding through public taxation. During WWIII, the necessity to provide medical aid to the wounded caused the various public health services of the UC to coordinate resources as if they were one organisation. This temporary pooling of manpower had proved extremely successful and was much applauded after the war.

The issue of a unified healthcare service between member states of the UC was a popular topic of political debate during the early 60s. Despite pressure being placed on the leaders in the Regal Senate and the Regal Council, there was not seen to be an adequately feasible way to create an international healthcare service to which all parties could agree. The topic of a unified public healthcare system became popular again in the later 60s after the 1967 amendments solidified the UC into the RCE. During her first term as Grand Senator, Tsétli Mín Xénya appointed Zu Va Lín as the first ever Health Consul and charged him with seeing through the unification of the many health services within the nascent republic. This took until Tsétli Mín's second term as Grand Senator to achieve, as large amounts of fiscal legislation had to be moved through the new Public Senate.

The resulting organisation, the UHS, acted more like a standards agency headed by the Health Consul. It standardised practice, services, funding and prescription across the whole republic. Funding distributed from the central government was intended to be supplemented by the funding of the respective states, and many decisions still remain within their jurisdiction.

A key debate that surrounded the establishment of the UHS was the nature of public health in the republic. During this debate, the three founding axioms that underpin the ethos of the service (universal, comprehensive and gratuitous) were devised. An aspect of this was the abolishment of public health insurance and replacing it with taxation-based funding for the various UHS providers. This originally did not include provision for dental, mental or optical health, which were expected to be funded privately by citizens, nor was there an expectation that drugs prescribed outside of a hospital setting would be paid for by the state, even if the state would provide them.

In 1998, after the incorporation of the Riyatan territories, there were calls to review the lack of dental, mental and optical care provision through the UHS. Despite lobbying from private sector investors, the RCE government passed legislation to expand the UHS into providing care in these sectors. A similar movement in 2012 to gain subsidised prescriptions was less successful, although it caused the government to legislate to allow certain populations where prescription would have a 'profound and unavoidable' impact on their finances exemption from prescription charges.

Treatment eligibility
Anyone who is resident in the RCE is able to use the UHS without being charged the full cost of any service they require, although prescription charges are still common in many city-states. As of 2012, certain populations are exempt from prescription charges due to negative impacts upon their financial wellbeing.

Since the foundation of the UHS, there have been questions surrounding health tourism and the provision of healthcare to visitors from overseas. The polemic was interpreted liberally in the past, however, growing political strain in the RCE has fostered a more restricted approach. Several solutions and legislative measures have been put in place by various governments since the UHS's establishment, mostly in the form of visitors requiring documentation in order to gain access to services as if resident.

Access to primary healthcare, and secondary emergency healthcare that does not require hospital admission have been deemed free for all, regardless of residency or citizenship. Citizens of the Kidal Sea Cooperative Union (KSCU) who have the relevant health insurance card are entitled to access the UHS as if residents of the RCE, alongside citizens of countries with which the RCE has bilateral health insurance agreements. Visitors to the RCE that intend to have an extended but temporary stay must pay an additional charge on their visas, in this way they are able to access services as if they are resident.

There are some groups of people to whom access to public services are always provided as if resident, such as students, government officials, armed forces personal stationed overseas and individuals under 21 years of age.