Column: International Healthcare Systems

This series titled “Column: US Healthcare System” is sponsored content from our partners at Axene Health Partners.  AHP offers highly specialized health care actuarial and consulting services across a number of states.  We have curated this content because we think it adds value to the work our readers are engaged in.  As always, we welcome your feedback on this series.


The United States is the only industrialized country in the world that does not have Universal Health Coverage for all citizens. While the Affordable Care Act (ACA) was a step in the direction of universal coverage, as of the end of 2016, 9% of all Americans (and 12.4% of US Adults aged 18 to 64) still did not have health insurance. This paper will give a high-level overview of where we are today, with a comparison to several other countries.

Defining the terms: Universal Health Coverage, Single Payer, and Socialized Medicine

When debating the future of health insurance in the US, terms such as Universal Health Coverage, Single Payer, and Socialized Medicine are often used interchangeably, but they are not the same thing. The World Health Organization’s definition of Universal Health Coverage is “that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.”

Unpacking that definition, Universal Health Coverage ensures:

  1. Universal access to health services
  2. Health services that are of high quality
  3. Receiving health services does not put people at risk of financial harm

Single payer systems are one method of achieving UHC, but not the only, and there are very few true single payer systems in the world. In a single payer system, the government pays for medical care and restricts alternative payment mechanisms for the services that it covers. Canada and Taiwan are the only 2 countries in the world with true single payer systems covering their entire populations, while within the US, Traditional Medicare is an example of a single payer system.

Just as a single payer system isn’t the only option for achieving UHC, so too Socialized Medicine is not the only way to achieve single payer. In addition to paying for health care, the government owns the facilities and employs the professionals in a socialized medicine system. Neither Canada nor Taiwan meets these criteria (though the UK does), and US Medicare is also not socialized medicine. However, the US itself does have a socialized medicine system in the Veterans Health Administration (VA) – all VA hospitals are owned by the government and the health care providers are all employees of the government.

Continue reading the column here.