Unit III HCS

HCA 4303, Comparative Health Systems 1

Course Learning Outcomes for Unit III

Upon completion of this unit, students should be able to:

1. Examine factors that influence health care in specified countries. 1.1 Compare health care systems and the factors that affect them.

4. Compare global health care services and systems. 4.1 Plan a comparative matrix on the Americas region.

5. Assess health care models used in other countries. 5.1 Identify specific health care systems in the Americas region.

Required Unit Resources

Chapter 5: United States - Read the following sections.

• Brief History of the Healthcare System

• Description of the Current Healthcare System

• Evaluation of the Healthcare System

• Conclusion

Chapter 6: Canada - Read the following sections.

• Brief History of the Healthcare System

• Description of the Current Healthcare System

• Evaluation of the Healthcare System

• Current and Emerging Issues and Challenges

• Conclusion

Chapter 7: Mexico - Read the following sections.

• Brief History of the Healthcare System

Chapter 8: Peru - Read the following sections.

• Brief History of the Healthcare System

• Description of the Current Healthcare System

Chapter 9: Brazil - Read the following sections.

• Brief History of the Healthcare System

• Description of the Current Healthcare System

• Evolution of the Healthcare System in Brazil

• Current and Emerging Issues and Challenges

UNIT III STUDY GUIDE

The Americas Region

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Unit Lesson

In Units I and II, we laid the foundation for global health and policymaking. Throughout the remainder of this course, we will review the world and its health care systems by region. In this unit, we will begin with countries in the Americas.

The United States of America

The United States of America has been called a land of plenty, and the residents of the United States enjoy one of the highest standards of living in the world. It also has the largest and most technologically advanced economy in the world.

The United States has a unique health system for its approximately 331 million residents, which comprises about 4.23 percent of the world’s population (WorldAtlas, n.d.). In the United States, health care is the largest industry, and it has a highly developed infrastructure for delivery of medical services (Johnson et al., 2018). Globally, on health care, the United States outspends all other nations. The facilities in the United States are ultramodern with high-caliber schooling. The infrastructure is owned mainly by the private sector; however, the government is a major financier of medical education health service research, and it operates the military and veterans’ health systems (Johnson et al., 2018). The life expectancy in the United States is 78.9 years (Organisation for Economic Co-operation and Development, 2021).

The United States has several types of facilities that are listed in the chart below. The inpatient institutions care for patients who require overnight stays in places like general acute care or specialty hospitals and long- term care facilities. Outpatient services are delivered via an ambulatory care setting and vary on factors, such as type of care needed, insurance, and location (Johnson et al., 2018). Home health and walk-in clinics also fall into the outpatient category. The United States also has public health services that are provided by local health departments. Walk-in Clinic (Urgent Care)

The managed care system is the most dominant delivery system in the United States. According to Johnson et al. (2018, p. 87), “Managed care is a system of health care delivery that (1) seeks to achieve efficiencies by integrating the basic functions of health care delivery, (2) employs mechanisms to control (manage) utilization of medical services, and (3) determines the price at which the services are purchased and consequently how much the providers get paid.” Employers and the government are the primary financiers of the system. There are two types of managed care organizations: HMOs (health maintenance organization) and PPOs (preferred provider organization). HMOs typically require in-network access while PPOs allow out-of-network access.

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Title The U.S. health care system is influenced by many external factors such as the economy, climate, technology, cultural and social values, the physical environment, and the population characteristics. The main characteristics of the United States health care system include:

• “No central governing agency and little integration and coordination

• A technology-driven delivery system focusing on acute care

• High cost, unequal access, and mixed outcomes

• Delivery of health care under imperfect market conditions

• Government as subsidiary to private sector

• Market justice versus social justice pervasive throughout health care

• Multiple players and balance of power

• Quest for integration and accountability” (Johnson et al., 2018, p. 90)

Canada

Canada is the second largest nation in the world and largest on the North American continent. Its environment is varied, ranging from its coastal regions, arid plains of the interior, to the polar cap. Canada’s population has exceeded 36 million people and it is aging (Johnson et al., 2018). The population density is about 4 people per square kilometer and about two-thirds of the population resides along the southern border (World Population Review, 2022).

The Canadian government is a constitutional monarchy that is led by the prime minister and has a parliament with a set number of appointed members. It was originally comprised of the liberal and conservative parties, but over the years, three to five substantial political parties have existed.

The economy has evolved from resource-driven origins to diverse market sectors, and it is heavily concentrated along the southern border. It has highly developed infrastructures and public school is provided at no direct cost to the students.

Cancer is the leading cause of death in Canada and diabetes has been steadily rising in the population. The prevalence of illness and chronic conditions is considerably higher in certain subpopulations. Canada has a contemporary health care system characterized by a system of mixed sources of funding, administrative, and delivery services. The residents of Canada are covered under Medicare, which is a jointly funded federal/provincial health insurance system and it represents the majority of health care spending. Residential care facilities and physicians are mostly nongovernmental entities, while hospital sectors are operated by local and provincial governments (Johnson et al., 2018). There are also not-for-profit private sector hospitals.

Mexico

Mexico is the largest Spanish-speaking country in the world, and it covers 1.9 million square miles of land (Johnson et al., 2018). It has a multiparty electoral system and is a federation with a presidential representative and a democratic republic. The government consists of three branches: the executive, legislative, and judicial.

Like many other countries, Mexico’s economy is experiencing major changes in economic and social variables. There are also many challenges regarding raising the quality of education, reducing government corruption, assuring public safety, controlling drug crimes, catching up on infrastructure backlogs, relieving poverty, and achieving well-being for the majority of Mexicans (Johnson et al., 2018).

