HEALTH CARE SYSTEMS UNITED STATES & CANADA

Health Care Systems United States & Canada

Health Care Systems United States & Canada

Introduction

Whilst Canada and the United States had quite similar healthcare systems in the 1960s, the two neighbors now stand in marked contrast in terms of healthcare system provision and payment. The United States features a market-based system of delivery and payment, whilst healthcare delivery is organized in Canada by provincial governments, which also are responsible for most healthcare expenditures (Beatrix, 2001). One of the biggest differences between the two is that the United States is one of only a few industrialized countries not to guarantee healthcare for all of its citizens, whilst Canada represents an example of a country with universal healthcare guaranteed due to the heavy involvement of the government in providing funding for care.

Although the United States' healthcare system is largely characterized by private provision, federal and state governments still play a substantial role in providing the funding for healthcare services, especially via large national entitlement programs, Medicare, Medicaid, and State Children's Health Insurance Program (SCHIP). Medicare provides direct payments from the federal government to private providers for physician and hospital services, and recently expanded to include funding for prescription drugs. Generally available to individuals over the age of 65, as well as certain other categories of people (such as those officially classified as disabled), Medicare and other public programs account for approximately 50 percent of all healthcare expenditures in the United States, and is funded via payroll taxes into a trust fund, one which is slated to run out of funds at some time in the 21st century without substantial overhaul of the program (Steffie, 2004).

Government-Sponsored Programs in USA & Canada

Medicaid also provides direct payments from state and federal governments to providers, often via state Medicaid programs. Whilst Medicaid eligibility is determined at the state level, this program is largely limited to poor, pregnant women, children, and elderly persons needing long-term care assistance. SCHIP generally covers children up to the age of 18 whose families make too much money to qualify for Medicaid but who are still considered “low income” according to state guidelines (Guy, 2004). A handful of states have extended SCHIP to all uninsured children in the state, regardless of family income. Other smaller government programs provide for direct provision of care for certain categories of people, such as military veterans and Native Americans. The federal government and many state governments also provide health insurance to employees, as do many municipal governments. In recent years, a growing number of providers have stopped accepting patients insured by Medicaid and even Medicare, citing burdensome administrative requirements and low reimbursement rates (Reinhardt, 2004).

Individuals who are not eligible for Medicare, Medicaid, or SCHIP in the United States must purchase health insurance or healthcare on the private market. Many Americans are provided with subsidized health insurance as a fringe benefit of employment, although the percentage of employers offering health insurance to workers and, especially, workers' dependents, is shrinking every year due to higher ...