A Comparison of Health Care in Canada and the United States
Health
care reform in the United States is a notion long in the making. Growing
concern over medical costs and availability of care has led to large-scale
debate over the future of the American health care system. Eyes have turned
north to Canada to compare their universal system of health care with that of
the U.S. The question is, can the Canadian model improve care available to all
citizens, while keeping the costs down?
The
Canadian and American health care systems are worlds apart, from their
acquisition of funds and government involvement, to the costs, delivery, and
even outcomes of the systems. The Canadian system is funded through a
single-payer system (the government), through tax revenue. The government pays
for almost all of the medical costs. The benefits of this system include accessibility
to services for all residents and lower administrative costs. The drawbacks of
the single-payer system include long wait times and staff shortages due to lack
of funding. The American health care system uses funding primarily from private
sources, and most residents have access to a variety of insurance plans. The
administrative costs associated with the numerous insurance companies are
extremely high.
In
a survey on health care satisfaction, Americans were found to be one
third less likely than Canadians to have a regular medical doctor, one fourth
more likely to have unmet health
care needs, and are more than twice as likely to go without required medication.
These numbers increase substantially for the uninsured. According to the study, more U.S.
respondents had unmet health care needs than did Canadians (13.2% and 10.7%,
respectively), however, their reasons for having such needs differed. 7% of U.S.
residents (and less than 1% of Canadians) had unmet needs because of finances,
whereas 3.5% of Canadians had unmet needs because of long waiting times. U.S.
respondents cited wait times as less than 1% for reasons behind unmet needs. The barrier to
meeting health care needs in the U.S. is the cost; in Canada, wait times are
the main offender. The
data suggests that Canada no longer enjoys greater satisfaction with its health
care than does the United States. It seems plausible that Canada’s far lower
health spending compromises aspects of care that affect satisfaction but not
health outcomes.
The
same health study observed at least 17% and perhaps as many as 21% of Canadian
women are not receiving recommended cervical cancer screening. This deficiency
may reflect low reimbursement rates for this service in Canada. However, death
rates from cervical cancer have historically been lower in Canada than in the
United States, possibly due to past screening practices and population risk
factors. According
to the Organization for Economic Co-operation and Development (OECD), the U.S.
has an exceptional track record of early cancer detection and treatment.
Canada’s
single-payer system for physician and hospital care is far more efficient in
comparison with the American multi-payer model when looking at administration.
Hospitals that are not-for-profit have considerably lower payments to
third-party payers in comparison to for-profit hospitals, while also achieving
lower mortality rates. Canada’s single-payer system, which relies on
not-for-profit delivery, achieves health outcomes that are at least equal to
those in the United States at two-thirds the cost. Some research into the issue
of single-payer systems has shown the administrative costs of billing individual
private insurance companies can be reduced by 20%. That would be a savings of
roughly 200 billion per year in the U.S.
Despite
the arguments that universal health care bears a hefty price tag, the U.S.
spends significantly more per year on their health care. According to the OECD,
Health care spending as a percentage of the Gross Domestic Product in 2007,
Canada spent approximately 10%, while Americans spend 16%. Americans spend significantly more on
their health care per year than any other country in the OECD. A recent report
from the organization also reveals that 35% of total health care expenditures is done by private
health insurance which is the highest in OECD countries. Regardless of the high
medical expenditures, the U.S. has fewer doctors per capita than most other
countries in the organization.
The
accessibility to medical services without charge is beneficial to those
residents with lower incomes. Although there is little difference in the
numbers of Canadians and insured Americans with regular medical doctors, in the
U.S., approximately 16% of the population is without insurance, and 20 million
in the U.S. are underinsured. One-third of the uninsured are in the lowest income quintile.
The likelihood of uninsured residents seeking regular medical attention for
preventive care or otherwise, is fairly low. Public insurance is available to
seniors, the military, veterans, the poor, and the disabled, but this is not
universal. As well, insurance premiums and deductibles continue to rise. Health
care costs are increasing, placing added financial burdens on the U.S.
residents. As the “baby boomers” continue to age, health care costs are
expected to increase substantially in the next few years.
Despite the massive spending on health
care, life expectancy in the U.S. is lower when compared with Japan, Switzerland,
Canada and Australia, and infant mortality rates are higher than in most OECD
countries. In 2006, it was 6.7 per live births relative to OECD average of 4.7.
Obesity rates among adults is the highest in the U.S. at 34.3% in 2006. Higher
obesity rates leads to higher health care spending in the future.
The
U.S. continues to be at the forefront of health care research and technology,
perhaps due to the for-profit nature of many of the health institutions. There
are some critical problems with the American health care system that could be
remedied in a number of ways. Looking at the universal system in Canada has
shown there is a way to have accessibility, while also keeping the costs down.
American policy makers will continue to investigate the system differences in
the two countries, hopefully resulting in ways to successfully navigate the
health care issues in the U.S.
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