U.S. health spending reached 17.2% of gross domestic product in 2024, above Canada and the United Kingdom, while international profiles show that broad coverage systems divide financing and delivery in different ways.
The Organisation for Economic Co-operation and Development (OECD) reported that health spending was 11.3% of GDP in Canada and 11.1% in the United Kingdom. The OECD average was 9.3%. It said the 2024 figures use provisional data from countries or preliminary estimates by its Secretariat. These ratios compare spending with economic output; they do not identify covered services or what patients pay.
The economics blog Conversable Economist argued in an Oct. 29 post that U.S. discussions of “national health insurance” often leave the system’s design unspecified. The Commonwealth Fund’s updated profiles cover 31 countries across six continents.
Canada assigns federal authorities a standards-setting role, while provincial and territorial governments run the public plans. Tax revenues fund the plans, which cover medically necessary hospital and physician care as well as some surgical-dental services. People may pay directly or use private insurance for services outside public coverage. OECD data show private insurance covered 69% of Canada’s population in 2023.
In England, national taxes fund the National Health Service (NHS). Most services are free, though charges can apply to prescriptions and dental care. England has a separate health system from Scotland, Wales and Northern Ireland. OECD data show private medical insurance covered 12% of the U.K. population in 2023. The Commonwealth Fund’s country profiles date the NHS to 1948 and trace Canada’s current federal framework to legislation enacted from 1957 to 1966.
The Netherlands requires people who live or work there to obtain standard insurance. The government sets the basic benefits, and insurers cannot reject applicants or vary the standard premium by age or health. Residents also pay an income-related contribution. Germany requires residents to have insurance through either statutory or private coverage.
Medicare includes a private-plan option. The Centers for Medicare & Medicaid Services (CMS) said private Part C plans covered 51% of Medicare beneficiaries in 2025. Payments for those plans’ Part A and B services made up about 52% of the combined benefit costs for those parts, the 2026 Trustees Report said.
The report says a funding warning requires the president to submit proposed legislation within 15 days after submitting the fiscal 2028 budget. Congress must consider the proposal on an expedited basis.
