By contrast, in most OECD countries today, with the exception of the U.S., private insurance provides supplementary coverage to predominantly publicly funded systems. In France, for example, 85% of the population purchases private policies to pay for co-payments; while in the Netherlands over 90% of the population purchases either principal or supplementary insurance plans (figure 3). In the OECD, when private insurance provides principal coverage, it generally faces significant restrictions. The European Union's directive on health insurance states that health insurance should only be subject to normal financial regulations except where a “general good” could be demonstrated. (14). When private health insurance is the only form of risk pooling for the population, the public interest can be clearly demonstrated, and the insurance regulations of many countries reflect this. (7)
Among wealthy countries, Australia and Ireland are unique in explicitly encouraging private health insurance as a strategy to complement public financing. Historically, both countries used private insurance to provide principal coverage for significant segments of their population and it is now used to relieve pressures on the public system. As a result of targeted interventions, about 45% of the population in each of these countries purchase private insurance. Despite the fact that private coverage is now supplementary, both countries have strong regulatory structures to manage the market and require private insurers to community rate premiums and meet guaranteed issue and renewal requirements.