Healthcare Models around the World

There are approximately 200 countries around the world, and while they may differ politically, ideologically, and economically, it is fairly safe to say that each country wants its people to be healthy, and, if possible, to provide care for them when they’re not.

Despite so many countries and so many different styles of governing, it may come as a surprise that there are just four basic healthcare models in the world. Just about every country—except the United States*—subscribes to one of these models, which applies to all its residents. If you are planning an extended stay in another country, it may help you to know what the healthcare system is like where you will be traveling or living.

In his book, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, journalist T.R. Reid explains the different healthcare systems:

The Beveridge Model

Named after William Beveridge, who designed Britain’s National Health Service, this system is financed by the government through citizens’ tax payments. Many of the hospitals and clinics using this model are government-owned. Some doctors are government employees, though there are also private doctors who collect their fees from the government, meaning that patients never receive a bill from their doctor. In this system, healthcare costs are low because the government determines what services doctors can offer and what they can charge.

Countries that use the Beveridge plan, or some form of it, include Great Britain, Spain, most of Scandinavia, New Zealand, Hong Kong, and Cuba.

The Bismarck Model

The Bismarck healthcare system is named for Prussian Chancellor Otto von Bismarck, who created a welfare state when Germany was unified in the 19th century. This model uses a health insurance system which is usually financed by both employers and employees through payroll deduction.

One hallmark of the Bismarck plan is that health insurers are required to insure everybody and they are not profit-making ventures. As a rule, hospitals and physicians in Bismarck-model countries are private. Although there are many health insurers, (Germany, for example, has approximately 240 different “sickness funds,” as they are known), they are tightly regulated by the government, which controls costs, much like the Beveridge model.

Among the countries using the Bismarck model are Germany, France, Belgium, the Netherlands, Japan, Switzerland, and, to a degree, several in Latin America.

The National Health Insurance Model

The National Health Insurance model is a hybrid of both the Beveridge and Bismarck plans. While it uses private-sector providers, payments are made through a government-run insurance program that every citizen helps fund. There is no advertising, no reason to deny claims, and no profit. As such, this model—also known as universal insurance—is usually less expensive to run.

Having just one payer also means more leverage when negotiating prices. In Canada, for example, lower prices from pharmaceutical companies mean lower medication costs for patients. As a result, many Americans now purchase their medications through Canadian pharmacies. Universal insurance plans also keep costs down by limiting medical services they will agree to pay for.

Canada is a well-known example of a National Health Insurance system, but some other countries, including Taiwan and South Korea, have also adopted this plan.

The Out-of-Pocket Model

Out of the 200 countries in the world, only the 40 or so industrialized nations have formalized health care plans. Most countries do not have the financial or administrative resources needed to provide medical care for the majority of their citizens. Wealthy citizens can pay for medical care; the poor, however, often must rely on folk traditions or local healers. In rural areas of Africa, India, China, and South America, people are often unable to ever see a doctor. (Medical missions sponsored by nonprofit organizations and individual doctors and hospitals in developed countries periodically visit many of these less developed countries, where the poor and the sick may travel for days for the opportunity to be treated.)

What To Know Before Going Abroad

Your health and well-being are top priorities and it’s important to understand what type of healthcare model you will have available to you, how care is delivered, and how you will be expected to pay for it.

Your health insurance needs will vary depending on the healthcare system used in your host country. In some countries private medical insurance is required, while in others you may have the option of purchasing private insurance in order to receive better care than that available to the general public.

If the doctors and nurses in the local hospitals and clinics do not speak the same language as you, find out how you can get medical care from people who understand your native language. What should you do in case of an emergency if there is a language barrier?

When you arrive in the country you’re visiting or staying in, you may need to register for medical care. The process varies from country to country and you may have to meet a number of requirements in order to become eligible for healthcare. Relocation guides for individual countries will contain detailed instructions for how to register for healthcare and how to avail yourself of medical services.

To learn more about your healthcare options abroad, check out online sources such as ExpatInfoDesk (www.expatinfodesk.com), embassies, national healthcare organizations, and supplemental insurance companies such as International SOS Assistance, Inc. (www.internationalsos.com).

* The United States has a more fragmented system, with different plans for different populations (i.e., government-sponsored Medicare for those over 65, free care for military veterans, employer-funded insurance for those who are working, private medical insurance for those who can afford it, and out-of-pocket care or medical assistance for those who have no insurance).