Countries with universal healthcare

Countries that offer free and universal health care aim to nurture their citizens’ health and well-being. A positive side effect is a more vibrant, productive, and cost-effective workforce. 

Employees who don’t have to worry about the financial strain of medical expenses can focus on their jobs with energy and motivation. Likewise, organizations that don’t have to budget costly private health insurance plans can direct funds elsewhere, including robust total compensation plans. So, universal health care means fewer sick days, increased productivity, and more focused growth strategies.

As you expand your distributed team abroad, choosing candidates in countries with free and universal health coverage can help you stretch your budget. Read on to learn what countries have free health care, the difference between universal and free health services, and why a robust health policy will bolster your business.

Differentiating free health care and universal health care

Every health care system varies, so learning basic concepts is a great place to start when building hiring and health care policies. Let’s start with a breakdown of two common health care terms: free versus universal health care coverage.

Free health care

Free health care systems are publicly funded and provide primary care at low or no cost to all citizens, ensuring access regardless of income. What’s not free? Some countries may heavily subsidize specific products and services, charging co-payments for medications or fees for vaccinations, paperwork, or diagnostic tests (e.g., lab tests or imaging services). 

Universal health care

Sometimes referred to as universal health coverage, universal coverage, or universal care, a universal health care system provides more than 90% of its citizens with access to health care services. Typically, quality standards are enforced to ensure that health care services meet specific benchmarks, although this can vary enormously from one country to the next. 

Additionally, many universal health care systems permit citizens to contract private health care options, ensuring flexibility while upholding a foundation of equitable public health policy.

Types of free or universal health care

Terms like national health insurance, single-payer, and mixed health care system are easily confused. Let’s break down some of the most common models: 

1. National health insurance

National health insurance (NHI) is a health care coverage system that provides compulsory financial protection and access to health care for all citizens. Funding and coverage vary by country and might include insurance from public agencies, private insurers, or a mixture of the two.

Likewise, governments may determine eligibility for coverage based on factors like age, income, or employment status. Under this framework, Medicare for adults over 65 and Medicaid for low-income households can be considered types of national health insurance in the U.S. This is different from universal health care, which guarantees medical care as a right of citizenship.

2. The Bismarck model

The Bismarck model is a cost-sharing health care system that relies on private facilities to deliver health care services. Citizens must purchase a plan from a non-profit private insurer, which is strictly regulated to ensure affordable, high-quality care. Governments typically subsidize the Bismarck model through payroll deductions and taxes to ensure that no citizen goes uninsured. 

3. Single-payer health coverage

Also known as the Beveridge model, this public health insurance framework employs public and private medical care facilities to provide health care services that are free at the point of service. Governments subsidize single-payer systems with income tax revenue that primarily funds government-run facilities.

What countries have free and universal health care?

According to the World Population Review, 78 countries have free or universal health care systems. Some form of universal health care coverage is common in developed nations, but free, government-funded health care is a rarity. 

Here’s a list of countries that offer free or universal health care:

• Albania
• Algeria
• Argentina
• Australia
• Austria
• Bahamas
• Bahrain
• Belgium
• Bhutan
• Botswana
• Brazil
• Brunei
• Bulgaria
• Burkina Faso
• Canada
• Chile
• China
• Colombia
• Costa Rica
• Croatia
• Cuba
• Cyprus
• Czech Republic
• Denmark
• Egypt
• Finland
• France
• Georgia
• Germany
• Ghana
• Greece
• Hong Kong
• Iceland
• India
• Indonesia
• Ireland
• Israel
• Italy
• Japan
• Kuwait
• Liechtenstein
• Luxembourg
• Macau
• Malaysia
• Maldives
• Mauritius
• Mexico
• Morocco
• Netherlands
• New Zealand
• North Korea
• Norway
• Pakistan
• Peru
• Philippines
• Portugal
• Romania
• Russia
• Rwanda
• Saudi Arabia
• Serbia
• Seychelles
• Singapore
• Slovenia
• South Africa
• South Korea
• Spain
• Sri Lanka
• Suriname
• Sweden
• Switzerland
• Taiwan
• Thailand
• Trinidad and Tobago
• Tunisia
• Turkey
• United Arab Emirates
• United Kingdom

Remember not to take this list at face value. Perform due diligence before expanding your hiring strategy into a country with a free or universal health care system. Even in developed countries, the quality of public health insurance varies widely. According to an annual study of developed nations by the Commonwealth Fund, the United States has the lowest-ranked health system despite high marks in areas like the care process. 

To decide whether an employee needs a supplemental insurance plan from a private insurer, you must first understand the quality of available care and coverage, plus the overall impact on employee well-being. 

Are visitors and foreigners covered?

There’s no single answer to this question. Each government establishes unique policies regarding access to medical care, both free and universal. This can pose challenges for remote workers residing temporarily in foreign countries or employees who travel frequently for work. 

For example, Brazil offers free and immediate health care to everyone regardless of immigration status. However, in the U.K., the National Health Service only extends free coverage to non-citizens and non-residents in specific circumstances. 

Understanding the health care landscape in countries where your employees are located is crucial for providing comprehensive health insurance coverage. Here are some key questions to consider: 

• Is the health care insurance you provide to employees recognized and accepted in their country of residence?
• How do health care costs in other countries compare to those in your country?

You don’t have to answer these questions alone. Oyster’s Benefits Advisor tool has all the information you need to supercharge your global recruiting strategy. 

Common challenges in free health care systems

Widely accessible health services can significantly improve a person’s quality of life. But that doesn’t mean free and universal health care systems are perfect. 

Here are three common challenges that can potentially impact the quality of care for your employees: 

1. Long wait times: High demand for health services can overwhelm resources, leading to delays that negatively impact health outcomes. This can be especially pronounced for medical care that requires more time and specialized physicians, such as surgical interventions, mental health treatments, and diagnostic imaging procedures.  
2. Variability in care quality: The quality of medical care can vary significantly, even within the same health system. Regional differences in funding, staffing levels, and infrastructure can lead to disparities in service. This can create unfair inconsistencies where some employees receive exceptional health services while others face significant barriers to quality treatment. 
3. Limited resources: Funding constraints can restrict the availability of medical supplies, physicians, and facilities. In some countries, patients in public hospitals may be required to provide their own food, bedding, or medical supplies. These limitations don’t just reduce the quality and availability of essential health services—they add extra stressors to patients and make government-funded health care less affordable.

Why global health care matters for your team

Health care often ranks among the top priorities for job seekers and employers, as it significantly impacts their personal, professional, and financial lives. Every facet of your employee benefits program adds to the overall well-being of your workforce and increases your company’s appeal to new talent. 

As you explore options for a robust health policy, Oyster can help you find the right solution. With international health benefits covering employees in over 165 countries, Oyster ensures competitive rates and access to essential medical care, including medical, dental, and vision coverage. Schedule a demo with an Oyster expert today.

About Oyster

Oyster is a global employment platform designed to enable visionary HR leaders to find, engage, pay, manage, develop, and take care of a thriving distributed workforce. Oyster lets growing companies give valued international team members the experience they deserve, without the usual headaches and expense.

Oyster enables hiring anywhere in the world—with reliable, compliant payroll, and great local benefits and perks.