Emanuel Baisire

Comparative Study: U.S.A. and Canada Health Care Systems: Introduction: The main thrust of the paper is to compare United States health care system with Canadas universal health insurance program. The paper compares different health care insurance programs provided by U.S. and Canadian government. In this case, health insurance coverage will refer to groups of people qualifying to enroll in U.S and Canada health programs. The analysis of U.S. health program will mainly focus on edicare, edicaid, and private insurance programs. !or the case of Canada, the analysis will e"plore the strengths and wea#nesses of Canadas universal and single payer health insurance system. In a bid to ma#e a clear comparative study of both countries$ the evaluation will be based on health care cost, health care accessibility level and the general health status. U.S. Health Care System: The United States health system has a combination of both publicly and privately funded programs. The U.S health care system is considered to be e"cellent in certain fields but not faring well in many quality measurement compared to other developed countries % anning, &''&(. Unli#e Canada, the United States does not have a national insurance program but have two most important public health care programs, military medical services and veterans medical. The national health insurance initiative was first proposed by ,resident -oosevelt in &'./ but was opposed by some lawma#ers and a cross section of the general public %-einhard, &'')(. edicare and edicaid were enacted as Title 01III and Title 0I0 of the Social Security +ct to provide health insurance to +mericans aged 23 and above, low4income families and people with disabilities. edicare and edicaid %Irvine, )**)(. +nother equally important federal funded health program is the

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In order to understand U.S health system, it is important to understand the role of federal, state, local and private sector in financing health care. Medicare: In )**., there were .& million edicare beneficiaries %health insurance(

covered for by the federal government %U.S. Census, )**3(. The program requires a federal payment of 5 )/6 billion annually to function. The payments are mostly financed through payroll ta"es on current wor#force, premiums and pension funds %Irvine, )**)(.There are three types of 7 and edicare coverage for pensioners$ edicare +, edicare edicare8Choice %C S, )**3(.9ligibility is based on age and monthly premiums edicare remains popular among politicians and

to receive supplemental health care services. :espite increased critics of the program and growing shortfalls of funding, beneficiaries. Medicaid and State Childrens health Insurance Program (SCHIP): This is a need based program that provides healthcare to poor families, children, people with disability and low4income elderly %Stone, &''/(. It is estimated that ./ million individuals received edicaid benefits by )**. at the cost of 5 ).2 billion in federal and state payments %U.S. Census, )**3(. edicaid is ;ointly funded by federal and state government and each edicaid program and eligibility edicaid edicaid recipients can edicaid is the states contribution is determined by its income levels % echanic,)**&(. Individual states are given the mandate to formulate their own requirements in line with federal guidelines %<aiser, )**&(. This e"plains why benefits and eligibility requirements vary from state to state.

access public or private hospitals of their own choice but coverage to a private physician is normally controlled by the programs low payment rate %Irvine, ,p.).( not enrolled in edicare or private insurance plans. largest single payer for long4term health care needs for the elderly and disabled that are

Private Health Insurance program: It is estimated that )** million +mericans are insured under employment4based health insurance or individually purchased insurance plans %<aiser, )**&(. It is often very e"pensive and difficult to purchase a non employment4based health insurance in the U.S.

This has left forty three million +merican without health insurance %U.S. Census, )**3(. !or the case of employment4based health insurance, U.S. employers usually set limits on the type of health benefit an employee is entitled to receive %-einhard, &'')(.9mployers normally put a ceiling on total e"pense an employee is entitled to utili=e and sometimes requires an employee to participate in a managed care plan. any employers restrict employees choice to visit a preferred doctor as a way of minimi=ing costs %>hite pp.&.(. ,atients are normally requested to see# approval before visiting a medical specialist outside the managed health care plan. +ccording to Irvine %)**)(, '*? of +merican wor#force and their dependants are covered under the @ealth %@ A( and ,referred ,rovider Argani=ations %,,A(. Therefore, in order to ma#e a clear comparison of U.S health care system with Canada, the analysis will be based on cost, accessibility to health care and good health. The United States has the highest health e"penditure compared to other developed countries. The U.S health e"penditure grew to 5&.6 trillion in )**/ and accounts for &3./ ? of U.S. B:, %Cevit 9t al, )**.(. Unfortunately, this most e"pensive health care system in the world does not deliver the highest health care services to its population. U.S health care delivery system has been ran#ed as poor4to4middling results %A9C:, )**3(. The high cost of U.S @ealth care e"penditure has been attributed to investment in medical technology, e"pensive prescription drugs and administrative cost %>oolhandler, )**&(. +s regards to health care accessibility, U.S. is the only country within A9C: members that does not provide health care to all its citi=ens %+yre, &''2(. This has resulted into ./ million +merican to remain uninsured compared with Canadas universal health care coverage. The lac# of health insurance has left many +mericans sic# and unable to visit a physician. This phenomenon has increased medical e"penses because uninsured individuals tend to visit a doctor only when the disease has progressed and in need of emergence operations %+C,, )**&(. aintenance Argani=ation

