the bismarck system was first employed in 1883 by prussian chancellor otto von bismarck. in this system, insurance is mandated by the government and is typically sold on a non-profit basis. in many cases, employers and employees finance insurers through payroll deduction. in a pure bismarck system, access to insurance is seen as a right solely predicated on labor status. the system attempts to cover all working citizens, meaning patients cannot be excluded from insurance due to pre-existing conditions. while care is privatized, it is closely regulated by the state through fixed procedure pricing. this means that most insurance claims are reimbursed without challenge, creating low administrative burden. archetypal implementation of the bismarck system can be seen in germany's nationalized healthcare. similar systems can be found in france, belgium, and japan.