Canada and the United States are some of the countries, which have had superior health systems. In discussions of various health-care reforms, many authors have portrayed Canadian system as a valuable model for the United States. The health care systems in the two countries are very different, i.e. the United States has a multi-payer contrary to single-payer approach in the Canadian health system. Profoundly, Canadian health system is publicly-funded whereas the US health system is mostly funded by individuals, private entities and corporations.  In addition, Canada provides universal access to health services to citizens. Unlike Canada, US health system seems to do less for more. The United States spends far more of its Gross Domestic Product (GDP) on health care yet it does not perform better than Canada as indicated by common health outcome measures, i.e. life expectancy and infant mortality rate. Despite these disparities, United States and Canada are culturally similar and this suggests that the health care systems in both countries resemble each other in various ways. Prior Canadian’s health reforms in 1960s, the two countries had similar health care systems (Mackillop et al. 1999, p. 2246).

Users’ issues

Over the past decades, the United States government has received numerous complaints from its citizens concerning the nation’s health care system. It is the duty of the national government to provide adequate health services to its citizens. Most US citizens have complained that the health care system is far more costly and has failed to produce demonstrably better health outcomes as compared to other systems of the developed countries of the world, particularly Canada. Many American residents have argued that the U.S. government is nowhere near “the quality health care system” owing to the fact that the system’s performance has fall markedly below of most developed and developing countries.  In the World Health Organization Report of 2000, the United States health care system placed 37th whereas Canada’s health care system was placed 35th in the world. US residents have complained of poor communication in various health institutions within the country. Notably, patients have encountered numerous problems in contacting doctors or other health practitioners, especially in the public health institutions. Citizens have also raised concern on the form of treatment given by some doctors in the public health institutions. Most blacks have cited discrimination to be common in most health institutions in the United States (World Health Organization, 2000).

Funding of the health services in the United States and Canada

In both countries, national government plays a vital role in the provision of health care services to its citizens. According toMackillop et al. (1999), Canada’s government funding amounted to $1,890 per person in 2004. In the United States, government funding amounted to $ 2,700 per person. The difference in funding in the two countries is since the Canadian healthcare systems are composed of various autonomous provincial healthcare systems. In addition, it has a federal system which covers the health needs of the veterans in Canadian societies.  Following 1960s and 1970s health reforms, the two countries have adopted a different mix of funding system. As stated earlier, Canada has embraced a universal single-payer system which covers more than 65% of total health expenditures. The country has established Canada Health Act, which requires that all insured citizens should be fully insured. The act also mandates all the hospitals and health care centers to provide various health care services without user-fees. Notably, more than 90% of the hospital expenditures are financed by the public sector. Almost all the expenses on physician services are also financed by the public sector. However, the dental and ophthalmology services are privately funded in Canada. The United States has adopted mixed public-private system in an attempt to provide health care services adequately and equitably. Docteur and Berenson (2009) confirm that approximately 45 million of Americans are uninsured at any time. The United States is among the countries of the world which have not adopted universal health coverage. The U.S. and the Canadian governments are involved either directly or indirectly in the provision of health services to its citizens. The central point of disparity in the government involvement in the health care systems between the two is in health insurance. The Canadian federal government is dedicated and committed to providing adequate financial support to its provincial governments for the entire health care expenses on condition that the province in question abides by the government’s accessibility guarantees as postulated in the country’s health act. The Canada Health Act prohibits charging of end users for medical procedures that are fully covered by the Medicare. Unlike US systems with public delivery, Canadian health system provides public coverage for private delivery. In most cases, Canadian hospital and other health service providing entities are controlled by private boards contrary to being part of the government as the case for the United States. The direct government funding of the health care system in the United States is limited to Medicaid, Medicare and the State Children’s Health Insurance Program. The U.S. federal government funds and controls the Veterans Administrations, a body which provides medical care and needs to the veterans and their families (Docteur and Berenson, 2009).