To briefly summari=e U.S health care system, it is important to loo# at the advantages and disadvantages of U.S health care patterns compared to Canada. Advantages: :ue to huge investments in medical technology, U.S physicians have access to new technology and easily adapt to advanced medical technology. !or e"ample U.S has ta#en a lead in the use of )**&(. Compared to Canada, U.S does not have a long waiting period for optional surgical procedure and it has also been confirmed that U.S. heart patients are more li#ely to undergo invasive cardiac procedure than Canadian patients %<osterlit=, &'E'(. The U.S does not have a universal health system but provides access to emergency services for critically sic# patients. Under U.S law, hospitals are required to treat patients regardless of their insurance coverage and ability to pay. The U.S health system provides incentives for physician to advance their s#ills with the goal of earning higher incomes. This has resulted into a great percentage %63?( of U.S doctors being specialists compared to Canada with only 3*? of medical specialists %B+A, &''&(. a;ority of U.S hospitals are privately managed thus enabling hospital officials to reach quic# decisions without government delay in resource allocation %Sclar, )***(. U.S hospitals compete with each other for patients and this leads to improved services and use of advanced medical technology %7ernard, )**&(. Disadvantages: The United States price for health care service is very e"pensive to the government. It has been argued that better health care services in the U.S is accessed by a few rich -I units and CT scanners. The U.S also en;oys a lead in the use of new technology in treating heart patients compared to Canada %Tech -esearch Detwor#,

individuals, employer4 based health programs, government sponsored programs. The rest of the population remains with no health care services. The U.S has low level medical services. U.S patients have a relatively low annual physician visit and hospital stay per capita due to patients fear of paying out of poc#et for medical e"penses %A9C:, )**3(. The e"istence of powerful private health insurance companies and managed care companies in the U.S limit the range of political choices in health care reforms. Canadas Health Care System: Canadas health care system is a publicly funded program which provides universal health care coverage to all residents. The health care system in Canada is provincially administered and equally financed by federal and provincial governments %7ernard, )**&(. !or provincial governments to qualify for federal government contribution, provinces have to ensure that more than '3? of their residents are enrolled in the program %<osterli=, &'E'(. Under the Dational @ealth +ct %&'22(, provincial health care plans have to be uniform in order to qualify for federal governments financial support. To discuss Canadas health care system, it is important to understand the origin of Canadas health care system. The general notion of universal health coverage in Canada was first established in Sas#atchewan province by Canadas social democratic party in &'3' %Terris, &''*(. The model faced strong opposition and criticism by doctors, insurance companies and the public %7enard, )**)( @owever, the Sas#atchewan model became popular among politicians and was later replicated nationally under the federal Dational @ealth +ct of &'22. Canadas health care e"penditure is relatively low even when it provides universal health coverage to its citi=ens. Canadas health e"penditure accounts for '.'? of B:, %A9C:, )**3(. Canadas health spending per capita was 5 U.S./**/ in )**/ compared to United States health spending per capita of 5 32/3 %A9C:, )**3(.

+s regards to health care access, Canada provides health care to all its citi=ens %+yre, &''2(.Canadas universal health care coverage allows Canadians to see# free medical services regardless of their income or age. This phenomenon has contributed to improvement in Canadians quality of life %7ernard, )**)(. Aver the years, Canadas life e"pectancy at birth has risen to 6'.6 years compared to U.S with 66.) years %A9C:, )**3(. Canada has also e"perienced a fall in infant mortality rate of 3.. per &*** live birth in )**), which is lower than the United States 6 death per &*** live birth. These figures suggest that Canadas standard of living fares well compared to the United States. Therefore, in order to understand the benefit of Canadas health care system, it is important to loo# at the advantages and disadvantages of the system. Advantages: I. Canadians have managed to build a universal system that caters for healthy needs of the poor and rich without any medical restriction. II. Canadian patients have more freedom to visit a physician of their choice unli#e U.S patients who are mostly controlled by the managed care system. III. Canadas single payer system has managed to contain administrative cost compared to the U.S which has over )*** insurance providers with different billing and administrative system resulting into increased medical cost. I1. Canadas system is also physician friendly because it allows hospitals and clinics to treat patient without worrying about patients ability to pay. 1. ,rivate health insurance companies are prohibited from providing health policies covered under the comprehensive provincial plan. This is important because it avoids duplication of services and protects the universal coverage plan from being undermined.

Disadvantages I. The fee for service system in Canada encourages doctors to perform unnecessary operations in order earn more income. This results into a waste of resources and time. II. Canadas national health care program attracts administrative delays and bureaucratic interference in implementing critical health decisions. III. ,rovincial government are reluctant to invest in new technology due to fear of rising health cost, unli#e in the U.S where decisions to invest in new technology is vested in individual hospitals see#ing to gain competitive edge in the mar#et. I1. :ue to high demand for speciali=ed medical operations, there are long waiting period for patients see#ing elective surgery and diagnostic procedures. 1. There is a widening difference among Canadian provinces in determining which health policy to be included in the comprehensive plan. Some provinces pay for certain medical operations while others dont. In summary, the comparison between Canada and the United States clearly indicates that providing universal health care services to the whole population improves the quality of life. This is indicated by Canadas longer life e"pectancy at birth and low infant mortality rate compared to the United States. +nother stri#ing feature of Canadas health system is that it provides comprehensive health care services and better health results at a lesser cost compared to the United States system that does cover the entire population.

9ven though Canadian health care system is more favorable compared to U.S., it also e"perience some problems. +lthough the system advocates for equality to health care services, it does not guarantee equality in health care services. +ccording Terris %&''*(, a fifth of rich Canadians tend to live 3 years longer than poor Canadians. Canadas national health care program attracts bureaucratic interference in resource allocation by health care providers. The system control doctor and patients relationship by determining which surgical operation should be done first according to the waiting lists for medical care. Conclusion: The United States health care system is under attac# due to increased health care costs and limited access to health care services. There is a need for health care reform supported by politicians and interest groups. ,olicy ma#ers need to improve the efficiency of health care spending and e"tend health care coverage to people who can not afford to purchase health insurance. The Canadian model of national health care provides useful information for policy ma#ers to craft a comprehensive health care policy that is affordable to all +mericans. y proposal is that U.S. policy ma#ers should not adopt Canadas health care system as it is but learn from Canada e"perience to build a stronger system that incorporate positive features of U.S. health care system.