Most of the universal public systems that we would compare to—the U.K., Sweden, Norway, Australia, New Zealand—have fairly limited copayments, with the exception of Australia. Australia has about a $35-per-prescription copay for general beneficiaries. If you're disabled, low-income, or over 65, you pay what's called a concessional fee, which is significantly less.
Unfortunately, in countries that have high copayments for all medicines, such as Australia, patients do go without prescriptions, just like Canadians do when we face deductibles and co-insurance.
This is why countries such as the Netherlands and most health management organizations or health maintenance organizations in the United States and other systems use what's called tiered copayments. The stuff that is truly essential, proven clinically effective, cost-effective, and preventative is free.
The stuff that is more discretionary, or second-line therapies, may have copayments. Again, in most comparable systems those copayments are relatively modest unless it's truly a third-line therapy that patients shouldn't be taking unless they've gone through prior therapies. Again, in most of these countries that we would compare to that are universal, the rate of access barriers are very low, with 4% or less of their population reporting those problems.