How do nations that have universal health care and health care through employment balance these two options

Are there nations with UHC where employer provided health insurance is still a major factor in insurance? If so, how do these nations handle it when people switch jobs, get laid off, start a small business, can’t work due to illness, etc?

It was my understanding, and correct me if I’m wrong, that in places like Germany you can get insurance through work but if you get laid off you get switched from your employers plan to a public plan. Anyone know? this is kind of similiar to the idea of medicare extra for all, which is a UHC plan for the US where everyone who isn’t covered by employer coverage, public coverage or private coverage is auto enrolled into the medicare extra plan.

I know in the Netherlands they have health exchanges, and if you don’t sign up, they just auto enroll you in the cheapest plan and bill you for it later.

Essentially are there nations with working UHC systems where some people get insurance through work, but the system seamlessly transitions them to a different insurance plan during things like job changes, unemployment, entrepreneurship, retirement, etc?

Let me give some examples from Canada.

Some years ago I developed heartburn, but it presented “oddly” and so the doctor wasn’t sure if it was angina (a minor heart attack, as I have a family history) or heartburn. The trip to the doctor cost me nothing. He sent me to the hospital, where they put electrodes on my chest and determined that it wasn’t a heart condition. This cost me nothing. I returned to the doctor, who prescribed me medication to make my stomach less acidic. The consultation cost me nothing, but the medicine cost me something. Where I work now, the medication would have been covered (80% or more) by my work insurance. That work insurance used to cost me $60. A year. Now it costs $0.

Medical services in Canada are generally free. This includes MRIs (I got one, paid nothing). However optometry is sometimes not free (lenses, frames, and contact lenses are never free), auditory is not free, dentistry and root canals are not free, and some other types of services are not free (stuff I haven’t used)). Medicine is pretty much never free. Prescribed devices (eg wheelchairs, canes, hearing aids, etc) are not free. A few types of surgery (such as wisdom tooth surgery) are not free. Most insultingly, ambulances are not free, which is ridiculous, but it’s only $75 if you’re poor (I think there’s some kind of sliding scale). Still, a poor person might not want to call an ambulance for this reason. They do not charge you on the spot.

My insurance covers practically everything, but there are severe limits on orthodontics and vision care. (In fact, vision care is not enough for my needs, and I might buy another insurance for that.) They also offer a very cheap (maybe $3 per month) private room hospital service. I don’t use that, so if I had to stay in the hospital I would only get a semi-private room. There’s some complicated stuff about care outside of the province or country which I read before I travel and then promptly forget.

Yeah but in Canada, the bulk of your medical costs are covered by a public system. Its a superior system than one where there are endless cracks to fall through.

I’m wondering more what happens if your insurance is provided by an employer, then you switch jobs. How do nations seamlessly transition you to a different plan?

I’m in the UK.
We have the wonderful NHS The NHS website - NHS (, which we are all covered by. You don’t have to be employed to benefit.
Some of my employers also offered private health insurance (usually we shared the cost.) When i left an employer the private health insurance lapsed (when the paid for period ran out.)

“Canadian care”, different in each province, covers the majority of doctor and hospital visits, stays and procedures. It covers some visits to other health professionals. It often does not usually cover dentistry, eyewear, some counselling, private hospital rooms, medications and many other things, so there is a role for private insurance often through work. In some provinces, some of these things (including medication) are covered for the elderly and below a certain age or income apart from a trivial charge (say $2).

The NHS covers the vast majority of my healthcare needs, but there are gaps:

Dental work may be subsidised if I can find a dentist who will work for the low NHS rates. I still have to pay for treatment.

Surgery that is considered cosmetic is not covered. I am not sure who decides that my facial lump is cosmetic or not, but some people get breast alterations if they can convince someone that it is seriously affecting their lives.

Eye tests and spectacles are not free apart for the young, pregnant and elderly. However, if an optician refers me to an ophthalmology clinic and I need surgery like a cataract for example, there is no charge.

