The US healthcare system, despite being the most expensive in the world, underperforms when compared to other high-income countries on key metrics such as quality, efficiency, and equity. To explore this disparity, our team conducted a study on the healthcare systems of several Asian countries, including Japan, Taiwan, and China. The research focused on various factors such as cost, funding, access to care, performance, and health outcomes in these nations.

Japan

• System Model

  National Health Insurance (NHI): A single-payer, social health insurance system also funded through mandatory payroll-based premiums and taxes.

Taiwan

China

United States

• System Model

  Mixed Public-Private: Basic public insurance with varying benefit levels across programs and regions. Complemented by private insurance and high out-of-pocket spending.

• System Model

  Mixed System: A patchwork of private, employment-based insurance; public programs like Medicare and Medicaid; and out-of-pocket payments.

• Coverage

  Universal and mandatory for all permanent residents. Covers 98.3% of the population, with the remainder covered by a public assistance program.

• Coverage

  Universal and mandatory coverage for over 99% of citizens and legal residents.

• Coverage

  Near-universal coverage (over 95%) through a few different public insurance programs, but with significant variations in coverage levels.

• Coverage

  Roughly 8% of the population remains uninsured, while many more are underinsured.

• Financing

  Primarily funded by mandatory contributions split between employers and employees, supplemented by taxes. Premiums are income-based.

• Financing

  Funded by premiums from employees, employers, and the government, plus taxes on non-payroll income.

• Financing

  Combination of government subsidies, employee and employer payroll taxes, and substantial out-of-pocket payments.

• Financing

  Funded through employer and individual premium payments, government taxes for public programs, and user fees.

• Cost Control
  The NHIA sets a global budget for different sectors of care and uses a fee-for-service payment system.

• Cost Control

  The government negotiates drug and service prices. Hospital pricing is set by local authorities, with a move toward diagnosis-related group (DRG) payments.

• Cost Control

  Largely unregulated. Prices are set through negotiations between private insurers and providers.

• Cost Control

  The government sets a uniform national fee schedule for all medical services and drugs, negotiating prices every two years

• Access

  High access with no gatekeeping. Patients can visit any clinic or hospital.

• Access

  High access with no gatekeeping. Patients can see any specialist without a referral.

• Access

  High access in urban areas, but long wait times for higher-tier hospitals due to a lack of effective gatekeeping in the system. Rural access is significantly more limited.

• Access

  Varies widely by insurance plan. Access is restricted for many, leading to longer waits.

• Affordability

  Low out-of-pocket costs. Co-payments are capped annually.

• Affordability

  out-of-pocket costs. Nominal co-payments and co-insurance are capped for catastrophic illnesses.

• Affordability

  High out-of-pocket costs, especially for serious or chronic illnesses, despite widespread public insurance.

• Affordability

  High out-of-pocket costs. High deductibles and premiums are common.

• Cost as % GDP

  Low. 10.9% in 2021.

• Cost as % GDP

  Low. 6.1% in 2017.

• Cost as % GDP

  Growing, but still low compared to the U.S. Reached 7.05% in 2022.

• Cost as % GDP

  High. The highest of any high-income country, at nearly 17% in 2021.

• Health Outcome

  Excellent. High life expectancy- 84 years (2016).

• Health Outcome

  Excellent. High life expectancy-
  >80 years.

• Health Outcome

  Improving, but still lags behind Japan and Taiwan, and urban-rural disparities exist. Life expectancy, reaching 78.2 in 2022.

• Health Outcome

  Poor. Compared to other high-income countries. - 77.5 years (2022).

• Healthcare System Ranking

  Highly Ranked overall, though recent innovation indices show fiscal strain due to aging population.

• Healthcare System Ranking

  Ranked #1 by CEOWORLD magazine in 2021, and #15 in a 2024 innovation index.

• Healthcare System Ranking

  Ranked #5 by CEOWORLD magazine in 2025, reflecting major progress.

• Healthcare System Ranking

  Lower-ranked overall due to high costs and unequal access, but with high innovation.

Comparison of Healthcare Systems

• System Model

  Statutory Health Insurance System (SHIS): A social insurance model funded by mandatory taxes and premiums