Comparisons of Health Care Systems

Comparisons of Health Care Systems in the United States, Canada, Germany, Japan, and Switzerland


The United States is ranked as the only industrialized nation without universal health coverage for all its citizens. The Affordable Care Act (ACA) may have a leap in the right direction. However, 12.4% of US citizens between 18 and 64 years were recorded to lack health insurance at the beginning of 2017. This paper gives an overview of where some top countries are ranked according to various metrics in the health care system.

The World Health Organization (WHO) asserts that universal health coverage should be one that makes all people and communities use the preventive, curative, rehabilitative, and palliative health services that they require. Accordingly, such services should be effective by emphasizing quality over cost. In other words, users should not suffer financial hardships while trying to access health care.

There are three broad categories in which health care systems fall globally. These classes are single-payer, insurance mandates, and hybrid systems.

Single-payer systems are ones in which governments restrict alternative payment mechanisms by paying for medical care. The Canadian health care system is an example of a single-payer system.

The insurance mandate system is where the government directs citizens to buy health insurance covers. The system involves directives that forbid underwriting and insurance aimed for profits. At the same time, the emphasis is put on standard minimum coverage and subsidizing low-income population. Examples of countries with this system include Germany, Switzerland, and Japan.

The third class is the hybrid system. This is a combination of both single-payer and private insurance mandates. Here, the government provides a standard set of care and let citizens supplement medical care through private insurance. Examples of countries that implement this system are France and the United Kingdom.

  1. The Single-Payer Systems

The Canadian healthcare system falls under the provincial administration. The funding is, however, shared between the provincial and federal governments. All health providers that offer services that are covered by the government are not allowed to receive private payments for the services they offer. Health care is covered on the first-dollar basis, and providers are restricted from billing citizens for amounts that fall above the negotiated fee schedule. All publicly insured services are not billed privately. However, other plans and enhanced services that are not paid for by the government are covered using private insurance.

Each province is expected to pass through specific criteria to be fully funded by the federal government. For instance, they have to b:

  1. Administered publicly
  2. Have comprehensive coverage
  3. Universal in coverage
  4. Accessible (no user fee, etc.)
  5. portable across the entire province

There is a distinction between general practitioners and specialists. Most general practitioners operate in the private sector and are paid a fee for their services. On the other hand, most specialists work out of hospitals and are equally paid for their services though they are not employees. The hospitals are either publicly or privately owned. In both cases, they are not-for-profit entities and are funded by the government under annual budgetary allocations.

The total health care expenditure in Canada amounted to 11.15 of the national GDP in 2017. 70% of this comes from public funding, while 14% amounts to the total out-of-pocket costs. Private insurance reflects 12% of the expenditure. The cost of services is managed through the budget allocation for hospitals and other related products and services.

      ii.            The Insurance Mandate Systems

Germans are required to buy health insurance covers from the 118 sickness funds that are non-profit entities. The Statutory Health Insurance system (SHI) regulates these funds. Individuals are free to opt out of the plan and purchase Private Health Insurance (PHI) from the 42 available non-profits and for-profits. All public service personnel like the military are covered under special health programs. All premium contributions from the SHI are pooled and distributed to the various Sickness Funds on a risk-adjustment basis. The PHI is mostly used by citizens to supplement the SHI to offer services not covered under the SHI. The government regulates the rates charged under the PHI.

Physicians are allowed to supplement their income by offering paid-for services. Family physicians make up 42% of the health care providers, while specialists cover the remaining 52%. Publicly held hospitals take up 50%, while the remaining part is covered by a mix of both for-profit and not-for-profit health care facilities. Unlike most countries, the German health system allows hospitals and providers to attend to both SHI and PHI patients.

The expenditure on health care amounts to 11.2% of the national GDP, according to the 2015 statistics. 74% of this figure is realized from public health programs, with 13.2 % coming from the out-of-pocket expenditure. The cost of health care is regulated by the provision of quality and efficient medical care.


Japan’s health care system takes the form of Social Health Insurance (SHI). The SHI applies to all employed citizens, with 5% of their salaries directed towards the payment for the cover. People who fall out of this category are covered using the National Health Insurance (NHI) plan. The amount paid for NHI depends on an individual’s level of income.

The government is obligated to cover 70% of the cost of medical care while patients pay the remaining 30%. The ratio is also flexible and may change in favor of patients with low income. The government determines all the costs of medical appointments. Physicians are involved in the process of establishing such costs, which are adjusted after every two years. This approach is taken to ensure the government has appropriate responsive measures to the changes in the economy to ensure that medical care is affordable for all.

The 47 regions implement the rules and regulations in the health care system. These regions are also allowed to establish their budgets that reflect their health concerns in the local setting. Additionally, the regions administer nursing care, which is a 2% added contribution required of all citizens above 40 years to cover for long term care.

Lastly, Japan does not allow physicians to undergo license renewal despite the emphasis on preventive care.

Twenty-six cantons administer universal health coverage in Switzerland. The funding for this program is derived from the tax revenues, premiums from Mandatory Health Insurance (MHI), and the contributions from social insurance. The government also allows Voluntary Health Insurance (VHI) for the services that are not covered under the MHI. However, VHI is only a supplement because MHI is compulsory for all citizens, with the government subsidizing premiums for low-income populations. The collected premiums are distributed among the insurers on a risk-adjustment basis.

All health practitioners that accept MHI are restricted from billing patients amounts above the scheduled fees. General practitioners form 40% of physicians. All specialists working on hospitals are salaried and allowed to supplement their income through private practice.  Health expenditure in Switzerland comes second after the United States at 11.1% of the national GDP.

The United States
United States citizens are insured under several health insurance covers. The systems overlap. 90.9% of citizens were recorded to have health insurance by 2015. Out of this number, 55.7% are covered by their employers, 16.3% have direct insurance purchases, and another 16.3% are covered through Medicare. Additionally, 19.6% receive their health coverage from Medicaid, while 4.7% have military cover, including the Veteran Health Administration (VA).

Federal laws require employers to continue offering medical cover to former employees. However, the entire cost of medical care is catered for by the insured. The government subsidizes employer-based insurance directly. At the same time, this form of insurance receives hidden incentives because premiums are not taxed unless when the coverage is purchased in the individual market.

70% of hospitals in the US are non-profits, while 15% are owned by the government and 15% are for-profits. The United States have the highest expenditure on health care than any other country. By 2015, the total expenditure on health care reflected 17.8% of the national GDP, a figure that is equivalent to $3.2 trillion.


Comparing different health care systems in the world offers an overview of the opportunity to identify areas for improvement. The best way examining the health care performance should take the cost and provision approach. This means evaluating the cost of accessing medical care that is efficient and of high quality. Based on the analysis of this study, it is clear that there are no perfect health care systems. However, combing the best practices from deferent countries can offer a near-perfect model.


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