Healthcare Systems, Research Paper Example

The United States has been subjected to much criticism concerning the effectiveness of its healthcare system. One of the major criticisms is that the Canadian healthcare system is best suited for the medical needs of Americans. At one point, Canada and the United States have similar healthcare systems, but Canada reformed many of its healthcare policies during the 1960s and 70s. As a result, Canada and the United States healthcare systems are quite different today. Canada’s healthcare system is primarily a single player system, meaning it is publicly funded. On the other hand, the healthcare system in the United States is a multi-player system, which means it is privately funded. The healthcare coverage in Canada seems to be more efficient than that of the United States because Canada offers universal coverage to all of its citizens. Although the healthcare scenario of both countries has problems, at the present time the healthcare system of the United States seem to be the worst case scenario. The publicly funded healthcare system in the United States only accounts for a small percentage of its citizens. Children, disabled, elderly, and those who are below the federal poverty line are the only ones that the United States government provides healthcare to. Ironically, the United States government spends more money in healthcare than Canada does. In Canada, healthcare costs are paid for through business and personal tax collections. Only Canadians who are considered financially capable are asked to pay premiums. As a result of being able to access adequate healthcare services, Canadians are reportedly healthier than Americans. Life expectancy, infant mortality, and death rates suggest that the Canadian healthcare services are effective. Canada’s healthcare services are more adequate than the United States because it provides all citizens with coverage; in comparing and contrasting the two systems the following are the most important factors: Access to healthcare, financial barriers, healthcare benefits, administration, and cost containment.

Access to Healthcare

Having access to adequate healthcare services is equally important to both Canadians and Americans. Canada has a universal program that provides healthcare to all of it citizens through a provincial healthcare insurance. Private insurance companies exist in Canada, but these companies are not allowed to cover services that are provided by Canada’s provincial plans. Each province has one insurance company that is responsible for reimbursing hospitals and physicians. Nonetheless, patients are free to choose their healthcare provider. Similarly, United States citizens are free to choose their healthcare providers; however it depends on the type of insurance they have. Some insurance companies provide patients with a list of acceptable providers. Others just designate certain patients to certain physicians. These stipulations are generally placed by the Medicare program. Medicare is a federally administered program with uniform eligibility that serves the elderly, disabled, and young in the United States. Although it is federally regulated, benefits can vary from state to state.

Financial Barriers

Canadians residents are not burdened by financial barriers. All Canadians have access to healthcare services under their provincial healthcare plans. The Canada Health Care Act does not permit user fees for publicly insured services with the exception of those who need extended care for chronic illnesses. When and if these charges are permitted, provinces are subject to dollar-for-dollar deductions under the Established Programs Financing. This system of checks and balances ensures that individuals will not be forced to omit needed care because of the expense. On the other hand, access to health care in the United States is limited by countless financial barriers. For example, private insurances are very costly and many public programs are inadequate. Consequently, Americans who have jobs that provide them with insurance and Americans who can afford to purchase their own private insurance have medical care readily available to them. Yet, there are millions of Americans who have no insurance coverage.

Benefits

The benefits of adequate healthcare are immeasurable. The Canada Health Act insurance plan covers all medically necessary hospital, physician, and dental services. They do provide benefits, such as prescriptions. There is no dollar amount limit on the amount of necessary services an individual may need. In contrast, the coverage provided in the United States varies from user to user and state to state. Some employers do not offer insurance; as a result many people who are employed full time do not have health insurance. Private health insurance accounts for only about two-thirds of the population, which adds up to be about 23 million people (CIHI, 2011a). Some people who are insured through their jobs will lose their benefits when they retire. Consequently, Americans tend to work longer than Canadians in effort to keep them and their families insured. Also, in the United States co-payment is common and sometimes healthcare providers even charge the patient for charges that exceed the insurance coverage. This is a problem in the United States because often citizens are charged different amounts for the same health care services because there isn’t a system that regulates the charges.

Administration

The administration of Canadian healthcare insurance is carried out by a public agency which operates on a non-profit basis. This agency has to report to the provincial government. The provincial government, in turn, is responsible for determining hospital budgets, physician’s fees, and the general cost of operating healthcare facilities. Physicians in private practice are paid on a fee by service basis; whereas, hospital physicians are paid a salary regardless to the number of patients they serve. Marchildon 2012 added that in 2010, of the total number of doctors in Canada (69,699), about half were family doctors and half were specialist. Primary care physicians largely act as gate keepers for further care. Most physicians are in private practices and are remunerated on a fee-for-service basis. Nonetheless, an increasing number of family doctors receive alternative payments such as capitation salary, salary, and blended salary. Payment is sometimes linked to performance. According to OECD Health Data 2012, out of pocket payments by private households only represented about 14.3 percent of the total spending. Out of pocket spending consisted of 20 percent doctor’s visits, 20 percent long term care, 17 percent prescription drugs, 12 percent vision care, and 10 percent for over the counter drugs. To the contrary, the healthcare system in the United States is administered by several different groups-private insurers, employers, federal, state, and local government. In 2010, 56 percent of Americans received primary care coverage from a private voluntary health insurance. 51 percent received insurance through their employers and 5 percent acquired coverage directly. 27 percent of Americans were covered through public programs-Medicare 14 percent and Medicaid 12 percent. Only 1 percent of the population was insured through military affiliation. Shockingly, 50 million Americans were uninsured. Yet more shocking, 29 percent of the people in America who are insured are underinsured leaving them vulnerable to high out of pocket expenses (Guterman, Collins, Stremikis, Rustgi, & Nuzum 2010).

