Timeline of universal healthcare

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This is a timeline of universal healthcare, focusing especially on first year implementation of universal healthcare policies in every adopting country. As of November 2024, the World Population Review reports that 78 countries have universal or free healthcare systems. While universal health coverage is prevalent in many developed nations, fully government-funded, free healthcare is uncommon.[1]

Big picture

Time period Development summary Details
Pre-20th Century Early beginnings Before the 20th century, healthcare systems are informal and primarily based on charity or local arrangements. Religious institutions and guilds often provide healthcare to the poor, while wealthier individuals can afford private medical care. Most people have to pay out-of-pocket for services. Public health is rudimentary, with little government involvement in healthcare provision. Epidemics and poor sanitation are common, but care is limited to the basics, with no formal structure to guarantee access or quality of treatment for all citizens. Socialized or national healthcare models are not yet envisioned or implemented.
Late 19th century – early 20th century Early reforms The 20th century marks a transformative shift in healthcare policy. Germany is the first country to implement social health insurance in 1883, with Otto von Bismarck’s reforms creating a system that allows workers to pay into insurance to cover healthcare costs. In the aftermath of World War II, nations like the United Kingdom introduce comprehensive national health systems, such as the National Health Service (NHS) in 1948, which guarantee free care at the point of service. These systems are based on the principle that healthcare is a right, and governments begin to assume responsibility for funding and organizing public health services.
Late 20th century - early 21st century Global Expansion Following the success of early universal health models in Europe, many other countries, particularly in the developing world, begin to adopt universal health coverage (UHC). The World Health Organization (WHO) plays a key role in advocating for UHC as a global goal, emphasizing health as a human right. Nations like Canada introduce their single-payer systems in the 1960s, while Latin American countries, such as Brazil, begin to establish universal health systems by the late 20th century. This era sees efforts to extend healthcare to underserved populations, especially in rural and remote areas, often with a focus on maternal and child health

