Understanding Health Insurance Across Countries

Understanding health insurance programs in different countries gives some perspective on how different each country’s systems are. As debate rages about changes to this country’s health insurance system, it is interesting to take a look at the type of health insurance offered elsewhere.

Great Britain

In England, healthcare is provided based on government funding.  The funding for Britain’s National Health Service is funded by taxes, much in the same way other services such as public works and police are funded. The government pays for medical services provided to its citizens so that a British citizen never receives a doctor’s bill.  Most of the hospitals and medical facilities are owned by the state and doctors and medical practitioners are employed by the government. There are private hospitals and medical service providers as well, but they are paid by the government, not the patients.


Germany uses what is known as the “Bismarck Model” named for Chancellor Otto von Bismarck.  The German system of health insurance is similar to the system in the United States in that it is an employer-employee paid system.  The country sets up “sickness funds” that are funded by joint contributions and used to meet the health care needs of German citizens.  

The distinguishing difference between the German and U.S. system however is that in Germany, everyone is covered (whereby in the United States nearly 48 million Americans do not have health insurance coverage).  The medical practitioners, hospitals and doctors do not work for a profit and the government maintains cost-controls in order to keep medical expenses in line. A form of the Bismarck Model can also be found in France, Belgium, the Netherlands and Japan.


The Canadian model for national health insurance is based on a government run insurance fund that every citizen pays into, which is similar to social security. The providers of medical services work in the private sector but since there is no marketing and other costs in providing services, costs are lower than in the United States.  This model of universal health care is often discussed as a model for U.S.-style public health insurance model.  Taiwan and South Korea also have adopted the National Health Insurance Model.

Other Countries

There are established systems of health insurance in about 40 of the 200 countries in the world. The British-style, Bismarck, National Health Insurance and employer-sponsored models are all found in the United States. Older Americans enjoy a universal health insurance system that is very similar to that offered to Canadians. Those individuals who access an employer-sponsored plan are receiving some of the elements of Germany’s Bismarck Model.

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