The heath care system in every country is one of the most important factors that determine the general welfare of the population. The model that is used to deliver health care system in a country determines the accessibility of health care service by the citizens of a particular country. Provision of comprehensive and affordable health care service has remained one of the most controversial issues in the United States. It has also turned out to be a political issue and the result is lack of access to affordable health care by a segment of the population which cannot afford private health care service. On the other hand Canada has maintained a public funded health care system which has ensured a high level of accessibility to health care service by majority of the population. The Canadian model of health care service delivery and management cannot be considered as a socialized medicine but rather it is a public system where most of the services are provided by the private entities. (Guyatt, 2007)
Compared to the level of spending, the US spends much more on the provision of health care service for the population compared to Canada. For example in 2005, the US spent approximately 15.3% of its GDP on health care while Canada spent 9.8%. However there is a difference in the level of financing. In the same year 70% of the health care spending in Canada was funded by the government while in the US the government funded only 44.7% of the overall health care spending. (Szick, et al., 1999)
Results of the difference
There have been mixed result on the outcomes of the differences between the two health care systems. A recent study carried out in 2007 revealed that comparing the outcomes of the two countries, Canada could be considered to provide a superior patient care than US but the results are not consistent. However life expectancy is longer in Canada and the infant mortality rate is also lower compared to the US standards. A 2000 World Health Organization rating of health care systems ranked Canada in position 30 while US was ranked in position 37. US has also been criticized that it is only the industrialized nation in the world that lacks a comprehensive health care system. (Szick, et al., 1999)
The main difference in the two health care systems has been traced to insurance schemes for the population. The US system is based on private insurance schemes while the Canadian government has been funding health care service instead of allowing the use of individual insurance schemes. The US has in the recent past enacted the Medicare bill which has introduced Health Savings Accounts in order to promote consumer driven health care but the difference in the two systems remains evident. (Guyatt, 2007)
The best in the two systems
Both countries had the same health care systems in the 1960s. But structural change in health care delivery and management saw the Canadian government play a key role in covering 70% of the health expenditure. The Canada Health Act assert that all those who are insured must be fully insured and there should be no co-payment or charging of user fee for all the medical service which are offered in hospitals and in physician care. The federal government of Canada usually provides funds to the provincial government for expenditure in health care as provide in the Canada Health Act which denies billing end users for any medical procedures that are covered under the Medicare. (Health Canada, 2008)
One of the most effective health management schemes in the US are the Medicaid, Medicare and State Children’s Health Insurance Program. These schemes are important as they help to provide health care service to senior citizens, the very poor people, the disabled persons and children. This is the segment of the society that is likely to be alienated in public funded medial service since they can be taken as other member of the population while they have more heath care demands. Under a private health care system like in the US, this is important to help the marginalized segment of the society to access health care service.
The worst of the two systems
There are criticisms which have been pointed in the two health care delivery systems. The Canadian health care system has been criticized on the wait times. Whether a patient is going to see a specialist or for any major elective surgery like replacement of the hip, they are usually forced to wait for a long time before they are served. A recent commonwealth Fund study found out that 24% of the Canadians patients are forced to wait in the emergency room for more than 4 hours as compared to 12% in the US. More than 57% of the Canadian population waits for about 4 weeks to seek specialist medical services.
On the other hand coupled to lack of comprehensive health care, the price of drugs in the US has been considered exorbitant by a number of studies. The US has put in place explicit laws which prohibit the main programs that are meant to assist the poor and the old i.e. Medicare and Medicaid from negotiating on the price of drugs. Not even the introduction of Medicare part D has reduced the price of drugs. A recent study carried out in 2007 found out that 40% of the sick adults in America did not fill out a prescription due to high cost. (Guyatt, 2007)
In the 1960s the US and Canada had a similar structured health care system. But along the way there has been a lot of restructuring of the delivery of the health care system with Canadian government positioning itself to funding health care service while the US system remained under the hands of the private sector. There have been unsuccessful attempts by various US governments to structure the health care system and provide comprehensive health care system but which have all failed. There are evident results which can be traced to this difference in provision of health care system. Canadian have more access to health care services and their life expectancy is longer while infant mortality remains lower than that of the US. The Canadian system has ensured that there is overall access of health care service by the population and there is charging of payment fee or end use billing. On the other hand the US has put in place Medicare, Medicaid and SHCIP programs which provide insurance cover for the poor, old and children. However there are weaknesses in the two systems in the at the Canadian system has a longer wait time before accessing medical service while the cost of drugs in US has constrained the delivery of effective heath care services.
Guyatt, G. H. (2007): Review of studies comparing health outcomes in Canada and United States. Open Medicine, Vol. 1(1)
Health Canada, (2008): Health Care system. Retrieved from http://www.hc-sc.gc.ca/hcs-sss/medi-assur/index-eng.php on 26th August 2008
Szick, S., Angus, D., Harrison, M., Page, J., & Moher, D. (1999): Health Care Delivery in Canada and the United States: Are there relevant difference in Health Care Outcomes? Retrieved fromhttp://www.ices.on.ca/file/Health%20care%20delivery%20in%20Canada%20and%20the%20United%20States%20-%20Are%20there%20relevant%20differences%20in%20health%20care%20outcomes.pdf on 26th August 2008