Health Care: An International Comparison
Countries with governments and economies similar to the United States have come up with a variety of methods to
make sure that all of their citizens receive health care. While residents in Europe and Japan may pay higher insurance
premiums or taxes than Americans, in the end, when all costs are added up, Americans spend more money on health
care per person — with fewer people covered. Compare countries:
United States
Population: 302 million
Life expectancy at birth: 78.1
Health spending as part of GDP: 15.3%
System type: Employer-employee
based (54%) and government funding
(46%). Government covers all older
adults and the disabled (Medicare), the
poor (Medicaid), veterans, government
employees and Native Americans.
Coverage: 82% of people under 65;
100% of people 65 or over.
Average annual per-person spending:
Total: $6,402. Breakdown: $2,884
by government; $2,676 for private
insurance, with 52% paid by employers,
48% paid by employees; $842 by
consumer out-of-pocket*
Financing: Larger companies self-
insured. Employers and employees share
costs. Income taxes fund Medicare,
Medicaid and other public programs. Co-
payments and deductibles highly variable
in the private system.
Notable features: Leading-edge
technology, drugs and facilities. Most
patients can choose doctors, hospitals.
Biggest challenges: Health access for
working poor. Discrepancies in care
between rich and poor. Rising costs.
Overuse of tests and procedures. Low
international rankings on basic health
measures, including infant mortality and
preventable deaths.
Prescription drug coverage: Of those
with insurance, 84% are covered. Most
plans require co-payments. No government
controls on prices or availability.
Doctors: Payments regulated in
government programs; insurers set fees;
no price controls for uninsured.
Hospitals: Payments regulated in
government programs; insurers set fees;
no price controls for uninsured.
* Payments borne directly by a patient,
separate from insurance fees.
Most information derived from the Organization for Economic Development and Cooperation, the Commonwealth Fund and the Henry J. Kaiser Family Foundation. Most data from 2005, the latest available.
More recent data used, when available.
Great Britain
Population: 61 million
Life expectancy at birth: 79
Health spending as part of GDP: 8.3%
System type: Tax-funded, government-
run.
Coverage: Universal coverage. All citizens
and legal residents.
Average annual per-person spending:
Total: $2,723. Breakdown: $2,371 by
government; $352 on supplemental
private insurance, OTC drugs, direct
payments to doctors.
Financing: 95% of funding comes from
taxes; 5% comes from user charges, such
as co-payments for prescription drugs.
Notable features: “Socialized” medicine.
Government directly pays doctor and
hospital fees. Patients do not receive
bills for National Health Service care. The
government’s National Institute for Health
and Clinical Excellence advises which
high-cost treatments should be covered.
Biggest challenges: Government doesn’t
cover care that it deems cost-ineffective
and some cosmetic surgery. Maintaining
a steady source of government funding
in the face of increasingly expensive
treatments and drugs.
Prescription drug coverage: Half of
England’s population receives drugs
for free, based on exceptions for age,
disability and pregnancy. Co-payments for
the rest in England. Wales and Scotland
have abolished all co-payments.
Doctors: Most paid by government
through salary or fees; some doctors
accept private insurance or fees directly
from patients.
Hospitals: Paid by government, some
funding from private insurers.
France
Population: 61.7 million
Life expectancy at birth: 80.3
Health spending as part of GDP: 11.1%
System type: Universal coverage.
Employment-based system, with
supplemental private insurance.
Coverage: 100%
Average annual per-person spending:
Total: $3,374. Breakdown: $2,693 by
government, $448 on private insurance,
$233 consumer out-of-pocket*
Financing: Employers pay equivalent
of 13.1% of employee’s salary to the
national health insurance program.
Employees pay 0.75% of salary. Income
taxes also helps provide universal
coverage for retirees, unemployed,
disabled and the poor. Most people
(87%) also have supplemental insurance
from private for-profit insurers, which
they purchase or is often paid for by an
employer.
Notable features: The national system
pays 100 percent of costs for people
with one of 30 long-term conditions,
including diabetes and cancer. Broad
choice in doctors and specialists. Strong
pre- and post-natal care, strong cancer
case management.
Biggest challenges: Controlling costs,
improving efficiency. Government
currently cutting number of acute
hospital beds and promoting
computerized medical records to curb
redundancy. Shifting some doctor duties
to nurses.
Prescription drug coverage: Drug
effectiveness determines patient’s co-
pay: 0% for most cost-effective drugs;
sliding scale of 35%, 65% and 100%
for drugs with more limited therapeutic
value. More generics since 2006, new
co-pays as of 2008.
Doctors: Government negotiates fees
with doctor unions. Most are in fee-
based private practice.
Hospitals: Government sets rates for
most hospitals.
* Payments borne directly by a patient,
separate from insurance fees.
Germany
Population: 82.3 million
Life expectancy at birth: 79
Health spending as part of GDP: 10.7%
System type: Universal coverage. Mostly
employer-employee based (88%).
Coverage: 99.8 % -- all citizens and legal
residents
Average annual per-person spending:
Total: $3,673 Breakdown: $2,518 on
mandatory employment-based coverage,
nonprofit insurance; $259 on for-profit
insurance; $349 by government; and
$547 consumer out-of-pocket*.
Financing: Workers split premiums with
employers, with each paying about 8%
of workers’ gross income to nonprofit
“sickness funds.” Those earning over
$75,000 may purchase insurance from
for-profit insurers.
Notable features: Comprehensive
coverage including basic dental and
long-term care. Short waits - usually
less than a month - for elective surgery.
New programs provide extra attention to
diabetes and other chronic illnesses.
Biggest challenges: Large and growing
aged population, high costs, high rate of
specialist visits.
Prescription drug coverage: Full
coverage with small copayments.
Federal panel controls prices and an
expert committee decides which new
treatments should be covered.
Doctors: Regional groups of office-based
doctors negotiate with insurers over
annual budgets. Hospital-based doctors,
including most specialists, are salaried.
Hospitals: Insurers negotiate with
hospitals over annual budgets.
* Payments borne directly by a patient,
separate from insurance fees.