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August 05, 2009

Comparing Healthcare in Canada and the United States and the World

Wikipedia has a lengthy comparison of the healthcare systems in Canada and the United States.

UPDATE: Comparison study of many national healthcare programs around the world by the CATO institute H/T reader Mercy Vetsel for the link



The WHO (World Health Organization) is study bases its conclusions on such highly subjective measures as “fairness” and criteria that are not strictly related to a country’s health care system, such as “tobacco control.” For example, the WHO report penalizes the United States for not having a sufficiently progressive tax system, not providing all citizens with health insurance, and having a general paucity of social welfare programs. Indeed, much of the poor performance of the United States is due to its ranking of 54th in the category of fairness. The United States is actually penalized for adopting Health Savings Accounts and because, according to the WHO, patients pay too much out of pocket. Such judgments clearly reflect a particular political point of view, rather than a neutral measure of health care quality


Of course, there is no single model for national health care systems in other countries. Indeed, the differences from country to country are so great that the terms “national health care” or “universal coverage” can be misleading—as if one collective model shows how other countries deal with health care and health insurance. Each country’s system is the product of its unique conditions, history,
politics, and national character. Those systems range from the managed competition
approach of the Netherlands and Switzerland to the more rigid single-payer
systems of Great Britain, Canada and Norway, with many variations in between.

Ezra Klein of the American Prospect calls France “the closest thing to a model structure out there.”

Some countries, such as France and Japan, impose significant cost sharing on consumers in an effort to discourage overutilization and to control costs. The French system ranks at or near the top of most cross-country comparisons and is ranked number one by the WHO.

Although the French system is facing looming budgetary pressures, it does provide at least some level of universal coverage and manages to avoid many of the problems that afflict other national health care systems. However, it does so in large part by adopting market-oriented approaches, including consumer cost sharing. Other aspects of the system appear to reflect French customs and political attitudes in such a way that would make it difficult to import the system to the United States. France provides a basic level of universal health insurance through a series of mandatory, largely occupation-based, health insurance funds. These funds are ostensibly private entities but are heavily regulated and supervised by the French government. Premiums (funded primarily through payroll taxes), benefits, and provider reimbursement rates are all set by the government. In these ways the funds are similar to public utilities in the United States.


END UPDATE

Canadians spend about 55% of what Americans spend on health care and have longer life expectancy, and lower infant mortality rates. Many Americans have access to quality health care. All Canadians have access to similar care at a considerably lower cost.

In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada's national health insurance program had overhead of 1.3 percent; the overhead among Canada's private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers' administrative costs were far lower in Canada.


The gap between U.S. and Canadian spending on health care administration has grown to $752 per capita. The administrative cost difference is a substantial part of the price difference.

Health care is one of the most expensive items of both nations’ budgets. In the United States, the various levels of government spend more per capita on health care than levels of government do in Canada. In 2004, Canada government-spending was $2,120 (in US dollars) per person on health care, while the United States government-spending $2,724.

However, U.S. government-spending covers less than half of all health care costs. Private spending for health care is also far greater in the U.S. than in Canada. In Canada, an average of $917 was spent annually by individuals or private insurance companies for health care, including dental, eye care, and drugs. In the U.S., this sum is $3,372. In 2006, health care consumed 15.3% of U.S. annual GDP. In Canada, only 10% of GDP was spent on health care. This difference is a relatively recent development. In 1971 the nations were much closer, with Canada spending 7.1% of GDP on health while the U.S. spent 7.6%.


In Canada, waiting is prioritized by patient according to relative urgency, with urgent patients receiving immediate access and the least urgent waiting longer. Studies by the Commonwealth Fund found that 42% of Canadians waited 2 hours or more in the emergency room, vs. 29% in the U.S.; 57% waited 4 weeks or more to see a specialist, vs. 23% in the U.S., but Canadians had more chances of getting medical attention at nights, or on weekends and holidays than their American neighbors without the need to visit an ER (54% compared to 61%). However, statistics from the free market think tank Fraser Institute in 2008 indicate that the average wait time between the time when a general practitioner refers a patient for care and the receipt of treatment was almost four and a half months in 2008, roughly double what it had been 15 years before.

There is online sources for tracking wait times at hospitals near your location in Canada (and similar sites in the US)



A Canadian systematic review concluded that differences in the health care systems of Canada and the United States could not alone explain differences in health care outcomes.

Canadians are, overall, statistically healthier than Americans and show lower rates of many diseases such as various forms of cancer. On the other hand, evidence suggests that with respect to some illnesses (such as breast cancer), those who do get sick have a higher rate of cure in the U.S. than in Canada

FURTHER READING
World Health Organization - World Healthcare Reports

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