[[France]], [[Germany]], [[Japan]], [[Austria]], [[Belgium]] and [[The Netherlands]] also use the multi-payer system in a style called ''shared responsibility''. Under this scheme workers and employers are required to pay into private, non-profit, government-regulated [[insurance fund]]s. The government covers the cost of the low- and no-income citizens. These insurance funds negotiate strict cost controls with the government and health care providers to keep out-of-pocket costs from skyrocketing. Private insurance can be purchased on top of the insurance fund, to pay for premium services.<ref name="contracosta" /> | [[France]], [[Germany]], [[Japan]], [[Austria]], [[Belgium]] and [[The Netherlands]] also use the multi-payer system in a style called ''shared responsibility''. Under this scheme workers and employers are required to pay into private, non-profit, government-regulated [[insurance fund]]s. The government covers the cost of the low- and no-income citizens. These insurance funds negotiate strict cost controls with the government and health care providers to keep out-of-pocket costs from skyrocketing. Private insurance can be purchased on top of the insurance fund, to pay for premium services.<ref name="contracosta" /> |