How Health Insurance Differs in the U.S. vs. the World
The United States of America is one of the richest countries in the world. It also has the most expensive health care. You may believe that it has the best health care in the world, but does it? Let’s look at the U.S. health care system compared with some other rich countries. We’ll look at the kinds of health insurance that are available, who pays for health insurance, and who doesn’t have health insurance. We’ll also look at how the U.S. and other rich countries compare when it comes to health outcomes.
Health insurance in the United States
Many people in the U.S. have insurance from a private insurance company. Others have insurance that is provided by the government. Some people have no insurance.
Many people in the U.S. who have full-time jobs have private health insurance. Usually, the employer pays a larger share of the cost, and the employee pays a smaller amount. When an employee sees a doctor, needs medication, or needs hospital care, they usually pay an additional amount. These additional payments are called “deductibles” and “co-payments”. Some employers offer a variety of plans with different monthly costs, deductibles, and co-payments.
This kind of coverage, sometimes called “employer-based coverage”, without guaranteed coverage for everyone, is unique to the U.S. It can work well if you’re employed and have a high enough salary to pay your share of the monthly cost, deductibles, and co-payments. But what happens if you lose your job? If you worked for a company with 20 or more employees, your former employer must let you continue your health insurance coverage for a limited time, usually 18 to 36 months. But your former employer is not required to pay part of the cost, so you’ll have to pay the entire amount.
If you do not receive insurance through an employer, you may be eligible for insurance coverage provided by the government. The two main government insurance programs are Medicaid and Medicare.
Medicaid is for people with low incomes. The details of who is eligible and what is covered vary from state to state. Medicare is for people 65 and older, and for some younger people with certain medical conditions.
The U.S. is the only rich country in the world that doesn’t guarantee health insurance coverage for everyone. Even though the Affordable Care Act of 2010 increased access to health insurance coverage, about 11.5% of people under age 65 in the U.S. are uninsured. And 20% of people under 65 lose coverage temporarily, for example with job changes.
In the U.S.:
On average, people live 79.11 years.
5.4 of every thousand children born alive die within the first year of life.
For every thousand children born alive, 23.8 mothers die from complications.
There are 2.6 doctors for every thousand people.
Do you want to learn more about health care in the U.S.? You’ll find additional details at:
Health insurance in Canada
The Canadian government provides basic health insurance for all residents. It covers most health care services and all emergency services for free. If you’re in the hospital, medications are free. Otherwise, it does not cover most medications, but it works to control drug costs. In some parts of Canada, medication may be available at a discount for people with low income and people over 65. Most dental care is not covered.
People in Canada can buy private insurance. As in the U.S., many people in Canada get private health insurance from their employer. About 67% of Canadians have private insurance. Private insurance policies reduce the cost of medication, physical therapy, and home nursing care. Private insurance may cover dental care, eye care and medical equipment.
Because most people in Canada have private health insurance, the system is like the U.S. in some ways. The difference is that the Canadian government provides basic insurance for everyone. No one in Canada is uninsured.
On average, people live 82.96 years (3.85 years longer or 4.9% more than people in the U.S.
4.5 of every thousand children born alive die within the first year of life (17% less than the U.S.)
For every thousand children born alive, 8.4 mothers die from complications (64.7% less than the U.S.
There are 2.8 doctors for every thousand people (7.7% more than the U.S.)
The yearly cost of health care in Canada is about 52% less per person than in the U.S.
Do you want to learn more about health care in Canada? You’ll find more information at:
Health insurance in Switzerland
Of the richest countries in the world, the health care system in Switzerland is closest to the system in the U.S. The Swiss system uses a combination of private coverage from insurance companies and public coverage from the government, like the U.S. But in Switzerland, everyone has basic health insurance coverage, and coverage isn’t provided by employers (except for worker’s compensation coverage for accidents).
In Switzerland, the government sets the minimum benefits that must be covered by all health insurance policies. The basic health insurance policy covers a range of services, hospital care, medical treatment, and medicine. Patients are required to pay a deductible and a co-payment for certain treatments. Private insurance companies sell the policies in Switzerland at a price that is lower than comparable policies in the U.S.
The system aims to provide high-quality health care for all residents, regardless of their income or social status. Everyone has access to basic health care services, and the government provides subsidies for those who can’t afford insurance. Patients can choose their health care provider, and insurance companies must compete to provide the best coverage at the lowest price.
On average, people live 84 years (5 years or 6% longer than people in the U.S.
2.4 of every thousand children born alive die within the first year of life (66% less than the U.S.)
For every thousand children born alive, 7 mothers die from complications (61% less than the U.S.)
There are 4.5 doctors for every thousand people (170% more than the U.S.)