Full timeline

Year Event type Details Country
1536 Reformation in Denmark reduces the role of charity organized through the church in welfare provision. This shift contributes to the growing role of public authorities in welfare and health care.[2] Denmark
1883 Program launch The world's first national social health insurance system originates in Germany with Otto Von Bismarck's Sickness Insurance Law, starting to implement compulsory sickness insurance program for workers.[3][4][5] Germany
1885 About 10% of Swedish workers join “Friendly Societies,” mutual aid organizations that offer sickness benefits to members who become ill. These societies represent an early form of health insurance, reflecting a growing trend in mutual aid for workers.[6] Sweden
1891 The Swedish government officially recognizes Friendly Societies as an important part of health insurance infrastructure. To support their growth, the government begins providing subsidies, allowing these societies to expand their coverage and improve their financial stability.[6] Sweden
1912 Norway becomes the first country to adopt a universal healthcare policy.[7][8] Norway
1928 Program launch France implements its National Health Insurance (NHI) program, initially covering salaried workers in industry and commerce whose wages are below a certain threshold, or low ceiling. This is part of early social welfare reforms aimed at providing basic healthcare to workers who have limited access to medical services. The program is designed to address health risks for the working class, ensuring that those in industrial and commercial sectors can receive healthcare benefits. Although initially limited in scope, this marks the beginning of France's expansion of healthcare coverage, which would eventually become universal.[9] France
1938 Japan achieves universal healthcare. The National Health Insurance act is enacted, widening the coverage of public health insurance not only to farmers, but also to the general public not covered by the Health Insurance Law.[10][8] Japan
1938 New Zealand passes the Social Security Act, establishing the foundation for universal health coverage. The government becomes the primary provider and funder of healthcare, ensuring all citizens had access to public hospital treatment and insurance through government-funded services. District health boards are created to plan, purchase, and deliver services locally. The system, largely publicly financed through general taxes, covers a wide range of services, including preventive care, hospital services, and mental health. While the public sector provides most care, private insurance helps cover additional services, with copayments for certain treatments.[11][8] New Zealand
1941 Program launch The Third Reich institutes a universal healthcare system. Free for widows and orphans, the benefits are enjoyed only by "racial comrades".[12][8] Germany
1945 Program expansion France significantly expands its National Health Insurance (NHI) program, extending coverage to include all industrial and commercial workers and their families, regardless of their wage levels. This marks a major step toward universal healthcare, ensuring that a broader segment of the working population have access to medical care. Prior to this, the NHI had been limited to salaried workers with lower wages. This expansion is part of a broader post-World War II effort to rebuild and strengthen France's social welfare system.[9] France
1945 Program launch Belgium establishes its compulsory health insurance system, integrating mutualities (mutual aid societies or historical institutions) into the national health care structure. These mutualities predate the national system and are adapted to fit into the new framework, marking a significant shift in the country's approach to public health and social security. This development lays the foundation for Belgium's modern health care system, which would be later revised and restructured in 1963 to adopt a form similar to the one in place in the 21st century.[13][14][8] Belgium
1945 United States President Harry S. Truman proposes a national health insurance program. The Congress would not approve it.[15] United States
1946 After decades of gradual legislative efforts, Sweden passes a law establishing a universal health insurance system. This marks a significant milestone in ensuring equitable access to healthcare for all citizens, addressing prior disparities in coverage between professionals and manual workers.[6] Sweden
1948 (July 5) Program launch The National Health Service Act 1946 is launched in England, creating the National Health Service (NHS) that would provide the majority of healthcare in the country.[16][17][8] United Kingdom
1950 Kuwait starts implementing free comprehensive healthcare to its citizens.[18][8][19] Kuwait
1954 The government of North Vietnam establishes universal healthcare.[8][20] Vietnam
1955 Universal coverage Sweden implements its universal healthcare system, nine years after the legislation was passed in 1946. This fully realized system ensures healthcare accessibility for all citizens, regardless of socioeconomic status. Primarily funded through taxation, it reflects Sweden's strong commitment to promoting health equity.[6][21][7][8] Sweden
1955 North Korea establishes universal healthcare.[8] North Korea
1956 Universal coverage The 1956 General Social Insurance Law in Austria establishes health care as a legal right, with 99% of the population covered by mandatory public insurance. The system provides four major benefits: health, accident, pension, and unemployment insurance. Austria's health care system closely mirrors Germany's, with notable differences, such as the direct provision of ambulatory services by sickness funds and the negotiation of service fees through regional physician chambers instead of national physician associations.[22] Austria
1957 Bahrain adopts universal healthcare policy.[7][8] Bahrain
1958 Brunei achieves universal healthcare policy.[7][8] Brunei
1961 Program expansion France's National Health Insurance (NHI) program is further expanded to include farmers and agricultural workers, two major sectors of the French economy that had previously been excluded from the system. This expansion reflects a growing recognition of the need to provide healthcare coverage to rural populations, who often face unique challenges in accessing medical care.[9] France
