OBJECTIVES Traditionally, the US can be broadly defined as having three sources of funding (private insurance, out-of-pocket funding and public funding through Medicare/Medicaid). This funding triangle can lead to varying degrees of inequality in the health care system. Meanwhile, European markets generally fund health care either through statutory health insurance schemes or by the government with very little being paid for directly by the patient. However, as governments consider how to meet their growing health care needs in a global recession, many will look towards a combination of cost reduction and new funding sources. This scramble to fund health care services will open markets to ideas once thought off-limits: just as the US starts moving towards universal care, some European markets, such as the UK, are considering the idea of supplemental, private provision of healthcare. METHODS Review of US states that now require health insurance, literature regarding the impact of Medicare Part D and policy papers regarding potential federal level changes to the provision of health care. Review of changes to the EU5 (France, Germany, Italy, Spain and the UK), including changes in the size of the private insurance market, the amount paid through co-payments and policy announcements regarding greater reliance on out of pocket/private funding. Review of the amount of generic drug versus branded pharmaceuticals spend in each market. RESULTS Despite growing utilization of generic drugs, healthcare systems are still struggling to fund the rising cost of health care. While the US system is moving towards a greater reliance on government funded health care, European markets are realizing necessity of additional funding sources. CONCLUSIONS In order to stretch budgets to meet growing health care needs, the 6 major markets are moving to a more diverse funding matrix for health care and, along the way, will more closely resemble one another.