Guide to different European healthcare systems

Table of contents

1. Types of healthcare systems in Europe

• The Beveridge Model

• The Bismarck Model

2. Other types of healthcare systems around the world

• The out-of-pocket model

• The national health insurance model

3. Consider international health insurance

In this blog, learn about the types of healthcare models in Europe, their main features and the other types of health systems found across the world.

Types of healthcare systems in Europe

Europe is home to some of the most advanced healthcare systems in the world, with countries such as Norway, Sweden, Iceland and Switzerland all ranking in the top ten of Statista’s best health systems worldwide in 2023. [1]

There are two kinds of state health systems in Europe that provide medical care to the population: the Beveridge Model and the Bismarck Model. Let’s take a look at these healthcare models in more detail.

The Beveridge Model

In countries that use the Beveridge Model, the state healthcare system is mainly funded through taxation. Under this, medical treatment is free at the point of service and can be accessed by all residents.

It is solely the government who pays for and provides healthcare services with funds from tax contributions, making it what is known as a ‘single-payer’ system.

One potential drawback of this model is long waiting times, as every citizen being entitled to receive medical care can place pressure on the system. There is also the possibility of over use, where patients might access treatment when they do not necessarily need it.

Below are examples of countries that have this model to demonstrate how it works in practice.

United Kingdom

The British healthcare system is called the National Health Service (NHS). This is managed by the Department of Health and Social Care and is available to everyone who is ordinarily resident in the country.

In many cases, expats can access by registering with a doctor and making an appointment to get an NHS number with their local authority. More information about how the UK’s national health service works can be found in our blog here.

However, depending on some circumstances, individuals may have to pay what is known as an immigration health surcharge (IHS). This is paid alongside the visa application and is necessary for those staying in the UK for more than six months. Here’s more information about who needs to pay the immigration surcharge.

Sweden

The Swedish healthcare system is funded through local taxes and operates a decentralised model. This means that while it is nationally regulated, healthcare is governed and managed by regional authorities.

Anyone who is a resident in Sweden can access the public system. However, it’s worth noting that this is only possible if individuals have been living in the country for longer than 90 days.

It’s worth noting that while waiting for residency, EU and Nordic citizens can access the public system on the same terms as Swedish nationals.

But non-EU nationals must have proof of private health insurance cover when applying for a visa and before they can register as a resident. The plan has to meet certain requirements, such as providing a minimum coverage level of €30,000 and be valid in all Schengen countries.

The Bismarck Model

The Bismarck Model’s key point of difference from the Beveridge Model is that it is mainly funded through social insurance contributions rather than taxation.

In this model, employers and employees will both contribute towards a public or private sickness fund. There are many different funds across the country responsible for collecting contributions to pay for healthcare services, so the system is classed as “multi-payer”.

All citizens are automatically covered under this model, and medical treatment is free at the point of use. However, they could sometimes have less choice in where they receive treatment, as funds may have a specified network of approved healthcare providers.

France

The French public healthcare system is known as Protection Maladie Universelle (PUMA). It is funded through both patient and social insurance contributions, and all residents are required to have some type of health insurance.

Anyone looking to move here can qualify for state healthcare if they make social security contributions and are either employed or a resident. An individual can register for residency if they have been in France for three consecutive months and intend to live here at least six months of the year.

Germany

This European country has one of the oldest healthcare systems in the world, where individuals have to choose whether to contribute social insurance contributions to either a public or private health fund.

Foreign residents living and working in Germany must have health insurance cover when applying for a visa, which must be approved by BaFin and accepted by the immigration authorities.

Other types of healthcare systems around the world

Though the above models are prominent for countries in Europe, there are two main other types of healthcare system found in the world.

The out-of-pocket model

This is most common type of healthcare model in the world. In countries where this is used, patients must pay the healthcare provider directly at the point of use for any medical treatment they need.

It means that patients can often face expensive medical bills, as there is no type of state insurance or tax-based structure in place to fund healthcare services. Nations that operate with the out-of-pocket healthcare model incorporate:

• USA

• Nigeria

• Armenia

• Cambodia

• Chad

• India

The national health insurance model

The national health insurance model has aspects of both the Bismarck and Beveridge Model. All residents are covered under the system, which is financed primarily through taxation and is free at the point of service.

Most healthcare providers in this model are private, with the government acting as the single-payer for services. Medical care is heavily regulated by the government, which helps to control costs.

Some of the negatives of the system include potential long waiting times for treatment, and less choice in where patients can be treated due to government restrictions.

Examples of countries that have the national health insurance model are:

• Canada

• South Korea

• Taiwan

Consider international health insurance

Anyone thinking about moving to Europe could consider purchasing an international health insurance plan to safeguard their healthcare needs while living abroad.

This can provide fast access to eligible medical care in leading provide medical facilities worldwide, and protect against the cost of potentially expensive medical bills. It also offers lots of flexibility, allowing members to decide where they receive treatment and who provides it.

Click here to find out more about APRIL International’s expat health insurance plans.