Introduction
The provision of an efficient healthcare system is the responsibility of any progressive government. In order to achieve a functional and efficient healthcare system, the government must mobilise the financial and human resources in a strategic manner. An efficient healthcare system promotes equality, access and coverage of its population. The United States of America and Canada are two countries that are members of the Organisation for Economic Co-operation and Development (OECD) with two structurally different healthcare systems. There has been an ongoing debate on the suitability of the universal single-payer healthcare system used by most of the OECD members compared to the commercialised mixed healthcare system preferred by some countries. Questions have surfaced on the efficiency, accessibility and equitability of the two systems. This paper compares the structure of the healthcare systems of the two countries based on funding and accessibility among other factors.
Historical perspective; background, type of healthcare system and population
The current healthcare system in Canada has been in operation since the year 1960. The Canadian healthcare system is a universal coverage single-payer system that covers most of the medical care expenditure of 100% of the citizens. The medical expenditure includes the hospital costs and the physician costs. The coverage of this healthcare system also includes medical services in both government and private healthcare facilities. The provincial governments administer this healthcare system guided by the Canada Health Act of 1984. This act ensures that the provincial insurance systems are non-profit, all necessary health services are insured, all citizens have access to the provincial insurance and healthcare facilities and that each resident that moves out of their home province is covered for the waiting time provided. The national government checks on the quality of the services provided through the various federal healthcare standards instituted. This single-payer system of healthcare covers the entire population. According to Canada’s national statistics agency, the estimated population as at the beginning of July 2014 is 35,540,419.
On the other hand, the current healthcare system in the United States of America is a product of a long period of transition. Currently, United States of America has a mixed healthcare system. In this system, healthcare services are provided by both the government and the private entities that are sometimes independent of each other but collaborate for smooth flow of healthcare provision. In this context, the American healthcare system is not a single-payer healthcare system. The regulation of the healthcare system spreads between the state and the federal governments. The United States of America and Turkey are the only countries out of the 34 members of the Organisation for Economic Co-operation and Development (OECD) without a universal healthcare system. At any one time, the insurance coverage of the American population in the healthcare system is under 100%. According to the united states census bureau, the population of the united states of America at the beginning of the month of July 2014 is 319 million.
Major health problems
The Canadian population has the reputation of being one of the healthiest populations in the region. This is one of the driving forces of the success of the universal single-payer healthcare system. Compared to its neighbours, Canada has a higher life expectancy at 82.4 years for women and 77.4 years for men. In addition to this, the infant mortality rate in Canada is 5.3 deaths per 1000 live births. This is one of the lowest infant mortality rates in the region. The major health issue in Canada is obesity and related complications like the heart diseases and hypertension. According to the available statistics, 19% of the female population is obese. Regardless of the fact that this obesity level is one of the lowest in the region, it is a major problem. It accounts for more expenditure in the management of the complications arising from it.
The life expectancy rate of the United States of America population is lower than that of the Canadian population at 80.1 years for females and 74.8 years for males. In addition, the infant mortality rate is higher in the United States of America compared to Canada at 6.8 deaths per each 1000 live births. This is an indicator of poor and deficient healthcare system since life expectancy and infant mortality rates are some of the most favourable indicators of a healthy population. In addition to this, the major health issues in the United States of America are diabetes, heart diseases, obesity and related complication. A greater portion of the American female population (33.2%) is obese compared to Canada. This makes obesity a more grave issue in the United States of America. Most of the expenditure on the healthcare services in the management of these major health concerns and associated complications.
Access to healthcare
The universal healthcare system in Canada guarantees universal access to healthcare services to the 100% of the citizens. However, this is not the situation on the ground since a portion of the Canadian population lacks access to the basic healthcare services. According to data from the Canadian bureau of statistics in 2010, 15.2% of Canadians aged over 12 years reported that they did not have access to a regular doctor (Canada Statistics, 2010).This is an indicator of less than 100% coverage that mandated by the universal healthcare system. Another issue with the healthcare system is the wait times for different medical services. According to data published on the health council of Canada website of a survey conducted in 2010 by the commonwealth, there were long waiting times for the access to essential healthcare services. Among the respondents interviewed, at least 42% had waited for more than 2 hours to access emergency medical services. In addition to this, 43% of the respondents had waited for more than 4 weeks to get services of a medical specialist. The study established that 47% of the respondents had to visit the emergency room in order to get the services that they could have gotten from the regular specialists if they could have gotten a timely appointment.
