Public and private health care: How do other countries do it?

Public-private funding

• 72% public – Provincial/federal health insurance plans
• 28% private – Voluntary health insurance, out-of-pocket payments and other sources

What’s publicly covered

• Medically necessary physician services
• Medically necessary hospital services
• Medically necessary dental surgical services in hospital 
• Inpatient prescription drugs
• Home care (to varying degrees according to province and territory)

What isn’t

• Vision care
• Community-based rehabilitation services
• Out-patient prescription drugs
• Some hospital services (e.g., private rooms, non-medically necessary procedures)    
• Out-of-hospital dental care 

(Note: Canadians with household incomes under $70,000 will receive full coverage by the end of 2023, with co-pays available for households with incomes under $90,00.)

Cost sharing

• Additional home care
• Long-term care

Exceptions

• Some funding for populations such as older persons, children and Canadians on social assistance

Public-private funding

• 73% public – Automatic enrolment in public Medicare program
• 27% private – Voluntary supplementary health insurance (purchased by about half of Australians), out-of-pocket payments and other sources

What’s publicly covered

• Hospital care
• Primary care (some co-payments)
• Home care (some co-payments)

What isn’t

• Dental care for adults
• Long-term care

Cost sharing

• Specialty care (15% of fee, capped)
• Select medicines
• Home care

Exceptions

• Rebate for supplementary insurance 
• Tax penalty on higher-income households that do not purchase supplementary insurance
• Means-tested home care
• Means-tested long-term care
• Dental care for children

Public-private funding

• 84% public – Automatic enrolment in public Medicare program
• 16% private – Voluntary health insurance, out-of-pocket payments and other sources

What’s publicly covered

• Hospital care 
• Primary care 
• Medications for patients with severe chronic health conditions
• Dental care
• Rehabilitation services (e.g., physio)

Cost sharing

• Hospital services
• Primary care
• Specialty care
• Mental health care
• Long-term care
• Medications 
   

Exceptions

• Home care, services for older persons and services for people with disabilities financed by public health insurance and revenues from annual working solidarity day, when employers pay the health plan employees’ daily wages

Public-private funding

• 85% public – Provincial/federal health insurance plans
• 15% private – Voluntary health insurance, out-of-pocket payments and other sources

What’s publicly covered

• Primary care
• Specialty physician care
• Dental care 
• Home/long-term care (via special, statutory insurance)

Cost sharing

• Hospital care
• Medications for adults
• Community mental health and rehabilitation services
• Dental care where provider charges over standard insured price

Exceptions

• Anyone self-employed or with incomes over a certain amount can opt out of sickness funds for private insurance
• Private insurance can be purchased to cover minor benefits not covered by sickness funds

Public-private funding

• 85% public – Provincial/federal health insurance plans
• 15% private – Voluntary health insurance, out-of-pocket payments and other sources

What’s publicly covered

• Primary care
• Hospital care
• Community mental health services
• Community rehabilitation services
• Home care
• Long-term care
• Vision care

What isn’t

• Dental care
• Contraceptives
• Alternative medicine

Cost sharing

• Annual deductible for all hospital care
• Annual deductible for specialist physicians
• Annual deductible for medications
• Annual deductible for mental health services
• Annual deductible for rehabilitation services (e.g., physiotherapy)
• Co-payments for home care and long-term care

Exceptions

• Health care insurers must accept all applicants. People with lower incomes receive a health care allowance to cover flat-rate for basic packages. Those who fail to pay for basic packages are still insured.

Public-private funding

• 83% public – Provincial/federal health insurance plans
• 17% private – Voluntary health insurance, out-of-pocket payments and other sources

What’s publicly covered

• Hospital care
• Physician care
• Mental health care
• Some long-term care
• Some home care
• Some dental care
• Medications

Cost sharing

• Medication
• Some dental care

Exceptions

• Medication for children, older adults and people with low incomes
• Regular financial support for means-tested home, nursing and residential care
• Private insurance is available for more rapid access to care, choice of specialists and better amenities, especially for elective hospital procedures.