premium is payable each year. Thus, France also has a mixed delivery system with complete patient freedom of supplier choice. There is a two-tier funding arrangement, with compulsory funding of core medical services from taxation, with optional private insurance for the cost of copayments. Germany Healthcare in Germany has multiple sickness funds, either publicly owned or not-for-profit mutuals. Membership of a sickness fund is compulsory for everyone except certain people, who opt out of the insurance system altogether. Doctors are usually self-employed, and hospitals may be publicly owned, privately owned or not for profit. Ireland Healthcare in the Republic of Ireland is financed mainly by the state. However, all citizens have the option of buying additional private health insurance, provided by four companies. They include VHI, a large publicly owned insurer, operating, like all other insurers, community rating; people are insured at the same basic rate regardless of health status. The other insurers are Glo Healthcare, LAYA and Avivia. Also, much smaller restricted membership companies provide benefits for certain professions, such as police officers. There are public as well as private hospitals. Private patients are often treated in public hospitals, as all privately insured patients have an entitlement to use the publicly funded system. Netherlands Healthcare in the Netherlands is essentially single tier, with all persons accessing a common system of private and public providers with complete freedom of choice between providers. Insurers are all private companies. It is heavily subsidized from tax revenues and heavily regulated, with a common, regulated standard insurance policy coverage set nationwide for all providers and a more flexible top up insurance, which is less regulated and set by each company as it chooses. Insurers set a standard price for each adult for the year throughout the country and must insure all people who apply for insurance at that price regardless of the age or health status of the applicant. An equalization fund, which is essentially a national sickness fund funded from a form of income tax on employers and employees, is used to pay for the health care of all children and to compensate insurers if they have more high risk profile clients than the other insurers. Thus, Dutch insurers welcome the sick and the elderly because they are fully compensated for the higher-risk profile of these clients. People living in more expensive areas of the country have to pay higher premiums, since they