By NextBestFitPhase 1: Enactment & build · Step 1.5
Define the benefit package & cost sharing
Months 0–12 · Congress (statutory categories); UHA Chief Medical Officer; HTA InstituteDiscuss this step
How other countries handled this same piece of implementation, what happened, and what it means for this plan.
Side by side
| Country | Approach | Result | Lesson for this plan |
|---|---|---|---|
| This plan (U.S.) | Write down exactly what UHP covers, what it excludes, and what patients pay at the point of care: nothing for covered services. Out-of-pocket spending falls from $556.6B to $197.3B; what remains is for excluded items. | ||
| Canada | Covers medically necessary physician and hospital care at no charge; drugs, dental, vision mostly outside the public plan. | About 1 in 5 Canadians report cost barriers to prescriptions or dental care. | Narrow benefits leave big out-of-pocket gaps; the plan includes drugs, dental, vision, and hearing. |
| Japan | Uniform benefits with 30% coinsurance (10–20% for children and elderly) and monthly income-based caps. | High use and low spending, driven by strict price control rather than cost sharing. | Cost sharing with caps restrains some use without catastrophic exposure. |
| Sweden | Small fees per visit with an annual cap (about SEK 1,450) and a separate drug cap. | Low financial barriers with some price signal. | Capped fees are a middle path the plan keeps on standby. |
| France | Coinsurance (ticket modérateur) covered by near-universal complementary insurance; full coverage for 30 long-term conditions (ALD). | Low out-of-pocket but two layers of insurance. | Cost sharing paired with private top-up adds administration without much saving. |
Canada
- What they did
- Covers medically necessary physician and hospital care at no charge; drugs, dental, vision mostly outside the public plan.
- What happened
- About 1 in 5 Canadians report cost barriers to prescriptions or dental care.
- Lesson for this plan
- Narrow benefits leave big out-of-pocket gaps; the plan includes drugs, dental, vision, and hearing.
Japan
- What they did
- Uniform benefits with 30% coinsurance (10–20% for children and elderly) and monthly income-based caps.
- What happened
- High use and low spending, driven by strict price control rather than cost sharing.
- Lesson for this plan
- Cost sharing with caps restrains some use without catastrophic exposure.
Sweden
- What they did
- Small fees per visit with an annual cap (about SEK 1,450) and a separate drug cap.
- What happened
- Low financial barriers with some price signal.
- Lesson for this plan
- Capped fees are a middle path the plan keeps on standby.
France
- What they did
- Coinsurance (ticket modérateur) covered by near-universal complementary insurance; full coverage for 30 long-term conditions (ALD).
- What happened
- Low out-of-pocket but two layers of insurance.
- Lesson for this plan
- Cost sharing paired with private top-up adds administration without much saving.
More precedent
- Canada covers physician and hospital care fully but not drugs, dental, or vision for most adults, leaving large out-of-pocket gaps.
- The UK NHS is free at the point of use except prescription charges in England and dental charges.
- Japan charges 30% coinsurance with monthly caps; France uses coinsurance mostly covered by complementary insurance.