Health Care Reform: Americans Abroad

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We finish our week-long series of health care roundtables with a look beyond our borders. We speak to three Americans living abroad about the health care systems in other countries. Christina Geyer  joins us from Bavaria, Germany, where she has lived since 2002. Lynne Udalov joins us from Moscow, where she has been for over 10 years. And Amanda Graham joins us from Derry, in Northern Ireland, where she moved in May.

Click through for an overview on the health care system of each country, or read the other round tables in this series.

Health care in Germany

  • Germany's health care system is a public-private hybrid. It is run by private nonprofit and for-profit health care providers, but is financed and tightly regulated by the government.
  • Health care coverage became mandatory in Germany as of January, 2009. All Germans are now required to have health care insurance.
  • German payroll taxes pay a portion of health insurance costs for the country's people, along with a premium that each working German pays for his or her own health care plans. Employers contribute around 45 percent of the worker's premium, and the amount of the premium is on a sliding scale, determined by how much each worker makes. 
  • If a person is working, the health care plans they have are extended to their partners, even if the partners are unemployed. The unemployed in Germany have health care, too, and it's paid for by a national unemployment insurance fund. Pension funds help finance health care for German senior citizens. German children are covered by the German government.
  • A national, government-run central fund collects the health care premiums paid by Germans, and redistributes the premiums to some 200 independent, nongovernmental, nonprofit health care providers – they are called “sickness funds” – and Germans can choose which fund they want for their health care plan.
  • Germany ranks 15th in the world for infant mortality, and has a life expectancy-at-birth of 79 years.

Health care in the UK

  • Before the NHS was set up in 1948 health care was provided by charities and voluntary hospitals, private medical clubs, occupational medical services and works clubs, fee for service insurance, friendly societies, public medical services (which were funded by subscription), and medical fees paid on an ad hoc basis.
  • The structured health insurance sector initially developed between 1940 and 1947 with the instigation of the London based Hospital Services Plan (now PPP Healthcare) and the amalgamation of several regional schemes into British United Provident Association (BUPA).
  • All legal residents of the United Kingdom and British Nationals are entitled to cover under the UK National Health Service (NHS).
  • In the UK, 11.5% of the population have supplementary private medical insurance. Those most likely to have private medical insurance are in the higher income groups (40% of adults with private medical insurance are in the highest income bracket compared to less than 5% in the lowest).
  • In all countries, England, Wales, Scotland and Northern Ireland, health care is predominantly funded through national taxation.
  • Private insurance is available, but it may be more limited than the public service (for example, most private insurers don’t cover HIV/AIDS)
  • The United Kingdom ranks 32nd in the world for infant mortality, and has a life expectancy-at-birth of 79 years.

Health care in Russia

  • Russia has a socialized health care system, meaning basic health care is publicly administered, and available to all Russians, free of charge. Wealthier Russians have the option to buy private health care.
  • In 1991, health care coverage became mandatory in Russia. Health care for all Russians is financed largely by the Ministry of Health, with some contribution from health care insurers and employers. Pension funds help finance health care for Russian senior citizens.
  • Although prescription drugs are free to hospitalized patients, Russians who are not hospitalized must purchase their own drugs. Since many hospitals in Russia have limited access to medicine, an estimated 80 percent of hospitalized patients pay a portion of the cost of their drugs.
  • All Russians can choose from more than 300 competitive private and public health care providers for their care.
  • In 2005, President Vladimir Putin wrote health care into a list of five top national priorities Putin also called for an 85 percent increase in health-related budget allocations.
  • Russia ranks 73rd in the world for infant mortality, and has a life expectancy-at-birth of 66 years.

(The U.S. ranks 45th in the world for infant mortality, and has life expectancy-at-birth of 78 years.)



"Healthcare Reform in Russia: Problems and Prospects," by William Tompson, July 2007. Economics Department Working Papers, No. 538 (opens a PDF)

"Health Care Systems in Transision," by Ellie Tragakes and Suszy Lessof. Edited by Ellie Tragakes, 2003 (opens a PDF)

2006 Library of Congress Russia profile, October 2006 (opens a PDF)


"Health Reform Without a Public Plan: The German Model," by Professor Uwe Reinhardt. Published April 17, 2009 on The New York Times

"The German Health Care System," by Reinhard Busse, M.D. M.P.H., Professor of Health Care Management, Berlin University of Technology & Charité – University Medicine Berlin (opens a PDF)


The British Medical Journal

World Health Organization


The CIA World Factbook