Canada and the U.S. are neighboring nations, and as one would expect, they have some great similarities, that include +1 calling code, driving on the right, McDonald’s, Starbucks, Walmart, and the list continues.
However, despite these similarities, the health care systems of these two nations are very different on many levels. The U.S. health care system is criticized for being a multi-tiered, for-profit system that guarantees health care only to those with an insurance (i.e., mostly private insurance). On the other hand, while Canada is a single-payer system that provides publicly funded, universal coverage, it is not without its pitfalls. For example, Canadians regularly complain about long wait times, not just in the ER, but also when accessing any kind of medical care services. Imagine having to wait for 6 months to have a simple sinus surgery, 3 months for an MRI scan, or a year to see a psychiatrist.
According to a relatively recent study published in the American Journal of Public Health, the lack of health insurance in the U.S. is responsible for 45, 000 deaths per year (Wilper et al., 2008). On the other hand, increasing wait times in Canada is a growing concern. For example, the wait time has increased from 9.3 weeks in 1993 to 18.2 weeks in 2013 to see a medical specialist (Barua et al., 2014). Delayed access to medically necessary services contributes to serious personal and economic consequences, as well as increased morbidity and mortality (Barua et al., 2014). It can increase patients’ pain, anxiety, and sufferings, as well as absenteeism from work that can lead to reduced productivity (Barua et al,. 2014). The study by Barua et al. (2014) found that the increases in wait times between 1993 and 2009 for medically necessary care (e.g., cardiovascular surgery) may have resulted in about 44, 273 deaths among females. About 1.2% of total mortality, including both males and females, during the same period may be attributed to delayed treatment.
The strength of the Canadian health care system lies in its publicly funded coverage. This means that everyone is covered under one system, regardless of their financial status or pre-existing health conditions. One of the mandates of the Canada Health Act is Universality. This may explain its high life expectancy rate and low health care expenditures compared to the U.S. (Lasser et al., 2006). Under most circumstances, Canadians don’t have to worry about going broke from paying medical bills, and therefore, they are unlikely to hesitate seeking help early. Further, unlike the U.S., insurance companies or hospitals in Canada don’t have to spend millions of dollars on advertisements and infrastructure to lure patients. For example, as Dr. Robinson said in his talk in November 2016, hospitals in the US would spend a lot of money on maternity wards to make them attractive to families. More patients with private insurance means more profit for the hospital. In contrast, Canada’s health care system works on a non-profit basis and do not need to compete. Despite universal coverage, there are some people in Canada who is not covered by the publicly funded health insurance. For example, in Ontario, tourists and visitors are not covered. Some services such as eye and dental care are not also not covered.
Health care system in the U.S. require private insurance under most circumstances. This means that although hospitals may be obligated to provide medically indicated care regardless of whether the patient has an insurance or not, they are not obligated to charge for the services at a reasonable price. That is, they can charge the patients at whatever price they want. It is therefore not uncommon for hospital bills leading to bankruptcy in the US. Obamacare tries to improve fair access to health care for people with pre-existing health conditions by having everyone buy a private insurance. However, not all states participate in this, and the premiums tend to increase at a sharp rate. It is also not quite clear how it ensures that working poor (i.e., who are not eligible for Medicaid) receive medically necessary care.
Hospitals in Canada have fixed budgets, but the expenditures tend to increase each year. As a result, attempts are made to reduce the health care costs by avoiding medically unnecessary procedures. Hospital staff and the government authorities work in collaboration to reduce unnecessary costs. For the most part, GPs judge what procedures are medically necessary for their patients. This can be problematic as errors can be made by misjudging the seriousness of the symptoms presented by patients. For example, when my friend visited her GP after having lower abdominal pain for over a month, as well as experiencing indigestion, and blood in stool, the GP sent her back home stating that it is probably just gas and hemorrhoid. Still not satisfied, my friend visited a walk-in clinic and was asked to undergo colonoscopy. From the patient’s perspective, this process wasted her time, increased her anxiety, pain, and suffering, as well as delayed her treatment. This also wasted resources because she had to pay visits to two different GPs before being taken seriously for the same problem, which means that the government would have to pay both GPs for the same case.
On the other hand, hospitals in the U.S. want to increase the amount of procedures that they can provide to their insured patients in order to attract them. However, every patient may have a different insurance, and therefore, doctors have to spend more time in documentation than in direct patient care.
In summary, both health care systems have pros and cons. Health care system in Canada may be simpler and better in encouraging ill people, regardless of their financial status and pre-existing health conditions, to seek help early, thus resulting in improved patient outcomes (i.e., lower maternal mortality and higher life expectancies). However, rich people or those with good-paying jobs may benefit more from the U.S. health care system as they would face reduced wait times and are likely to receive a more generous hospitality at the hospitals or clinics.
Barua, B., Esmail, N., and Jackson, T. 2014. The Effect of Wait Times on Mortality in Canada. Fraser Institute.
Lasser, K.E., Himmelstein, D.U., and Woolhandler, S. 2006. Access to Care, health status, and health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey. Am J Public Health. 96: 1300-1307.
Wilper A.P., Woolhandler S., Lasser, K.E., McCormick, D., Bor, D.H., Himmelstein, D.U. 2009. Health Insurance and Mortality in US Adults. Am J Public Health. 99(12)2289-2295. doi: 10.2105/AJPH.2008.157685
Some ideas inspired from Dr. Robinson’s talk at Sunnybrook Health Sciences Centre in November 2016.