The Difference Between Public vs. Private Healthcare: Guide for Global Employers

You’re expanding globally, building a fantastic team across different countries. Then someone asks about healthcare benefits in Germany. Or Australia. Or Brazil. And suddenly you’re Googling “public vs private healthcare” at 2 a.m., wondering how you went from hiring great people to navigating international health insurance regulations.

But healthcare isn’t just another checkbox on your benefits list when you’re hiring internationally. It’s often the deciding factor for top talent. That developer in Berlin is comparing your offer against companies that understand exactly how German healthcare works. The marketing manager in Sydney wants to know you’ve got their family covered properly.

But here’s what makes this tricky—healthcare systems work completely differently depending on where your people live. What’s standard in one country might be illegal in another. What’s optional here could be mandatory there. And what looks like an excellent benefits package to you might seem confusing or inadequate to someone who grew up with a different healthcare system.

The good news? Once you understand how public and private healthcare work around the world, you can design benefits that attract the talent you want while staying compliant everywhere you operate. You just need to know what you’re working with first.

So let’s break down how healthcare systems function across different countries, what your team members expect, and how to build benefits packages that work for everyone—without accidentally breaking any local laws in the process.

What is public health insurance?

Public health insurance is typically a statutory entitlement and is provided by a country’s government. Sometimes called universal insurance, public healthcare is managed by government agencies or highly regulated private providers.

There are three common frameworks that countries use to deliver universal healthcare to citizens:

• National Health Insurance. In this system, private facilities provide care, but the government pays the bill. Some countries that use this system, like Canada and South Korea, also often require a small co-pay from the patient.
• Bismarck Model. In this framework, citizens access healthcare through private facilities but must buy health insurance. The government regulates health insurance and mandates coverage for certain benefits. Citizens typically pay for insurance through payroll deductions or taxes. Germany, Japan, and France all use the Bismarck Model.
• Beveridge Model. In the Beveridge Model, the government runs and owns most medical facilities, and healthcare costs are covered through taxes. New Zealand, Spain, and the U.K. all follow the Beveridge Model.

Countries with the best and worst public healthcare

Public healthcare systems differ worldwide, with some offering far more comprehensive benefits than others. Here’s a list of the best healthcare across the world, according to Legatum Institute’s 2023 report on healthcare.

Legatum’s “Health Pillar” measures the “extent to which people are healthy and have access to necessary services to maintain good health, including health outcomes, health systems, illness and risk factors, and mortality rates.”

What is private health insurance?

Unlike public health insurance, individual policyholders typically pay out of pocket for private health insurance. Private for-profit providers manage private healthcare, and plans and prices vary widely depending on the provider’s policies and policyholders’ demographics.

It’s common (but not required) for employers in many countries to offer private health insurance coverage to employees as a supplemental benefit.

Public vs. private healthcare: What this means for your team

When you’re trying to figure out what healthcare benefits to offer, the differences between public and private systems matter more than you might think. Here’s what affects your team—and your budget:

Cost

Public healthcare plans are generally less expensive—and often free—to residents. Residents who want additional coverage must typically purchase private healthcare insurance on an open marketplace or through employer-offered benefits packages.

Services

While public healthcare is less costly to residents, people with public insurance tend to have fewer options for medical services. Private healthcare plans typically offer a wider range of included services, making it easier for policyholders to access the care they need.

Urgency

Public healthcare recipients must often wait for medical treatment because the system triages patients who require urgent attention.

For example, in the U.K., patients could wait up to 18 weeks for non-urgent, consultant-led treatments when using the country’s public healthcare system. This long wait time could lead to worsened symptoms and a longer recovery.

Private healthcare insurance policyholders generally have faster access to care and potentially fewer long-term repercussions, thanks to shorter wait times for services.

Example: Healthcare in Mexico

For instance, consider the healthcare in Mexico: Despite its commendable affordability and accessibility, the country’s healthcare system is overburdened, faces a shortage of doctors and medicines, doesn’t cover all preexisting conditions, and requires long wait times for treatment.

As a result, employers in Mexico typically offer additional health coverage to ensure their employees receive the care they need.

