Pros and Cons of Us Healthcare System free essay sample

Canada spends far less of its GDP on health care (10. 4 percent, versus 16 percent in the U. S. ) yet performs better than the U. S. on two commonly cited health outcome measures, the infant mortality rate and life expectancy. But what constitutes high quality health care? The U. S. Institute of Medicine’s definition, which has grounded expert work in the United States and elsewhere, describes quality as â€Å"the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. A healthcare system can be reviewed by many standards. It can be reviewed by its effectiveness and efficiency, its fairness and receptiveness to the expectations of its population. It can be reviewed through its non-discriminatory economic contributions and suitability and lastly, it can be reviewed through its population’s overall health. Both the Unites States and Canada have Medicare prog rams that are publicly funded. We will write a custom essay sample on Pros and Cons of Us Healthcare System or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page However, the United States unlike Canada has other types of programs that are publicly funded. These programs for example include the States Childs Health Insurance Program (SCHIP) for children of low income families and the Veterans Hospital Administration Program (VA) which supplies military veterans’ with health benefits via a network of government hospitals. Canada’s government in contrast to the U. S. offers a single payer system for health care to its citizens where fundamental services are supplied by private physicians (socialized medicine). Physician care in the U. S. is typically provided by a physician in private practice but can come from the government as well. A good number of U. S. and Canadian physicians also utilize a fee per visit rate. Roughly 2/3 of hospitals in the United States’ urban areas are non-profit hospitals unlike Canada. Numerous citizens in both countries encounter difficulties obtaining access to health care. Many U. S. citizens either have no health insurance because they are not able to afford it or it is inadequate, unlike Canada where all members of society are covered for health care. Both Canada and the U. S. have restricted programs that supply prescriptions to the underprivileged. A number of provinces in Canada still charge individuals and families premiums and in the U. S, states like Connecticut and Minnesota have moved toward Universal Health Care. For the most part both countries seem to hold equal acceptability and equal restrictions. Essentially, when comparing and contrasting the U. S. and Canada, the Canadian health care system has a smaller number of physicians as oppose to the United States but there is more government involvement in the Canadian health care system than in the United States We will explore the positives and negatives of the U. S. and Canadian healthcare system. Given the presence of social insurance programs in the United States, this paper will evaluate the role of managed care approaches in meeting the cost-containment, access, and quality objectives of the two Health Care Programs in the United States and Canada. We will attempt to compare and contrast the benefits and liabilities inherent in the two neighboring countries. We will also focus our study on problem analysis; try to offer solutions and recommendations; and justify why our recommended solution and implementation will solve the identified problems. We will also determine which country’s approach is the most effective. Comparative Study of United States and Canadas Health Care System I. Problem/Issue Statement Medicare is facing a fiscal crisis that threatens its sustainability. The need for significant Medicare reform is increasingly urgent as 76 million baby boomers are expected to retire over the next two decade. According to the 201 Medicare Trustees Report, the Hospital Insurance trust fund will be depleted in 2024. This translates to $27 trillion in unfunded liabilities over the next 75 years. Current projections indicate that health care costs will increase by more that 70 percent over the next ten years and will continue thereafter to consume an increasingly greater portion of personal income. For Americans, health care coverage depends primarily on whether health insurance is provided by their employer or through two major public programs, Medicaid for the poor and Medicare for the elderly. For both public and private employees, health care benefits and cost vary tremendously. By making workers dependent upon their employer for health care, there is an extra burden on workers who are forced to change or lose their jobs in the U. S. Also, a growing number of people with a history of health problems, or with what insurance companies deem to be preexisting conditions, find themselves uninsurable. With rising health care costs, many employers in the private sector do not provide any health care benefits at all. Most employers, whether private or public, are attempting to shift the cost of health care programs onto workers. Medicare, for example, now covers only about 40% of the health care costs of the aged. II. Literature Review In 2009, Americans spent $7,960 per person on health