Comparing International Programs for Universal Coverage

Comparing International Programs for Universal Coverage


A recent study from the Commonwealth Fund has an excellent analysis that compares universal health programs in 12 other wealthy developed nations on several important components: the roles of the federal government, the roles of private health insurance, and the role of consumer cost sharing.


Most of these countries programs differ from the Medicare for All proposals of Senator Sanders and Representative Ocasio-Cortez – i.e. 1) they are not administered by the federal government; 2) they have ample roles for private insurance, and 3) they have significant consumer cost sharing.


France for example is the only large nation with centrally administered and financed health system. Canada’s health systems by contrast are administered by each province and financed locally with a federal block grant to assist the provinces.


England, Germany and Denmark stand out as countries with broad health benefits and low consumer copays. Canada by contrast has narrower covered benefits, but with no copays on those covered benefits. Most of the other countries have moderate cost sharing with patients paying for about 15% of the costs of services. Canadians’ out of pocket accounts for 15% of their national health expenditures.


Most of these nations have a complementary or supplementary role for private health insurance – encompassing between 15 and 30% of national health expenditures. Supplementary means they pay for your uncovered services. Complementary means they pay for your copays and deductibles. Two thirds of Canadians have complementary or supplementary private health insurance, mainly through their employers, and private health insurance accounts for 30% of national health expenditures. In some countries, private health insurance allows patients to jump the queues for elective services or to access doctors or hospitals who don’t accept public coverage.


Prepared by: Lucien Wulsin

Dated: 4/15/19





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