The public-private insurance mix in European countries

The crux of Dr. Day’s case is he would like to bill the government for the amounts on the fee schedule, and then bill the patient or the private insurer. In his interviews, Dr. Day infers this will be like European private/public hybrid health care delivery systems, usually pointing to France, Germany and Switzerland.

There is no singular European health care system; each nation has its own. Thus, he is comparing apples to oranges, pineapple, bananas and kumquats.

The World Health Organization's European Observatory on Health Systems and Policies publishes health system review reports about each nation. 


Switzerland has most expensive system in the world, right behind the USA, because of the private insurance. A major part of the Swiss economy is insurance companies, for everything. Private health insurance is mandatory, but all private insurers must sell the exact same basic benefit package, for the exact same price. By law, there is no competition on the price of basic insurance. Instead, they can only compete on the supplemental insurance they also sell. In that sense, for basic insurance, they are a multi-payer system that functions as a single payer system.

That's not the kind of private insurance Day wants.


The private health insurance sold in France is specifically to cover the costs of the co-payment they introduced. It's insurance to cover the cost of the per-visit user fee France introduced, which people couldn't afford, so they then introduced private insurance to cover that fee. That's not the kind of private insurance Day wants.


The private insurance sold in Germany is for those wealthy enough to leave the public system entirely. But once they leave, they can never come back, no matter how expensive their care becomes. It's a one-way door. How many Canadians would want to leave the Canadian health care system entirely.

That's not the kind of private insurance Day wants.