Update 1/21/2013: With the Supreme Court’s decision to uphold the ACA (aka Obamacare), and President Obama’s inauguration to a second term today, the US will have universal health care in 2014 using an insurance mandate system.



Thirty-two of the thirty-three developed nations have universal health care, with the United States being the lone exception [1]. The following list, compiled from WHO sources where possible, shows the start date and type of system used to implement universal health care in each developed country [2]. Note that universal health care does not imply government-only health care, as many countries implementing a universal health care plan continue to have both public and private insurance and medical providers.

Country Start Date of Universal Health Care System Type Click links for more source material on each country’s health care system. Norway 1912 Single Payer New Zealand 1938 Two Tier Japan 1938 Single Payer Germany 1941 Insurance Mandate Belgium 1945 Insurance Mandate United Kingdom 1948 Single Payer Kuwait 1950 Single Payer Sweden 1955 Single Payer Bahrain 1957 Single Payer Brunei 1958 Single Payer Canada 1966 Single Payer Netherlands 1966 Two-Tier Austria 1967 Insurance Mandate United Arab Emirates 1971 Single Payer Finland 1972 Single Payer Slovenia 1972 Single Payer Denmark 1973 Two-Tier Luxembourg 1973 Insurance Mandate France 1974 Two-Tier Australia 1975 Two Tier Ireland 1977 Two-Tier Italy 1978 Single Payer Portugal 1979 Single Payer Cyprus 1980 Single Payer Greece 1983 Insurance Mandate Spain 1986 Single Payer South Korea 1988 Insurance Mandate Iceland 1990 Single Payer Hong Kong 1993 Two-Tier Singapore 1993 Two-Tier Switzerland 1994 Insurance Mandate Israel 1995 Two-Tier United States 2014? Insurance Mandate

Will the United States join this list in 2014?

[1] Roughly 15% of Americans lack health insurance coverage, so the US clearly has not yet achieved universal health care. There is no universal definition of developed or industrialized nations. For this list, those countries with UN Human Development Index scores above 0.9 on a 0 to 1 scale are considered developed.

[2] The dates given are estimates, since universal health care arrived gradually in many countries. In Germany for instance, government insurance programs began in 1883, but did not reach universality until 1941. Typically the date provided is the date of passage or enactment for a national health care Act mandating insurance or establishing universal health insurance.

System Types:

Single Payer: The government provides insurance for all residents (or citizens) and pays all health care expenses except for co-pays and coinsurance. Providers may be public, private, or a combination of both.

Two-Tier: The government provides or mandates catastrophic or minimum insurance coverage for all residents (or citizens), while allowing the purchase of additional voluntary insurance or fee-for service care when desired. In Singapore all residents receive a catastrophic policy from the government coupled with a health savings account that they use to pay for routine care. In other countries like Ireland and Israel, the government provides a core policy which the majority of the population supplement with private insurance.

Insurance Mandate: The government mandates that all citizens purchase insurance, whether from private, public, or non-profit insurers. In some cases the insurer list is quite restrictive, while in others a healthy private market for insurance is simply regulated and standardized by the government. In this kind of system insurers are barred from rejecting sick individuals, and individuals are required to purchase insurance, in order to prevent typical health care market failures from arising.