Lawmakers in the United States spent the past few months trying and failing to roll back some health-insurance requirements, but much of the rest of the world has been living under universal healthcare for decades. Nearly all developed nations provide insurance or require their citizens to buy a policy. But how those programs work and how much people pay varies widely. In some cases, patients would leave the hospital with no bill at all. In others, they'd owe lots of money. Business Insider has 14 editions around the world, so we asked our international colleagues what would happen if they were to break an arm in their countries. Here's what they told us. Sweden: Government insurance with a private boost Where would you go? The main option is urgent care at a regional hospital, which is run and funded by the county council. (There are 20 in Sweden.) You can also go to a local emergency unit, also known as a walk-in center, for which there are both private (for-profit) and public (nonprofit) options. Doctor's offices and primary care units do not provide urgent care. How long would it take to get there and to get treatment once you're there? Most Swedes live within an hour's drive from the nearest hospital or local emergency unit. You can call the emergency number 112 to get an ambulance to remote locations. Once you've checked in, urgent care at a hospital usually takes four to six hours in all, depending on severity. Local emergency units are faster and provide care within a couple of hours. How much would the broken arm cost you? How much would it cost you if you didn't have insurance? All emergency healthcare in Sweden is funded by the government (i.e., the county council). The patient will need to pay $35 to $45 for a hospital emergency-clinic visit. If they have If P&C insurance, this fee could be covered afterward. The Swedish — and Nordic — principle of equal healthcare access for all means you can't pay extra to get preferential treatment. How does your insurance work? Do you pay for it? Do you get it from your employer, the government, or somewhere else? All Swedish residents, including expats, are covered by a government-funded universal healthcare insurance. Employers and labor unions may offer private group insurance, but these will generally not cover urgent cases such as fractures. Some 650,000 out of 10 million Swedes currently have private healthcare insurance — a number that is likely to increase because of a shortage of nurses and other skilled medical staff. A patient can freely choose between public and private primary healthcare providers, as far as local capacity permits. This policy has resulted in a steady increase in the amount of private healthcare options in Sweden. Healthcare in Sweden is decentralized to local county councils and municipalities. About 90% of the work of Swedish county councils concerns healthcare, but they also deal with other areas such as culture and infrastructure. Italy: No cost at the hospital Where would you go? If I were to break my arm, I would go to a public hospital. How long would it take to get there and to get treatment once you're there? It depends on the seriousness — on average, for such an accident, within a day. How much would the broken arm cost you? How much would it cost you if you didn't have insurance? I would pay zero. How does your insurance work? Do you pay for it? Do you get it from your employer, the government, or somewhere else? In Italy, you don't need to have insurance. Some employers — for example, journalists — have special insurances that enable them to go to private hospitals, but that's something more, an additional option. Because if you break an arm, you can go to a public structure and obtain there everything you need. United Kingdom: Fully government-run health service Where would you go? I would go to the National Health Service's A&E (accident and emergency) department, which is funded by the British government. How long would it take to get there and to get treatment once you're there? In London, there would generally be one that is accessible. The waiting times can vary. It could be hours. How much would the broken arm cost you? How much would it cost you if you didn't have insurance? The medical care would have no cost. It's funded by taxpayers through an NHS tax. How does your insurance work? Do you pay for it? Do you get it from your employer, the government, or somewhere else? Employers can provide supplementary private medical insurance. You may be taxed at a higher rate by signing up for private health insurance. You generally have to visit an NHS general practitioner before your private health insurance will approve a private visit. Each treatment/office visit is assessed individually by your insurer. Germany: Insurance required Where would you go? You can either go to a hospital or to the office of an orthopedic surgeon. Doctor's offices are privately owned; hospitals can be either privately owned or owned by the government. There are also many hospitals that are operated by universities. How long would it take to get there and to get treatment once you're there? If you live in the city, the drive is short. In rural areas, it can take a while. There is a dramatic shortage of doctor's offices in these areas. You never know how long you have to wait. Sometimes you get treatment pretty fast; sometimes the waiting room is full of other injured patients. I've heard from someone with a severe sepsis who had to wait a whole day in the hospital. How much would the broken arm cost you? How much would it cost you if you didn't have insurance? People in Germany are legally required to have insurance. The only other option is private insurance, which is often used by wealthy people because they get better treatment. You pay nothing for a broken arm or other injuries or health issues. There are, however, certain extra treatments that are not covered by insurance, like dental cleaning or plastic surgery. Those are treatments that are not necessary. How does your insurance work? Do you pay for it? Do you get it from your employer, the government, or somewhere else? One-half of the insurance is paid by your employer, the other half is subtracted from your salary. The amount depends on your salary. If you earn more, you pay more. You can choose the insurance company yourself. If you are unemployed or unable to work, your insurance is covered by the government. The Netherlands: Up to €350 Where would you go? The first place to go is urgent care (usually part of a hospital), which is funded by the Dutch government. How long would it take to get there and to get treatment once you're there? Usually, people live within half an hour of an urgent-care facility. You can call the emergency number 112 to get an ambulance; if an experienced person is available, they can also determine to have a private car take you to urgent care. Once you arrive, the waiting time depends on the relative urgency of your case at that moment. So it can vary between no time and about one hour. How much would the broken arm cost you? How much would it cost you if you didn't have insurance? In the Netherlands, each year people have to pay the first €350 ($400) of medical costs out of pocket. Everything above that is covered under the "basic health insurance policy," which includes basic hospital care like treating a broken arm. So for a broken arm, it depends on your total medical costs during the year. How does your insurance work? Do you pay for it? Do you get it from your employer, the