care, while our neighbors in Canada spent $4,808. There are many possible explanations for why Americans pay so much more. It could be that we’re sicker. Or that we go to the doctor more frequently. But on close inspection, found that Americans don’t see the doctor more often or stay longer in the hospital than residents of other countries. Quite the opposite, we spend less time in the hospital and see the doctor less often than the Canadians. The United States spends more on health care than Canada without providing more services than Canada. Canada’s Health Care prices are set by the government. The creation of Medicare in Canada in 1966 rapidly led to government funding of much of the health system. The American government has also has become deeply involved in the delivery of health care, but has not created a system of universal government coverage. Comparing and Contrasting the U. S. Health Care System A healthcare system can be reviewed by many standards. It can be reviewed by its effectiveness and efficiency, its fairness and receptiveness to the expectations of its population. It can be reviewed through its non-discriminatory economic contributions and suitability and lastly, it can be reviewed through its population’s overall health. Roughly two-thirds of hospitals in the United States’ urban areas are non-profit hospitals unlike Canada. Numerous citizens in both countries encounter difficulties obtaining access to health care. Many U. S. itizens either have no health insurance because they are not able to afford it or it is inadequate, unlike Canada where all members of society are covered for health care. Both Canada and the U. S. have restricted programs that supply prescriptions to the underprivileged. A number of provinces in Canada still charge individuals and families premiums and in the U. S, states like Connecticut and Minnesota have moved toward Universal Health Care. For the most part both countries seem to hold equal acceptability and equal restrictions. Essentially, when comparing and contrasting the U.S. and Canada, the Canadian health care system has a smaller number of physicians as oppose to the United States but there is more government involvement in the Canadian health care system than in the United States (Holt , 2007, Para 7,8, and 9). Pros and cons in the U. S and Canadian Health care Systems As usual there are pros and cons to the Canadian health care system. For example a small number of well-revealed and somewhat erroneous cases show that has a con, Canada’s health care system is in great need of improved urgent care for its citizens requiring immediate treatment. Another con is that Canadians also pay higher taxes to pay for health care. Further examination reveals that as a con, the Canadian health care system does a very meager job at handling and controlling chronic disease. Furthermore, as a major con, the health care system’s wait time for elective care is way beyond the required time a citizen should have to wait for treatment and this includes appointments with family physicians, specialists and elected surgical procedures (Suphan 2009, para. 6). On the other hand, when viewing the pros of the system, all Canadians have insurance coverage for hospital and physician services. The citizens do not have co-pays or deductibles on basic health care services. In addition, the majority of Canadian provinces supply coverage for programs such as home health care, long-term care, pharmaceuticals and durable health care equipment, though these services do have minimal co-pays. The main pro that Canada’s health care system has are its costs. Canada pays out roughly 10% of its economic value on healthcare plus Canadians essentially receive more of the majority of services. Just as Canada has pros and cons to its health care system, likewise the United States’ health care system has pros and cons. One of the pros of the U. S. health care system is that its medical research systems are some of the best in the world. Institutions such as the Mayo Clinic, Cleveland Clinic and the medical school at Harvard possess some of the most world-renowned researchers in the world because of the advances they are making in medicine and also because of the current free-market system. Another pro to the United States’ health care system is that Americans’ who have enough money for it or those who possess jobs with great benefits have some of the best health insurance plans in the world. One more advantage of the present U. S. health care system is that taxpayers do not sustain the cost coupled with supplying health care insurance to all single people. Furthermore, the U. S. health care system as a major pro pays health care for elderly and very poor. On the other side of United States health care system are its cons. For example one of the main cons of the present U. S. health care system is that Americans pay out a large amount extra for their health care, but the sad fact is, many American citizens are not any healthier than other citizens in other nations that pay out much less in funds for health care. The amount of money paid out on American health care is astounding to say the least. Another major drawback of the U. S. health care system is that a great majority of American citizens