International Health Systems


Health care systems in the Organization for Economic Cooperation and Development (OECD) countries primarily reflect three types of programs:

  1. In a single-payer national health insurance system, as demonstrated by Canada, Denmark, Norway, and Sweden, health insurance is publicly administered and most physicians are in private practice.
  2. Great Britain and Spain are among the OECD countries with national health services, in which salaried physicians predominate and hospitals are publicly owned and operated.
  3. Highly regulated, universal, multi-payer health insurance systems are illustrated by countries like Germany and France, which have universal health insurance via sickness funds. The sickness funds pay physicians and hospitals uniform rates that are negotiated annually (also known as an “all-payer” system).

The OECD regularly publishes a CD-ROM with 10+ years of comparative data for those interested in pursuing further research. It is available on the OECD website at

Snapshots of health systems in 16 countries

This publication covers the organization and financing of the health systems,and the provision of and developments in health care in each country. Edited by Susanne Grosse-Tebbe and Josep Figueras, the state of affairs is presented for Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Israel, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden, and the United Kingdom.
Please click on the link below to read the article


Australia’s population size of 19 million people is roughly the same as that of Texas. Its infant mortality rate is 5 per 1,000 live births, and life expectancy at birth is 75.9 years for men and 81.5 years for women. In 1941, the beginnings of Australia’s universal health care system emerged. Australia spends 8.5% of its GDP on health care, and its 1998 per capita expense was $2,043-US.

The government administers the compulsory national health insurance program (Medicare). National health insurance is funded by a mixture of general tax revenue, a 1.5% levy on taxable income (which accounts for 18.5% of federal outlays on health), state revenue, and fees paid by patients. The government funds 68% of health expenditures (45% federal and 23% state) and has control over hospital benefits, pharmaceuticals, and medical services. States are charged with operating public hospitals and regulating all hospitals, nursing homes, and community based general services. Additionally, the states pay for the public hospitals with federal government assistance negotiated via five yearly agreements. Mainly not-for-profit mutual insurers (private insurance) cover the gap between Medicare benefits and schedule fees for inpatient services. Private insurance covers 1/3 of the population and accounts for 11% of health expenditures.

Patients are free to choose their GP. Primary care physicians act as gatekeepers, and physicians are generally reimbursed by a fee-for-service system. The government sets the fee schedules, but physicians are free to charge above the scheduled fee or they may directly bill the government when there is no patient charge. Prescription pharmaceuticals have a patient co-payment, and out-of-pocket payments account for 19% of health expenditures. Physicians in public outpatient hospitals are either salaried or paid on a per-session basis.


Austria is home to 7.6 million people, approximately the same number that live in North Carolina. The country has universal access to health care through a compulsory system of social insurance. A system of private insurance also exists. About 8.2% of Austria’s GDP is spent on health care, and the 1998 per capita expense was $1,968-US.

Private doctors with contracts to the social insurance funds are paid on a fee-for-service system with expenditure limits based on the case and per doctor per pay period. Hospital physicians are salaried. Approximately 50% of the health expenditures are funded by progressive payroll taxes, 25% are financed by non-specific taxes, and the rest is funded directly out-of-pocket or through private insurance companies. The contributions to the health insurance funds (payroll taxes) are split between employers and employees on a parity basis.

Patients are free to choose their physicians, as long as the physician has a contract with the insurer. Benefits and prices of services are fixed in agreements between representatives of the insured and representatives of the providers. All medical and nursing education is free. The infant mortality rate in Austria is 4.9 per 1,000 live births, and life expectancy at birth is at 74.7 years for men and 80.9 years for women.


Belgium is home to about 10.2 million people, almost the same number of people who live in the state of Ohio. Its infant mortality rate is 6 per 1,000 live births, and its life expectancy at birth is 74.8 years for men and 81.1 years for women. Today, Belgium spends 8.8% of its GDP on health care, and the 1998 per capita expense was $2,081-US.

The health care system is funded primarily through sickness funds. Belgium’s health insurance program operates at four distinct levels: the central government, national associations, federations of local societies, and local mutual aid societies. The general attitude in Belgium is that the pluralism of the health insurance system stimulates each local fund to work hard to attract and satisfy its members.

Patients have their free choice of any doctor. Primary care physicians are paid via fee-for-service, directly from the patient, or partially reimbursed, except with low-income patients who are exempt from pay. They are reimbursed with a negotiated fee, but extra billing is allowed. Specialists are paid via fee-for-service and are not restricted to hospitals.


Canada’s population size of 30.5 million people is roughly the same as that of California. Its infant mortality rate is 5.5 per 1,000 live births, and its life expectancy at birth is 75.8 years for men and 81.4 years for women. National health insurance had been discussed in Canada at the federal level since 1919, but no real action was taken until 1944. Today, Canada’s health system is characterized by single-payer national health insurance, and the federal government requires that insurance cover “all medically necessary services.” Canada spends 9.5% of GDP towards health care, and the 1998 per capita expense was $2,312-US.

National health insurance (Medicare) is a public program administered by the provinces and overseen by the federal government. Medicare is funded by general tax revenues. Federal contributions are tied to population and provincial economic conditions, and provinces pay the remainder. Medicare accounts for 72% of health expenditures. In addition, the majority of Canadians have supplemental private insurance coverage through group plans, which extends the range of insured services, such as dental care, rehabilitation, prescription drugs, and private care nursing. The private sector (private insurance and out-of-pocket payments) accounts for 28% of health expenditures.

Most physicians in Canada are in private practice and accept fee-for-service Medicare payment rates set by the government. Provincial medical associations negotiate insured fee-for-service schedules with provincial health ministries. Some physicians set their own rates but are not reimbursed by the public system. Hospitals are mainly non-profit and operate under global institution-specific or regional budgets with some fee-for-service payment. Less than 5% of all Canadian hospitals are privately owned.

The Cochrane Collaboration is a Canadian non-profit clearinghouse for studies in clinical epidemiology.It is based at McMaster University and compiles systematic reviews of the effects of health care interventions. It also hosts annual conferences for researchers. †The Cochrane Library is at