Structured Lists Directory

TOML

Health Insurance Systems - TOML

Health insurance systems are social institutions designed to reduce citizens' medical expenses and ensure access to healthcare services. They are classified into four major types: the Beveridge Model (national health service), Bismarck Model (social health insurance), National Health Insurance Model, and Out-of-Pocket Model. Each country designs its system according to its national circumstances. Japan adopts the Bismarck Model, achieving universal health coverage through a three-tier structure of employee health insurance, national health insurance, and late-stage elderly medical care system.

health insurance social security healthcare system universal health coverage medical insurance social insurance healthcare costs 
[[items]]
code = "01"
slug = "beveridge-model"
name = "Beveridge Model (National Health Service)"
description = "A healthcare model where the government provides and operates healthcare through tax revenue."
coverageRate = "99-100%"
examples = "[\"UK\",\"Spain\",\"Sweden\",\"Norway\",\"New Zealand\",\"Cuba\",\"Hong Kong\"]"
fundingSource = "General taxation"
originCountry = "United Kingdom"

[[items]]
code = "02"
slug = "bismarck-model"
name = "Bismarck Model (Social Health Insurance)"
description = "A social insurance model where employers and employees share insurance premium contributions."
coverageRate = "85-99%"
examples = "[\"Germany\",\"Japan\",\"France\",\"Netherlands\",\"Belgium\",\"Switzerland\"]"
fundingSource = "Employer and employee contributions (payroll deductions)"
originCountry = "Germany"

[[items]]
code = "03"
slug = "national-health-insurance-model"
name = "National Health Insurance Model"
description = "A hybrid model where the government acts as the insurer while private providers deliver services."
coverageRate = "99-100%"
examples = "[\"Canada\",\"Taiwan\",\"South Korea\",\"Australia\"]"
fundingSource = "Government insurance program (taxes or premiums)"
originCountry = "Canada"

[[items]]
code = "04"
slug = "out-of-pocket-model"
name = "Out-of-Pocket Model (Market-Based)"
description = "A model without an organized system where individuals pay for healthcare directly."
coverageRate = "Variable (often <50%)"
examples = "[\"Rural Africa\",\"Rural India\",\"Rural China\",\"Cambodia\",\"Burkina Faso\"]"
fundingSource = "Individual direct payment"
originCountry = "N/A (Developing countries)"

[[items]]
code = "05"
slug = "japan-employee-insurance"
name = "Japan: Employee Health Insurance (Occupational)"
description = "Japanese health insurance for employees of companies and organizations and their families."
coverageRate = "約60%（日本国内）"
examples = "[\"協会けんぽ\",\"健康保険組合\",\"共済組合\",\"船員保険\"]"
fundingSource = "Equal employer-employee contributions"
originCountry = "Japan"

[[items]]
code = "06"
slug = "japan-national-health-insurance"
name = "Japan: National Health Insurance (Regional)"
description = "Japan's regional health insurance for self-employed, farmers, and non-regular workers."
coverageRate = "約27%（日本国内）"
examples = "[\"市町村国保\",\"国民健康保険組合\"]"
fundingSource = "Household premiums (with national, prefectural, and municipal subsidies)"
originCountry = "Japan"

[[items]]
code = "07"
slug = "japan-late-stage-elderly"
name = "Japan: Late-Stage Elderly Healthcare System"
description = "Japanese healthcare system for individuals aged 75 and older."
coverageRate = "約16%（75歳以上の全員）"
examples = "[\"後期高齢者医療広域連合\"]"
fundingSource = "Premiums (with support contributions and public funding)"
originCountry = "Japan"

[[items]]
code = "08"
slug = "uk-nhs"
name = "UK: NHS (National Health Service)"
description = "The world's largest publicly funded healthcare service established in 1948."
coverageRate = "99-100%"
examples = "[\"NHS England\",\"NHS Scotland\",\"NHS Wales\",\"HSC Northern Ireland\"]"
fundingSource = "General taxation and National Insurance contributions"
originCountry = "United Kingdom"

[[items]]
code = "09"
slug = "germany-gkv-pkv"
name = "Germany: GKV and PKV Dual System"
description = "Germany's healthcare system with coexisting statutory and private health insurance."
coverageRate = "99-100%"
examples = "[\"AOK\",\"TK\",\"Barmer\",\"DAK-Gesundheit (GKV)\",\"Allianz\",\"AXA (PKV)\"]"
fundingSource = "GKV: payroll deductions (employer-employee split) / PKV: individual premiums"
originCountry = "Germany"