are in fact underinsured or worst case scenario, uninsured. Lastly, the United States’ health care system most major cons deal with the lack of health care access, high costs and comprehensive quality health care for everyone requiring health care. A 2007 review of all studies comparing health outcomes in Canada and the U. S. , in a Canadian peer-reviewed medical journal, found that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent. (Guyatt et. al. , 2007) Life expectancy is longer in Canada, and its infant mortality rate is lower than that of the U. S. but there is debate about the underlying causes of these differences. The World Health Organizations ratings of health care system performance among 191 member nations, published in 2000, ranked Canada 30th and the U. S. 37th, and the overall health of Canadians 35th to the American 72nd. (The World Health Report 2007) Compare and Contrast Government involvement Canadas single-payer health care system is universa l, while in the United States, with its mixed public-private system, 16% are uninsured at any one time. The governments of both nations are closely involved in the delivery of health care. The central structural difference between the two is in health insurance. In Canada, the federal government is committed to providing funding support to its provincial governments for health care expenditures as long as the province in question abides by accessibility guarantees as set out in the Canada Health Act, which explicitly prohibits billing end users for procedures that are covered by Medicare. While some label Canadas system as socialized medicine, the term is controversial. Princeton University health economist Uwe E. Reinhardt says that single-payer systems are not socialized medicine but social insurance systems, because doctors are in the private sector. In the U. S. , direct federal and state government funding of health care needs of its citizens is limited to Medicare, Medicaid, and the State Childrens Health Insurance Program (SCHIP) insurance programs for eligible senior citizens, very poor, disabled persons, and children. One study estimates that about 25 percent of the uninsured in the U. S. are eligible for these programs but unenrolled, but extending coverage to all who are eligible remains a fiscal and political challenge. The federal government also runs the Veterans Administration, which provides care to veterans, their families, and survivors through medical centers and clinics. For everyone else, health insurance must be paid for privately. Just fewer than 60% of U. S. residents have access to health care insurance through employers, although the workers expected contribution to such plans varies widely. Those whose employer does not offer health insurance, as well as those who are self-employed or unemployed, must purchase it on their own. Despite the greater role of private business in the U. S. , federal and state agencies are increasingly involved in U. S. health care spending, paying about 45% of the $2. 2 trillion the nation spent on medical care in 2004. Beyond its direct spending, the U. S. government is also highly involved in health care through regulation and legislation. For example, the Health Maintenance Organization Act of 1973 provided grants and loans to subsidize Health Maintenance Organizations and contained provisions to stimulate their popularity. HMOs had been declining before the law; by 2002 there were 500 such plans enrolling 76 million people. The Canadian system has been 69-75% publicly funded, though a substantial portion of services are provided by private corporations, namely the privately incorporated medical practices of most physicians (however, despite the fact that many doctors will refer to their private clinics, these are in fact merely private corporations that derive nearly all their revenue through government billings). Although some doctors work on a purely fee-for-service basis (usually family physicians), some family physicians and most specialists are paid through a combination of fee-for-service and fixed contracts with hospitals or health service management organizations. Canadas universal health plan does not cover certain services. Non-cosmetic dental care is covered for children up to age 14 in some provinces. Prescription drugs are not covered, but some provinces have drug cost programs that cover most drug costs over a certain portion of a familys income. Drug prices are also regulated, so brand-name prescription drugs are often significantly cheaper than in the U. S. Optometry is only covered in some provinces and is sometimes only covered for children under a certain age. Visits to many specialists may require an additional fee. Also, some procedures are only covered under certain circumstances. For example, circumcision is not covered, and a fee is usually charged when a parent requests the procedure; however, if an infection or medical necessity arises, the procedure would be covered. Coverage and access In Canada, every citizen has coverage, but access can still be a problem. Based on 2003 data from the Canadian Community Health Survey, an estimated 1. 2 million Canadians do not have a regular doctor because they cannot find one, and just over twice that number do not have one because they havent looked. Those without a regular doctor are 3. 