The structure of health systems and PHI roles influence differences in access to health care by insurance status. In OECD countries with no observed waiting times for elective surgery – such as the United States, France, Switzerland, Japan, Belgium and Germany – all insured individuals enjoy timely access to care irrespective of whether their main form of coverage is public or private health insurance. These countries generally include insurance-based systems (public or private), where money follows the patient, specialists are paid fee-for-service rather than on the basis of salaries, and there are lower overall constraints on activity than occurs in health systems with tighter caps on.
