The functions of the American healthcare system has largely been criticized to be incapable functioning properly, or being incredibly for-profit that many Americans choose to avoid it. Especially when compared to Canada, a system widely compared to the US’s, it seems to fail in most aspects. However, many aren’t aware of how the American healthcare system functions, nor how the Canadian healthcare system functions. Through careful analysis of how both systems function, it becomes discernible as to why one system is widely praised, while the other is heavily criticized internationally.
With a population of over 37.59 million, Canada runs on a publicly funded healthcare system, widely known through the nickname Medicare. This system is currently ranked at 30 in the world by the World Health Organization (WHO), with most services being free at the point of access. It is considered better than both systems in the U.S. and Australia. The most common healthcare funding method in Canada is the global budget, which is when a specific payment is handed out to a provider to cover their expenses over a period of time. Healthcare is regionalized in most provinces, meaning that local health authorities are the ones responsible for delivering health services. The majority of these authorities rely on the global budgets to fund their groups of services, such as hospitals, rehabilitation facilities, and other mental and physical health services. The amount of money they receive through this funding is generally based on inflation, politics, or historical budgets, without respect for the number of patients or resources the hospitals have. Because of this, multiple provinces, including British Columbia, Alberta, and Ontario, are experimenting with other sources of funding. On the other hand, Canada’s funds also come from public taxes, making the income tax significantly higher compared to other countries.
The majority of these free services can be accessed through a Health Card (also referred to as Care Cards), which are issued to all Canadian residents and citizens. They are a provincial responsibility, meaning that you must apply for your Health Card in your province. The level of coverage and supplementary benefits can vary based on location. Generally, Health Cards must be shown for anything not considered emergency care as a method for identification. Nevertheless, these Health Cards do not cover everything as there are a variety of services that do not fall under the umbrella of universal healthcare. These include prescription medications, dental care, physiotherapy, ambulance services, and prescription glasses. When you are given a prescription for a medication, filling out the prescription itself may require paying out of pocket. However, in certain circumstances, you may be eligible for a provincial drug plan which can cover these costs. Dental care is not covered by Medicare either, and most people pay for these services directly or through private health insurance. There are exceptions to certain cases, such as children from low-income families. Similar to dental care, physiotherapy and prescription glasses are paid mostly out of pocket, with exceptions for people not of working age. Finally, ambulance services have a fee that must be paid for. For example, in Ontario, essential medical ambulance rides will cost around $45.00, while one that is deemed medically unnecessary will cost around $240.00.
Healthcare ethics are another important aspect to understand, and the Canadian Medical Association (CMA) stresses five virtues that should be exemplified by any medical professional. They are compassion, honesty, humility, integrity, and prudence. Compassion is defined by, “sympathetic pity and concern for the sufferings or misfortunes of others” (Oxford English Dictionary, 1884). In a medical setting, this virtue is seen as a professional who will recognize the suffering endured by the patient and is understanding of the circumstances that surround them. The professional must seek to alleviate any problems the patient is having in a supporting and dignified way. The next value listed is honesty. A physician must be respectful of the truth and seek to communicate it to the patient sensitively and in a compassionate manner. Humility is another virtue underlined by the CMA, and is described as a doctor who ensures not to overstep the boundaries of their knowledge or skills, who seeks advice from colleagues if unsure, and who recognizes how much the patient knows about their situation. Furthermore, a physician that practices integrity is one that remains consistent with their intentions and actions, all while acting in a truthful manner that aligns with their professional expectations. The final quality listed is prudence. Making decisions carefully, using clinical and moral judgments, and considering all medical knowledge and circumstances are actions that a medical professional should take.
There is a specific set of rules that need to be followed in order to gain access to universal healthcare in Canada. There are several requirements to qualify for healthcare in Canada: one must be a Canadian citizen or permanent resident and have resided within the country for a total of three months prior to applying to the universal healthcare system. However, Canada has also series of private health insurances similar to insurance in the U.S. These companies are for-profit and can be costly, meaning the best course of action would be to apply for universal healthcare as soon as possible.
The United States of America lacks a nationwide system of health insurance. Instead, they have two types of health insurance: private health insurance that can be bought, or insurance provided by the government to specific groups. The former is provided by either for-profit commercial insurance companies or non-profit insurers. Approximately 84% of the population is covered by public insurance (which is 26%) or private insurance (which is 70%) and about 61% of this coverage is directly linked to employment (Ridic and Gleason 2012). This is because of the cost savings that are related to group plans that are often purchased through an employer (Santerre and Neun 46).
There are two ways this can happen: a fully self-insured firm or a partially self-insured firm. The former is when the employers will voluntarily sponsor their employees’ health insurance plans as they can fund an internal health insurance plan thus avoiding buying from external parties such as insurance companies. This firm (business) is now taking on the risks for all of its employees’ health care costs whereas a partially self-insured pan can limit these risks by buying “stop loss” insurance coverage to protect them from incurring costs after a specific maximum amount. However, in both cases, the firms will contract a third party to administrate the health insurance program.
As mentioned earlier 26% of the American population is covered by this type of health care insurance. There are two major types of insurance that were instituted in 1966 and they are known as Medicare and Medicaid. Medicare is meant for senior and disabled individuals and is a uniform national public program. It consists of two parts. Part A is mandatory and provides coverage for inpatient hospital care. This is limited to only nursing home services and some home health services. This part of Medicare is funded by a Medicare tax while part B is funded by monthly premiums and general taxes. Part B is a voluntary or additional plan that covers physician services, outpatient health services, outpatient laboratory and radiology services as well as some home health services. Medicaid is the health insurance coverage specific to certain economically disadvantaged groups. This type of public health insurance is financed by both the federal and state governments. Since the states are in charge of administrating Medicaid the eligibility requirements vary from state to state. Medicaid covers about 12% of the American population and is the only public program that finances long-term nursing homestay.
You may have noticed that uninsured individuals are excluded from both public and private insurance. This is significant because at any point in time about 16% of Americans lack health insurance. To put that in perspective, right now about 52 million Americans are not covered by health insurance. This lack of coverage results in increased financial insecurity and hardship. However, that is not to say that uninsured individuals have no access to health care services. They can receive the services provided by public clinics and hospitals, state and local health programs or private providers that can finance their care through charity and by translating costs to other payers. Yet, uninsured individuals are commonly found themselves in emergency rooms after it’s too late for the proper medical treatment.
Written by Emaan Rana and Sasha Bahdanava
Edited by Joyce Qian
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