Prescriptions are charged at a flat rate (currently £9.35 per item) but many people are exempt.

Some employers offer health insurance - free or subsidised, and this is especially useful for treatments that have a long waiting list. The downside is that private hospitals don’t deal with emergencies, so if a surgeon nicks an artery, they whip you off to the nearest NHS hospital for treatment.

Just to clarify, partly because a lot of Brits don’t even know about it and end up spending too much, prescriptions should never cost more than £100pa. If your prescription costs are going to be around a tenner a month, basically, you buy a pre-payment certificate. Then that’s all prescriptions covered.

OP, I’m not too clear on the question. In most countries with UHC, there’s optional private insurance, either through an employer or just one you buy yourself, but it’s a top-up. If losing that means you are in a system where hardly any of your needs are met, then I’m not sure the system would count as universal healthcare.

I have private healthcare for free via my employer but it’s just a top-up. It’s not really necessary at all TBH. It’d get me a nicer room if I had to stay in a hospital overnight, and I think it entitles me to some physio sessions that I need - I haven’t had time to investigate yet.

Yes, I assume OP is asking about systems based on employer-organised insurance, but AFAIK countries that have an insurance/contribution system also have varying degrees of government supervision, regulation and/or funding) of a limited range of schemes employers and employees pay in to, rather than that employers are expected to be in charge.

This is generally correct, and addresses the OP’s question from a Canadian perspective by noting that employer-provided supplementary insurance (or your own private insurance) can be useful for covering costs like outpatient medications, most dental procedures, and some of the other things you mention. It was nice to have, but I’ve been retired for many years and never really missed the loss of supplementary insurance. Full medical coverage under UHC has been a Godsend, however.

But a few nitpicks with some of the details, which vary by province. Prescription medication is automatically covered if you’re over 65 in Ontario and I believe most other provinces. Prescribed devices (wheelchairs, walkers, etc.) are not automatically covered by the Ontario plan but they are at least partly covered in many cases by other means, such as for a person receiving home care services, which in Ontario is part of the Ministry of Health but a separate program from UHC itself. Finally, in Ontario ambulance service is free in many cases (such as for those receiving home care services, for inter-hospital transfers, and in some other situations) but otherwise the co-pay is $45, billed at discharge from the hospital as a non-covered expense. The one time in my life I was in hospital (for a whole week) I didn’t have to pay a cent for any non-covered expenses (although IIRC the ex-wife paid for TV and internet service, one of the sneaky ways the hospital makes extra income).

I’m in the Netherlands. Its system seems similar to Obama Care in that you have to buy health care yourself from a company, and it can be a little expensive. You can generally get insurance via your employer for slightly cheaper (which I am not doing). If you loose employment you keep the insurance but the rate goes up slightly (since it isn’t through your employer).

I do not know what happens if you can’t afford health insurance for some reason. In my case I imagine they’ll just kick me out of the country (since I’m on a year-by-year employment VISA). I imagine there is some program for poor Dutch citizens and permanent residents to get free health care.

This site gives a good overview of the Dutch healthcare system, which seems to have a few drawbacks,

Dutch people believe the system is by public funding and when I explain them that is not true, they just end with ” Well, still is not as bad as the US”.

From my experience, Dutch healthcare is far from perfect. Indeed it is sometimes frustrating to get your GP to listen.

However, it is indeed orders-of-magnitude superior to the U.S. system. If there is a real issue, then it will be treated competently.

I’ve found hospital and doctors visits to be significantly less frustrating and the doctors to be significantly more competent. For example, I’ve had significantly better psychological care here (I’ve encountered incompetent therapists here too, but the competence ratio is far better than the US). My ex has had a lot of health problems that US doctors mostly refused to treat (because they thought she was just complaining to much about pain, these are normal women issues. etc… A lot of sexist and racist bullshit (shes African american)) . While here she has gotten the health care she needs. The doctors here, unlike the US, are actually trained in health issues specific to black people.

