A single payer healthcare system is a system where all citizens have government health insurance. Now most countries with single payer healthcare allow people to buy supplemental private insurance, though some have restrictions on what that supplemental insurance can cover.

In any case, several 2020 Democratic Presidential candidates, including Bernie Sanders and Elizabeth Warren, support a single-payer healthcare system where supplemental private insurance plans are not allowed to offer duplicative coverage, i.e. they’re not allowed to cover any of the same benefits that the government plan covers. They’re only allowed to cover benefits not covered by the government plan.

My question is, which countries with single payer healthcare have a similar ban on duplicative coverage? I think Canada may be one. Are there any others?

  • In a lot of cases duplicate cover is simply pointless so it doesn't exist. If you already have a government mandated insurance that pays for a certain procedure, why would you pay extra to get the exact same procedure? If you have mandated health insurance, all other offers are supplementary or offer to do a slightly difference procedure for the same illness.
    – quarague
    Feb 25, 2020 at 8:53
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    Does " duplicative" mean "the same services at the same hospitals" or "the same services, but potentially at different hospitals with shorter waiting lists"?
    – MSalters
    Feb 25, 2020 at 12:18
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    @user253751: This is the Politics SE. I agree that the first sort is pointless, but that might be precisely why some governments outlaw it. It would be a ban on misleading advertising.
    – MSalters
    Feb 25, 2020 at 12:37
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    @ThomasKoelle That's not the rule described here. What is being prohibited is selling a certain type of insurance policy. You can still go to any private hospital you want.
    – Relaxed
    Feb 25, 2020 at 21:37
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    @quarague; You wouldn’t pay extra to get the exact same care. You’d pay extra to better care more quickly than what the government-mandated plan offers. For example, if you need a joint replacement and you don’t want to be placed on a waiting list. A Canadian who can afford it can go to the US for that procedure and schedule it for next week with the doctor of their choosing rather than 6 months from now with the default doctor at the location closest to them.
    – Wes Sayeed
    Feb 25, 2020 at 22:13

3 Answers 3


Here is a document from OECD Health Statistic detailing the kinds of private health insurances available in countries where public health insurance is provided. The document defines three kinds of private health insurance:

  • Duplicate where coverage is available for risks also covered by public health insurance. This would allow someone to choose to e.g. have their operation done in a private clinic.
  • Complementary where coverage is available for additional costs of a healthcare treatment partially covered by public healthcare - for example if public healthcare only covered 90% of the cost this would pay for the other 10%
  • Supplementary This would cover treatments not provided by public healthcare.

The coverage the question asks about is Duplicate. The list of countries where duplicate coverage is not available is:

  • Austria
  • Belgium
  • Canada
  • Czech Republic
  • Denmark
  • Estonia
  • Finland
  • France
  • Germany
  • Hungary
  • Japan
  • Korea
  • Luxembourg
  • Netherlands
  • Poland
  • Portugal
  • Slovakia
  • Slovenia
  • Sweden
  • Switzerland
  • Turkey

I've omitted some edge cases, for example where health coverage is provided by private insurers but is mandated by the state.

  • Your link doesn't work. I don't know about the other countries, but in Sweden it is definitely possible to buy private health insurance that covers the same procedures that the national health insurance program covers. Those allow the insured to bypass the queues that exist in the public system. Feb 27, 2020 at 8:27
  • The link is fixed. Feb 27, 2020 at 14:02
  • Not sure I understand the final comment: Health insurance in the Netherlands is in fact provided by private insurers but mandated by the state. Also, shouldn't “Duplicate where coverage is available for risks also covered by private health insurance.” actually read “Duplicate where coverage is available for risks also covered by public health insurance.“?
    – Relaxed
    Feb 27, 2020 at 14:51
  • Not available is not the same as banned though. Feb 27, 2020 at 15:02
  • @Relaxed Fixed the mistake in "Duplicate". Feb 27, 2020 at 15:10

Canada is indeed one.

Under most provincial and territorial laws, private insurers are restricted from offering coverage that duplicates that of the publicly funded plans, but they can compete in the supplementary coverage market.

Countries where it is permitted include Finland, Italy, New Zealand, Ireland and the United Kingdom, Australia and France.

Duplicate insurance is available in many countries, including Finland, Italy, New Zealand, Ireland and the United Kingdom. In some places it attracts a large share of the population, as in Australia, where nearly 45% of citizens hold this type of insurance. In other countries, its role is marginal because of competition from public health insurance, especially where waiting lists are almost non-existent, as in France.

  • Are there any countries other than Canada that ban it? Feb 25, 2020 at 21:40
  • I don't know. This is what I know. I'm hoping others will know more. Feb 26, 2020 at 0:47
  • What about Norway and Denmark? Feb 26, 2020 at 4:21
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    This answer is really superceded by my other one. I'm going to leave this one here for a bit, but I'll delete it if the other one is more useful Feb 26, 2020 at 14:13

For Denmark a lot of companies have an extra health insurance. It e.g. means workers can get an operation faster or get something that isn't covered (e.g. physiotherapy).

I don't know about other European countries

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