The quality of health care is a challenge for the Mexican health system. The life expectancy in Mexico is 75.1 years (Organisation for Economic Co-operation and Development, 2021). Noncommunicable diseases and injuries are rapidly increasing in Mexico. This has increased demand for the need for changes that can meet the needs for cost-effective and equitable services. The Mexican health system has two sectors: public and private. The public sector includes the social security institutions, Segura Popular, and institutions offering services to the uninsured. These facilities run and own their own health care facilities and employ their own staff (except for Segura Popular). The private sector includes facilities and providers who offer for-profit services (Johnson et al., 2018). The table below explains the Mexican health care system.

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Title Public Sector

• Social Security Institutions

• Segura Popular

• Institutions offering services to the uninsured o These facilities run and own their own health care facilities and employ

their own staff (except for Segura Popular)

Private Sector • Facilities and providers who offer for-profit services

According to Johnson et al. (2018, p. 131), “The Mexican health system is a segmented system with three broad categories of beneficiaries: (1) workers of the formal sector of the economy and retired people and their families; (2) self-employed, workers of the informal sector of the economy, and unemployed and their families; and (3) the population with the ability to pay.”

Mexico is working to increase access and availability of health care and trying to improve the quality of the available services. However, challenges still remain (emerging diseases, balance between investments in public health and personal curative health services and narrowing health gaps).

For further information on Mexico, please consult Chapter 7 of your textbook.

Peru

Several different Andean civilizations have called Peru home, most notably the Incans. The Spanish invaded Peru and conquered the Incans in 1533, but in 1821, Peru declared its independence. Peru is in the central- west region of South American. Its topography lends itself to a wide variety of climates, but only 3% of the land is arable (Johnson et al., 2018).

Almost 9 million people live in Lima, the capital and largest city of Peru, and more than half of the country’s population of 29 million live in the coastal regions (Johnson et al., 2018). The education level of the population is increasing and the number of women with advanced education is also increasing.

The government is a constitutional republic with 24 departments, 188 provinces, one constitutional province, and 1,793 districts. Similar to the United States, it has three branches: executive, legislative, and judicial. Elections for the president and congress are held at the same time and decided and by popular vote.

Peru’s geography helps its economy. Its abundant mineral resources from mountainous areas make it the world’s second largest producer of silver and third largest producer of copper. However, the economy is still fragile and vulnerable to fluctuations of the international market. There are also political and legal instabilities, natural disasters, and epidemics of concern in Peru. The national poverty rate in Peru has been declining. However, poor infrastructure hinders the spread of growth in the coastal areas (Johnson et al., 2018).

The Peruvian health system is composed of two sectors: public and private. The public sector consists of MINSA and EsSalud and the armed forces and police health units and the private sector is made up of doctors’ offices, local companies, private clinics, and NGOs (Johnson et al., 2018). Below is a table explaining the Peruvian health system.

Public Sector

• MINSA

• EsSalud

• Armed forces

• Police health units

Private Sector

• Doctors’ offices

• Local companies

• Private clinics

• NGOs

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There are four ways to receive health insurance in Peru:

1) Health insurance (SIS): Publicly funded health insurance with a focus on poor and vulnerable populations.

2) Social health insurance (EsSalud): Provides health and social services to contract and salaried workers in the public and private sectors and their relatives, and a small percentage of independent workers.

3) Armed Forces and Police Forces health services: Each has its own hospital. This insurance covers members and their families.

4) Private insurance companies

Brazil

Brazil was discovered by the Portuguese in 1500 and gained its independence in 1882. It is the largest and most populated country in South America. It is the sixth most populated country in the world (Johnson et al., 2018). It continues to be the net recipient of immigrants and it does have a growing middle class. However, the poverty rate and unequal income levels remain high. Disparities lead to social exclusion and contribute to a high crime rate in Brazil.

Brazil is a federal republic. Its powers are vested in the central government through a constitution. It contains 26 states and the federal district, Brasilia. It has three branches of government: the executive, legislative, and judicial. Each state has its own governor and legislature, and the president heads up the executive branch. The highest court is the Supreme Federal Court which contains 11 justices. (Johnson et al., 2018). The federal government regulates education through the Ministry of Education and federal funding is used to develop state and local education programs.

Health care is a top priority for Brazilians. The public health care (SUS) system is hierarchized, universal, and an integrated system. It provides a wide range of services from primary care to complex surgical procedures. Health care is available in Brazil to every person, citizen or not, who needs it. There are also no reimbursement compacts for health care among the Latin American countries and broad-scope services are not yet fully available in all Brazilian states. Further, there is difficulty to develop a comprehensive strategic plan for public health care services because of intensive internal and external immigration realities and funding restrictions.

Pharmaceutical assistance in Brazil is comprised of a generic drug program. There is free medication distribution at public primary care units and an agreement with pharmacies throughout the country to promote the free distribution of subsidized medicines (Johnson et al., 2018).

Conclusion

This unit focused on the Americas region, specifically the United States, Canada, Mexico, Peru, and Brazil. It provided foundational knowledge on the countries demographics and political systems, as well as provided facts about their health care systems. To learn more about each country, please consult your textbook.

References

Johnson, J. A., Stoskopf, C. H., & Shi, L. (2018). Comparative health systems: A global perspective (2nd ed.). Jones & Bartlett Learning. https://bookshelf.vitalsource.com/#/books/9781284145038

WorldAtlas. (n.d.). Countries by percentage of world population. https://www.worldatlas.com/articles/countries-by-percentage-of-world-population.html

World Population Review. (2022). Canada population 2022. https://worldpopulationreview.com/countries/canada-population