Health For All: Universal Healthcare Systems Around the World in Action

To some, universal healthcare may seem like an idealistic tenet of a far-off utopian society. Yet, for some countries, financially accessible access to health services regardless of income level is a reality. Around the world, universal healthcare has manifested itself in three main forms: the Beveridge model, the Bismarck model, and the National Health Insurance model. But what exactly is the difference between these three models, and how do they apply in real countries?

Beveridge Model: United Kingdom

The Beveridge model of universal healthcare involves one entity—typically the government—that pays for all healthcare fees and costs financed by taxes. In countries with the Beveridge model, the government owns hospitals and employs healthcare professionals.

A prime example of the single-payer model can be seen in the United Kingdom, where nearly 66.4 million people benefit from the National Health Service (NHS). Residents of the UK fund the NHS through general taxation, then get to enjoy largely free services like emergency treatment, General Practitioner (GP) appointments, mental health services, maternity care, screenings, and more. While dental services, prescriptions, and other healthcare options may incur some fees, certain demographics are exempt.

Additionally, hospitals are generally owned by the NHS. Although notorious for long wait times and workforce shortages, the NHS is still valuable in the way it holds a strong focus on prevention, offers a wide yet standardized range of care, and is accessible to all residents of the UK regardless of ability to pay.

Bismarck Model: Japan

Named for and pioneered by 19th-century German chancellor Otto von Bismarck, the Bismarck model is a more privately-run, multi-payer model of universal healthcare as opposed to the government-run single-payer Beveridge model. With coverage being mandatory for all citizens, “sickness funds” are payments made by both employees and employers that finance the system. Although healthcare providers are private and not covered by the government, they are still heavily regulated by the government.

The Bismarck model can be found in Asia, specifically Japan, where healthcare is covered by a combination of taxes and sickness funds. Though individuals do cover 30% of medical costs, the Bismarck system allows for healthcare to be affordable and widely accessible for many residents and even some foreigners. Unlike the NHS, most providers are private and not government-owned, yet the government still tightly controls healthcare coverage with standardized fee schedules that are reviewed every two years. Japan’s aging population serves as both a testament to the efficacy of its universal healthcare and a reason for why it’s so important to be sustained.

National Health Insurance Model: Canada

Perhaps the most straightforward way of thinking about the National Health Insurance model is to see it as a combination of the Bismarck and Beveridge models. It incorporates the system of government-funded healthcare fuelled by taxes from the Beveridge model, while the actual delivery of healthcare services is through private providers, an aspect of the Bismarck model.

The National Health Insurance model can be seen in action with Canada’s Medicare system under the Canada Health Act. Medicare is funded by tax revenue from territories, provinces, and federal taxes. However, many physicians and hospitals are private, and doctors are private contractors, billing the government. Providers cannot charge patients for publicly insured services, ensuring that all patients are able to access said services.

While it’s clear that nations all over the world are benefiting from universal healthcare, it’s still important to acknowledge the continued disparities that persist in countless other countries. So long as healthcare is considered a universal human right, universal healthcare can hopefully expand globally to ensure everyone has access to lifesaving services regardless of income.