1966 Program expansion France expands its National Health Insurance (NHI) program to include independent professionals, such as doctors, lawyers, architects, and other self-employed individuals who were previously excluded from the system. Prior to this, the NHI primarily covered salaried workers, agricultural laborers, and their families, leaving independent professionals to arrange their own healthcare coverage. This change recognizes that independent professionals, despite not being employed by a company, also face healthcare needs and should have access to the same social protections as other workers. The reform is an important step toward achieving a more universal healthcare system in France.[9] France
1966 Andorra adopts universal healthcare.[7] Andorra
1966 Universal healthcare is achieved in Canada, after the Parliament approves a publicly-funded healthcare system under the principle that access to healthcare shouldn’t depend on location, income, or wealth.[23][7][8] Canada
1966 The Dutch Sickness Fund Act (Ziekenfondswet, ZFW) enters into force in the Netherlands, adding compulsory insurance for the whole population to cover severe medical risks.[24] This is the year the Netherlands is considered having adopted universal healthcare policy.[7][8] Netherlands
1967 Austria adopts universal healthcare policy.[7][8] Austria
1971 The United Arab Emirates adopt universal healthcare.[7][8] United Arab Emirates
1972 Finland implements a universal health care system centered on municipally run health centres, aiming to provide comprehensive primary care to the entire population. These centres integrated services such as general medical care, dental care, preventive health, and rehabilitation under one roof, delivered by multi-professional teams.[25][7][8] Finland
1972 Slovenia establishes universal healthcare.[8] Slovenia
1973 Denmark establishes its current universal public healthcare system through legislative reform. This development marks the formalization of universal access to healthcare, building on a gradual evolution that began in the late 1800s with nongovernmental sickness funds covering primary care and hospital user charges. The reform enshrines the government’s responsibility to ensure population health, prevent and treat illness, and provide high-quality care with equal access for all citizens.[26][7][8] Denmark
1973 Luxemburg adopts universal healthcare policy.[7][8] Luxembourg
1974 Universal coverage France passes a law declaring the goal of making National Health Insurance (NHI) universal. Prior to this, while various groups, such as salaried workers and farmers, were covered, some, like certain self-employed individuals, were still excluded. This law aims to provide healthcare coverage to all residents, regardless of employment status or income, ensuring no one would be left out.[27][7][8] France
1975 (July) Program launch Medibank, Australia’s first universal health insurance system, begins, providing free access to hospital and medical services. However, it faces resistance, including from the medical profession. Years later, after Malcolm Fraser becomes Prime Minister in 1975, key reforms would be made, including a 2.5% income levy to fund the program and changes to hospital funding and private insurance rebates. Following the challenges and eventual abolition of Medibank, the Australian Government would move to create a more sustainable system, culminating with the creation of Medicare.[28][7][8] Australia
1975 Algeria establishes universal healthcare.[8] Algeria
1976 After reunification of Vietnam, the universal healthcare system is extended to the South.[20] Vietnam
1977 Ireland adopts universal healthcare policy.[7][8] Ireland
1977 South Korea passes law mandating health insurance for industrial workers.[19] South Korea
1978 Italy adopts universal healthcare policy.[7][8] Italy
1979 Program launch Portugal establishes the National Health Service (Serviço Nacional de Saúde, SNS), which formalizes the State's role as the provider of universal, comprehensive, and free health care. This marks a significant milestone in ensuring health care as a right for all citizens. However, Portugal faces financial, organizational, and access-related challenges in implementing this system at the time, particularly in the broader context of political, economic, and social changes following decolonization and the transition to democracy.[7][8][29] Portugal
1980 Cyprus adopts universal healthcare policy.[7][8] Cyprus
1983 Program launch Greece institutes a national health system in which the government, under the Constitution, is required to guarantee all citizens access to a complete range of high-quality health services, free at the point of service. This system combines universal mandatory coverage through a public insurance system with a low level of cost-sharing arrangements. However, despite these provisions, Greece would later develop one of the most privatized health care systems in the European Union, with a significant portion of health expenditures coming from private sources.[30][7][8] Greece
1984 (February 1) Medicare is officially launched in Australia, as a refined version of previous system Medibank. It aims to provide universal access to health and hospital services, with the main feature being a publicly funded scheme that ensures equitable healthcare for all Australians. Medicare replaces Medibank and would become a cornerstone of Australia’s healthcare system.[28] Australia
1986 Spain adopts universal healthcare policy.[7][8] Spain
1988 South Korea adopts universal healthcare policy.[7][8] South Korea
1988 Brazil establishes the Unified Health System (Sistema Único de Saúde), an approach to having free healthcare for all, a constitutional right.[8][19][31] Brazil
1990 Iceland adopts universal healthcare policy.[7][8] Iceland
1991 Colombia establishes the right to healthcare within its constitution.[32] Colombia
1993 Hong Kong adopts universal healthcare policy.[7][8] Hong Kong
1993 Free choice of hospital is introduced in Denmark, allowing citizens to choose which hospital they wish to receive treatment from, enhancing accessibility and patient autonomy.[2] Denmark
1993 Colombia establishes universal healthcare.[8] Colombia
1993 Singapore reinforces its commitment to universal healthcare through the establishment of the Medical Endowment Fund (MediFund) within the framework of the Central Provident Fund (CPF) system. Serving as a financial safety net, MediFund offers assistance to citizens who are unable to meet their medical expenses after exhausting other support schemes, such as MediSave and MediShield. Together with these complementary mechanisms, MediFund contributes to ensuring that all Singaporeans have access to essential healthcare services, regardless of their financial circumstances.[7][8][33][34] Singapore
1994 Switzerland adopts universal healthcare policy.[7][8] Switzerland
1994 Moldova begins a mandatory health insurance program with the aim of providing the entire population with basic healthcare. Today, people who are unemployed or not working are insured by the government, while employed Moldovans chip in a portion of their income through a payroll tax or a flat-rate contribution.[35] Moldova