Offering supplemental healthcare to your employees

If the public healthcare system in the country where your employee lives is substandard or lacks basic services, you should offer supplemental healthcare to fill the gaps and retain talent.

Offering supplemental healthcare to international employees ensures your talent’s access to quality healthcare. It also leads to the following employer benefits:

Stand out from competitors

Offering supplemental health insurance gives international employees peace of mind that they can access quality healthcare. Providing healthcare insurance to your global workforce helps you stand out from competitors who may not offer the same comprehensive benefits to their employees.

Improve talent retention

Good healthcare benefits do more than check a box—they’re what keep your best people from taking that call from the recruiter. When your team knows they’re covered, they can focus on their work instead of worrying about what happens if someone gets sick. And in a competitive hiring market, comprehensive healthcare often tips the scales when candidates are choosing between offers.

Support talent’s well-being

Providing high-quality healthcare shows you care about your employees’ well-being. Many supplemental healthcare packages include mental health benefits, like counseling or therapy, which is critical given the growing awareness of mental health’s importance in the workplace.

Lower healthcare costs for talent

Supplemental healthcare benefits can help reduce the financial burden on employees. It often covers costs that basic health insurance might not, like co-pays, deductibles, or specific treatments. This reduction of out-of-pocket expenses eases financial stress, enabling employees to seek necessary medical care without worrying heavily about cost.

Enjoy potential tax incentives

In the U.S., when employers incur costs related to healthcare insurance for employees or dependents, those expenses are 100% tax-deductible. Your employees also have the opportunity to reap tax benefits if they’re able to contribute to their plans using pre-tax money.

Healthcare-related tax incentives vary by country, including whether contributions to health plans are tax-deductible, types of healthcare costs covered, and criteria for eligibility. Be sure to consult a tax professional to understand the specific tax benefits available in each country.

The challenges of providing healthcare to global talent

Providing health insurance to a global workforce presents several challenges for domestic and international companies. Key issues revolve around the disparities in healthcare systems and the complexities of ensuring comprehensive coverage across various global markets.

• Geographic variance. Managing health coverage for employees working from various states or countries demands in-depth research and investment in market-specific medical benefits, which is time-consuming and costly for busy HR departments.
• Financial restraints. Offering diverse health plans across multiple markets can strain budgets, hindering the ability to cater to the needs of a geographically dispersed workforce.
• Access limitations. Ensuring consistent access to quality healthcare is challenging in regions with disparities in medical infrastructure and healthcare standards. Providing employees with quality care, no matter their location, can be a challenging endeavor.

Given the complexities of providing quality health insurance to your global workforce, it makes sense to work with a partner that takes the guesswork out of the equation.

Let Pebl handle the global benefits complexity—you focus on what you do best

You know what separates successful global expansion from the kind that keeps you up at night? Having someone who already knows how healthcare works in 185+ countries.

When you’re building a distributed team, benefits administration gets complicated fast. German statutory health insurance works differently from Australian Medicare. Brazilian private healthcare has different rules from Canadian coverage. And figuring out what’s compliant, competitive, and valuable to your team is a full-time job you probably don’t have time for.

Here’s where Pebl comes in. As an Employer of Record (EOR), we don’t just handle the paperwork—we make sure your team gets benefits that matter to them, wherever they live. Our Global Benefits service takes care of local compliance, competitive packages, and all the administration that comes with hiring internationally.

What does this mean for you? Your developer in Berlin gets health benefits that make sense in Germany. Your marketing manager in São Paulo gets coverage that works with Brazil’s healthcare system. And you get to focus on growing your business instead of becoming an expert in international health insurance regulations.

We handle employment, payroll, and benefits in more than 185 countries, so you can hire the best talent without worrying about whether you’re offering the right coverage in the right way.

Ready to see what worry-free global benefits look like? Let’s talk about what this means for your specific situation.

This information does not, and is not intended to, constitute legal or tax advice and is for general informational purposes only. The intent of this document is solely to provide general and preliminary information for private use. Do not rely on it as an alternative to legal, financial, taxation, or accountancy advice from an appropriately qualified professional. The content in this guide is provided “as is,” and no representations are made that the content is error-free.

© 2025 Pebl, LLC. All rights reserved.