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national health insurance A system for public funding of the costs citizens incur when they require personal medical and hospital care. Many nations provide at least partial support from the public purse for some of their citizens, and in many OECD (Organization for Economic Cooperation and Development) nations personal medical care and hospital costs are wholly or partly publicly funded. This has been an evolving process since it was introduced by the German Chancellor Otto von Bismarck (1815–98) in 1883–4. The British National Health Service (NHS) introduced in 1948 provides comprehensive tax-supported personal and hospital care, but financial constraints and rising costs have eroded some aspects, and fees are now charged for some aspects of care. By the late 1980s, all European Union nations and all OECD nations except the United States had comprehensive publicly funded personal health care services, usually with the proviso that people pay additional personal expenses.