[[items]]
code = "10"
slug = "us-mixed-system"
name = "USA: Mixed Healthcare System"
description = "A complex system with private insurance as the mainstay and government programs for specific populations."
coverageRate = "約92%（未加入者約8%）"
examples = "[\"Medicare\",\"Medicaid\",\"CHIP\",\"VA\",\"Employer-sponsored insurance\",\"ACA Marketplace\"]"
fundingSource = "Private premiums, government tax revenue, individual payments"
originCountry = "United States"

[[items]]
code = "11"
slug = "singapore-medisave"
name = "Singapore: Medisave System"
description = "A unique healthcare financing system centered on personal savings accounts."
coverageRate = "100%（Medishield Lifeは強制）"
examples = "[\"Medisave\",\"Medishield Life\",\"Medifund\",\"Integrated Shield Plans\"]"
fundingSource = "Personal savings (CPF), insurance premiums, government funds"
originCountry = "Singapore"

[[items]]
code = "12"
slug = "france-universal"
name = "France: Universal Health Coverage"
description = "France's social insurance system renowned for world's highest healthcare access."
coverageRate = "99-100%"
examples = "[\"CPAM\",\"CMU-C\",\"mutuelle\"]"
fundingSource = "Social insurance contributions (payroll), general taxation"
originCountry = "France"

[[items]]
code = "13"
slug = "canada-medicare"
name = "Canada: Medicare System"
description = "A single-payer public health insurance system operated by provincial governments."
coverageRate = "99-100%"
examples = "[\"OHIP (Ontario)\",\"MSP (British Columbia)\",\"RAMQ (Quebec)\",\"AHCIP (Alberta)\"]"
fundingSource = "Provincial taxes and federal transfers"
originCountry = "Canada"

[[items]]
code = "14"
slug = "taiwan-nhi"
name = "Taiwan: National Health Insurance (NHI)"
description = "An efficient single-insurer healthcare system introduced in 1995."
coverageRate = "99%以上"
examples = "[\"National Health Insurance Administration (NHIA)\"]"
fundingSource = "Premiums (employer-employee split for workers), government subsidies, tobacco taxes"
originCountry = "Taiwan"

[[items]]
code = "15"
slug = "south-korea-nhis"
name = "South Korea: National Health Insurance"
description = "A system introduced in 1977 that achieved universal coverage by 1989."
coverageRate = "99-100%"
examples = "[\"National Health Insurance Service (NHIS)\",\"Health Insurance Review and Assessment Service (HIRA)\"]"
fundingSource = "Premiums (employer-employee split for workers), government subsidies"
originCountry = "South Korea"

[[items]]
code = "16"
slug = "australia-medicare"
name = "Australia: Medicare"
description = "A public health insurance scheme introduced in 1984."
coverageRate = "99-100%"
examples = "[\"Medicare\",\"Medicare Levy Surcharge\",\"Private Health Insurance Rebate\"]"
fundingSource = "General taxation (Medicare levy)"
originCountry = "Australia"

[[items]]
code = "17"
slug = "netherlands-mandatory"
name = "Netherlands: Mandatory Private Insurance"
description = "A mandatory private insurance system introduced in 2006."
coverageRate = "99-100%"
examples = "[\"Zorgverzekeringswet (Zvw)\",\"Zorginstituut Nederland\"]"
fundingSource = "Individual premiums, income-related premiums, government subsidies"
originCountry = "Netherlands"

[[items]]
code = "18"
slug = "switzerland-mandatory"
name = "Switzerland: Mandatory Health Insurance"
description = "A mandatory private insurance system introduced in 1996."
coverageRate = "99-100%"
examples = "[\"KVG/LAMal\",\"Swiss Federal Office of Public Health (FOPH)\"]"
fundingSource = "Individual premiums, cantonal subsidies"
originCountry = "Switzerland"

[[items]]
code = "19"
slug = "sweden-regional"
name = "Sweden: Regional Public System"
description = "A tax-funded public healthcare system operated by regional governments."
coverageRate = "99-100%"
examples = "[\"Region Stockholm\",\"Region Skane\",\"Vastra Gotalandsregionen\"]"
fundingSource = "County and municipal taxes, national subsidies"
originCountry = "Sweden"

[[items]]
code = "20"
slug = "private-supplementary"
name = "Private Health Insurance (Supplementary)"
description = "Private health insurance that supplements public health insurance."
coverageRate = "各国・各制度により異なる"
examples = "[\"Cancer insurance\",\"Advanced medical care riders\",\"Private hospital rooms\",\"International health insurance\"]"
fundingSource = "Individual premiums"
originCountry = "Various countries"