By NextBestFitPhase 1: Enactment & build · Step 1.6
Sign up providers & set participation rules
Months 6–18 · UHA Provider Enrollment; state licensing boardsDiscuss 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.) | Every licensed provider that wants to bill UHP signs one participation agreement. Participating providers accept UHP payment as payment in full (no balance billing). Opted-out providers may see patients privately but cannot bill UHP for anyone. | ||
| Canada | Physicians may opt out but cannot bill the public plan while opted out; private insurance for insured services is banned or restricted in most provinces. | Very few physicians opt out (well under 1%) because there is little private market. | Banning duplicative insurance keeps physicians in the public system. |
| France | Sector 2 physicians may charge above the national fee (dépassements d'honoraires). | Access gaps for lower-income patients in specialties and regions where most doctors are Sector 2. | Allowing balance billing creates income-based access tiers; the plan bans it. |
| Australia | Doctors choose per patient whether to bulk-bill (no charge) or charge a gap. | Out-of-pocket gap fees have risen; bulk-billing rates fell before 2023–24 incentives. | Per-patient choice to charge extra erodes universality over time. |
Canada
- What they did
- Physicians may opt out but cannot bill the public plan while opted out; private insurance for insured services is banned or restricted in most provinces.
- What happened
- Very few physicians opt out (well under 1%) because there is little private market.
- Lesson for this plan
- Banning duplicative insurance keeps physicians in the public system.
France
- What they did
- Sector 2 physicians may charge above the national fee (dépassements d'honoraires).
- What happened
- Access gaps for lower-income patients in specialties and regions where most doctors are Sector 2.
- Lesson for this plan
- Allowing balance billing creates income-based access tiers; the plan bans it.
Australia
- What they did
- Doctors choose per patient whether to bulk-bill (no charge) or charge a gap.
- What happened
- Out-of-pocket gap fees have risen; bulk-billing rates fell before 2023–24 incentives.
- Lesson for this plan
- Per-patient choice to charge extra erodes universality over time.
More precedent
- Medicare: about 1% of physicians have opted out (concentrated in psychiatry).
- Canada: physicians may opt out but few do, because private insurance for covered services is barred so the cash market is small.