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How is the delivery system organized and how are providers paid?

Health System Features

Australia

Physician education and workforce: Physicians are trained primarily at public (but also private) universities, with their fees subsidized through the tax system. Annual tuition fees are approximately AUD 65,000 (USD 45,454), with the student contribution capped at AUD 10,754 (USD 7,520) per annum for Australian citizens.

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Brazil

Physician education and workforce: In 2018, Brazil had 451,777 registered physicians (2.18 physicians per 1,000 inhabitants). Of this number, about 63 percent were specialists and 37.5 percent were general practitioners.

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Canada

Physician education and workforce: Students who obtained a medical degree from one of Canada’s 17 public medical schools paid an average annual tuition of CAD 14,780 (USD 11,730) in 2018–2019. About 27 percent of Canada’s physicians received their degree outside Canada.

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China

Physician education and workforce: The number of physicians is not regulated at the national level, and the government is trying to encourage more people to complete medical school. All the medical schools are public. Tuition varies by region, ranging from CNY 5,000 (USD 1,408) to CNY 10,000 (USD 2,816) per year. Tuition is heavily subsidized by the government.

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Denmark

Physician education and workforce: The number of physicians is regulated at the national level through limitations on the number of medical education training positions and the number of practicing physicians per region who can receive public funding. There are four medical schools, all public, offering medical studies lasting six years. None of them charge tuition fees.

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England

Physician education and workforce: There is a growing shortage of doctors, affecting primary care and certain specialties. In 2016, the government promised an additional 5,000 GPs by 2021, including new trainees, overseas recruits, and physicians returning to practice. Financial incentives have been made available to trainees and returnees to attract doctors to areas where there are shortages, including rural and urban areas.

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France

Physician education and workforce: Once a year, the Ministry of Social Affairs, Health, and Women’s Rights determines the maximum number of students that can be admitted to medical, dental, midwifery, and pharmacy schools, which are all public by law. Tuition fees are approximately EUR 500 (USD 633) per year.

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Germany

Physician education and workforce: About 35 public universities and five private ones offer degrees in medicine. Studying at public universities is free, while private institutions sometimes require tuition fees ranging from EUR 6,000 (USD 7,702) to EUR 11,500 (USD 14,763) per semester. The minimum qualifications for a medical degree are determined at the federal level by the Licensing Regulations for Physicians, state laws, and individual university requirements. Specialization requirements are regulated and enforced by the medical chambers within each state.

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India

Physician education and workforce: Medical education is provided by both state-led institutions and private colleges. In some states, private medical colleges charge about 16 times the fees charged by government colleges. Private fees for a five-year course typically range from INR 3 million to INR 5 million (USD 42,000–70,000 for undergraduate education.

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Israel

Physician education and workforce: Israel has six medical schools, which are all part of public, nonprofit universities. The number of medical schools and students is regulated by the higher education council. As of 2015, more than half (58%) of Israeli physicians under age 65 had completed their medical studies abroad. Annual tuition, heavily subsidized by the government, is approximately NIS 11,100 (USD 3,000) for the first three years and NIS 14,800 (USD 4,000) for the next three years.

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Italy

Physician education and workforce: Enrollment in university medical education programs (medicine, surgery, and dentistry) is based on a competitive assessment exam. There are also restrictions on advancement to postgraduate levels, where medical school graduates can specialize in fields such as cardiology, neurology, and general surgery. Medical schools are largely public, with yearly fees of approximately EUR 2,200 (USD 2,500). Postgraduate students pay the same fee but also receive a monthly stipend of EUR 1,800 (USD 2,000).

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Japan

Physician education and workforce: The number of people enrolling in medical school and the number of basic medical residency positions are regulated nationally. The number of residency positions in each region is also regulated.

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Netherlands

Physician education and workforce: The number of medical doctors is regulated through caps on the number of medical students, at both a national and a university level. Medical schools are located in private, nonprofit university medical centers. Medical students pay a yearly tuition fee of approximately EUR 2,100 (USD 2,691). The Capacity Body (Capaciteitsorgaan) advises the Ministry of Health on all specialized postgraduate training programs for medical specialists to ensure that supply matches demand.

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New Zealand

Physician education and workforce: Practicing physicians must be registered with the Medical Council of New Zealand. There is no limit to the number of registered physicians. However, the two medical schools, Otago and Auckland, both public, have a limited student intake, and specialist colleges also limit training places. Medical school limits are determined largely by the government, which is the primary funder of medical education.

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Norway

Physician education and workforce: Medical education programs are offered at four public universities. The yearly educational capacity is set at 600 students, and the tuition fees are about NOK 1,200 (USD 118).

In 2015, 38 percent of physicians were trained outside Norway; however, nearly 50 percent of foreign-trained doctors are Norwegian-born. Many Norwegian students choose to study in EU countries and return to Norway to practice medicine.

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Singapore

Physician education and workforce: Singapore has three medical schools, all of which are part of public universities. Clinical teaching is carried out almost exclusively in public health care institutions. The government regulates the number of doctors by varying the number of admissions to medical schools according to projected needs. The pipeline of doctors is supplemented by foreign-trained doctors. The government regulates the entry of these doctors by adjusting a list of approved overseas medical schools.

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Sweden

Physician education and workforce: Medical schools are public, and there is no tuition fee for medical education; however, the number of students accepted each year is limited.

Primary care: Primary care accounts for about 17 percent of all health expenditures, and about 16 percent of all physicians work in this setting.

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Switzerland

Physician education and workforce: Medical training takes place in public universities in a six-year program. After receiving the federal medical diploma, graduates enter the specialist training phase. The title of “specialist” is one of the conditions for practicing medicine in an independent medical practice.

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Taiwan

Physician education and workforce: Taiwan's government limits medical school admissions to 1,300 per year. There are both public and private medical schools. In 2018, tuition and fees at public medical schools were approximately TWD 36,170 (USD 1,194) per semester. Private tuition and fees were TWD 72,269 (USD 2,385) per semester.17

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United States

Physician education and workforce: Most medical schools (59%) are public. Median tuition fees in 2019 were $39,153 in public medical schools and $62,529 in private schools. Most students (73%) graduate with medical debt averaging $200,000 (2019), an amount that includes pre-medical education.21 Several federal debt-reduction, loan-forgiveness, and scholarship programs are offered; many target trainees for placement in underserved regions. Providers practicing in designated Health Professional Shortage Areas are eligible for a Medicare physician bonus payment.

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