The Costs

Cost of services an important issue. Americans are puzzled as to how it is that Canadians are paying less, but receiving more services than they are. For example, since the 1970s Canada has spent a smaller portion of its total economic output on healthcare than the United States has. As a result, Canadian spending has been lower on a per capita basis. According to the Canadian Institute for Health Information (2012), due to recent economic recession in Canada, the provincial government has had to enact budget constraints. They are aiming to contain costs and maintain good value of each dollar used. Some of the provinces in Canada have enacted the use of generic drugs to help contain costs. Canadian officials are hopeful that the use of generic drugs will save them about three million dollars within a three-year period. In the United States, healthcare costs exceed 11 percent of the national gross and is continuing to rise.

Implications for Reform

Healthcare in America is not working for all its citizens. With millions of Americans uninsured, President Obama is trying to remedy that. In January of 2014 President Obama’s Patient Protection and Affordable Care Act will go into effect. Most people are calling is Obama Care. The goal of this Act is to provide affordable healthcare to all citizens and reduce the growth in healthcare spending. President Obama’s Act will not replace private insurance, Medicare, or Medicaid. Obama Care will provide preventive coverage to 47 million women and make it illegal for insurance companies to charge women different prices than men are charged. According to David Naylor, “Obama Care cuts $716 billion of waste from Medicare and reimbursements to private Medicare Advantage plans and reinvests it into Obama’s health care reform. In other words $716 billion is saved and then $716 billion is reinvested back into Obama Care and Medicare. Doctors and hospitals almost universally agree on this reform” (p. 15). Obama Care seeks to do away with the denial of patients due to pre-existing ailments. Obama Care will provide seniors with free preventive services, cheaper drugs, and close some loopholes in Medicare Part D. In 2011, Obama Care was responsible for about 86 million Americans using free preventive services that had previously been subject to co-pays or deductibles. Under Obama Care employers with more than 50 employees must insure their workers or pay a tax to the government for not insuring their workers. The purpose of this law is to force employers to provide insurance for their worker. When weighing the options, many employers would fair financially better if the provided insurance than if they were required to pay federal taxes. Overall, the Obama Care has made some positive and needed changes in the American healthcare system. Nevertheless, there are still people who are not satisfied with the changes.

Conclusions

America is in desperate need of healthcare reform. Although neither the United States nor Canada has a perfect healthcare system, Obama Care seems to be taking the United States towards a system that benefits more Americans. According to Igiehart, “Canada is perceived to have one of the best health care systems in the developed world, publicly funded and providing universal coverage. It has avoided the direct governmental controls of Britain’s National Health Service and the increasingly close monitoring of medical decisions by third-party players in the United States” ( p. 1770). In other words, the United States needs to find a common ground in the healthcare arena. All Americans should have access to healthcare. There are many people who would like to see Obama Care repealed because they don’t agree with it. Nonetheless, if Obama Care is repealed millions of people will continue to be without healthcare insurance or not have adequate insurance. No person living in civilized culture should have to decide whether or not they should buy groceries or pay for a needed prescription. Obama Care may not be perfect; many people may not agree with it, but the pros outweigh the cons. If Canada can provide universal care that is governed by individual provinces, the United States should be able to provide healthcare that has fewer stake holders manipulating the finances. If Obama Care is repealed millions will be denied insurance due to existing conditions. Americans have suffered dire consequences for years as a result of a system that has been controlled by private insurance companies, whose main objective is finances, not the overall health of the people they serve. Reform is imminent.

References

Canadian institute for health information. (2012). National health expenditure trends 1975-2012. Ottawa: Canadian institute for health information.

Davis, K., Guterman, S., Collins, S.R., Stremikis, K., Rustigi, S., & Nuzum, R. (2010). Starting a path to a high performance health system: Analysis of the payment and system reform provisons in the patient protection and affordable care act of 2010.

Igiehart, J.K. ( 1999). The united states looks at canadian health care. American Medical Association, 321, 1767-1772.

Marchildon, G. (2012). Canada: health system review. Copenhagen: who regional office for Europe on behalf of the european observatory on health systems and policies, forthcoming.

Naylor, D. (2011). The canadian health care system: an overview and some comparisons with America. Unversity of Toronto, Department of Medicine, 14-16.

OECD Health Data 2012.