Universal health systems in many of the countries measured by the Organisation for Economic Co-operation and Development (OECD) include a balance of public and private funding — but every country handles that balance differently. That means which health services patients pay for out-of-pocket versus what’s “free” or covered by public funding varies from country to country. Here is a snapshot of six countries, including Canada, along with performance rankings.
Please note: Compulsory health insurance (often co-financed by governments, employers and employees) is categorized as publicly funded care.
Jump to: Canada | Australia | France | Germany | Netherlands | United Kingdom
Health care in Canada
Canada’s publicly funded health system largely focuses on physician and hospital services. Many other health services are paid for out-of-pocket or through private health insurance.
Public-private funding
- 71% public – Provincial/federal health insurance plans
- 29% private – Voluntary health insurance, out-of-pocket payments and other sources
What’s publicly covered
- Medically necessary physician services
- Medically necessary hospital services
- Medically necessary dental surgical services in hospital
- Inpatient prescription drugs
- Home care (to varying degrees according to province and territory)
What isn’t
- Vision care
- Community-based rehabilitation services
- Out-patient prescription drugs*
- Some hospital services (e.g., private rooms, non-medically necessary procedures)
- Out-of-hospital dental care**
*In 2024, the federal government announced its intent to introduce a national, universal pharmacare program, starting with access to contraceptives and diabetes medication.
**Since May 1, 2024, dental visits for seniors 70 and older are covered under the Canadian Dental Care Plan. The program will eventually cover about 25% of Canadian residents who don’t have private dental plans.
Cost sharing
- Additional home care
- Long-term care
Exceptions
- Some funding for populations such as older persons, children and Canadians on social assistance
Performance
11.7%
Health care spending as percentage of GDP (2021)
– OECD average 8.8%
2.5
Hospital beds per 1,000 population (2019)
– OECD average 4.4
2.7
Practising doctors per 1,000 population (2019)
– OECD average 3.6
82.1
Life expectancy at birth (2019)
– OECD average 81
Health care in Australia
Every Australian is eligible for Medicare, which covers primary care and public hospitals. It also has a parallel, private health system where patients can access private facilities — most often for elective procedures and uninsured services such as dental care.
Public-private funding
- 73% public – Automatic enrolment in public Medicare program
- 27% private – Voluntary supplementary health insurance (purchased by about half of Australians), out-of-pocket payments and other sources
What’s publicly covered
- Hospital care
- Primary care (some co-payments)
- Home care (some co-payments)
What isn’t
- Dental care for adults
- Long-term care
Cost sharing
- Specialty care (15% of fee, capped)
- Select medicines
- Home care
Exceptions
- Rebate for supplementary insurance
- Tax penalty on higher-income households that do not purchase supplementary insurance
- Means-tested home care
- Means-tested long-term care
- Dental care for children
Performance
10.6%
Health care spending as percentage of GDP (2021)
– OECD average 8.8%
3.8
Hospital beds per 1,000 population (2019)
– OECD average 4.4
3.8
Practising doctors per 1,000 population (2019)
– OECD average 3.6
83
Life expectancy at birth (2019)
– OECD average 81
Health care in France
In France, enrolment in a statutory health insurance system is mandatory and covers most of the cost for hospital care, physician services, long-term care and prescription drugs. Patients are responsible, however, for coinsurance, copayments and any physician charges that exceed fees set out by public health insurance. Patients with low incomes or long-term conditions get further government support and can often access care for free.
Public-private funding
- 84% public – Statutory health insurance
- 16% private – Voluntary health insurance, out-of-pocket payments and other sources
What’s publicly covered
- Hospital care
- Primary care
- Medications for patients with severe chronic health conditions
- Dental care
- Rehabilitation services (e.g., physio)
Cost sharing
- Hospital services
- Primary care
- Specialty care
- Mental health care
- Long-term care
- Medications
Exceptions
- Home care, services for older persons and services for people with disabilities financed by public health insurance and revenues from annual working solidarity day, when employers pay the health plan employees’ daily wages
Performance
12.4%
Health care spending as percentage of GDP (2021)
– OECD average 8.8%
5.8
Hospital beds per 1,000 population (2019)
– OECD average 4.4
3.2
Practising doctors per 1,000 population (2019)
– OECD average 3.6
82.9
Life expectancy at birth (2019)
– OECD average 81
Health care in Germany
Germany’s statutory health insurance provides primary care and specialist consultations for free at point of access. Patients are typically expected to pay nominal copayments for hospitalization and prescribed outpatient drugs and medical devices.
