Single Payer: Case Studies

Not all single payer systems are designed and deployed the same. Varying degrees of private insurance involvement, system funding via taxes, and coverage limits make the system customized to meet the needs of the constituents. Canada is often used as the model example of a single payer system since it shares a border with the United States. In Canada’s single payer system, the government funds healthcare insurance, but the private sector delivers most of the care. The insurance benefits are run at the provincial level and private, nonprofit supplemental insurance is also available for drug, dental, and vision coverage.

Switzerland is the second most commonly used model for countries that utilize a single payer healthcare system. The country requires all citizens to buy health insurance. The health plans are similar to the ones in the Affordable Care Act in the states offered by private insurance companies where the plans are community rated, prices vary by scope of provider network, size of deductibles and premiums, and amount of coverage (Carroll & Frakt, 2017). A noteworthy piece of the Swiss healthcare system is its broad maternity coverage that everyone contributes to. It covers every aspect of labor and delivery including prenatal care, delivery, weeklong post-delivery stay, class on how to care for a baby, and post-natal home visits (Appleton, 2017). The Switzerland government highly regulates the competitive, private insurance firms. Almost a third of people in Switzerland receive subsidies to offset insurance costs based on their income. Supplemental insurance is also available from private, for-profit companies.

Britain runs a slightly different kind of single payer system. Its coverage is broad and most services are free to citizens. The system is almost entirely financed by taxes. This is important to note as most believe that funding a single payer system completely by taxes is not sustainable. There have been lots of recent efforts to increase competition between facilities and increase the quality of care its patients receive. There are numerous network and coverage options available to citizens. The system is efficient, produces quality outcomes, has low access barriers, low spending, and gives citizens plenty of care options.

Lately Singapore has been gaining press when people discuss successful single payer models. Singapore offers cheap, basic care in government-run hospitals. Workers contribute over a third of their wages into a mandated savings account that is only to be spent on healthcare, housing, insurance, education, or investment. The country’s government is highly involved with decisions about investing in new technology, controlling drug spending, and limiting the number of medical students and how much they earn post-graduation (Carroll & Frankt, 2017). A commonly discussed downfall of this system is the lack of data sharing. Because of this, it’s hard to determine the quality of care that patients actually receive. It has been observed that the quality of care varies greatly at the different ends of the socioeconomic ladder. The fundamental flaw of this system is that when people spend more of their own money on healthcare, they will substitute quality care, for cheap care.

France has a very similar system to Singapore in that the government, The Ministry of Health, set budgets, regulates hospital beds, determines number of medical professionals that get trained, and set prices for hospital procedures and drugs (Carroll & Frankt, 2017). Also, most of the citizens have some kind of supplemental coverage through their employer in addition to the required coverage. The major difference between Singapore and France is that France’s system is very costly and comprehensive. The system is extremely comprehensive, easy to understand, and delivers quality outcomes with access for all.


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