Publicly Funded Health Care - Varieties of Public Systems

Varieties of Public Systems

Most developed countries, with the exception of the United States, have partially or fully publicly funded health systems. Most western industrial countries have a system of social insurance based on the principle of social solidarity that covers eligible people from bearing the direct burden of most health care expenditure, funded by taxation during their working life.

Among countries with significant public funding of health care there are many different approaches to the funding and provision of medical services. Systems may be funded from general government revenues (as in Canada), or through a government social security system (as in France, Belgium, Japan and Germany) with a separate budget and hypothecated taxes or contributions. The proportion of the cost of care covered also differs: in Canada, all hospital care is paid for by the government, while in Japan patients must pay 10 to 30% of the cost of a hospital stay. Services provided by public systems vary. For example, the Belgian government pays the bulk of the fees for dental and eye care, while the Australian government covers eye care, but not dental care.

Publicly funded medicine may be administered and provided by the government, as in the Nordic countries, Spain and Italy; in some systems, though, medicine is publicly funded but most hospital providers are private entities, as in Canada. The organization providing public health insurance is not necessarily a public administration, and its budget may be isolated from the main state budget. Some systems do not provide universal healthcare, or restrict coverage to public health facilities. Some countries, such as Germany, have multiple public insurance organizations linked by a common legal framework. Some, such as Holland, allow private for-profit insurers to participate.