Bismarck systems operate with multiple competing or occupational non-profit insurance funds, whereas Beveridge systems centralize administration under a single government-run insurer.

Bismarck structures maintain a decentralized network of sickness funds divided by occupation or geography. The state regulates these private, non-profit entities to ensure they cannot deny coverage or generate profits. By contrast, Beveridge structures eliminate these intermediary funds. The government acts as the sole payer and owner of clinical infrastructure. This eliminates administrative overhead but introduces centralized queues for non-urgent care.