5 times more likely to visit an emergency room for treatment. In the U. S. , the federal government does not guarantee universal health care to all its citizens, but publicly funded health care programs help to provide for the elderly, disabled, the poor, and children. The Emergency Medical Treatment and Active Labor Act also ensure public access to emergency services regardless of ability to pay. Wait times One of the major complaints about the Canadian health care system is waiting times, whether for a specialist, major elective surgery, such as hip replacement, or specialized treatments, such as radiation for breast cancer. Studies by the Commonwealth Fund found that 24% of Canadians waited 4 hours or more in the emergency room, vs. 12% in the U. S. ; 57% waited 4 weeks or more to see a specialist, vs. 23% in the U. S. In a 2003 survey of hospital administrators conducted in Canada, the U. S. , and three other countries, 21% of Canadian hospital administrators, but less than 1% of American administrators, said that it would take over three weeks to do a biopsy for possible breast cancer on a 50-year-old woman; 50% of Canadian administrators versus none of their American counterparts said that it would take over six months for a 65-year-old to undergo a routine hip replacement surgery. Yet U. S. administrators were the most negative about their countrys health care system. Hospital executives in all five countries expressed concerns about staffing shortages and emergency department waiting times and quality. In the U. S. , patients on Medicaid, the low-income government programs, can wait three months or more to see specialists. Because Medicaid payments are so low, doctors dont want to see Medicaid patients. In Benton Harbor, Michigan, specialists agreed to spend one afternoon every week or two at a Medicaid clinic, which meant that Medicaid patients had to make appointments not at the doctors office, but at the clinic, where appointments had to be booked months in advance. Price of health care Health care is one of the most expensive items of both nations’ budgets. The U. S. government spends more per capita on health care than the government does in Canada. In 2004, the government of Canada spent $2,120 (in US dollars) per person on health care, while the United States government spent $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 number is $3,372. In 2004, health care consumed 15. 4% of U. S. annual GDP. In Canada, only 9. 8% 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%. The health share of gross domestic product (GDP) in America is expected to hold steady in 2006 before resuming its historical upward trend, reaching 19. 6 percent of GDP by 2016. The mixed system in the United States has become more similar to the Canadian system. In recent decades, managed care has become prevalent in the United States, with some 90% of privately insured Americans belonging to plans with some form of managed care. Managed care is when the insurance company controls patients health care to reduce costs, for instance by demanding a second opinion prior to any expensive treatment. Administrative costs for health care are higher in the United States than in Canada. Medical professionals Some of the extra money spent in the United States goes to doctors, nurses, and other medical professionals, all of whom receive higher compensation than their counterparts north of the border. According to health data collected by the OECD, average income for physicians in the United States in 1996 was nearly twice that for physicians in Canada. Canada has fewer doctors per capita than the United States. In the U. S, there were 2. 4 doctors per 1,000 people in 2005; in Canada, there were 2. 2. Some doctors leave Canada to pursue career goals or higher pay in the U. S. Many Canadian physicians and new medical graduates also go to the U. S. for post-graduate training in medical residencies. Often new and cutting-edge sub-specialties are more widely available in the U. S. as opposed to Canada. However, statistics published in 2005 by the Canadian Institute for Health Information (CIHI), show that, for the first time since 1969 (the period for which data are available), more physicians returned to Canada than moved abroad. Drugs Both Canada and the United States have limited programs to provide prescription drugs to those in need. In the United States the introduction of Medicare Part D has extended partial coverage for pharmaceuticals to Medicare beneficiaries. In Canada all drugs given in hospitals fall under Medicare, but other prescriptions do not. The provinces all have some programs to help the poor and seniors have access to drugs, but while there have been calls to create one, no national program exists. About two thirds of Canadians have private prescription drug coverage, mostly through their employers. In both countries there is a significant population not fully covered by these programs. A 2005 study found that 20% of Canadas and 40% of Americas sicker adults did not fulfill a prescription because of cost. One of the most important differences between the two countries is the much higher cost of drugs in the United States. In the United States $728 per capita is spent each year on drugs, while in Canada it is $509. At the same time consumption is higher in Canada, with about 12 prescriptions being filled per person each year in Canada and 10. 