On the other hand, the United States of America healthcare system is no stranger to accessibility challenges. While the statistics of accessibility of healthcare services vary from state to state, the overall picture is poor accessibility of the healthcare services. According to data from the United States census bureau, 16.3% of the American population did not have any form of health insurance (U.S Census Bureau, 2010). This exposes the major weakness of the non- universal healthcare system. Other countries with universal healthcare systems record lower proportions of the uninsured citizens. For instance, Canada which has a universal healthcare system has only 5% of the population being uninsured. In addition to this, the wait times for accessing the healthcare services are also long. According to data published on the health council of Canada website of a survey conducted in 2010 by the commonwealth, 29% of the American respondents interviewed waited for more than 2 hours to access emergency medical services. In addition to this, 10% of the American respondents had waited for more than 4 weeks to get services of a medical specialist. The study established that 50% of the respondents had to visit the emergency room in order to get the medical services that they could have otherwise received from the regular specialist if they had secured an appointment in time.
Funding of the healthcare system
In Canada, the universal healthcare system is universal. Therefore, a single payer, the government, funds the healthcare system. The government institutes its funding through both the federal and the provincial levels of government. The funds used to finance the universal single-payer healthcare system come from the public through personal income taxes and corporate income taxes at the national level. The funds also come from other diverse sources including the proceeds from the lottery and the domestic sales tax at the provincial level. Some provinces get supplementary sources of income from the health premiums imposed. These are Alberta, British Columbia, and Ontario. While these premiums are not in accordance to the Canada Health Act, they are legal after the 2005 landmark high court ruling that termed the Canada Health Act unconstitutional. According to the 2012 statistics from the World Bank, Canada spent 10.9% of its GDP on the universal coverage single-payer healthcare system (World Bank, 2012).
On the other hand, the United States of America spent 17.9% of its GDP in 2012 to fund its healthcare system (World Bank, 2012). In the current system, the funding of the healthcare system is by both the private sector and the public sector. Some of the funding is from the pockets of the citizens. The government funds approximately 48% of the healthcare system from the public funds and the private and third party entities account for 40% of the healthcare funding. The individual citizens pay the remaining 12% out of their pockets for the services offered. While there is apparent equality in the contribution of the public and the private sector, the equality is not translated proportion of the population that benefits from each. While public funding is almost half of the funding of the healthcare system, only 30% of the population of the United States of America benefits from the public funding through Medicare and Medicaid . A majority of the American population (54%) benefits from the private health insurance or through insurance plans funded by the employer.
The future issues with the continuation of the healthcare systems
The Canadian healthcare system faces the problem of accessibility and long waiting times. While it covers most of its population, the quality of its services needs to be improved. The funding of the healthcare system has taken a new trajectory with the declaration in 2005 that the Canada Health act is unconstitutional by the high court. This gave the provinces the ability to source more funding for the healthcare systems at their level. In the future, this will see the single-payer healthcare system undergoing transition to a dual payer healthcare system. With the advancement in information technology and medical technology, there are prospects that the quality of the medical services provided through this healthcare system will improve. However if the system does not take advantage of the new legal and technological environment, future challenges will lie in poor services.
On the other hand, the future of the American mixed healthcare system lies in the centralisation of the healthcare provision to a simple universal system. The American healthcare system faces inequality, inefficiency and inaccessibility. In addition to this, the American healthcare system is very expensive in its current form. It is the most expensive in terms of the per capita healthcare expenditure among the OECD member states. With the increasing population, future challenges will lie on the high number of the uncovered citizens
Conclusion
While the United States spends a greater proportion of its GDP compared to Canada, Canadians enjoy healthier lives than the Americans do. In addition to this, the Canadian healthcare system is able to achieve a greater coverage with more efficiency compared to the American health system. Therefore, the American system can borrow a leaf from the Canadian system. As opposed to the addition of more funds to the healthcare system, the provision of a universal coverage healthcare system is the most appropriate model. The strength of the universal healthcare system lies in its simplicity. Given the large size of the American population, a simple universal single-payer system is practical as opposed to the current mixed system. In conclusion, the American government can achieve more in the healthcare provision with fewer funds if it adopts the universal healthcare system.
References
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