1995 Israel passes National Health Insurance Law, setting out a system of universal healthcare.[8] Israel
1995 Taiwan institutes its National Health Insurance (NHI). Taiwan
1999 Program launch Rwanda establishes a national health plan. Since then, healthcare insurance would extend to reach about 91% of the population, a greater percentage than the United States.[35][19] Rwanda
1999 Venezuela's new Constitution recognizes health as a fundamental social right and mandates the State to guarantee access, marking a shift from the 1961 Constitution, which focused only on prevention and care for vulnerable groups. Articles 83–85 establish the State’s responsibility to fund and implement public health policy. Despite this, the health system would remain fragmented. In 2020, public health spending would be just 1.68% of GDP, well below regional recommendations. Funding would come from various sources, including oil revenues and social security contributions. Persistent challenges would include reliance on private care, shortages, and staff retention issues exacerbated by sanctions and migration.[8][36] Venezuela
2000 (January) Program expansion France expands its National Health Insurance (NHI) system by granting comprehensive first-dollar health insurance coverage to the remaining uninsured population, based solely on their residence in France. Prior to this, certain groups, such as undocumented immigrants or those without stable employment, remained outside the formal NHI system. The reform ensures that all residents, regardless of their employment status or financial situation, have access to healthcare from the first dollar spent, meaning there are no deductibles or barriers to accessing essential medical services. This policy aims to provide universal healthcare coverage for everyone living in France.[9] France
2000 Recognition The French healthcare system is ranked N° 1 by the World Health Organization.[27] France
2002 Thailand introduces the "30-bhat scheme" (Less than US$ 1 at the time), a plan aimed at extending health coverage to all citizens. About 14 million previously uninsured people are added to the Thai system with this plan. According to a WHO report, prescription drugs, hospitalizations and services like chemotherapy, surgery and emergency care are free to patients.[35][8][19] Thailand
2005 Chile establishes access aimed at all its citizens to a basic package guaranteeing treatments for up to 80 health problems, setting upper limits to waiting times and out-of-pocket payment for treatments.[32] Chile
2007 Universal coverage Germany achieves a major milestone in health care by mandating health insurance for all citizens and permanent residents. This final step toward universal health coverage requires individuals to obtain insurance through either statutory health insurance (SHI) or private health insurance. The system ensures comprehensive coverage for the entire population and provides a generous benefit package. Germany’s health care system is structured around shared decision-making between federal and state governments and self-regulated organizations, with the Federal Joint Committee playing a pivotal role in determining coverage, setting quality measures, and regulating physician capacity based on population needs.[37] Germany
2009 (April 10) The Government of Peru publishes the Law on Health Insurance to enable all citizens access to quality health services.[38] Peru
2011 China achieves universal health insurance with more than 95% of its population insured. This represents the largest expansion of insurance coverage in human history.[35] China
2012 Mexico establishes universal healthcare.[8][39] Mexico
2012 (December 12) The United Nations General Assembly adopts a resolution on Global Health and Foreign Policy, calling on nations to expedite efforts toward universal health coverage (UHC). This initiative emphasizes the necessity for everyone, regardless of location, to have access to high-quality and affordable healthcare as a fundamental aspect of international development. Member states also acknowledge the crucial role of universal coverage within national health systems, particularly through primary healthcare and social protection measures, to ensure that all individuals, especially the most disadvantaged, can access essential health services.[40] United Nations member states
2013 The Albanian government commits to implementing universal healthcare coverage, making significant strides since then. By January 2016, around 600,000 uninsured Albanians would gain access to free family doctor visits and reimbursable medications, while nearly one million individuals aged 35-70, both insured and uninsured, would benefit from free medical check-ups under a PPP contract.[41] Albania
2015 All Qatari citizens and expatriates are expected to be covered by national health insurance.[18] Qatar
2015 (September 25) The United Nations' resolution Transforming Our World: the 2030 Agenda for Sustainable Development establishes the goal of achieving universal health coverage by 2030. This includes financial risk protection, access to high-quality essential healthcare services, and the availability of safe, effective, high-quality, and affordable essential medicines and vaccines for all.[40] United Nations
2016 Argentina establishes universal healthcare.[8] Argentina
2017 (December 12) The United Nations adopts its third resolution on Global Health and Foreign Policy: Addressing the Health of the Most Vulnerable for an Inclusive Society. This resolution urges Member States to enhance dialogue and collaboration with various stakeholders, including civil society, academia, and the private sector, to foster greater engagement and contributions toward achieving health-related goals through an intersectoral and multi-stakeholder approach. Additionally, the UN system, development partners, and initiatives such as UHC2030 support Member States in developing and reinforcing the sustainability of universal health coverage at the national level, aiming to improve access to healthcare services for the most vulnerable populations.[40] United Nations member states
2019 (September) During the United Nations High-Level Meeting (UN HLM) titled “Universal Health Coverage: Moving Together to Build a Healthier World,” world leaders endorse the most ambitious and comprehensive political declaration on health to date. By adopting this declaration, they pledge to guarantee that by 2030, all individuals in their countries will have access to the quality health services they require without experiencing financial hardship.[40] United Nations member states