6 in the United States. The main difference is that patented drug prices in Canada average between 35% and 45% lower than in the United States. The price differential for brand-name drugs between the two countries has led Americans to purchase pward of US$1 billion in drugs per year from Canadian pharmacies. Technology The United States spends more on technology than Canada. The study Medical Imaging in Canada, 2004 reported that in 2004, Canada had 4. 6 MRI scanners per million population while the United States had 19. 5 per million. Canadas 10. 3 CT scanners per million also ranked behind the United States, which had 29. 5 per million. Malpract ice litigation The extra cost of malpractice lawsuits accounts for some of the difference in health spending in the two countries. In Canada the total cost of settlements, legal fees, and insurance comes to $4 per person each year, but in the United States it is $16. Average payouts to American plaintiffs were $265,103, while payouts to Canadian plaintiffs were somewhat higher, averaging $309,417. However, malpractice suits are far more common in the U. S. , with 350% more suits filed each year per person. While malpractice costs are significantly higher in the U. S. , they make up only a small proportion of total medical spending. The total cost of defending and settling malpractice lawsuits in the U. S. n 2001 was approximately $6. 5bn, or 0. 46% of total health spending. Critics say that defensive medicine consumes up to 9% of American healthcare expenses. In the same year in Canada, the total burden of malpractice suits was $237 million, or 0. 27% of total health spending. Ancillary expenses There are a number of ancillary costs that are higher in the U. S. Administrative costs are significantly higher in th e U. S. ; government mandates on record keeping and the diversity of insurers, plans and administrative layers involved in every transaction result in greater administrative effort. One recent study comparing administrative costs in the two countries found that these costs in the U. S. are roughly double what they are in Canada. Another ancillary cost is marketing both by insurance companies and health care providers. These costs are relatively higher in the U. S. , contributing to higher overall costs in that nation. Health care outcomes In 2007, Gordon H. Guyatt et al. conducted a meta-analysis, or systematic review, of all studies that compared health outcomes for similar conditions in Canada and the U.S. , in Open Medicine, an open-access peer-reviewed Canadian medical journal. They concluded, Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent. Guyatt identified 38 studies addressing conditions including cancer, coronary artery disease, chronic medical illnesses and surgical procedures. Of 10 studies with the strongest statistical validity, 5 favored Can ada, 2 favored the United States, and 3 were equivalent or mixed. Of 28 weaker studies, 9 favored Canada, 3 favored the United States, and 16 were equivalent or mixed. Overall, results for mortality favored Canada with a 5% advantage, but the results were weak and varied. The only consistent pattern was that Canadian patients fared better in kidney failure. 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. In terms of population health, life expectancy in 2006 was about two and a half years longer in Canada, with Canadians living to an average of 79. 9 years and Americans 77. 5 years. Infant and child mortality rates are also higher in the U. S. Some comparisons suggest that the American system underperforms Canadas system as well as those of other industrialized nations with universal coverage. For example, a ranking by the World Health Organization of health care system performance among 191 member nations, published in 2000, ranked Canada 30th and the U. S. 7th, and the overall health of Canada 35th to the American 72nd The Positive Aspects of the United States Healthcare System. United States have lower cancer mortality rates than Canadians. Breast cancer mortality is 9% higher, prostate cancer is 184% higher and colon cancer mortality for males is 10% higher in comparison with the United States. United States have a higher ground gateway to chronic diseases trea tment than patients in other developed countries. For example: 56% of United States patients are beneficiaries of statins to reduce cholesterol levels and heart disease protection. United States has improved access to preventive cancer screening than Canadians. Proportionally to the age/population groups who had consigned from prescribed tests for cervical, prostate, breast and colon cancer: * 89% of middle aged American women had received a mammography in comparison to less than 72% of Canadians. * 96% of American women had received a pap smear, in comparison to less than 90% of Canadians. * 54% of American males have received a PSA test, in comparison to less than 16% Canadians. * 30% of Americans have received a colonoscopy, in comparison of the 5% of Canadians. Lower income Americans are in better health than comparable Canadians. American senior citizens with incomes under the median are reported as having excellent health in contrast with Canadian seniors 11. 