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Comparison of the Canadian and American Health Delivery Systems
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The operation of the Canadian health care delivery system is defined by the provisions of
the Canada Health Act passed in 1984. The health delivery system is subdivided into provincial
health plans that are managed at provincial levels. The health plans provide broad first dollar
coverage for all the services that are medically required. Health coverage is provided to all
Canadians without any out of pocket charges except in very minor exceptions. In most cases, the
payment for physicians is provided on a fee for service basis ensuring high levels of practice
autonomy (Henderson 487). In this case, complete autonomy in the case of the physicians is
demonstrated in cases where there is no second mandatory opinion for surgery like the case in
US since the Canadian policy makers do not believe in intrusive controls. Additionally, these
intrusive kinds of controls are regarded to be unnecessary since the policy makers strike to
eliminate unnecessary hospital global budgets and physician budgets (Ridic, Goran, Gleason, and
Ognjen Ridic 112). The provision of private health insurance is illegal for the covered services.
Private health insurances are mostly used for uncovered services like dental services and
prescription drugs. Thus, nearly all physicians are obligated to participate and the provincial
health plan caters for all the inhabitants of a given province. The reimbursement process
primarily occurs between the government and the physicians and as a result the patients do not
take place in the reimbursement process. Hence, there is no monetary exchange between the
patients and the physicians. Each province has ministry of health that is responsible for
regulating the medical costs. The control of costs is basically attained through the introduction of
global budgets as well as the use of predetermined fees for the health care providers (Henderson
487). Particularly, the operating budgets of the healthcare institutions are approved and solely
funded by the provincial health ministries with an annual global budget being settled between the
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ministry and each healthcare institution. Since the ministries fund the bulk of the hospital
spending, it must approve all capital expenditures.
On the other hand, the United States lacks the nationwide health delivery system with
universal health insurance like the case in Canada. Health insurance in the country is individually
purchased in the private marketplace or in other cases granted by the government to given
groups. Private health insurance is mainly purchased from either the for-profit insurers or non-
profit insurers. Approximately 84% of Americans are covered with 26% being publically
covered whereas 70% of the population is covered by private insurers (Ridic, Goran, Gleason,
and Ognjen Ridic 112). The two primary types of public health insurances in the country are
Medicare and Medicaid. 61% of the population is covered by employment related health
insurance covers where the employers willingly provide health insurance plans. The American
health care system in much diversified in regards to production methods. Unlike Canada that has
a single payer-system; America has a multiplayer system whereby numerous third-party payers
such as the commercial health insurance companies, the federal and state government are
accountable for reimbursing physicians (Ridic, Goran, Gleason, and Ognjen Ridic 112).
Reimbursement takes place in different ways based on the third party payer responsible for
reimbursement. The commonly used type of reimbursement is the fee-for-service. Other types of
reimbursement that have gained popularity include the prospective payment and the prepaid
health plans. Hence, the health insurance plans are responsible for reimbursing the physicians on
the fee-for-service basis.
In regards to efficiency, the U.S health care system is characterized by advanced
technology that presents its greatest strength compared to that of Canada. For example,
premature babies born in America have higher chances of survival due to the advancements in
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technology. The advanced state of health care technology in America is also reflected by the
country’s high life expectancy after the age of 80 compared to that of Canada (Ridic, Goran,
Gleason, and Ognjen Ridic 112). Additionally, in terms of pharmaceutical innovation, the United
States has been identified as the world leader. However, despite its strengths, the American
health care system the primary weakness of the system is manifested in the fact that over 42
million people in the country do not have health insurance. This lack of coverage presents a
major challenge in accessibility to health care and subjects the income of these families to the
vagaries of health issues. Further, the health care costs have escalated over the years presenting a
major challenge to the families without health insurance and the country at large.
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References
1. >Henderson WJ.>Health Economics and Policy.>South – Western Publishing; 2002. 487
2. Ridic, Goran, Suzanne Gleason, and Ognjen Ridic. "Comparisons of health care systems in the
United States, Germany and Canada.">Materia socio-medica>24.2 (2012): 112.
