A THIRD OPINION: A Comparative Analysis of World Health Care Systems with a Focus on Reform in Canada and the United States

Abstract

Different health care systems exist due to the failures of the free market in the field of health care provision and delivery. Countries have therefore been forced to create better solutions for their citizens. Although faced with a common goal, many countries have different methods of supplying health care and coverage to their populations. Some, such as Canada, provide care on a near single-payer basis, and restrict private care on the basis that “equality” must be maintained. Others, such as the United States, rely predominantly on private insurance with some state subsidization and support (Medicaid, Medicare, etc.). These two countries are examples of health systems that have evolved to different extremes of health care provision. However, most other developed countries, such as England and Germany, have hybrid models, where public universal care is supplemented by options for private coverage. Studies have shown that these models perform better in terms of costs and quality of care. What features of hybrid systems allow them to perform better? To answer this question, we must look at the problems with the Canadian and US health care systems. In Canada, hospital and physician services are government funded, without any co-payments, but there are extremely long waits for treatment. In the US, the insured population is largely covered by private health insurance, but care is usually relatively timely. However, there is an uninsured population in the US that does not have coverage. The US also spends an exorbitant amount on health care compared to any other country. Universal hybrid models do not have long wait lists as the private sector relieves the public system of heavy demand. They also insure all citizens at a fraction of US health costs. Clearly, there are lessons to be learned from these universal hybrid systems. Methods of funding different aspects of the health care system can create different incentives. For example, paying doctors on a fee-for-service basis and on a salary basis may leave them with different attitudes toward their provision of care, sometimes to the detriment of the patient. Health care systems need to balance opposing incentives in order to maintain fair and efficient health care. Governments have a duty to care for the underprivileged in society. Health care systems should include programs of social welfare. Even in countries that have universal care, the poor still tend to suffer the worst access and outcomes. Both the US and Canada are underperforming by the standards of their peer countries, and restructuring must be a priority for both. Although the different cultures of countries may have affected the evolution of their health care systems, and much of the debate is still open on some issues, it is clear that, in some systems, there are areas where necessary change is indisputable.