Critics of the US health care system often demand reforming it by using foreign patterns. They point out that health expenditures in many countries are much lower than in the United States, and the effectiveness of health services is higher. The skeptics argue that United States should adopt the international experience, and create a public health system. However, a careful study of the situation shows that the health systems in almost all countries of the world face similar problems of rising costs and inaccessibility of health care to the population. Healthcare organizations in any country can be considered universal models that can be used all over the world. The specifics of every country make this idea impossible due to a number of peculiarities referring to regulations and distribution of costs, centralization of the system, and the role of private and governmental insurance.
The paper discusses the problems that exist in the healthcare system of the USA, compares it to the healthcare system of Canada and suggests possible solutions that the US system might use for its improvement.
Problems in the US Healthcare System, Their Definition
The general trends in the development of national health care in the world lead to the following points. The presence of health insurance does not guarantee universal access to health services. In practice, in many countries insurance gives access to medical services in the framework of its specific regulations, in other countries people have to spend a lot of time waiting for treatment. Increased cost of health care is not unique to the United States. While in other countries, these costs account for a far smaller percentage of total GNP and GNP per capita, they grow almost everywhere, causing budget deficits, higher taxes, and cuts in social benefits (MargotSmith, 2012 ). Not a single country in the world raises the question of the abolition of universal health insurance, but a change from the centralized state control and transfer to a market basis should be cognized as the dominant global trend (Di Gregorio, 2010). Thus, nationalization will not help to solve the problems in the US healthcare system, but a deep analysis of other countries experience would prove the insolvency of centralized administrative system and the benefits of the consumer incentives and freedom of choice.
Analysis of Literature on the Issue
Many critics mention that American medicine has its own problems which are evident. Too many American citizens do not have health insurance and/or cannot afford medical treatments of the highest quality. It is necessary to actively reduce health care costs and expand access to health services (Relman, 2003). Both patients and health care institutions require a greater volume of useful information. As part of the American system, the system of finance distribution requires better planning of costs spending. Besides, the system requires monitoring of the quality of care, as it is uneven. The miscalculations in the implementation of public health programs such as Medicare and Medicaid threaten future generation with significant debt and tax burden (Marchildon, 2005). People have to spend additionally in case they have urgent medical issues and have to come to the hospital. Their medical treatment bills are to be paid by the medical insurance companies as well as by the patients themselves which makes medical services more expensive. Besides the high level of medical services costs, the US citizens experience one more significant problem, which is not having the required access to care and medicine (Relman, 2003). The necessary drugs are distributed in expensive drugstores and people are not offered cheaper substitutes for popular pills. Moreover, countrys national resources for providing high quality medical care to patients are not provided for to the full capacity. Private clinics offer very high prices and municipal clinics do not have enough space to allocate all the patients. This problem was partially solved by providing home treatment care. although it requires additional nurses and family doctors.
Place New Order
Possible Solutions Based on Other Countries Experience
Many other countries have had positive experience in reforming their healthcare systems. For example, health care system of Canada has a number of instances of their system of medical services being better than the one of the US. That is why such examples should be taken into account during the reform. However, the health system reform should be guided and well thought through in order to apply only positive practices and not acquire drawbacks and mistakes of other countries. Therefore, before transferring to state medicine, it is important to examine carefully the health system existing in other countries, evaluating their advantages and disadvantages. Many of these systems are currently undergoing major reforms.
Within the health system built on the principle of single-payer, health services provided to all citizens are financed by the state. It collects taxes for health care and pays for it directly. In essence, private insurance is replaced by a completely nationalized system. Usually the government develops a total budget for health care, distributing costs between the necessary purposes and defining the amount of necessary compensations. In some cases, doctors are government employees receiving a salary. In others, they remain independent and receive compensation depending on the volume of services provided and the level of treatment measures. As part of the hard version of a single-payer system any private health insurance and other ways of voluntarily choosing a medical insurance company besides the state medicine is prohibited.
