I. Universal coverage with single-payer system
Everyone is covered by a national health-care plan that is fully funded by the government, the so-called single payer.
- In countries with socialized health care, such as Cuba and the United Kingdom, the government also delivers care through public hospitals and clinics.
- In single-payer systems, such as Canada, doctors are not government employees.
II. Universal coverage with multi-payer system
A national health insurance system administered by competing insurers usually exists alongside a private insurance option for high-income people. Governments keep costs low through regulation and direct negotiation with pharmaceutical companies.
- In countries such as France, Germany, and Switzerland, people are required to have health care, which is mostly publicly funded.
- Singapore has an option for people to pay more for better, more individualized service.
III. Multi-payer system with no universal coverage
A mix of health-care programs exists, although health care is not required. More autonomy is given to private insurance companies by the government, resulting in pharmaceutical innovation and advanced medical technology along with high costs and no guarantee of health coverage.
- The only example of this system is the United States, where people may have private insurance through their employers; be covered under single-payer Medicare if they are sixty-five or older; be covered under government-funded Medicaid if they have a disability or earn less than a certain amount; receive socialized care through Veterans Health Administration if they have served in the military; purchase private insurance on exchanges set up by the Affordable Care Act; or simply go uninsured, as twenty-eight million people currently do.
IV. No national health-care infrastructure (fully out of pocket)
There is an important fourth reality in that, for most of the developing world, no national health-care infrastructure exists.
- Health care is subsidized minimally, or not at all: the government of an average low-income country spends $23 per person on health, compared to the United States, which spends $3,860, and the United Kingdom, which spends $2,695.
- Access to doctors, vaccines, and medications can be limited.
- Aid organizations sometimes fill the gap, but a significant portion of global health financing today targets specific diseases, not holistic or preventive care.
With different economic, geographic, and political domestic situations, it is unrealistic to expect one approach to health care to work for all countries. More important than one system, however, is a universal goal: to provide quality health care to the maximum number of people at an affordable price.