Thirty-two of the thirty-three developed nations have universal health care, with the United States being the lone exception [1]. The following list, compiled fromWHO sources where possible, shows the start date and type of system used to implement universal health care in each developed country [2]. Note that universal health care does not imply government-only health care, as many countries implementing a universal health care plan continue to have both public and private insurance and medical providers.
Country | Start Date of Universal Health Care | System Type |
Click links for more source material on each country’s health care system. | ||
Norway | 1912 | Single Payer |
New Zealand | 1938 | Two Tier |
Japan | 1938 | Single Payer |
Germany | 1941 | Insurance Mandate |
Belgium | 1945 | Insurance Mandate |
United Kingdom | 1948 | Single Payer |
Kuwait | 1950 | Single Payer |
Sweden | 1955 | Single Payer |
Bahrain | 1957 | Single Payer |
Brunei | 1958 | Single Payer |
Canada | 1966 | Single Payer |
Netherlands | 1966 | Two-Tier |
Austria | 1967 | Insurance Mandate |
United Arab Emirates | 1971 | Single Payer |
Finland | 1972 | Single Payer |
Slovenia | 1972 | Single Payer |
Denmark | 1973 | Two-Tier |
Luxembourg | 1973 | Insurance Mandate |
France | 1974 | Two-Tier |
Australia | 1975 | Two Tier |
Ireland | 1977 | Two-Tier |
Italy | 1978 | Single Payer |
Portugal | 1979 | Single Payer |
Cyprus | 1980 | Single Payer |
Greece | 1983 | Insurance Mandate |
Spain | 1986 | Single Payer |
South Korea | 1988 | Insurance Mandate |
Iceland | 1990 | Single Payer |
Hong Kong | 1993 | Two-Tier |
Singapore | 1993 | Two-Tier |
Switzerland | 1994 | Insurance Mandate |
Israel | 1995 | Two-Tier |
United States | 2014 | Insurance Mandate |
Will the United States join this list in 2009?
[1] Roughly 15% of Americans lack insurance coverage, so the US clearly has not yet achieved universal health care. There is no universal definition of developed or industrialized nations. For this list, those countries with UN Human Development Index scores above 0.9 on a 0 to 1 scale are considered developed.
[2] The dates given are estimates, since universal health care arrived gradually in many countries. In Germany for instance, government insurance programs began in 1883, but did not reach universality until 1941. Typically the date provided is the date of passage or enactment for a national health care Act mandating insurance or establishing universal health insurance.
Single Payer: The government provides insurance for all residents (or citizens) and pays all health care expenses except for copays and coinsurance. Providers may be public, private, or a combination of both.
Two-Tier: The government provides or mandates catrastrophic or minimum insurance coverage for all residents (or citizens), while allowing the purchase of additional voluntary insurance or fee-for service care when desired. In Singapore all residents receive a catastrophic policy from the government coupled with a health savings account that they use to pay for routine care. In other countries like Ireland and Israel, the government provides a core policy which the majority of the population supplement with private insurance.
Insurance Mandate: The government mandates that all citizens purchase insurance, whether from private, public, or non-profit insurers. In some cases the insurer list is quite restrictive, while in others a healthy private market for insurance is simply regulated and standardized by the government. In this kind of system insurers are barred from rejecting sick individuals, and individuals are required to purchase insurance, in order to prevent typical health care market failures from arising.
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