Countries With Free Healthcare, and Why These Ones Have It

Countries with free healthcare, meaning a tax-funded public system that covers everyone and charges little or nothing when you see a doctor or go to hospital, include the United Kingdom (NHS, since 1948), Canada, New Zealand, Sweden, Norway, Denmark, Finland, Iceland, Italy, Spain, Portugal and Brazil, along with Bhutan and the Gulf states of Kuwait, Brunei and the United Arab Emirates, where care is free for citizens. Many other rich countries, such as Germany, Japan and Switzerland, have universal coverage paid through compulsory insurance instead, and the United States is the only wealthy industrialised nation without universal coverage. The table below lists the tax-funded systems, ordered by the year universal coverage began.

The start years come from a list of universal health care start dates compiled by the New York State Department of Health. “Free” is never absolute: several of these systems charge small fees, and many charge for dental care. What they share is that the state, not an insurer, pays for most care, and nobody has to show an insurance card to be treated.

Why these countries and not others? The answer is rarely wealth alone. The list clusters around a handful of causes: the shock of depression and war, social-democratic politics in the Nordic region, oil revenue in the Gulf, the return of democracy in southern Europe and Brazil, and, in one Himalayan kingdom, a constitution written with health in mind.

New Zealand in 1938 and Britain in 1948: Systems Born of Depression and War

The idea itself is older than either country’s system. After the revolution of 1917, Soviet Russia set up what is usually described as the first fully free and universal health system in July 1918; modern Russia kept a universal system after 1991 but now funds it through the Federal Compulsory Medical Insurance Fund, which is why it is not in the table. The two oldest systems on the list were created by Labour governments responding to economic collapse and war. In New Zealand, the First Labour Government passed the Social Security Act 1938, whose aim was a free health system with hospital and other services available to every New Zealander. That vision was never fully realised because of disputes with the medical profession, and from 1941 general practice was subsidised through General Medical Service benefits instead. Since the 1980s, reforms have added market and insurance elements, but public hospitals remain free.

In Britain, the blueprint was the Beveridge Report of November 1942, which recommended comprehensive health and rehabilitation services. After the Second World War, cross-party agreement led to the National Health Service, launched by the health minister Aneurin Bevan on 5 July 1948 at Park Hospital in Davyhulme, near Manchester, now Trafford General Hospital. That day 1,143 voluntary hospitals and 1,545 municipal hospitals in England and Wales passed into the NHS.

The NHS was built on three principles: that it meet everyone’s needs, that it be free at the point of delivery, and that it be based on clinical need rather than ability to pay. Today the UK’s four systems still provide care without charge to residents, with the exceptions of dental treatment and optical care, and prescription charges for non-exempt patients in England. The original 1948 services covered England and Wales, Scotland and Northern Ireland; a separate Welsh system was set up in 1969.

Saskatchewan to Ottawa: How Canada Built Medicare

Canada’s system grew from the provinces upwards, which explains why its coverage is still run province by province. Saskatchewan in 1947 and Alberta in 1950 began publicly funded care at provincial level. Tommy Douglas and his Co-operative Commonwealth Federation won the 1960 Saskatchewan election on a promise of publicly funded medical care, against opposition from the medical profession, and the idea spread. Federally, the Hospital Insurance and Diagnostic Services Act of 1957 was followed by the Medical Care Act of 1966, and the two were merged in the Canada Health Act of 1984. Doctor and hospital visits are free to insured residents, although prescription drugs and dental care are largely outside the public plans.

Sweden, Norway, Finland, Denmark and Iceland: Free Care With Capped Fees

Every Nordic country is on the list, a result of decades of social-democratic welfare policy funded by high taxes. On the New York list, Sweden introduced universal coverage in 1955, Norway in 1956, Finland in 1972, Denmark in 1973 and Iceland in 1990, although other histories date national health insurance in Iceland to 1956, Denmark to 1961 and Finland to 1964. Health care in these countries is organised and paid for largely by regional or municipal governments.