According to the new reform of health care system that was recently implemented, there medical insurance was established in the workplace. The state requires employers to provide their employees with health insurance, often through semi-health insurance. These insurance funds can operate within one or more sectors of the economy. The government sets benefits and the size of contributions. Often, such contributions are a kind of a tax on salary and are paid directly to the fund. Medical institutions are independent, and the volume of their remuneration for the services is established as a result of negotiations with the funds, sometimes individually and sometimes nationally.
Suggesting Solution for Finance System of Healthcare
Although the Canadian health care system is often referred to as national, it is decentralized. Broad powers in this area are delegated to regions including 10 provinces and three territories. The funds for it are provided together by regional and federal authorities, like for the American program Medicaid. To gain access to the means of the federal budget, provincial health programs must comply with five criteria (Marchildon, 2005). Their character should be universal, apply to all residents of the province on an equal footing. They have to be comprehensive and cover all the necessary services for medical workers, doctors, and hospitals. They have to provide mobility and save medical coverage for the citizens when they move to other provinces (Fierlbeck, 2011). Besides, they have to be available and exclude any financial barriers to care, such as deductions or equity. The final requirement is that they have to be state managed by a non-profit body within the jurisdiction of the provincial government.
One of the most important positive experiences that Canadian health care system can offer to the US system is financing and costs planning. In Canada, general tax revenues finance federal health care system. The federal government gives each province a single grant of approximately 16% of its health spending. The main part of the financing constitutes income from regional taxes, primarily on revenues. Some provinces and regions like British Columbia, Alberta, and Ontario collect contributions from citizens, although the inability to pay does not give the right to refusepatient care (Marchildon, 2005). Canadians are proud of their healthcare system as it is the largest social element of their state, taking almost half of the social spending of its budget. The provinces are obliged to provide the citizens with certain types of care, including physician services, specialists, inpatient, and dental surgery. At the same time, patients have to pay for dental therapy, prescription, and physiotherapy on a voluntary basis. Some provinces provide insurance coverage for these elements and others do it partially. Additionally, there are areas where they are not covered. Except in cases of emergency, for an appointment with a specialist a patient needs a referral from the general practitioner. Payment service providers are determined at the regional level. In some provinces, the amount of aggregate income of doctors is limited (Marchildon, 2005). Typically, however, compensation is performed on a fee-for-service basis. Hospitals get a specified sum of money to cover all the costs but the fixed assets. The costs of the last category require specific approval in each case.
More and more Canadians also have medical insurance purchased from private insurance companies that their employer provides. Initially, this kind of insurance creates a possibility to have additional insured medical services that are not included into national system coverage. Some time earlier, provincial authorities banned private companies from insuring any services and procedures, which are covered by government programs (Di Gregorio, 2010). However, in 2005 the Supreme Court annulled in force in the Province of Quebec prohibition on contracts with private insurers (Skinner, Rovere & Warrington, 2008). In addition to public hospitals funded by the authorities, there are numerous private clinics providing specialized services in Canada. The main advantage of private clinics is that they provide help one can get faster than in public health facilities. For example, people have to wait for months for magnetic resonance imaging in hospitals, while private clinics provide this service in a short period of time.
Disadvantages of Canadian Healthcare System
Canadian healthcare system has a number of advantages. However, it is important to mention one of the most important disadvantages that ruin all positive impressions of previous points. The major drawback of Canadian healthcare system is the Waiting List (MargotSmith, 2012). This is one of the most serious problems encountered within the Canadian system. Precise official data on this subject is available. Judging by the reports of health authorities, queues for treatment in provinces are moderate but still exist. The most reliable information can be found in the data survey of Canadian physicians conducted by the Fraser Institute. They found out that almost 800,000 Canadians wait for their turn to receive health care services at any given time (Di Gregorio, 2010). According to this study, the duration of the whole treatment process from getting directions from the therapist, receiving specialist medical procedures themselves in all specialties and all kinds of assistance including emergency, non-urgent or planned averaged 17.7 weeks. This period does not include waiting for the first appointment with a therapist (Skinner, Rovere & Warrington, 2008). Supporters of state medicine are trying to present the waiting lists as a secondary importance issue, claiming that in fact these terms are shorter than they are presented, or that the majority of people in the queues are those who signed up for elective surgery. However, analysis of the situation in those types of medical cases where waiting lists are particularly large, shows that the longest period of time patients have to wait for operations to replace a knee, hip, or cataract, which can be called routine. Meanwhile, in the areas of medicine, where timing can seriously affect the health of the patient, for example, in neurosurgery, people have to wait their turn, too, for a long time, but in these cases, the delay can be extremely dangerous.