In order to make an informed assessment concerning quality of a health care system of one country versus that of another country, it is paramount to consider a vast range of indicators. Basically, health care entails sophisticated array of activities, and this necessitates the adoption of a single measure that can provide a meaningful proxy. Cross-country comparisons of quality of the health care system in Canada and the United States have been strengthened by various studies conducted in the recent times. Modest research literature focused on making explicit comparison of quality of the health care systems of Canada, and the United States has shown that United States superior health care system has not been effective and has failed to provide quality health services to its citizens. In most cases, the quality of the health care system of a country is determined by considering mortality and life expectancy. These factors reflect overall effectiveness and quality of the country’s health care system. According to Davis et al (2006), cross-country comparisons of quality of health care systems consider crude mortality rates for specific populations, health-adjusted life expectancy, potential year of life lost and disability-adjusted life expectancy.  Docteur and Berenson (2009) suggested that the quality of the health care system in Canada, and the United States is quite mixed. In their summary report, Davis et al. (2006) indicated that the United States has a relatively high-quality preventive health care than other developed countries such as Mexico and Canada. In their studies, Davis et al (2006) showed that more than 85% of American women receive a mammogram within the last two years between ages 50 to 64, something that does not happen in Canada and other developed countries of the world. Surveys conducted by Docteur and Berenson (2009), reflected that the United States has a Mammography rate of 61 percent, which is higher than the rates in Canada (55%). The cervical cancer screening rate is high in the United States than in Canada and other developed countries of the world. The United States has established numerous preventive care initiatives. For example, it has above-average rates of flu vaccination for American adults. More specifically, the country has 65 percent rates of flu vaccination for adults whereas Canada has 55 percent of flu vaccination rate. However, the childhood vaccination is higher in Canada than in the United States (Davis et al., 2006).

Quality of care for chronic conditions in both countries

The findings by Carey et al. (2009) portrayed a mixed picture in regard to quality of care for chronic conditions in the United States. In comparison to Canada and other developed countries, the United States is ranked lower in adult asthma care. In the United States, the number of adults admitted in hospitals due to asthma is very high, an indicator that the country’s healthcare system provides inadequate care for the condition. In the recent statistics by U.S. government, 12 per 10,000 American residents are admitted to adult hospitals for asthma. Furthermore, the U.S. asthma mortality is high compared to those of Canada. A handful of studies undertaken in 2008 have compared the health outcomes for Canada and the United States patients suffering from end-stage renal disease and indicated that American patients experience shorter survival times while in hemodialysis programs, after going through a kidney transplant and even when extensive adjustment for comorbidity is done. According to survey by Davis et al. (2006), most of the U.S. diabetic’s victims have to be recommended for various advanced medical services due to the chronic situations which could have been averted if quality care had been provided (The Commonwealth Fund Commission on a High Performance Health System, 2008).

Quality of cancer care

Several researchers have conducted studies in an attempt to compare the rates and the numbers of cancer victims and mortality in the United States and Canada, and this has resulted in varying outcomes. According toCarey et al. (2009), the study of cancer epidemiology calls for subjectivity.  An in-depth assessment by Carey et al. (2009)found that deaths due to cancer are almost similar in Canada and the United States, and this has been supported by the Health Canada. The National Cancer Institute of Canada showed that cancer mortality rates are higher in the United States than in Canada in 1998. However, incidence rates for specific types of cancer such as stomach cancer and colorectal are actually higher in the United States than in Canada. In 2005, researchers conducted a study comparing health outcomes in the United States and Canada. Their findings indicated that the survival rates for childhood leukemia and colorectal cancer is high Canada than in the United States. Nevertheless, the survival rates for breast and cervical cancer was higher in the United States. The findings of the researchers have supported the study based on data collected from 1970s through 1980s, which revealed the similar survival rates in both countries (Hadley, 2003).

