United States and Canadian Healthcare Systems

Given the means wherein the healthcare nationalized model in the United Sates resembles that of Canada and the ways in which it is exceptional, can cross-national comparative analysis actually provide with useful lessons? If the United States is truly excellent in the nationalized healthcare model, that it can be argued that there is little to learn. To the extent that the United States is like other nations, however, a case can made of drawing lessons from their experience.

There are widely shared beliefs among American policymakers that a nationalized healthcare model providing for universal entitlement to healthcare would result in runaway costs. To counter this argument, Shi and Singh (2008) point to Canada that entitle all of their residents to a higher level of healthcare services while spending less than the United States on administration and on care.

Canada has produced some of the leading physicians and hospitals in the world. Judging by various measures of health outcome, Canada is in the same league as, or better than, the United States. Meanwhile, the United States has high non-insurance rates and spends more for healthcare than Canada.

Should Americans therefore implement a Canadian model of healthcare financing and organization? Or should they maintain their current system and recognize that it is a manifestation of American exceptionalism (Gusmano et al, 2006, p. 510) - that is, of the ways in which the United States is fundamentally different from most OECD countries? Both of these responses are probably inadequate. The second 'they're different' response insulates from U.S. from the experience of other nations. It smacks of ethnocentrism, makes U.S. conservative, and thereby supports the status quo (p. 511). The first response - that U.S. should adopt a Canadian model - errs in the other direction, by relying too heavily on the experience of Canada, whose system has flaws too. Moreover, it disregards some healthcare delivery models in the United States - for example, innovations that promote healthcare services integration in the Veterans Health Administration (Oliver, 2007) and those of prepaid multi-specialty health maintenance organizations, such as Kaiser Permanente (Kaiser Family Foundation, 2007).

Virtually no one in Canada views the U.S. healthcare system as a model to follow. There is no question about eliminating national health insurance in Canada. Nevertheless, a number of fashionable American themes have drifted north to Canada (Hussey, et al., 2004, 89). In the context of the problems - inefficiency in the allocation of health care resources, lack of continuity between levels of care, and the absence of consumer voice in most healthcare organizations (Hussey, et al., 2004, 89) - the concept of a managed care organization, in combination with elements of market competition, has a certain appeal to policymakers in Canada.

The U.S. healthcare system stands in conspicuous contrast to the healthcare systems of other developed countries. The centrally controlled universal healthcare system that most developed countries have authorize the financing, payment, and delivery of healthcare to all residents (Marmor, et al., 2005, 331). The U.S. system, however, is not centrally controlled and therefore has a variety of payment, insurance, and delivery mechanisms, and healthcare is financed through employers, accounts for approximately 55% of total healthcare expenditures (p. 331). In a system under National Health Insurance, such as Canada, the government finances healthcare through general taxes, but the actual care is delivered by private providers. In the context of the quad-function model, NHI requires a tighter consolidation of the financing, insurance, and payment functions which are coordinated by the government. Delivery is characterized by detached private arrangements.

Undoubtedly, the healthcare system of the United States is one of the most expensive systems in the world. In 2007, there were over 47 million uninsured U.S. citizens (Centers for Disease Control and Prevention [CDC], 2008). The Institute of Medicine's (IOM) 1999 report indicated that nearly 100,000 citizens die each year as a result of medical errors (Kohn et al, 1999). Department of Labour (DOL) statistics reported in 2009 indicated that a number of unemployed persons increased to 14.5 million. Estimates indicate that more than 50% have lost their health insurance because the unemployed could not pay the premiums without employer contributions to their healthcare (DOL, 2009).

These rates are some of the highest in the world but, unlike Canada, the U.S. does not offer healthcare coverage as a right of citizenship. Canada had a universal healthcare program, which means access to all citizens. Many of these systems are typically run by the federal government, have centralized health policy agencies, are financed through different forms of taxation, and payment of healthcare services are by a single player - the government (Shi & Singh, 2008).

The U.S. has a unique system of healthcare delivery, but the system lacks worldwide access; therefore, incessant and all-inclusive healthcare is not enjoyed by all Americans. Healthcare delivery within the United States is characterized by a hodgepodge of subsystems developed either through promotion forces or the need to take care of certain population segments. Canada and other European nations, however, with a nationwide healthcare program have a private sector that varies in size. The system framework provides an organized approach to an understanding of the various components of the United States' healthcare delivery system.