The US and Canada are often contrasted for their starkly different healthcare systems. The industrialization of American healthcare has been a critique of the US for decades, extending far beyond the administrations many of us have witnessed. Most often, the US stands in comparison to Canada. However, many people fail to acknowledge the similarities between Canadian and American healthcare, and many also fail to acknowledge other differences extending beyond profit.
A significant aspect of the American healthcare system is the lack of choice given to consumers when choosing their health care providers. This is because of the introduction of Managed Care Organizations (MCO) and government policies. There are two types of MCOs: Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). HMOs combines the insurer and producer functions in their healthcare delivery system, as they are pre-paid and provide comprehensive services. PPOs also combine insurer and producer functions, however they are third party payers that provide financial incentives to enrollees who receive their medical care from a specific set of physicians and hospitals. The primary issue here is that if an individual belongs to a specific HMO they can only receive care from that organization. If they choose to access other forms, then the individual will be responsible for all of the financial burdens of their medical care.
In contrast to Canada, multiple parties such as the federal and state government as well as insurance companies are responsible for reimbursing their health care providers. There are many ways reimbursement can happen. A common approach is the fee-for-service method. Most MCOs provide reimbursements through the fee-for-service plan. Other forms are the prospective payment plan - payments made on a case by case basis - and prepaid health plans. Any services performed by physicians under Medicare and almost all the time for Medicaid are reimbursed on a fee-for-service basis but this fee is fixed by the government based on the following charges: the actual charge of the physician, the common charge of in the local area of the customary charge of the physician. If a physician chooses to accept an assignment of a patient under Medicare or Medicaid they are accepting the government-determined fee and are not allowed to charge the patient more than the normal 20% co-payment. However, without assignment, the patient must pay the actual physician charge and will receive a reimbursement of 80% of the Medicare fee.
The United States healthcare system is known for its mix of pluralism and private markets but a benefit of the system is the quality of its technology. This is reflected in the high life expectancy and the survival rates of premature babies in the U.S. The U.S. is also the world leader in pharmaceutical innovations that extend, save and improve the quality of patient’s lives. Despite this strength of their technology, the fact that 52 million Americans are without insurance is a glaring weakness. This inefficiency to control costs creates many issues such as medical access problems and the relationship between a family’s income and their health insurance. Balancing its strengths and weaknesses is a difficult task as can be seen from Table 1 below.
Table 1
It is clear that despite the fact that America has the greatest GDP per capita healthcare spending it does not have the most physicians or hospital beds per 1000. This only emphasizes the severity of the disadvantages of the American healthcare system as they have huge spending on services but not enough services to provide to their population, keeping in mind that the American population is now approximately 328 million, the largest of the three countries in Table 1. This increased spending causes a huge burden on the system as they do not have enough resources to provide to the increasing patient population.
Table 2
From Table 2, it can be observed that the American population is not as satisfied as to the Canadian or German population. This corresponds to the fact that in Canada and Germany costs are lower reducing or eliminating the existence of financial barriers and there are more services provided. However, that is not to say that the United States must adopt the Canadian or German approach, as they have a population almost ten times greater than those nations, meaning the transition would not be as easy as it sounds and it may not benefit this heterogeneous country.
The American healthcare system displays multiple differences as compared to Canadian and German healthcare that emphasizes it as particularly flawed, despite several similarities between each system. Although many characteristics are distributable across all three systems, the largely exploitative nature of the US healthcare system creates a particular effect in which many citizens are unhappy and take steps to avoid engaging with it. Clearly, changes are needed in order to create a system which benefits every American citizen, as ethical healthcare is a right for all.
Written by Emaan Rana and Sasha Bahandava
Edited by Joyce Qian
References
Goran Ridic, Suzanne Gleason, Ognjen Ridic. Comparisons of Health Care Systems in the United States, Germany and Canada. [Nih.gov]
Clifford K. Section A; Page 3; Column 1; Foreign Desk. The New York Times; 2003. Feb 13, Long Lines Mar Canada’s Low – Cost Health Care. [Google Scholar]
Sherman F, Goodman AC, Stano M. The Economics of Health and Health Care. Prentice-Hall; 2000. [Google Scholar]
Henderson WJ. Health Economics and Policy. South-Western Publishing; 2002. [Google Scholar]
Susan G. Markets and Medicine: The Politics of Health Care Reform in Britain, Germany, and the United States. Ann Arbor: The Univ. of Michigan Press; 2002. [Google Scholar]
The Source Book of Health Insurance Data. 1994.
OECD Health Data 2000. Empirical Evidence and International Comparisons. Paris. 2000.
OECD Health Data 2000. Life Expectancy at Birth and Life Expectancy at Age 65
Blendon RJ, Leitman R, Morrison I, Donelan K. Satisfaction with Health Systems in Ten Nations. Health Affairs, Summer 1990, Exhibit 2. p. 188. [PubMed]
Rexford SE, Neun SP. Health Economics: Theories, Insights and Industry Studies. Orlando, FL: Dryden. Harcourt Brace College Publishers; 2000. [Google Scholar]
Earl HD, Klees BS, Curtis CA. Overview of the Medicare and Medicaid Programs. Health Care Financing Review. 2000;22(1):175–193. [PMC free article] [PubMed] [Google Scholar]
Current funding. (n.d.). https://healthcarefunding.ca/key-issues/current-funding/
CMA Code of Ethics and Professionalism. (n.d.). https://www.cma.ca/cma-code-ethics-and-professionalism
Healthcare in Canada Explained for Immigrants. https://www.visaplace.com/blog-immigration-law/healthcare-in-canada-explained-for-immigrants/
Health insurance for Canada. (n.d.). https://www.aetnainternational.com/en/individuals/destination-guides/expat-life-in-canada/health-insurance-for-canada.html
Canada, H. (2016, August 23). Government of Canada. https://www.canada.ca/en/health-canada/services/health-cards.html
So interesting l!