Table 1.

The Structure and Financing of Health Care in Israel, the United States, Germany, and England

Provider Type	Country	Structure	Payment
General Practitioners	United States	Employed by private groups, private or public health centers (∼50%) Self‐employed (∼50%) a	Employed: usually reimbursed salary, often tied to productivity Self‐employed: mainly fee‐for‐service (FFS)
	England	Self‐employed GP practice partners (> 50%) or salaried GPs employed by the practice	Employed: salary Self‐employed: weighted capitation + FFS + pay‐for‐performance
	Germany b	Employed in health centers, group practices (∼ 17%) Self‐employed (∼ 83%), mostly in solo practice	Employed: salary Self‐employed: contact capitation (per quarter) + FFS
	Israel	Employed by health plans (60%) Self‐employed (40%)	Employed: salary + capitation Self‐employed: capitation based on number of patients enrolled
Outpatient Specialists	United States	Employed by private groups, private or public health centers (∼60%) Self‐employed (∼ 40%) a	Employed: reimbursed through a combination of salary and FFS Self‐employed: mainly FFS
	England	Nearly all salaried employees of the NHS Able to work in private practice	Employed: salary Rates paid in private practice much higher than in public practice
	Germany b	Employed (∼ 18%) in health centers’ group practices Self‐employed (∼ 82%), mostly in solo practice	Employed: salary Self‐employed: contact capitation (per quarter) + FFS
	Israel	Employed by health plans (20%) Self‐employed (80%)	Employed: mixture of contact capitation (80%) and FFS (20%) up to a quarterly ceiling Self‐employed: FFS at higher rates.
Inpatient Specialists	United States	Employees of hospitals (perhaps half) Others with admitting privileges (right to practice as an independent physician) at hospitals	Employed: salary + productivity bonus Admitting privileges: FFS
	England	Nearly all salaried employees of the NHS Able to work in private practice	Employed: salary
	Germany	Employees of hospitals (95%) Self‐employed as either attending specialist or freelancer	Employed: salary + bonuses Self‐employed: FFS (attending specialists) or hourly rates (freelancers)
	Israel	Employees of public hospitals Self‐employed: 60% supplement by working in private hospitals	Employed (at nonprofit hospitals): salary Self‐employed at for‐profit hospitals: FFS
Hospitals	United States	Public (23% of hospitals) c Private nonprofit (60%) Private for‐profit (27%)	Mostly paid DRGs, some paid per diem Rates of reimbursement vary by a factor of 3 for the same DRG depending on insurance plan Global budgets in 1 state (Maryland)
	England	Largely public provision, only 3.3% acute beds private for‐profit	Public hospitals largely DRG‐based Some commissioners using global budgets
	Germany	Public (29% of hospitals, 48% of beds) Private nonprofit (34% of hospitals, 33% of beds) Private for‐profit (37% of hospitals, 19% of beds)	DRG‐based case payment within global target budget (with end‐of‐year adjustments for exceeding the budget/staying below the budget) Daily nursing fees (depending on DRG)
	Israel	Public nonprofit hospitals (97% of beds) Private, for‐profit elective surgical care and imaging only	Public hospitals: paid per diem for medical care and a combination of per diem and DRGs for surgical care under a cap (upper and lower) Private hospitals: paid DRG‐like payments

^aAmerican Medical Association. Employed physicians outnumber self‐employed. Press release. May 6, 2020. https://www.ama‐assn.org/press‐center/press‐releases/employed‐physicians‐outnumber‐self‐employed. Accessed November 11, 2020.

^bFederal Medical Register. Statistical information. Berlin, Germany: National Association of Statutory Health Insurance Physicians; December 31, 2019. https://www.kbv.de/media/sp/2019‐12‐31_BAR_Statistik.pdf. Accessed October 30, 2020.

^cAmerican Hospital Association. Fast facts on U.S. hospitals. Chicago, IL: American Hospital Association; March 2020. https://www.aha.org/statistics/fast‐facts‐us‐hospitals. Accessed November 11, 2020.