Many 2020 Democratic Presidential Candidates in the United States, including Elizabeth Warren, Bernie Sanders, and Andrew Yang, support a "Medicare for All" single payer healthcare system with zero copays and zero deductibles. Now many countries around the world have single-payer healthcare systems. But my question is, how many of those systems have zero copays and zero deductibles?

I think Canada is one example. Are there any others?

EDIT: To define terms, single-payer means that everyone has government health insurance. A copay is an arrangement where you pay part of the cost of a specific medical service (like a doctor's visit or surgical procedure) and the insurance pays for the rest. A deductible is where only if your total healthcare spending in a given period exceeds a certain threshold will the insurance pay for healthcare, and that too it will pay only for the amount exceeding the threshold, not the full amount.

  • 6
    I'm not sure this question will be answerable, just because different funding models don't necessarily match up. E.g. would a lack of free eye tests rule a country out?
    – origimbo
    Oct 25, 2019 at 16:44
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    Please for the rest of the world explain what a "single-payer healthcare with 0 copays and 0 deductibles" is. Oct 25, 2019 at 16:47
  • In Poland we have single payer system, which fully pays for the most of medical procedures (in theory no copays, no deductibles... but exceptions and queues apply).
    – Shadow1024
    Oct 25, 2019 at 16:52
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    @origimbo makes a good point, if you do not consider the services provided the answers might be missleading. For example Country A that offers public dental services for a modest copay would not make the cut, while Country B that does not offer public dental services at all forcing the public to go to private clinics would appear in the list. The answer would only show the difference in philosophies, but would leave important details out.
    – SJuan76
    Oct 25, 2019 at 17:52
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    "even so called Socialists states pay more out of pocket than in the US" - citation needed..
    – pjc50
    Oct 26, 2019 at 16:55

2 Answers 2


The UK is obviously supposed to be the main example, but if you're being pedantic then England (but not the other home nations) residents have to pay a prescription charge for each prescription filled - but there are a lot of exemptions to that.

(Also, non-nationals have to pay an NHS surcharge which I think is something like £400 a year)

  • 1
    Isn't the surcharge based on immigration rather than purely nationality?
    – origimbo
    Oct 25, 2019 at 20:27
  • 1
    The UK (possibly just England) also has NHS dental charges, although they are capped [pun not intended] -- it's rather like the excess on an insurance policy. But it certainly isn't "free at the point of delivery" any more. Oct 26, 2019 at 16:07
  • 1
    @AndrewLeach for many people in the UK, finding a dentist prepared to work on NHS terms is practically impossible
    – mikado
    Oct 27, 2019 at 7:21
  • Drugs are likewise not free in Canada. Oct 28, 2019 at 7:24

As mentioned in some of the comments, the breadth and scope of a health system are too wide to be able to say that any system has absolutely no co-payments or deductibles (or more generally any out of pocket expenses). Any public system has to draw the line somewhere.

In Australia:

  • The govt sets the amount that the universal insurance scheme (called Medicare) will pay for visits to practitioners. Practitioners are free to set their fees higher than this if they wish, in which case the patient has to pay the difference (called a "gap payment").

    If the practitioner elects to charge the amount determined by Medicare, then the patient does not have to pay anything. This is referred to as "Bulk Billing". Quite a lot of general practitioners offer bulk billing, either to all patients or to pensioners and those on lower incomes, but many do not.

    In Australia gap payments are not classified as "co payments", because you can find practitioners which bulk bill. A few years back one of the political parties here proposed an actual co-payment scheme, but it was met with such fierce opposition that they shelved it.

  • Medicare covers 100% of the cost of hospital treatments as a public patient in a public hospital. There are some caveats though: you cannot choose your own doctor, and there may be long waiting lists for elective surgeries. To bypass these you can use a private hospital, or be seen as a private patient in a public hospital, in which case Medicare will pay 75% of the costs and you or your private health insurer will pay the rest.

  • For most people, Medicare does not cover allied health practitioners (Physio, Podiatry, Psychologists, etc) or Dental care. There are other exclusions.

  • Getting your prescriptions filled is not covered by Medicare. We have another system, the Pharmaceutical Benefits Scheme (PBS), which subsidizes the cost of medicines. Under that system there is a copayment of up to a maximum of $41 (or $6.60 for concession holders) per script.

    As an aside, the PBS is not popular with Pharmaceutical companies or with the US government, which has tried to use free trade agreements to influence Australian governments to wind back or disband the scheme.

More details on the Medicare system are available here.

There are no "deductibles" (which in insurance terms I would have called an "excess"). However if your out of pocket spending due to gap payments and/or private hospital treatment exceeds a threshold then you can get a tax rebate.

I would argue that there are no mandatory copayments, since if you choose a bulk billing doctor and don't use private hospitals then you will not have to pay. But it does not cover all possible treatments you might need and does not cover filling prescriptions.

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