Numerical and visual data

Google Scholar

The following table summarizes per-year mentions on Google Scholar as of November 6, 2021.

Year "universal health care"
1970 11
1975 21
1980 17
1985 26
1990 149
1995 493
2000 740
2005 1,160
2010 2,530
2015 4,100
2020 5,090

The chart below shows Google Trends data for Universal healthcare (Search term), from January 2004 to April 2021, when the screenshot was taken. Interest is also ranked by country and displayed on world map.[42]

Google Ngram Viewer

The chart below shows Google Ngram Viewer data for Universal healthcare, from 1980 to 2019.[43]

Wikipedia Views

The chart below shows pageviews of the English Wikipedia article Universal healthcare, from July 2015 to March 2021.[44]


Meta information on the timeline

How the timeline was built

The initial version of the timeline was written by User:Sebastian.

Funding information for this timeline is available.

What the timeline is still missing

Timeline update strategy

See also

References

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  25. Kokko, Simo (25 June 2009). "Integrated primary health care: Finnish solutions and experiences". International Journal of Integrated Care. 9: e86. doi:10.5334/ijic.310. PMC 2707593. PMID 19590612.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  26. "Denmark". The Commonwealth Fund. Retrieved 2025-01-02.
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  36. "Venezuela (República Bolivariana de)". P4H Network. Retrieved 25 April 2025.
  37. "Germany". Commonwealth Fund. Retrieved 2024-12-31.
  38. "Peru: Universal Health Insurance". loc.gov. Retrieved 16 November 2017.
  39. "Mexico achieves universal health coverage, enrolls 52.6 million people in less than a decade". harvard.edu. Retrieved 7 November 2017.
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  43. "Universal healthcare". books.google.com. Retrieved 18 April 2021.
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