Question

Assignment Purpose:

Understanding how the U.S. healthcare system relates to systems in other economically developed countries can help during reform efforts. In this assignment you will compare and contrast the U.S. system with another country’s system.

Assignment Details:

Create a visual aid, such as a map, of the U.S. and another economically advanced country such as Canada, UK, or Germany. This map will serve as a visual reference identifying how the country provides healthcare (governmental coverage, private third-party, etc.) and five specific areas of strength or weakness within that countries healthcare system, such a mortality rates, who provides insurance, access to care, etc. Then choose one strength and one weakness for each country that you feel is the most important and summarize why.

Answer 1

In the US, healthcare plans are usually provided through private companies. There are some instances where the government steps in with some safety nets for those who have disabilities, are unemployed, or live at or close to the poverty level. Otherwise, Americans take care of their own healthcare without assistance from the government.

Canada’s healthcare is funded by a “single-payer” system, but it doesn’t function as one single, unified system. Coverage is publicly-funded, meaning that the funds come from federal and provincial taxes.

Additionally, care is provided by plans created in each province or territory, rather than a single, unified federal health plan. The Canadian government pays into these plans, but each territory and province is responsible for taking this money to create their own system under the guidelines set forth by the Canadian Health Act (CHA).

In the US, we have a private healthcare system. This differs from the single-payer, government-funded system used in the UK, known as British National Health Service (NHS). NHS employees (including care providers) are all employees of the UK government. The UK’s system is just one of many examples of the different ways single-payer, government systems can work.

In Canada, however, physicians are private providers rather than government employees. These providers see patients and charge insurance plans, just as they do in the US. In this instance, “Obamacare” vs. Canada Health Act has more similarities than differences.

In the US, we wrestle with the question of who should be covered by healthcare. Some citizens are concerned about paying for care for individuals who have overstayed their visa, entered the country illegally, or done something fraudulent to appear eligible for benefits.

Residents of Canadian provinces and territories are covered by public insurance. Territories and provinces are allowed to make their own requirements for their insurance (and what it covers), so long as it’s in compliance with CHA.

Individuals who are not Canadian residents are not covered by the universal healthcare system, though they are eligible for limited benefits. People who fall under this umbrella are undocumented immigrants, temporary visitors, illegal immigrants, and individuals who stay past their permit dates.

Canadian

Canada

Canada also has a capitalist economy and its health care uses a fee-for-service system, but its plan is administered by government entities. In this system, there is universal coverage for health care services; moreover, all Canadian citizens are covered! Each of Canada's 10 provinces manages itself, but there are very few differences. Furthermore, most of the cost of the plans are paid by the provincial governments through subscriber premiums and through taxes. The Canadian government provides additional funds to the provinces through a system of grants and the transfer of funds generated from personal and corporate income tax revenues [Iglehart, 1986aJ. For example, all residents of Ontario are entitled to participate in the health plan regardless of age, health status, or financial means. A payroll tax on employers pays 13 per cent of the provincial expenditures, and general taxation provides the rest of the province's contribution. The benefits covered in the plan include doctors' services in the office and in the patients' home, hospital care in a ward of four or more patients, prescription drugs in the hospital, and care in long-term facilities such as nursing homes. However, the plan does not cover drugs are taken at home, dental care, or cosmetic surgery.

Doctors are paid according to fees which are determined by negotiations between the provincial government and an association of doctors. Hospital expenditures are also regulated by the government. In other words, all expenses regarding expenditures are monitored and approved by the government.

Canada also has its advantages and disadvantages. The main advantage is that there is universal health care coverage. Health care costs are also rising Canada, but because each province has only one payment source, the administrative costs are appreciably lower. As for disadvantages, the control of hospital expenditures has created a situation where some forms of technology such as cardiac surgery have led to increasing waiting lists and delays faced by patients. The physical condition of some hospital facilities has also deteriorated because they lack sufficient funding for maintenance[Iglehart, 1990; Orford, 1991].

The Netherlands

The Netherlands has adopted a third system which is socially administered. Three sources of health-care funding exist in the Netherlands: the sickness funds, private health insurance, and the Exceptional Medical Expenses Act [Kirkinan-Liff, 1991]. Approximately 62 per cent of the public receives health services from the sickness funds. There are about 35 regional funds, and they serve all individuals and their families whose income is below a specified level. A national "general fund" supports the sickness funds which is itself supported by contributions from employers, employees, retirement funds, and unemployment funds. The rest of the population (38 per cent) purchases private insurance. The cost of the insurance is based on the age and sex of the purchaser, and employees who purchase insurance receive a contribution from their employer. Finally, the Exceptional Medical Services Act covers the cost of long-term care and maternal and child health services. This fund is supported by government contributions and mandatory contributions by employers [Kirkman-Liff, 1991].

Doctors in the Netherlands are either family doctors or specialists who are paid on a fee-for-service basis. Family doctors are paid by private insurance or by the sickness funds, and family doctors are the ones who decide when a patient needs to see a specialist. Hospitals are all nonprofit, and they annually receive income from the sickness funds and the private insurers in their area. Similar to the U.S. and Canada, rising health care costs and administrative costs in the Dutch system are genuine concerns [Kirkirian-Liff, 1991].

universal care doesn’t cover everything, however. Though the CHA dictates that medically-necessary services are covered at no cost, there is no distinct definition as to what “medically necessary” means specifically, leaving each province and territory to decide.

In Canada, regular visits to primary care doctors, hospitals, and diagnostic services are covered by Provincial Health Insurance. However, there is some cost sharing when it comes to other services, like ambulances, prescription/over-the-counter medications, dental care, vision care, and long-term care facilities. This does pose a bit of an issue for people who have large out-of-pocket expenses, but the government does provide a tax credit to ease this burden.