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Indeed, so much is different between the US and Europe. This difference cuts across various aspects of life, including governance, institutions, etiquette, and public perception. Although healthcare is regarded as a fundamental human right, there exist apparent differences in the delivery of this critical service in the US and Europe.

Like all things America, the American government at both state and federal levels participates less in healthcare insurance. Across Europe, a hands-on approach by the governments is seen in most countries with a few exceptions.

The distinctions in healthcare insurance schemes and their administrations significantly affect cost, effectiveness, quality of service, and access. These factors are the bases for the comparison. It is equally essential to have a clear view of how health insurance operates within the US and Europe.

  1. Health Insurance Structure
  2. Cost of Health Insurance
  3. Access to Healthcare Services
  4. Quality of Healthcare Service
  5. Efficiency of Healthcare Service
  6. Equity of Healthcare Service
  7. Why US Healthcare Insurance is More Expensive
  8. Conclusion

Health Insurance Structure

In America, citizens, employers, and the government are responsible for healthcare. Partially funded by the state and federal governments, Medicaid provides healthcare to low-income earners. Medicare provides healthcare to disabled people and the elderly through federal government subsidies. Anyone that is not eligible for Medicare or Medicaid would have to purchase private healthcare insurance through their workplace or independently.

Within Europe, many different health insurance schemes exist. In the UK, the National Health Service or NHS provides almost all healthcare services for free to residents of all the four countries (England, Wales, Northern Ireland, Scotland).

This system is completely funded through the taxes collected across the states. Many countries within Europe have healthcare systems that are similar to what is seen in the UK. Russia is another country that provides free healthcare through subsidies and company taxes.

The Universal Health Care system in Spain operates almost precisely as the NHS. The only difference is that residents within the country would usually have to pay for copayments for some specific services.

France operates the National Health Insurance system, which is mostly funded by the government and some specific taxes from residents and businesses. Residents typically pay less than 40% for healthcare within the country.

Most European countries have healthcare systems similar to what is obtained in the UK and Spain or France. Germany, on the other hand, has an entirely different scheme. The German healthcare system is considered as one of the oldest. It is built on the Social Health Insurance scheme, which is utterly devoid of government funding. Employees pay for half of their healthcare, while their employers pay for the remaining half. Self-employed individuals are responsible for their entire healthcare funding.

Cost of Health Insurance

Considering how healthcare is structured within the US, it is easy to see why it is quite expensive. The health insurance of America is considered as the most costly in the world. The money spent per capita on healthcare stands at about $8,000. This figure is about two times the cost of healthcare in Luxembourg (at $5,500), which is the second most expensive. The cost of healthcare in America is the reason why more people are losing access to medical services.

Although the German healthcare system is devoid of government funding, the cost of healthcare per capita is about $4,800, which is cheap for its quality and standard. This efficiency reflects in the life expectancy within the country, which stands at 80.6 years.

The cost of healthcare per capita in France and the UK is about $4,000 and $3,341, respectively. These amounts are considered reasonable.

Access to Healthcare Services

Access to healthcare services is another factor that the US is lagging behind Europe in general. For every 1,000 American residents, there are only 2.6 specialist doctors and primary care physicians. This figure is insufficient to guarantee adequate caregiving. However, considering the 300 million-plus population and the vast geographical expanse of the country, such a low ratio is excusable and, in many cases, considered acceptable.

Across the aisle, the ratio is much higher within more significant economies. Austria has the highest rate, which stands at 5.1 to 1,000. Germany, France, and the UK have 4.2 to 1,000, 3.2 to 1,000, and 2.8 to 1,000, respectively. These ratios are partly responsible for the better quality of healthcare that is obtainable within the countries that are geographically referred to as western Europe. Additionally, the smaller populations within these countries is another reason for the higher ratios.

However, across Eastern Europe, particularly countries that were part of the former Soviet Union, these ratios are less favorable. The emigration of skilled medical professionals to Western Europe and North America partly accounts for the low proportion across such countries.

Quality of Healthcare Service

In terms of the quality of healthcare, the service within the US is higher than that provided in most of Western Europe. Therefore, countries like France, Germany, the Netherlands, and most of Scandinavia do not have a better-quality healthcare service than that of the US. Amongst all these countries, the United Kingdom ranks number one in terms of safe care, effective care, patient-centered care, and coordinated care. The quality of UK healthcare is down to the structure of the NHS. Although expensive for the government, this service is quite effective.

Efficiency of Healthcare Service

Although the healthcare service in the US is of good quality, its efficiency is low compared to other European countries. Similarly, the insurance system and the healthcare service within the UK are the most efficient. This efficiency is also closely related to the structure of the NHS. The country that comes close to the UK is Sweden, which has a fairly efficient healthcare system.

The lack of efficiency of the American healthcare system is due to excessive bureaucracy and abuse of emergency services by patients. In general, these issues are lower within Europe due to the small size of the population and geographic expanse.

Equity of Healthcare Service

Just like with efficiency, the American Healthcare service is the least equitable compared with many European countries. Low-earner patients can access healthcare within Europe. However, within the US, many low-earning Americans are more likely to not go for follow-up appointments and recommended tests to prevent accumulating debt.

Why US Healthcare Insurance is More Expensive

Naturally, many people assume the cost of living in the United States is the reason for the high cost of healthcare. However, this assertion is further from the truth. America sits at number 28 in terms of cost of living according to Numbeo. Most of the spots from number 1 to number 27 are occupied by European countries.

In general, the main cause of the cost of healthcare in the United States is there is no competition in the healthcare system. In the last few years, many hospitals have merged into large healthcare facilities. This action has significantly crushed competition. It has forced many smaller hospitals and other medical facilities to look for bigger institutions to merge with. Or, they risk closure due to a lack of clients. As a result, patients have limited options. Therefore, the cost of hospitals has consistently increased at the expense of the patients.

By extension, the mergers of hospitals led to the mergers of several healthcare insurance companies. In the last decade, many larger insurance companies have purchased smaller businesses. Similarly, patients are denied access to competitive healthcare insurance policies. In addition, healthcare insurance is considered a business within the US. However, it is considered a basic human right within most European countries.

Across Europe, the issue of hospital and healthcare insurance takeover is a rare occurrence. The governments and regulatory institutions within Europe keep in check the operations of healthcare facilities and insurance institutions.


Although the US is the biggest economy globally, it is unable to provide universal essential health to all of its residents, as it is obtainable in most of Europe. Those Americans that have access to healthcare do so at a considerable cost compared to the residents of most of Europe.

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