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The joint Canadian-American studies on the health of the population, as a part of Canadian Bureau of Statistics and the US National Center for Health Statistics project, indicate that 33% of those Canadians whose health care needs are not fully satisfied according to their own words, experience pain that interferes with their daily activities (Skinner, Rovere & Warrington, 2008). In the decision to annul some provisions of law of Quebec on health care provincial population, chairman of the Supreme Court of Canada Beverley McLachlin noted an indisputable fact that many people waiting for treatments are constantly in pain, and some patients die while on the waiting list.
Advantages of Canadian Healthcare System Comparing to the US Situation
The Canadian health system experience can be used effectively enough to cope with the problem of cost control. The Canadian healthcare system is financed by the state and is best described as a system of insurance and medical plans of ten provinces and three territories. This system is known as Medicare, providing partially free and totally free medical services for people in Canada (Fierlbeck, 2011). Such structure has been designed so that health care is in the department of local, provincial authorities, and not the federal government. Health care systems in each province or territory are linked by common principles, which are set at the national level. Management and provision of health services are in the area of responsibility of each province or territory. The province or territory has to plan, finance, and evaluate the provision of hospital care, the services of physicians and other professionals, providing medicines and special treatments.
Canadas health care system relies heavily on primary care physicians, who make up about 51% of all practicing physicians in Canada (ONeill & ONeill, 2007). They are the link between the patient and the formal health care system. Besides, they perform control access to the majority of medical specialists, hospital care, and diagnostic checks as well as prescribe drugs that can be given to a patient on the prescription only. Such family doctor can be changed at any time for any given reason. In Canada, however, there is no system of public medicine, where doctors work directly for the governmental. Most doctors have their own private practices and have a high degree of autonomy. Some doctors work in hospitals and local health centers (MargotSmith, 2012). Doctors and private traders are paid by state for the services provided, depending on the amount of assistance. Doctors are paid directly from the province or territory budget. Therapists that do not have a private practice receive a fixed salary. Their fee depends on the amount of medical services rendered. When Canadians need medical care, they go to the doctor, physician, or clinic of their choice and use their health insurance card, which is issued to all legal citizens and residents of the country (MargotSmith, 2012). Canadians do not pay directly for medical services and they do not need to fill in various forms for services covered by insurance. For such services, there is no limits in terms of money or additional payments.
Dentists work independently from the health care system, except when emergency care of a dental surgeon is needed. Pharmacies are also independent from the state. More than 95% of all Canadian hospitals operate on the principle of non-profit private institutions, managed by the local council of directors, volunteer organizations, or municipalities (ONeill & ONeill, 2007). In addition to the national health insurance system, the provinces and territories also provide medical care to that part of population that needs more medical services, including elderly people, children, and the unemployed. These additional packages of health services often include free medicine, dental treatment, optician services, and a variety of devices for people with disabilities including prostheses, wheelchairs, and more. While provinces and territories provide additional services to some segments of the population, this is a service industry that belongs to the private sector, which means that patients have to pay for it (Boychuk, 2008). In this case, they have a reasonable opportunity to purchase insurance that covers most of the cost of dental care, eye specialists, and other services. Moreover, such insurance is often included in the compensation package, which is offered along with wages.