The yearly cost of health care in Switzerland is about 40% less per person than in the U.S.
Do you want to learn more about health care in Switzerland? You’ll find additional details at:
Federal Office of Public Health (FOPH). (2021). Health insurance in Switzerland. https://www.bag.admin.ch/bag/en/home/versicherungen/krankenversicherung.html
Health insurance in Norway
Everyone in Norway has health insurance. The goal is for all people to have the same access to health care no matter how much money they have or where they live.
Coverage is provided by the government. It includes primary care, specialty care, mental health services, maternity care, rehabilitation, home care, and hospital care. Some prescription drugs are also covered. Dental care is provided for children and some older people. People can select their doctors and change doctors. Patients make co-payments for many services. The amount each person pays each year is capped, so the cost is affordable even when expensive treatment is needed.
Private insurance is available in Norway. It provides earlier appointments for non-urgent issues, and access to more doctors. About 1 in 10 of people have private insurance. Most of them get it as a benefit from their employers who offer it to attract and keep people with certain skills.
On average people live 83 years (about 4 years or 5% longer than people in the U.S.).
1.6 of every thousand children born alive die within the first year of life (60.4% fewer than the U.S.)
For every thousand children born alive, 3.7 mothers die from complications (89.7% fewer than the U.S.)
There are 5.2 doctors for every thousand people (twice as many as the U.S.)
The yearly cost of health care in Norway is about 43% less per person than in the U.S.
Do you want to learn more about health care in Norway? You’ll find additional details at:
European Observatory on Health Systems and Policies (2022), Norway: Health System Summary. https://www.commonwealthfund.org/international-health-policy-center/countries/norway
Health insurance in Germany
The German government provides health insurance coverage for all residents. It covers primary care, specialist care, hospital care, and prescription drugs. Some drugs require a co-payment. The German health care system also provides dental care, vision care, and rehabilitation services. Some of these require co-payments. Patients have the freedom to choose their doctor or hospital, and they can switch doctors at any time.
The German system is paid for by the government. Some of the funds come from employer and employee payroll taxes. Private insurance is available for some, including people who have high incomes or are self-employed.
On average people live 82 years (3 years or 3.7% longer than people in the U.S.)
3.1 of every thousand children born alive die within the first year of life (47% fewer than the U.S.)
For every thousand children born alive, 3.6 mothers die from complications (85% fewer than the U.S.)
There are 4.5 doctors for every thousand people (170% more than the U.S.).
The yearly cost of health care in Germany is about 40% less per person than in the U.S.
Do you want to learn more about health care in Germany? You’ll find more information at:
Health insurance in England
Everyone in England can receive health care without service-based charges or monthly fees. Primary care, specialty care, mental health care and hospital care are covered. Medicine given in the hospital is covered. Most prescription medicines are covered. Some cost $12.50, but not for children, students, pregnant women, people with low income, and people over 60. Long-term care is covered, but there are co-payments for people who earn above a certain amount. Some dental care is covered, but there are co-payments. Dental care is covered for children, pregnant women, and people with low income.
People in England can also buy private insurance. About 1 in 10 people chose to purchase it. Private insurance offers faster access to care, a larger choice of specialists, and care in private hospitals. Most private insurance does not cover primary care, mental health, maternity care, or emergency care.
On average people live 81.6 years (2.5 years or 3% longer than people in the U.S.)
3.6 of every thousand children born alive die within the first year of life. (33% less than the U.S.)
For every thousand children born alive, 6.5 mothers die from complications. (73% less than the U.S.)
There are 3.2 doctors for every thousand people
The yearly cost of health care in England is about 56% less per person than in the U.S.
Do you want to learn more about health care in England? You’ll find more information at: https://www.commonwealthfund.org/international-health-policy-center/countries/england
The U.S. is the only rich country that does not guarantee health coverage. People in the U.S. have poorer health than people in other rich countries. Health care in the U.S. is more expensive, yet people die earlier. More infants die in the first year of life, and more women die after childbirth. On the other hand, the U.S. does a better job of screening for breast and colon cancer than most other countries.
No system is perfect for every person in every circumstance. In some countries with guaranteed health coverage, people must wait longer for some medical services. But in most countries, people see a doctor more often than we do in the U.S.
Is universal coverage (guaranteed health care for everyone) socialism? No. Socialism is a form of government, not a form of health insurance. Providing health care for everyone is no different than providing public libraries, a police force, or a fire department. These municipal services are provided in the U.S., but that doesn’t make the U.S. a socialist form of government.
If the U.S. changed from employer-based health coverage to any of four types of universal coverage, the cost would be lower, and outcomes would be better. To understand why, look at this report from the non-partisan Congressional Budget Office:
In addition to the sources listed above, you can learn more about health care in different countries by reading: