In private health insurance, premiums are paid directly from employers, associations, individuals and families to insurance companies, which pool risks across their membership base. Private insurance includes policies sold by commercial for profit firms, non-profit companies, and community health insurers. Generally, private insurance is voluntary, in contrast to social insurance programs, which tend to be compulsory. [ 23 ] In some countries with universal coverage, private insurance often excludes many health conditions which are expensive and which the state health care system can provide. For example, in the United Kingdom, one of the largest private health care providers is BUPA , which has a long list of general exclusions even in its highest coverage policy, [ 24 ] most of which are routinely provided by the National Health Service . In the United States, dialysis treatment for end stage renal failure is generally paid for by government and not by the insurance industry. Persons with privatized Medicare ( Medicare Advantage ) are the exception and must get their dialysis paid through their insurance company, but persons with end stage renal failure generally cannot buy Medicare Advantage plans. [ 25 ] The Planning Commission of India has also suggested that the country should embrace insurance to achieve universal health coverage. [ 26 ] General tax is currently used to meet the essential health requirements of all people. A particular form of private health insurance that has often emerged in environments where financial risk protection mechanisms only have a limited impact is