I can’t compare it to any other country however.

about the expense: I don’t mind. I’m happy that my money is going to useful places (as useful as politics can be). Unlike the US where the majority of my taxes go to human rights suppression.

Note to all. Except for @GeneralTang, no one has actually addressed the OP. If you want to vent about your local health care, open another thread. In fact, I am about to do so.

No, that’s not how it works, at least not in Germany. The German system is two-tiered, but the line between the two tiers don’t run the way you describe.

The two tiers are called statutory (gesetzliche in German) and private (private) health insurance (Krankenversicherung). The vast majority of Germans are insured in the statutory scheme, which is not composed of one insurance company but several, though their schemes are largely aligned. If you have employment, you’re obliged to join one of the statutory schemes unless your salary exceeds a certain limit. Government workers with Beamter status are exempted. In other words, the statutory scheme comprises all employed workers except those above the salary limit and Beamte. In this scheme, your health insurance contribution is a percentage of your salary (in other words, it is more tax-like than insurance-like, since your contribution is not assessed on the basis of your actuarial risk). Part of the contribution is paid by the employer; the other part is technically yours, but withheld by the employer and paid directly to the insurance.

Those who are not mandatorily included in the statutory scheme (i.e., salaried employees above the salary limit, Beamte and self-employed people) can choose between the statutory scheme and the private health insurance. Those calculate their contributions via actuarial methods, i.e., on the basis of an assessment of the risk you constitute rather than a percentage of your income). For young high-income earners, this can mean contributions can well be lower than in the statutory scheme, which may well change as you age. It’s a highly politicised debate, because the private health insurances have more generous coverage than the statutory ones; as a consequence, there is a widespread suspicion that privately insured patients get better treatment, or at least have shorter waiting times until they get an appointment, than statutory ones. Either way, irrespective of how you are insured, this is still a matter between you and your insurance provider; your employer pays part of your contributions, but it is not a case of your employer providing a health plan to you as part of the remuneration package you get for your work.

All this means that normally, a change of employment does not automatically come with a change of your insurance status, unless you’re changing from employment that is exempt from the mandatory statutory scheme into one that isn’t, or you’re changing from one that is not exempt into one that is and decide to opt for private health insurance. Both transfers certainly happen, but by and large most Germans tend to keep their insurance when they change jobs.

In Finland the transit is almost transparent except when you transit first time form some private healthcare operator to the public, you must give the public system concent to allow them download your records from the private operator. You need to do this once for each private sector operator but after that the system (should) work. In my case it has worked just fine.

There is also the fact that when your employer pays you salary when you are on sick leave they get reimburced by the social security system by the basic sick leave allowance. That amount is the same as the basic unemployment allowance and what for example a self employed person would get if they have no other insurance when sick.

An example how this works is what happened to me. I was working temporarily on one company and late in the gig I had a mishap where I injured my left knee. I went to the healthcare provider my employer used and they catscanned my knee and treated it. When my stint ended I got from the healthcare provider a letter where a DVD was attached and I was told that I should present it to my public side doctor. So I gave the DVD to my doctor and she asked what she was supposed to do with it. I told that it has some information on my left knee and that was that. About month later I got a notice from public sector that I need to go to have my knee catscanned. Six months after that I got a second notice to get my knee catscanned. About week later I got a summon to the ortopedic section of Helsinki Univercity hospitals and I went there. Here how the exchage went:

Doctor: “Why are you not angry?”
Me: “Why should I be?”
Doctor: “Because we had time pass and did nothing.”
Me: “Nonsense, the law says that you have six months to treat me and that what you have followed.”
Doctor:“That was not the case. Have you ever wondered why the private sector stopped treating you even thought this case was work related injury? The fact is that they found a tumor in your knee and we wanted to see if it was growing.”
Me “Is it?”
Doctor: "No. And that’s the problem. We cannot say when the tumor was formed. It can bee that it has been there since your knee was that size in first time or it might have grown later. But we don’t know. But what we can do is this: If you ever have a problem with your left knee you can walk trough the door of this facility and announce you in.
Me “Ok and thanks.”