Public-private funding
- 85% public – Statutory health insurance (called “sickness funds”) from competing, not-for-profit, non-governmental plans
- 15% private – Voluntary health insurance, out-of-pocket payments and other sources
What’s publicly covered
- Primary care
- Specialty physician care
- Dental care
- Home/long-term care (via special, statutory insurance)
Cost sharing
- Hospital care
- Medications for adults
- Community mental health and rehabilitation services
- Dental care where provider charges over standard insured price
Exceptions
- Anyone self-employed or with incomes over a certain amount can opt out of sickness funds for private insurance
- Private insurance can be purchased to cover minor benefits not covered by sickness funds
Performance
12.8%
Health care spending as percentage of GDP (2021)
– OECD average 8.8%
7.9
Hospital beds per 1,000 population (2019)
– OECD average 4.4
4.4
Practising doctors per 1,000 population (2019)
– OECD average 3.6
81.4
Life expectancy at birth (2019)
– OECD average 81
Health care in the Netherlands
All Dutch residents must purchase statutory health insurance from private, not-for-profit insurers, who are required to accept all applicants. Some basic services, such as seeing a family doctor, are free at point of use, while others, such as hospital admission, are subject to a deductible.
Public-private funding
- 85% public – Statutory health insurance from private providers
- 15% private – Voluntary health insurance, out-of-pocket payments and other sources
What’s publicly covered
- Primary care
- Hospital care
- Community mental health services
- Community rehabilitation services
- Home care
- Long-term care
- Vision care
What isn’t
- Dental care
- Contraceptives
- Alternative medicine
Cost sharing
- Annual deductible for all hospital care
- Annual deductible for specialist physicians
- Annual deductible for medications
- Annual deductible for mental health services
- Annual deductible for rehabilitation services (e.g., physiotherapy)
- Co-payments for home care and long-term care
Exceptions
- Health care insurers must accept all applicants.
- The government fully covers the cost of insurance for children.
- People with lower incomes receive a health care allowance to cover flat-rate for basic packages. Those who fail to pay for basic packages are still insured.
Performance
11.2%
Health care spending as percentage of GDP (2021)
– OECD average 8.8%
3.1
Hospital beds per 1,000 population (2019)
– OECD average 4.4
3.7
Practising doctors per 1,000 population (2019)
– OECD average 3.6
82.2
Life expectancy at birth (2019)
– OECD average 81
Health care in the United Kingdom
In the United Kingdom, all residents are automatically entitled to free public health care through the National Health Service (NHS). Private facilities do exist and offer treatments that are either not available under NHS or subject to long wait times in the NHS. The cost to access private care is not regulated.
Public-private funding
- 83% public – National Health Service (NHS)
- 17% private – Voluntary health insurance, out-of-pocket payments and other sources
What’s publicly covered
- Hospital care
- Physician care
- Mental health care
- Some long-term care
- Some home care
- Some dental care
- Medications
Cost sharing
- Medication
- Some dental care
Exceptions
- Medication for children, older adults and people with low incomes
- Regular financial support for means-tested home, nursing and residential care
- Private insurance is available for more rapid access to care, choice of specialists and better amenities, especially for elective hospital procedures.
Performance
11.9%
Health care spending as percentage of GDP (2021)
– OECD average 8.8%
2.5
Hospital beds per 1,000 population (2019)
– OECD average 4.4
3
Practising doctors per 1,000 population (2019)
– OECD average 3.6
81.4
Life expectancy at birth (2019)
– OECD average 81