government, or somewhere else? The basic health insurance policy is obligatory. Every Dutch adult has to have one, and it costs, on average, €109 per month in 2017. The government determines what is covered under this insurance, but people get the basic insurance from private insurance companies. Private insurance companies are not allowed to exclude applicants for the basic insurance policy on medical grounds. However, the government gives financial compensation to private insurance companies with a lot of high-risk customers. There are some differences in the price of the basic health insurance, but these are relatively small, as every insurer offers the same package. Additionally, you can get extended insurance which covers things that fall outside the basic policy. People can decide for themselves if they want or need one. Prices differ, and private insurance companies have the right to refuse people. Singapore: Public and private insurance Where would you go? I would go to A&E at a hospital. The first choice would be the hospital nearest to me at the time, and it usually doesn't matter if it is a public or private hospital because I am covered by insurance. Having said that, most people would usually opt to go to a public hospital even if they are insured, because these are larger and more cost-friendly. The timing of the incident also matters, as private hospitals may not have 24-hour staff on standby for specific procedures. So I would opt for a government-owned hospital if the accident occurred late at night. How long would it take to get there and to get treatment once you're there? How long it would take depends on where you live. As Singapore is a small nation, most people will find themselves within five to 20 minutes of the nearest hospital. In any case, it would not take more than 30 minutes to get to the hospital unless there is a very bad traffic jam at the time. Waiting times vary. In my experience, it can take less than one hour to be seen by a doctor, or it can take up to seven hours, especially late at night, if the hospital happens to be busy. How much would the broken arm cost you? How much would it cost you if you didn't have insurance? Including basic tests and X-rays, the A&E consultation itself would cost about 115 Singapore dollars ($85). The cost of additional or follow-up treatments differs according to the type of specialist seen and where treatment is sought — a government clinic versus a government hospital versus a private clinic. How does your insurance work? Do you pay for it? Do you get it from your employer, the government, or somewhere else? In Singapore, we are covered by a government-administered insurance called MediShield Life, which provides coverage for treatments at public hospitals. This insurance can be upgraded with Integrated Shield Plans offered by private insurers. This will allow us to be insured for treatment in private-class wards and private hospitals as well. Many people in Singapore also have private insurance or are covered under an employer-sponsored insurance, which will usually be sufficient to cover any outstanding amount on the bill. We can also pay for certain medical treatments with our Medisave accounts. The Medisave is a national savings scheme administered by the government-run Central Provident Fund Board that involves mandatory monthly savings, taken from our salary, and compulsory contributions made by employers. Japan: Even the unemployed must be insured Where would you go? The first place to go is the hospital (orthopedics). You can go to family-run clinics or hospitals run by family, local, or prefectural governments. How long would it take to get there and to get treatment once you're there? Usually, it takes around half an hour to go to the nearest hospital. Once you arrive at the hospital, the waiting time can vary from five to 30 minutes. If you have a serious injury, you'll have to go to a bigger hospital, which can have longer waiting hours. How much would the broken arm cost you? How much would it cost you if you didn't have insurance? Depending on the family income and the age insured, patients typically pay 10% to 30% of the cost, with the remaining covered by the government. The total cost of the broken arm is around 68,000 yen ($600). Of this, you pay 20,000 yen, with the remaining 48,000 yen covered by the government. How does your insurance work? Do you pay for it? Do you get it from your employer, the government, or somewhere else? A person pays a certain amount of money every month to a public insurer. If you go to a hospital and get some medical services and you pay the 30% of it, the hospital charges the medical fee to a screening/payment institution, which then passes it on to the public insurer. The associations comprise several public insurers that manage the funds raised by the premiums people pay. Every Japanese citizen, including the unemployed, is required to participate in National Health Insurance. During their working years, most people get their insurance through their employers as a benefit. A certain portion of your monthly paycheck is deducted by your employer, which pays your premium to the public insurer. Patients ages 75 or older pay only 10% of the medical costs. In some cities in Japan, children under 15 can receive free medical treatments because the government pays for them. Nigeria — some employers provide insurance Where do you go? A government-owned hospital. How long does it take to get there and get treatment once you're there? It is based on how severe the case is. If it's not, you may have to come back after administering first aid. How much would the broken arm cost you? At least N200,000 ($654). Additional cost would be added based on the severity of the injury. How does your insurance work? My insurance comes from my employer and covers expenses I may incur from this operation or treatment. United States - Many without insurance Where would you go? You can either go to an urgent care center or the emergency room. How long would it take to get there and to get treatment once you're there? In a city, it might not take very long to get to a center or ER. In more rural areas, it can be harder to find a center. According to ProPublica, average ER wait times for the Us are between 38 and 80 minutes until treatment gets started. So in many cases, it could take a few hours to get your broken arm treated. How much would the broken arm cost you? How much would it cost you if you didn't have insurance? It fluctuates across the country, but according to Amino, a consumer healthcare company, in the Bay Area a broken arm could cost more than $1,200 if you have a high deductible health plan. If you’re uninsured, the cost could be even higher. How does your insurance work? Do you pay for it? Do you get it from your employer, the government, or somewhere else? The majority of Americans have either private or public insurance. The government funds the healthcare plans for millions of Americans through Medicare (for those 65 and up) and Medicaid. Medicaid provides insurance primarily to pregnant women, single parents, people with disabilities, and seniors with low incomes. Those who aren’t covered through the government either get insurance through their employers or the individual marketplace set up under the Affordable Care Act. The private plans all come with monthly fees, or premiums. According to Gallup, 11.3% of Americans have no health insurance at all. They face steep — sometimes crippling — costs if they suffer a medical emergency. Source
