Weeel now. As an example Finland - while there is a fairly functional state paid health service, most affluent people take the health insurance anyway and go to private clinics for day-to-day needs to avoid the public queues. Most eployees have a compulsory medical coverage by the employers, which is a bought service from the private clinics. Thus the medical scene is a bit more complex than "state pays it all". It can require quite a bit of effort to get proper medical attention in the public side unless one is ill in a critical, easy-to-diagnose form. Best places in the world to have a cancer or such though, since the state pays most of the treatment (thus Breaking Bad creates quite strong cultural dissonance initially).

In Finland, there's not really a compulsory medical coverage by employers. The only compulsory part is planning and processes to prevent work-related health hazards and harms, and to protect and advance workplace safety, ability to work and health. (See law 2001/1383)

So, some paperwork is mandatory, no actual health care.

The reason many employers voluntarily provide an actual health insurance (or simply reimburse private-sector medical costs directly) is that it is one of the few tax-free benefits that employers can give to people, so it works efficiently as an additional compensation. And of course, because employee absences are costly, it makes good sense to try to keep them in good health.

The public sector health care does practically nothing in terms of preventive health care for people between 25-65 and in employment (except for maternity-related things). This is left to employers.

"So, some paperwork is mandatory, no actual health care."

The way the law is brought to action is that the private clinics have specific service tiers which they offer to employers, of which even the basic one covers consultation by a general practitioner. The easiest way for employers to fulfill the letter of the law is to buy the service.

Which means that working adults seldom tend to the public services unless they are really ill, which means more business for the private clinics and increases the appeal of a health insurance (it's easier).

This is getting really obscure for this forum, but as a reference: The specific law is

https://www.finlex.fi/fi/laki/ajantasa/2001/20011383

Which in google translate is

https://translate.google.com/translate?sl=fi&tl=en&js=y&prev...

I was founder in a SW startup, and those of us who had a <15 % minority share were technically employees for whom the mandatory services had to be arranged. What it meant was that there was a paper that the managing director had to sign, and some small amount of money to pay to KELA (the public insurer). There was no occupational doctor or care service assigned.

Yes, this is obscure for this forum (perhaps that's why some people downvoted the previous comment) but just for the note, in Finland the employer is not really required to buy any services from private clinics. The legal requirement is for existence of a preventive plan, and a specification for what other services the plan covers. It's okay by law if the coverage effectively evaluates to nil, and employees just are off to the public system's queue.

Ok, this is really obscure but thanks for the clarification :)

It is still insurance when administered by the government and payed through taxes.

I think that differs quite a bit by country. At least in Denmark it's administered in a considerably different manner, more like any other public spending that decides on priorities and allocates resources. Some parts of it do have actuarial elements that parallel what an insurance company would do (pooling risks across the population), but many don't. The cost of many things is well known in advance and has little uncertainty (especially when the whole country is taken in aggregate), and it's just a public-health choice whether to pay for it or not. Routine childhood vaccinations are a clear example, which are just budgeted as a public-health measure, like water purification or whatever. Hospitals have an element of risk-pooling when individual patients are looked at, but at the public level are run more like fire departments or police departments, which also have an element of risk pooling. I guess you could argue that fire departments are really some kind of state-administered fire-response-insurance system, but I'm not aware of that being a common approach. Data and statistics and people to look at them are still needed though, of course, but they are looking at more "real" problems, like which procedures best improve morbidity-adjusted life expectancy.

I know in some other countries, like Germany, it is set up much more closely to insurance, in the sense that procedures have prices, are billed out to patients, who are covered by insurance plans that reimburse patients for costs, etc., in which case I imagine the bureaucracy is much more insurance-like.

The dynamics of the financial incentives involved are a bit different with goverment provided health care and private clinics funded through medical insurance.

Private clinics which are the main receivers of insurance money are often owned by the doctors. Thus, they have an incentive to over-charge, over diagnose and run expensive labs whenever they can. I'm not saying it happens, just that the incentive is there. Government provided healthcare offers no financial incentives for practicioners to over-diagnose - on the contrary this system then incentivizes to be as prudish as possible with the public resources.

I'm not saying one or the other is better or worse, just that they are not equal in every way.

Much of Europe has mandatory public health insurance if you work.

It also has voluntary private health insurance.

What you probably are referring to is that USA has not private health insurance at all.

In the US only your employer could give you insurance, so it is not personal and private, but collective, if you try to do on your own it is prohibitively expensive.

Clearly the state budget planners have no need to compute the expected future health care expenses of the state.