They are not strictly free at the point of use. In Sweden, patients pay a nominal fee of roughly 150 to 400 kronor for a doctor’s visit, but there is a yearly ceiling on fees, and prescription costs are capped at 2,350 kronor a year. Norway uses a similar cap: once a patient has paid a set amount in user fees in a calendar year, they receive an exemption card, the frikort, and pay nothing more that year. The design keeps small charges as a brake on overuse while protecting people who need a lot of care.

Kuwait, Bahrain, Brunei and the UAE: Oil Revenue and Citizenship

A second cluster owes more to geology than to politics. Kuwait (1950), Brunei (1958) and the United Arab Emirates (1971) all built free public health systems for their citizens, paid for by states whose budgets rest heavily on oil and gas, and Bahrain’s universal system dates back to about 1960. Brunei’s health service is funded directly by the General Treasury.

In the Gulf, “free” usually depends on your passport. Kuwait provides treatment without charge to Kuwaiti citizens, with a separate public insurance scheme for non-citizens. The UAE gives free care to Emiratis, while expatriates must be covered by health insurance that their employer or sponsor is required to provide. Bahrain’s government care is free for citizens and subsidised for others. Because foreign workers make up a large share of the population in these states, a significant number of residents pay for their care through insurance.

Italy, Portugal, Spain and Brazil: Health Care Written Into Democratic Reform

Four countries on the list built national health services in the years after authoritarian rule or during a wider democratic rebuilding. Italy’s constitution, in force since 1948, treats health as a fundamental right in Article 32, and in 1978 the government created the Servizio Sanitario Nazionale, a tax-funded service on the British model.

Portugal’s Carnation Revolution of 1974 ended the Estado Novo dictatorship, and its Serviço Nacional de Saúde followed in 1979. In 2012 it introduced user fees, paid at the end of treatment, to help keep the service sustainable. In Spain, the General Health Law of 1986, steered by health minister Ernest Lluch a decade after the end of the Franco era, set universal coverage as the system’s goal, and the Public Health Law of 2011 gave everyone in Spain the right to free care.

Brazil’s case is the largest. After two decades of military rule, the 1988 Constitution set out to guarantee health for everyone, not only workers with formal contracts, and the Sistema Único de Saúde (SUS) was created in 1990. It is the largest government-run health system in the world by number of users, serving virtually the entire population of more than 200 million across 8.5 million km², and it is free at the point of service to anyone, including foreigners.

Bhutan: Free Care Guaranteed in a Himalayan Constitution

Bhutan is the most unexpected country on the list, a kingdom with a population of just over 800,000 in a mountainous territory of 38,394 km² between India and China. Universal coverage dates from 1970, and the 2008 Constitution of Bhutan requires the government to provide free access to basic public health services in both modern and traditional medicine. The public system therefore offers traditional medicine, delivered by traditional physicians known as drungtshos and smenpas, alongside modern treatment.

Bhutan’s small size makes a single national system easier to run, and the most complex cases are referred to the national hospital in the capital, Thimphu.

Why Germany, Japan and Switzerland Are Not on the List

Several countries with excellent health care are missing because their systems run on insurance rather than taxation. Germany’s model began with the Health Insurance Bill of 1883 under Otto von Bismarck, which covered certain groups of workers, only about 5 to 10% of the population; today most Germans belong to statutory health insurance funds paid for by contributions from wages. Japan achieved universal health insurance in 1961, but patients usually pay 10%, 20% or 30% of the cost of treatment themselves. Switzerland has no free state health service at all: since 1994 every resident has been required to buy basic health insurance from a private insurer.

These systems still cover everyone, so they count as universal health care. They simply are not free at the point of use in the way the NHS or Brazil’s SUS is. For how the different systems compare on quality rather than cost, see our ranking of countries with the best healthcare, and for one of their outcomes, the list of countries with the highest life expectancy.