Various comparative studies have revealed that cancer survival rates differ with a population in the United States, a situation which has rarely been found in Canada. According to Mackillop et al. (2001), cancer survival rates are directly correlated with the socio-economic factors in the country.  They also indicated that those people with low income are likely to die to cancer due to inadequate detection of asymptomatic cases among them. In most of the poor communities in the United States, the prostrate cancer conditions are often neglected thus resulting to significant deaths among them. According to Hadley (2003), low-income Americans whose median income is below $17,000 experienced significantly lower survival rates than those high-income Americans. In Canada, individuals do not suffer from any form of cancer because of their low income. In comparison with the low-income Americans, the Canadian counterparts have been found to experience significant survival advantage. This suggests that low-income Canadians enjoy advantages of equitable health systems. Canadian government has strived to provide the value of care for all the citizens. In many nations’ histories, the aspect of unequal income distribution has been very cruel among the poor people. Historically, low-income earners not only experience difficulties in meeting the material wants of their lives but also suffer illness and die at younger age (Hadley, 2003).

 In the massive study conducted by Hadley, J. (2003), income and mortality data were critically analyzed from major Canadian provinces and all the U.S. states. In 1990s, Statistics Canada also undertook a massive study of 280 American and 50 Canadian metropolitan areas with the aim of ascertaining the relationship between income and mortality rate. In both studies, it was concluded that the connotation between income inequality and mortality differs from one country to another depending on social and political systems and structures. In other words, country’s political aspects have far-reaching effect on the relationship between mortality and the income inequality. The studies showed that high number of deaths in the United States is closely associated with income inequality. However, this relationship does not exist in Canada both at the province or metropolitan areas (Hadley, 2003).

According to World Health Organization (2000), Canadian’s health care system performs better than that of the United States. WHO ranked Canada health care system 30th while the United States system was placed position 37 out of 191 countries.  This ranking was based on life expectancy and infant mortality. Basing on the results of meta-analysis conducted by Docteur and Berenson (2009), it is clear that health care provision is superior in Canada than in the United States. However, the differences are not consistent. Docteur and Berenson further identified 38 studies, which addressed different conditions, which included coronary artery disease, surgical procedures and chronic medical illness. From the 10 selected studies with the strongest statistical validity 8 of them favored Canada. The results portray that Canadians are healthier than the Americans.  In reference to general population, life expectancy was found to be high in Canada in 2006. Canadians were found to live three years longer than the Americans.  Infant mortality rate, which is commonly used to reflect the health of the mothers and their ability to access a vast range of prenatal and postnatal care, have been used by health researchers as a tool for measuring the health of the general population. The 2010 U.S. government statistics indicate that Canada’s infant mortality rate is lower than its own. Out of 220 countries, Canada’s infant mortality rate was ranked 23rd following U.S. government statistics. U.S. A. was ranked 43rd i.e. almost in the same level as Croatia and Lithuania. The U.S. infant mortality rate has been ascertained to be about 7 per 1,000. This has been argued to be the highest among the industrialized countries and much higher than some of the developing countries such as India, which have well established health systems for mothers and infants. According toCarey et al. (2009), more than 8% of mothers in some inner cities of the United States do not access appropriate prenatal care prior giving birth.

In mid-twentieth century, new drugs and procedures have become available in developed countries. Therefore, a steady decline in mortality rates in these countries was expected. However, neither Canada nor the United States has experienced a decrease in a mortality rate. In the 20th century, the United States Medicare was fully equipped and applied; however, official statistics indicate that death rates have not plummeted. In the 1970s, overall mortality rates in the United States dropped but not so precipitously as those in Canada. Despite being the richest country in the world, today’s overall mortality rates in the United States are shocking (Carey et al., 2009).


The U.S. health system has been considered the most expensive and superior in the world, but comparative studies consistently indicate that the system has been under performing relative to other developed and developing countries, particularly Canada. Taken collectively, the analysis and findings of international researchers of health care quality provide a definitive answer that the United States health care system falls markedly below the expectations of its citizens. Cross-examination of these findings reveals that the U.S. health care system has a great deal of quality deficiencies as compared to that of Canada as reflected by patients’ experiences. Even though the United States dedicates great deal of resources on improving health care system, quality is severely lacking. The country’s substantial investment in health care has not yielded anticipated returns in relation to citizens’ satisfactions. Arguably, U.S.-Canada comparison shows that Canadian health care system is better. As result, most users have disliked the system (Davis et al., 2006).

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