7% vs. 5. 8%. Americans spend less time waiting for care than patients in Canada. Canadian patients have waited the double time lapse to go to a specialist to receive these types of healthcare services for example: radiation therapy or surgery replacements. Approximately 827,429 Canadians are on waiting lists for medical procedures. People in countries with more government control of health care are highly dissatisfied and believe reform is needed. 70 percent or more citizens from Canada, Germany, Australia, etc. , adults think that their health system needs to be reform. On recent satisfaction polls Americans are more satisfied with their healthcare than Canadians. When Americans were asked about their healthcare not their healthcare system 51. 3% were satisfied in comparison to a 41. 5% of Canadians the dissatisfaction level was 6. 8% for Americans and 8. 5% to Canadians. Americans have easier access to new medical technologies than patients in Canada. American health specialists have concluded that (MRI) magnetic resonance imaging and (CT) computerized tomography are the major helpers to improve patient well-being. The United States account for CT’s is 34 scanners per million Americans, in comparison of 12 per Canadians. For MRI’s the count is 27 machines per million Americans in contrast of 6 per million of Canadians. American medical facilities are responsible for almost all the health care discoveries and technologies. U. S. ospitals have conducted more clinical research than any other country. Since the 1970s, the Nobel Prize in medicine or physiology has been awarded to American recipients. The Negative Aspects of the United States Healthcare System First, is the U. S. A’s health care system productively efficient relative to Canada’s health care system? Second, is the U. S. A. ’s problem of rising health care costs a particular concern? Although no country can claim to have eliminated inefficiency, the US’s high costs stand out. Thirdly, what effect does the U. S. A. ’s uninsured have on the Health Care system? Lastly, how does the restriction in choice of health care effect the USA? U. S. A. ’s Health Care’s Rising Costs Healthcare costs will continue to increase in the foreseeable future. Americans are dissatisfied with their health care system (Schoen, et. al. , 2007) but also spend more than the citizens of other countries. Other countries negotiate very aggressively with the providers and set rates that are much lower than we do. In America, Medicare and Medicaid negotiate prices on behalf of their tens of millions of members and, not coincidentally, purchase care at a substantial markdown from the commercial average. But outside that, it’s a free-for-all. Providers largely charge what they can get away with, often offering different prices to different insurers, and an even higher price to the uninsured. â€Å"Organizations of all sizes can embrace to take advantage of the rapid changes that our healthcare system will likely deliver in the next few years by positioning the organization to take a â€Å"proactive† approach to rising health care costs. So who’s to blame: Drug companies, insurers, politicians, lawyers, and the bad habits of Americans all figure into high and rising health-care costs? But the biggest contributors to high costs—doctors and hospitals—get off easier among consumers, our survey found. Sellers of healthcare services in America have considerable power to set prices, and so they set them quite high and they set them with margins as high as almost 20 percent. Unfortunately, the 2010 health-reform law does little to directly address prices. It includes provisions forcing hospitals to publish their prices, which ultimately would bring more transparency to this issue. † (Miller, 2008) Consequently, when all is said and done, health is a business in the United States. Restriction in Choice of Health Care One aspect of the USA’s Health Care system is that today’s employer-based insurance system restricts individuals’ choice of insurance, and many people are locked into jobs for fear of losing coverage. In the early 1990s, when insurers tried to reinvent themselves by embracing managed care, health insurers and employers sought to sharply limit patients’ choice in health care providers. Instead of just paying doctor and hospital bills, insurers also assumed a greater role in their customers’ medical care by restricting what specialists they could see or which hospitals they could go to. The issue of health care freedom is not discussed much in the debate over health care policy. Unfortunately, most policymakers prefer that government tell health care consumers what they can purchase and what treatments they can receive. Most do not favor greater health care freedom, which means the health care consumer is paramount, not a government bureaucrat or politician. Health Care’s Uninsured â€Å"A record rise in the number of people without health insurance across the nation is fueling renewed debate over a health care law that could work better at boosting coverage than controlling costs.