• US mapUnited States

    As of 2022, Americans obtain insurance through a complex mix of public and private, for-profit and nonprofit insurers, and approximately 10% of Americans lack health insurance. Roughly 80% of hospitals are not-for-profit, 15% are for-profit, and 5% are operated by the federal or local governments. Physicians are generally paid fee-for-service, though this has been changing since the passage of the Affordable Care Act. The federal government directly funds health insurance for seniors (adults aged 65 and older), people on dialysis and certain individuals with disabilities through the national Medicare program. There are additional government insurance programs for veterans and individuals with low-income (Medicaid and the Children’s Health Insurance Program). States and local government manage and pay for aspects of coverage for the safety net. Private insurance, the dominant form of coverage, is provided primarily by employers. Arguably the defining concerns in U.S. healthcare have been high spending (costs/prices) and lack of universal health insurance. (Read more from the Commonwealth Foundation, the Kaiser Family Foundation, and Health Affairs)

  • CA mapCanada

    The Canadian government provides insurance through a national health insurance model (Canadian Medicare) administered by each of the country’s 13 provinces and territories. Each jurisdiction has its own insurance plan, meaning that available services can differ somewhat across jurisdictions, subject to certain overarching federal requirements. All citizens and permanent residents receive medically necessary hospital and physician services without co-payments or cost-sharing. Canada lacks any meaningful private delivery system meaning that virtually all hospital and physician services are paid for and delivered by the public system. Common concerns in Canadian healthcare have included issues of capacity/access to physician and hospital services as well as a lack of national drug or vision/dental/hearing coverage. (Read more from The Commonwealth Fund, JAMA, and the Government of Canada)

  • Eng mapEngland

    All English citizens and legal residents receive health insurance through the National Health Service (NHS), including access to hospital and physician services through the public system, generally without user fees or cost sharing. The National Health Service budget is funded primarily through general taxation. The overarching federal program NHS England, oversees and allocates funds to 191 local Clinical Commissioning Groups, which govern and pay for care delivery at the local level; there are separate but similar systems for Scotland, Ireland, and Wales. England also has a parallel private system of hospitals and physicians are able to work in both the public system and the private system; generally, costs/prices/reimbursement to physicians is higher in the private system. Common concerns for the NHS include cost/spending to the government and patient access to hospital and physician services. (Read more from The Commonwealth Fund, the British Medical Journal, and the NHS)

  • Neth mapNetherlands

    The Netherlands achieves universal health insurance coverage by requiring all legal residents to purchase insurance through a finite number of carefully regulated private insurance companies. These companies must provide a specified basket of services, but have discretion around additional services to be included.The private companies largely receive their revenue from the government, but enrollees also pay a modest monthly premium, with some exceptions for people with very low income. The national government is responsible for setting health care priorities and monitoring access, quality, and costs. Standard benefits include hospital, physician, home nursing, and mental health care, as well as prescription drugs. Enrollees typically have copayments on select services and drugs. The government pays for children’s coverage up to age 18. (Read more from the Commonwealth Fund, the Dutch government, and the New England Journal of Medicine)

  • Is descIsrael

    Israel provides health insurance to all citizens and permanent residents as part of its national health insurance program. People can choose from four competing nonprofit health plans that provide a mandated benefit package, including hospital, primary, specialty, mental health, and maternity care, as well as prescription drugs and other services. Insurance plans do include cost-sharing for specialist visits and prescription medications. Insurance is funded primarily through taxes, but supplemented by out-of-pocket payments. Most citizens also purchase voluntary health insurance for medications not covered by the benefit package and for faster access and greater provider choice. Israel also has a parallel private care system that can provide additional services and better access, but at a higher cost to patients. (Read more from the Commonwealth Fund and the Israel Journal of Health Policy Research)

  • Taiwan mapTaiwan

    Taiwan’s national health insurance (NHI) system was created in 1995.  The NHI provides coverage to all legal residents of Taiwan and there is very little private care delivery outside of the public system. Taiwan’s single payer system is generally financed through a payroll tax, but there are substantial subsidies provided to people with lower incomes. Physician practices are generally private and paid fee-for-service.  Hospitals are a mix of public and private not-for-profit and are generally reimbursed on a fee-for-service (DRG) basis. Long-term care, a more recent addition, is provided separately. Taiwan’s NHI has been recognized for its low costs and good population-health, but there is growing pressure for better access to high-cost tertiary and quaternary care services. (Read more from the Commonwealth Fund and Vox Media)