The United States healthcare system is among the most debated topic in the political and public space. Human health is among the fundamental things in life that most governments worldwide struggle to provide good healthcare for their citizens. The U.S. has a unique healthcare system compared to other developed countries. The country’s spending on healthcare has been continuously increasing in recent years. In 2013 United States used 17% of the gross domestic product on healthcare which is expected to grow to 20.1% in 2025 (Keehan et al., 2016). The Canadian healthcare system tops the international standards of medical provision and outcomes. The Organization for Economic operation and Development ranks the Canadian health system among the best in the world. However, the plan faces various challenges as it cannot manage multiple chronic diseases that people suffer from. With the increased number of service providers in Canada, the system has changed from the original objective (service delivery) to profit-making. This paper evaluates the healthcare system of the United States and Canada by looking at their structure and organization. Also, the paper investigates key pertinent issues and challenges faced by both countries toward healthcare and strategies on how to address those issues. Finally, the report recommends whether the United States should model its healthcare system to increase the quality of healthcare provision or remain with the existing healthcare structure.
The United States Healthcare
The U.S healthcare system comprises several hospitals, nursing homes, and exceptional healthcare facilities. It is considered a million-dollar industry as it accounts for over 18% of the gross domestic product. The sector grows years to deal with the ever-existing health problems. The U.S government has two major healthcare providers. First are the primary providers of organizations that offer health services while the second is secondary providers that provide the financial, technological, and financial resources. Two providers work together to provide quality healthcare services to citizens. The United States lacks recognized nationwide health insurance. The majority of the countries health insurance is acquired from the private sector. It can either be from profit-oriented commercial insurance. The majority of healthcare insurance targets the employment community due to getting the money from the employer directly. Some employers in the U.S voluntarily offer to provide health insurance to their employees. The insurance can be purchased from an external provider or organized internally through a mutual agreement between the employee and the employer. Some employers provide full insurance to their employees, while others agree on partial insurance. In the complete self-insured agreement, the employer caters to the employee’s health cost irrespective of the amount incurred. Partial self-insured has a stop loss where the firm can only cater to a certain amount of medical bills. Anything above the agreed-upon amount will have to be paid privately by the employee (Bichay,2020). Partial self-insurance aims to prevent firms from making losses.
The Private insurance system has been shifting, with people focusing on managed care. The country has a Health Managed Organization Act enacted into law in 1973. The act came into law due to the “Managed Care Movement” that championed managing the quality of healthcare and increased access to health services. Health Maintenance Organization (HMOs) and Preferred Provider Organizations (PPOs) are the two major types of managed care organizations. HMO can be prepaid and offers several services to its members. PPOs are third-party players in the field offering friendly and affordable incentives to people (Health Coverage Guide, 2016).
Besides private health insurance, the U.S government has a Medicare national insurance program. Medicare offers insurance for people living with disabilities and older people above 65 years (Department for Professional Employees, 2016). The insurance program consists of Hospital Insurance that offers inpatient hospital care and supplementary medical insurance that includes outpatient services and physician services. Medicare has covered over 52 million U.S citizens since signed into law in 2015. Also, the country has a welfare-based insurance program called Medicaid. Medicaid focuses on low-income people and those living with disabilities (Cohen et al., 2015). This program covers broader services that are not covered by other government programs as it operates as both federal and state-organized initiatives. The function of the federal government in the industry is to offer general guidelines. In contrast, the state government develops its policy on providing insurance cover to its citizens. The federal government provides a more significant percentage of funding the initiative, with the remaining amount financed through municipal taxes and state government.
Canada Healthcare System
The Canadian government has a well-structured national health insurance program that covers the entire population with several benefits. National health insurance is a general tax-oriented system with a single-player responsible for providing medical services. Health providers such as physicians receive payments after negotiations by the government, while hospitals are allocated funds annually. The Canadian healthcare system is called Medicare. Although the name is similar to that of the U.S, the Canadian system covers the entire population, unlike the one in the United States that only covers the elderly. The Canadian national health insurance system started in the 1940s when some provinces initiated compulsory health insurance programs.
The Canadian healthcare system consists of structured regional systems of health provision. The structure begins at the local stage, where they have the local hospitals that provide primary care to people and handle standard health-related cases. Above the local hospitals are the district hospitals that deal with more complex issues that could not be held in the local hospitals. The doctors in the district hospitals are more experienced than those at the local hospitals because of the nature of the health cases they need to handle. At the peak is the base hospitals. The base hospitals deal with more complex issues that require experts (Allin & Rudoler, 2015). The medical personnel at base hospitals specialize in specific fields that help come up with policies to make the healthcare system in Canada better.
