Module 9 · Insurance
Health insurance systems around the world
How countries pay for health care through contributions, taxes or private cover, how Slovenia's system works since 2024, and what a European health card does and does not cover.
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In this lesson
- Tell the Bismarck, Beveridge and private-heavy models apart
- Explain Slovenia's mandatory health contribution and calculate what it costs
- Work out a share of health contributions and co-payments from simple numbers
- Say what the European Health Insurance Card covers when you travel
Tomaž, from Slovenia, breaks a leg skiing in Austria. A public hospital treats him quickly. Then the doctor says he needs a medical flight home. Who pays for the treatment, and who pays for the flight?
Who pays for health care?
Almost every country uses some mix of three ways to pay. Money for comes from one or more of them:
- Bismarck model. Workers and employers pay compulsory contributions out of wages into health insurance funds, which pay doctors and hospitals. It began in Germany in 1883 and is used in Germany, France, Austria, Japan and Slovenia. The is also called social insurance.
- Beveridge model. General taxes fund the service and the state provides most care directly. It began with the UK’s National Health Service in 1948 and is used in the UK, Spain, Italy, Portugal and the Nordic countries. This is the .
- Private and out-of-pocket. Employers, individuals or households pay premiums or pay directly. The United States and India rely heavily on this, with government programmes for older and poorer people.
In every system there is a catch. Most systems charge a , the share of a treatment’s cost that the patient pays. Tax-funded systems may have waiting lists, which are a hidden price. Public health care is never free: it is prepaid.
How it works in Slovenia
Slovenia uses the Bismarck model, with one public fund, the Health Insurance Institute of Slovenia (ZZZS). Before 2024, many people bought voluntary supplementary insurance to cover co-payments. Those who skipped it faced large bills. That product was abolished on 31 December 2023. Since 1 January 2024, people in the listed groups pay a flat monthly mandatory health contribution instead, and the compulsory insurance covers the full basket of covered services. The contribution is the same for everyone, whatever the income.
The amount is adjusted each March by the growth of average gross wages. It was €37.17 a month from March 2025 and €39.36 a month from March 2026. Children insured as family members do not pay, and the state pays for some groups, such as pensioners whose pension is too small to cover it. Private add-ons, for example for faster specialist access, still exist.
Germany: contributions shared with the employer
Germany’s public insurance charges a general rate of 14.6% of gross wages in 2026, plus an extra rate that varies by fund (the official average for 2026 is 2.9%). Employer and employee split the total.
Travelling: what the European card covers
The European Health Insurance Card () gives you access to necessary state-provided treatment in other EU and EEA countries and Switzerland, on the same terms as local people. That includes local co-payments. It does not cover private clinics or a flight home. Tomaž’s treatment is covered; his flight is not. Travel insurance with medical repatriation fills the gap.
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