International Profiles of Health Care Systems

DECEMBER 2020

AUSTRALIA

BRAZIL

CANADA

CHINA

DENMARK

ENGLAND

FRANCE

GERMANY

INDIA

ISRAEL

ITALY

JAPAN

NETHERLANDS

NEW ZEALAND

NORWAY

SINGAPORE

2020

SWEDEN

SWITZERLAND

TAIWAN

UNITED STATES

International Profiles

of Health Care Systems

EDITED BY

Roosa Tikkanen and Robin Osborn

The Commonwealth Fund

Elias Mossialos, Ana Djordjevic, and George Wharton

London School of Economics and Political Science

Contents

The Australian Health Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

The Brazilian Health Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

The Canadian Health Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

The Chinese Health Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

The Danish Health Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

The English Health Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59

The French Health Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71

The German Health Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

The Indian Health Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93

The Israeli Health Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105

The Italian Health Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117

The Japanese Health Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127

The Dutch Health Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137

The New Zealand Health Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .149

The Norwegian Health Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159

The Singaporean Health Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169

The Swedish Health Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181

The Swiss Health Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191

The Taiwanese Health Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201

The U.S. Health Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211

Table 1. Primary and Secondary Health Insurance Coverage and Financing . . . . . . . . . . . . . . . . . . . . . . . .224

Table 2. User Fees and Safety Nets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .226

Table 3. Health Care Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227

Table 4. Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .228

The Australian Health Care System

Lucinda Glover, with contributions from Michael Woods

London School of Economics

Australia has a regionally administered, universal public health insurance program (Medicare) that is financed through

general tax revenue and a government levy. Enrollment is automatic for citizens, who receive free public hospital care and

substantial coverage for physician services, pharmaceuticals, and certain other services. New Zealand citizens, permanent

residents, and people from countries with reciprocal benefits are eligible to enroll in Medicare. Approximately half of

Australians buy private supplementary insurance to pay for private hospital care, dental services, and other services. The

federal government pays a rebate toward this premium and also charges a tax penalty on higher-income households that

do not purchase private insurance.

How does universal health coverage work?

It took 10 years of political tension to establish Australia¡¯s universal public health insurance program, known as Medicare.

A universal health care bill was initially introduced in Parliament in 1973 but failed three times to pass through the Senate.

Because of these failed attempts, a new parliamentary election was called, a procedure known as double dissolution, to

resolve the deadlock. The new Parliament passed the health care legislation in 1974, establishing free public hospital care

and subsidized private care. However, following a change in government in 1975, access to free health care services was

limited to retired persons who met stringent means tests.

After another change of government in 1984, the current Medicare system was established. Medicare provides free public

hospital care and substantial coverage for physician services and pharmaceuticals for Australian citizens, residents with

permanent visas, and New Zealand citizens following their enrollment in the program and confirmation of identity.1

Restricted access is provided to citizens of certain other countries through formal agreements.2 Other visitors to Australia,

as well as undocumented immigrants, do not have access to Medicare and are treated as private-pay patients, including

those needing emergency services.

Role of government: Three levels of government are collectively responsible for providing universal health care:

The federal government provides funding and indirect support for inpatient and outpatient care through the Medicare

Benefits Scheme (MBS) and for outpatient prescription medicine through the Pharmaceutical Benefits Scheme (PBS). The

federal government is also responsible for regulating private health insurance, pharmaceuticals, and therapeutic goods;

however, it has a limited role in direct service delivery.

States own and manage service delivery for public hospitals, ambulances, public dental care, community health (primary

and preventive care), and mental health care. They contribute their own funding in addition to that provided by federal

government. States are also responsible for regulating private hospitals, the location of pharmacies, and the health care

workforce.

Local governments play a role in the delivery of community health and preventive health programs, such as immunizations

and the regulation of food standards.3

At the federal level, intergovernmental collaboration and decision-making occur through the Council of Australian

Governments (COAG), with representation from the prime minister and the first ministers of each state. The COAG focuses

on the highest-priority issues, such as major funding discussions and the interchange of roles and responsibilities among

governments. The COAG Health Council is responsible for more detailed policy issues and is supported by the Australian

Health Minister¡¯s Advisory Council.

The federal Department of Health oversees national policies and programs, including the MBS and PBS. Payments through

these schemes are administered by the Department of Human Services.

Other federal agencies involved in health care include the following:

? The Pharmaceutical Benefits Advisory Committee provides advice to the Minister for Health on the cost-effectiveness

of new pharmaceuticals (but not routinely on delisting).

International Profiles of Health Care Systems, 2020

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