Canada Health Act of 1984 outlies the health delivery services in the country. According to the act, each provincial health program is provided at the regional level and offers all necessary medical services. The health coverage is available to all people with nobody expected to pay directly for their pocket. Physicians in Canada are paid services with various benefits of practicing autonomy. Although private insurance is offered to people to supplement the national insurance program, the government has continuously limited direct monetary exchange between the patient and health care provider in the country. As a result, all medical costs are controlled by the ministry of health. After an extensive negotiation between the ministry and hospitals, annual hospitals receive annual budgets for planning and implementation. Since physician’s fee is controlled by the ministry of health in the country, it is easy to track yearly financial expenses.
Physicians’ prices are negotiated periodically between the provincial medical association of Canada and the ministry of health. No patient is expected to pay extra money from the agreed amount as extra billing was removed when the government of Canada passed the Health Act bill of 1984. Although many people argue that the Canadian health system is “single-payer” because of the variation in the provincial plans, each plan aims at serving a single buyer. The national health insurance program makes it easy to control spending in the health sector, which enhances decision-making, including capital investment.
Comparison between the U.S and Canadian Healthcare System
There exist several differences between the United States healthcare system and the Canadian healthcare system. First, the Canadian health care system is entirely run and organized by the government through the ministry of health (Pichler et at., 2019). Unlike the U.S, where the health care system is run by a multi-payer system and heavily privatized. The government of Canada controls everything in the health sector, including the amount of money paid to physicians. There is zero monetary transaction between the patient and the health service provider. Secondly, healthcare in the United States is more expensive compared to Canada. In Canada, all citizens have a right to good health care services irrespective of their income level (Smith et al., 2019). However, the country does not recognize and appreciate the importance of universal healthcare; private corporations have taken the provision of insurance to citizens at a very high cost making some people unable to afford good healthcare services. Also, the government of Canada spends much money on healthcare compared to the United States. Complete control of the healthcare sector makes it easier for the Canadian government to monitor how much money is being used and to what capacity. This prevents the loss of capital through corruption and bribery.
Challenges and Strategies
Healthcare is a complex sector that can not lack challenges. Both the U.S and Canada experience various challenges toward providing healthcare to their citizens. The lack of universal healthcare in the United States has led to an increased number of uninsured people, making it difficult to access health services. The problem of insurance in the U.S is associated with several issues. The primary element is the high cost of insurance. People prefer paying directly from their pockets to receive medical services instead of monthly subscriptions that are more expensive and difficult to cope with. Also, high administrative costs are another challenge facing healthcare in the United States. The U.S uses modern technology, including modern machines that are very expensive to purchase. To cater to the high cost of machines and administration, healthcare prices rise, making it difficult for low-income families to afford good healthcare services. The healthcare system in the United States is fragmented and unclear. The introduction of an affordable healthcare system failed as it did not clearly show any signs of reducing medical costs. The government should develop a universal healthcare system that appeals to all people irrespective of their financial status, age, color, and race.
One of the most significant challenges facing the Canadian healthcare system is the long waiting to see a health specialist. However, Canadian citizens enjoy universal healthcare with every right to healthcare services. It takes a lot of time for someone to see a specialist. Only patients under life-threatening conditions have priority when seeking medication. The long waiting time has resulted in many people dying without receiving treatment. Some people travel to the United States to seek medical attention quicker to save their lives (Sezer & Bauer, 2017). Lack of investment and research is another challenge facing the healthcare sector in Canada. Unlike the United States, recognized for its investment in research and technological change, Canada does not allocate enough funds for research and innovation to curb the rising challenges in the health sector. Increasing funding of the health sector help introduce new and better technology that can go a long way in reducing waiting time and delays when seeking medication. The government of Canada is increasing funding of the healthcare sector to develop mechanisms to reduce the waiting time and better the health services in the country.
In conclusion, the United States should model its healthcare system after Canada’s healthcare system. Healthcare is a fundamental need for citizens irrespective of how much money they have or their social status. Having a national health service delivered by the government creates equitable healthcare that can control the cost of receiving health services and protect the vulnerable population. Also, the system allows for price negotiation between the government and medical practitioners, which reduces the amount of spending toward healthcare. Compared to the United States, the Canadian system is more affordable with minimal financial barriers, which may be why Canada has a high life expectancy compared to the United States.
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