A Look at Types of Universal Healthcare

Americans all around the nation are giving their support for Medicare for all. On March 29 of this year, we wrote a blog called “Is Medicare For All the Solution?” In case you don’t know what Medicare For All is,

“Medicare For All is a universal health care plan that was developed by Vermont Senator, Bernie Sanders. This would be built off what former President Barack Obama had with the Affordable Care Act (ACA), also known as Obamacare. Medicare For All is a solution that would help give health insurance at affordable rates, covering primary and specialty healthcare, vision, hearing, dental, mental health, addiction services, and many other essential health care solutions.”

Niran S. Al-Agba, MD, explains universal health care through the following four points:
1. Most universal health care systems are not highly centralized,
2. Most universal coverage systems offer narrow benefit packages and incorporate cost-sharing for patients.
3. Private health insurance plays a significant role in most developed countries with universal coverage.
4. Countries with universal coverage have strict immigration policies to control health care expenditures.

The Commonwealth Fund recently compared universal health care systems around the globe with the United States single-payer bills proposed in Congress. The country that most resembles the US proposal (where decision making is centralized) is France. In France, the government is responsible for 77 percent of total health expenditures. However, there is an out-of-pocket cost share for patients that is around 7 percent, annually. A few other countries that also use a highly centralized system are the Netherlands, Singapore, and Taiwan. However, these countries have populations that are more similar to that of only one state in the US.

Another type of Universal Healthcare is a “hybrid” system, where decision making and financing are shared at the federal, regional, and local government levels. This form of government is the most cost-effective system to deliver universal health care coverage to a larger population. In Australia, Denmark, the United Kingdom, and Norway, policy making and resource allocation decisions remain centralized. However, there is flexibility within a region to distribute funds in a more individualized way that is best for local needs.

There is also a “decentralized” universal health coverage system, where decision making and resource allocation is regulated at the regional or provincial level. Canada, Germany, Sweden, and Switzerland use this system. For example, in Canada, each province receives (per capita) block grants from the federal government. A block grant is a fixed amount of money the government allocates to a province in advance. Regions are usually held accountable through the establishment of broad national guidelines to ensure fairness and service uniformity.

Now that we’ve gone over a few different universal health care systems which do you think is the best? Using our comment section is a safe place to share your opinions and see what others think about the article or things we’ve talked about in the blog.


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