Such example is a good way to keep people sure that they would have all the necessary elements of treatment when they need it. Besides, every compensation package is based on the place of work and includes services for all possible risks that can occur. Another positive experience of Canadian system of healthcare is mobility of people as when they move from one province to another or to another territory they are still guaranteed too have all the necessary medical aid in case they need it (Fierlbeck, 2011). To strengthen the public health system the government announced in 1999 that the provinces and territories would receive an additional $11.5 billion for the period from 1999 to 2004, for the additional needs of the system (Boychuk, 2008). Since that time, the essence of the Canadian health system is in the improvement of the existing order of things, and not the creation of a fundamentally new method of insurance and providing health care for Canadians. One of the most important indicators of the success of the existing health care system of Canada is the health of its population. According to the The World Bank Group, the infant mortality rate in 2015 was 4 per 1,000 live births, which is one of the lowest rates in the world and it lowers every year according the statistics (2015). The life expectancy of Canadians is 81.4 years for women and 75.8 years for men, which is one of the highest rates among developed countries.
Implementation Plan and Its Justification
In order to reform the healthcare system in the US and make use of the above-mentioned advantages of Canadian system it is important to implement the ideas systematically. The suggested solution in the sphere of finance planning, distribution, and spending will require involvement of the whole structure. The financial system should be restructured on the governmental level involving cooperation with current medical insurance companies. The implementation plan includes the following points:
1. Investigate the current situation in healthcare system and define the drawbacks.
2. Develop a centralized single payer system, basing all the finance in one center.
3. Calculate the necessary amount that has to be in the system for every person in case of emergency.
4. Make the calculations of possible dotation costs from the government that will be directed for development of medical system.
5. Divide the healthcare system into various segments for each state.
6. Each state should work out the best system of taxes that will be transferred to the healthcare system to cover possible necessary medical costs.
7. Develop high quality monitoring system that will make it possible to tax the peoples salary taking into account all the possible costs.
8. Give full rights to distribute costs for medical staff salaries and covering all costs to the regional representatives in each state. They have to send the reviews to the head office that will control the amount of taxes, costs, and required donations.
9. People who have medical insurance will have an opportunity to transfer the costs from their insurance companies to a centralized system and will have a free-of-tax period for their medical costs.
10. Analyze the effectiveness of the new system and see the difference in peoples reaction as well as effectiveness of spendings according to the new system.
This suggested solution requires significant finances and restructuring of the whole system of finance optimization in the US healthcare system. Moreover, insurance companies would be restructuring their work significantly, as they will have to develop new insurance plans that will be provided to people in their workplaces. The implementation plan may seem unreal at first. It requires research that is more thorough, including sample implementation and analysis with forecasts on possible results. Using the described experience of Canadian healthcare system would be productive and effective if applied during the reform of healthcare system in the US. People would have more opportunities to have necessary medical treatment when they need it. Such layers of population as elderly people, children, and the unemployed, who cannot afford medical insurance would have ways of getting necessary medicine and pills as well as medical equipment necessary for everyday use.
The role of the federal government in the health care system is limited to ascertaining compliance with the general principle of Medicare, partial funding of health programs of the provinces or territories, and other functions specified in the Constitution of Canada. One such feature is the direct medical care for specific groups of Canadian citizens, which include veterans, Aboriginal Canadians living in reservations, military, and employees of the Royal Canadian Mounted Police (Fierlbeck, 2011). Other functions include prevention and protection of public health and promoting healthy lifestyles. Such practices of the Canadian healthcare system prove that this system is well-structured and people of all layers of population will have more access to the required pills and necessary medical equipment.
In conclusion, it is important to mention that Canadian system of healthcare can offer a number of productive solutions to the existing problems in the US healthcare system. The best and the most important is the question of financing, service provision, and distribution of costs. The system of single payer has to be thoroughly planned and developed in the US because it will make payments for services easier and doctors will receive the costs in time. Nationalization of medical system is good for finance resource planning, but at the same time the US system can follow the example of Canadian doctors in the question of autonomy of doctors and centralized payments. However, the Canadian system as a whole cannot be transferred to the healthcare system of the US as the former has a number of drawbacks and mistakes. Only specific features can be considered as productive and progressive for the US system of healthcare.