Table 1.

Overview of the health insurance systems of major OECD countries¹¹⁾

		Japan (2012)	Germany (2011)	France (2011)	Sweden (2010)	The United Kingdom (2011)	The United States (2011)
Type of system		Social insurance system * Universal health insurance * Occupational insurance and regional insurance	Social insurance system * Around 85% of citizens enrolled * Employees enroll in public health insurance by workplace or by region. Not compulsory for employees over a certain income, self-employed people, civil servants, etc. * People for whom it is not compulsory are obliged to subscribe to private health insurance (general compulsory enrollment), in effect universal health insurance	Social insurance system * Universal health insurance (99% of citizens enrolled) * Enrolled by employee system by workplace or non-employee system (self-employed), etc. (People for whom it is not compulsory subscribe to a universal health system benefit plan.)	Public health and medical services through the tax system * For all residents * Landstinger (regional governments) are the providing entities (cash benefits are implemented nationally)	State-owned National Health Service (NHS) through the tax system * For all residents	Social insurance system (Medicare/Medicaid) * Medicare targets those over 65 and persons with disabilities; Medicaid targets low-income earners who meet certain criteria * Does not constitute universal health insurance [16.3% (2010) of the population not covered by any health insurance at all], large role played by the private sector
Individual contribution		30% Pre-compulsory education: 20% 70–74 years: 20% (30% for those on par with active income earners) 75 years or older: 10% (30% for those on par with active income earners)	- Outpatient : €10 examination fees per quarter for the same illness (free of charge for people with referrals) - Inpatient : €10 per day (up to 28 days per year) - Medication: 10% fixed rate (maximum expenses €10, minimum €5)	- Outpatient : 30% - Inpatient : 20% - Medication: 35% (0% for anti-cancer agents and other expensive medications with no alternatives; 70% for stomach medicines; 85% for less-useful medications; 100% for vitamins and tonics) * Reimbursement system requiring full payment up front (however, in-kind benefits are paid for hospitalization, etc.) * Supplementary medical costs insurance has been developed to cover individual contributions. (Mutual aid association format; 80% of citizens enrolled.) * In addition to the above fixed rates, there is an outpatient contribution (€1 per day, maximum €50 per calendar year) and an inpatient fixed contribution (€18 per day, €13,5 for psychiatry) These cannot be reimbursed by supplementary medical costs insurance.	Inpatient : Set independently by each landstinger at about 80 kr as the daily maximum. * In many landstinger , free of charge to those aged 18–20 years Outpatient: Set independently by each landstinger Individual contribution for primary care can be 100–200 kr per time (By law, the maximum individual patient contribution nationwide is 900 kr per year; landstinger can set a lower amount than this.) - In many landstinger , free of charge for persons below 20 years of age. - Medication: Fully self-paid up to the maximum individual contribution of 900 kr (Maximum of 1,800 kr per year.)	No individual contribution principle * Outpatient prescription medication has a fixed amount per prescription; three types of fixed-amount contributions for dental treatment. Further exemptions for elderly, low income earners, pregnant women, etc. There are many exemptions for medications.	Inpatient : (Part A) Medicare (compulsory enrollment) 60 days from admission: individual contribution up to $1156 61–90 days: $289/day 91–150 days: $578/day 151+ days: full amount - Outpatient : (Part B) (optional enrollment) $155 per year + 20% of medical expenses - Medication: (Part D) (optional enrollment) Up to $310: full amount self-paid $310–2,830: 25% $2830–4550: full amount self-paid $4,550+: 5%
Funding	Premiums	10% of remuneration (half paid by the employer) * Japan Health Insurance Association	15.5% of remuneration Individual: 8.2% Employer: 7.3% * Common to all insured persons * Self-employed persons: individual pays the full amount	13.85% of total wages Individual: 0.75% Employer: 13.1% * Employee health insurance system enrolled in by private merchants (general system)	Nil	Nil * More than 20% of NHS costs are appropriated from national insurance premiums for cash benefits, such as retirement pensions, etc.	Inpatient (Part A) 2.9% of salary (half paid by the employer) * Self-employed persons: individual pays the full amount Outpatient (Part B) Around $115.40 per month (individual pays the full amount) Medication (Part D) (average premium) Around $40.72 per month (individual pays the full amount)
	State contribution	16.4% of benefit expenses, etc. * Japan Health Insurance Association	By law, set at €4 billion in 2009 and to increase by €1.5 billion each year until it reaches a total of €14 billion. Under secondary economic measures, set in January 2009, associated with the economic and financial crisis, €3.2 billion (€6.3 billion based on a full fiscal year) was injected, as the premium rate was set to be reduced by 0.6% in July 2009. Accordingly, the maximum of €14 billion is expected to be reached in 2012.	Traditionally, state liability was limited to making up deficits; however, the state contribution increased in 1991. Appropriated from general public contributions (purposed tax) to fund medical care, pensions, etc. (Tax rate: 7.5% of wage income, including 5.29% medical portion) * Employee insurance system funding breakdown (2008) - Premiums: about 56% - General public contributions: about 37% - Other purposed tax (tobacco, alcohol, etc.): about 5%	No such principle. * Covered by landstinger tax revenues (residents’ income tax, etc.) and individual patient contribution amounts. * Small general allocation taxes and subsidies are available from the national government.	Financed by taxes.	Inpatient (Part A) Financed by social security tax Outpatient (Part B) Around 75% of costs Medication (Part D) Around 75% of costs