Health Insurance Coverage by Country

Topic Box from the 2006 Sixth Annual Benchmark Report

In 2003, the public share of total health spending in Organisation for Economic Cooperation and Development (OECD) countries ranged from a low of 44 percent in the US to a high of 90 percent in the Czech Republic. Canada, at 70 percent, came in just below the OECD average of 72 percent. The private insurance share ranged from none in Norway, Iceland and the Slovak Republic to a high of 37 percent in the US. Canada and France tied for third and fourth highest private insurance spending at 13 percent. An additional 15 percent of health spending in Canada came from out-ofpocket payments, which ranged from a low of 7 percent in Luxembourg to a high of 51 percent in Mexico.

The utilization of private health insurance varies greatly among the countries in the OECD. Five countries (Belgium, Germany, the Netherlands, Spain and the United States) have Primary private health insurance that represents the only available access to basic health coverage because there is no public coverage or individuals are not eligible for coverage (principal) or individuals have chosen to opt out of public coverage (substitute).

Seventeen OECD countries have private coverage that duplicates, complements or supplements the public system. The remaining twelve have negligible private health insurance or, in the case of South Korea, do not have data available.

Canada and Switzerland are the only countries where private coverage is restricted to services not covered by the public system. Five other countries have similar restrictions but also have negligible (i.e., less than 1 percent) private coverage.

Duplicate: private health insurance that offers coverage for health services already included under public health insurance, while also offering access to different providers or levels of service. It does not exempt individuals from contributing to public health coverage programs.

Complement: private health insurance that complements coverage of publicly insured services by covering all or part of the residual costs not otherwise reimbursed (e.g., copayments).

Supplement: private health insurance that provides coverage for additional health services not covered by the public system.

Sources: Organisation for Economic Cooperation and Development (2004), Private Health Insurance in OECD Countries; (2005) Health at a Glance, OECD Indicators.