There is no single way to achieve universal health care — countries have done it in many different manners. Some have systems built on a foundation of public health coverage; others lean more heavily toward the private sector. Building largely on information from The Commonwealth Fund, we’ve compiled six examples.
Switzerland
Basic coverage: Residents must purchase basic health insurance from private, nonprofit insurers.
Basic coverage funding: Individuals must pay premiums. The government also contributes via general taxes and other funding.
Cost-sharing: Individuals pay out of pocket for services like primary care, specialty care, hospitalizations and prescriptions drugs, up to an annual deductible. After that’s met, patients pay coinsurance up to a cap. Hospitals also charge a small amount per day for stays.
Supplemental or alternate coverage: People can also purchase supplemental private insurance from for-profit insurers for services not covered by the basic plan, to get a greater choice of physicians, or to get better hospital rooms.
Notes: The government may help individuals with income-based premium subsidies.
The Netherlands
Basic coverage: Residents must purchase basic health insurance from private, nonprofit insurers.
Basic coverage funding: Individuals must pay premiums, and employers pay payroll taxes. The government also contributes via a central health insurance fund supplied by income taxes and government grants.
Cost-sharing: Individuals pay out of pocket for things like hospital admissions, specialist services and prescription drugs, up to a deductible. After that, copayments, coinsurance or direct payments may be required for select services, like physiotherapy, medical devices and out-of-network care.
Supplemental or alternate coverage: People can also purchase supplemental insurance for services not covered by the basic plan, like dental care and contraceptives, or brand name drugs.
Notes: The government may help individuals with income-based premium subsidies.
Germany
Basic coverage: Residents under a certain income are required to enroll in one of many private, nonprofit health insurance plans known as sickness funds.
Basic coverage funding: Most funding comes from income-dependent wage contributions for each individual (up to a ceiling). This cost is split between the individual and their employer. These contributions are pooled by the government in a central fund along with a tax subsidy, and then reallocated to individual sickness funds. Some individual sickness funds also charge income-dependent contributions on top of that, also split between employees and employers.
Cost-sharing: There is no deductible for basic coverage. Certain services, like prescription drugs, medical devices and hospital care, require copayments. There’s an annual out-of-pocket maximum based on income.
Supplemental or alternate coverage: Individuals above a certain income can opt out of buying into a sickness fund and instead purchase private health insurance. People in sickness funds can also purchase supplemental insurance to help with payments for things like dental care or private hospital rooms.
Notes: Individuals in certain fields, like civil servants, may also be able to opt for private health insurance or be insured through a different government program.
Canada
Basic coverage: As part of the nation’s overall health care program, residents are automatically enrolled in the health insurance program of their home territory or province.
Basic coverage funding: Provincial and territorial taxes and federal funding.
Cost-sharing: Applies only to non-covered benefits, such as outpatient prescription drugs or dental care.
Supplemental or alternate coverage: People can buy private insurance or receive it through their employers to help pay for outpatient prescription drugs and other services. Provinces or territories also offer outpatient drug plans.
Notes: Individuals with significant out-of-pocket expenses can get tax credits. Private hospital rooms may charge a fee.
Australia
Basic coverage: Citizens are automatically enrolled in a universal public health insurance program. Non-citizens may be allowed access to the program or may be treated as private-pay patients.
Basic coverage funding: A government levy on individuals and other tax revenue. The government may also charge a tax penalty on higher-income households that do not buy private insurance.
Cost-sharing: There are no deductibles or out-of-pocket costs for care at public hospitals. Patients can incur cost-sharing for outpatient visits and outpatient pharmaceuticals, but the government generally caps out-of-pocket fees. Certain medicines may not be covered at all.
Supplemental or alternate coverage: About half of Australians buy private supplementary insurance to pay for such things as private hospital care and dental and vision care.
Notes: The government may help individuals with income-based premium rebates for private insurance.
England
Basic coverage: Residents are automatically enrolled in public health coverage.
Basic coverage funding: General taxation, plus a payroll tax paid by employers and employees.
Cost-sharing: Limited to certain services, like some travel vaccinations or dentistry, and out-patient prescription drugs. Individuals can purchase a yearly certificate that will cover all pharmaceuticals.
Supplemental or alternate coverage: Residents can purchase private insurance, primarily to gain faster access to elective care.
Notes: Each country inside the United Kingdom (England, Scotland, Wales and Northern Ireland) has its own National Health Service program providing universal health care, but there are differences between them. Private hospitals may not be covered by England’s National Health Service. Certain visitors to the country may have to pay a health surcharge.
