US Health Insurance vs. Canadian Health Insurance - Essay Example

US Health Insurance vs. Canadian Health Insurance Health insurance in the United s is failing patients and physicians alike. In this country 37 million uninsured face economic barriers to care, and the health of many suffers as a result. The "corporatization" of medical care threatens professional values with an unprecedented administrative and commercial intrusion into the daily practice of medicine. Competitive strategies have also failed their most ostensible goal--cost control. In contrast, Canada offers a model of a national health insurance plan that provides universal and comprehensive coverage, succeeds at restraining health care inflation, and does little to abrogate the clinical autonomy of physicians in private practice. The big difference here in the US is that there are multiple insurance companies. In Canada you really only have one (one for each province) those offering extended insurance for things like private hospital rooms, vision, dental, etc. The next big difference is managed care. In regards to optometry, you can think of this as the insurance companies that only provide for well vision care contacts and glasses. If there is a medical eye problem (i.e. a disease) they do not pay for the necessary care (generally), and those things should be billed to the major medical. They also pay much discounted fee's compared to medical, Medicare (gov't insurance for seniors) and private pay patients. Optometrists in the US also tend to directly bill the insurance companies, OD's in Canada tend to only bill their respective provincial insurance plans, veteran's affairs, or Indian affairs, while patient's not covered by the above are billed directly by paying cash. If those patients have supplemental vision insurance then they can submit a claim for reimbursement. When KHE talks about insurance discrimination he means that there are many insurance companies in the US that will not pay an optometrist for services performed that they will pay ophthalmologists for, even if the optometrist is licensed to do so in that state. There are some states that have "any willing provider" laws to prevent this, but it still occurs. However, the same thing happens in Canada: Take a look at the OHIP schedule of fee's for optometry, and then compare to that for ophthalmology. You'll find that many tests, procedures, and treatments that optometrist are licensed to perform are covered by OHIP if done by an ophthalmologist, but not an optometrist. However, it could be argued that is just as well since OHIP isn't exactly known for generous fees. In making a rational comparison of the Canadian and American health systems it is more reasonable to contrast service levels and costs of the systems rather than trading anecdotes. Canadians pay about 9% of national GDP to insure 100% of citizens in our single-payer system, compared with more than 14% of GDP to insure 85% of Americans. The Kaiser Family Foundation reports that the average compound annual growth rate in U.S. health insurance costs has been 11.6% over the past five years. It is therefore not surprising that polling by Kaiser found that 75% of Americans were worried or very worried about the amount they would need to pay for health insurance in the future and that 63% were worried or very worried about not being able to afford health-care services. There is no question that restriction of supply with sub-optimal access to services has contributed to the lower cost of health care in Canada. However, a new approach of targeting investments to reduce waiting times combined with transparent reporting of wait times is having a substantial impact on access in the Canadian system. Canadians spend about 55% of what Americans spend on health care and have longer life expectancy, and lower infant mortality rates. Many Americans have access to quality health care. All Canadians have access to similar care at a considerably lower cost. The introduction of private insurance or private-for-profit health care for medically necessary services is not the answer to challenges in the Canadian health-care system. In a systematic review of 38 studies published in Open Medicine in May, 17 leading Canadian and U.S. researchers confirmed the Canadian system leads to health outcomes as good, or better, than the U.S. private system, at less than 50% of the cost. Unwanted side-effects of competitive health care include a drain of highly trained professionals from the public system and "cream skimming" of patients by private clinics who choose the healthiest patients, leaving the most complex to the increasingly overburdened public system. In June 2006, the Canadian Medical Association reviewed all the evidence from other jurisdictions and concluded that private insurance for medically necessary physician and hospital services does not improve access to publicly insured services; does not lower costs or improve quality of care; can increase wait times for those who are not privately insured; and, could exacerbate human resource shortages in the public system. Medicare is not only more equitable, but more efficient and produces higher quality health care than the alternatives. This conclusion is supported by the best national and international evidence, including reports from the World Health Organization and the Organization for Economic Co-Operation and Development. So what should Canada do about patients who do not receive timely access to essential medical care Numerous expert reports, including the 2002 Royal Commission on the Future of Health Care in Canada, have already told us we need to restore and strengthen Medicare, not decimate it. In May the Canadian Centre for Policy Alternatives reported that successful initiatives in team-based care and improved administration produced dramatic cuts in waiting times for surgery in B.C. Alberta, Saskatchewan and Ontario, without any need for competition. An impressive array of data shows that Canadians live longer, healthier lives than we do. What's more, they pay roughly half as much per capita as we do ($2,163 versus $4,887 in 2001) for the privilege. Exactly why Canadians fare better is the subject of considerable academic debate. Some policy experts say it's Canada's single-payer, universal health coverage system. Some think it's because our neighbors to the north use fewer illegal drugs and shoot each other less often with guns (though they smoke and drink with gusto, albeit somewhat less than Americans). Still others think Canadians are healthier because their medical system is tilted more toward primary care doctors and less toward specialists. And some believe it's something more fundamental: a smaller gap between rich and poor. Perhaps it's all of the above. But there's no arguing the basics. "By all measures, Canadians' health is better," says Dr. Barbara Starfield, a university distinguished professor at Johns Hopkins Medical Institutions. Canadians "do better on a whole variety of health outcomes," she says, including life expectancy at various ages. According to a World Health Organization report published in 2003, life expectancy at birth in Canada is 79.8 years, versus 77.3 in the U.S. (Japan's is 81.9.) "There isn't a single measure in which the U.S. excels in the health arena," says Dr. Stephen Bezruchka, a senior lecturer in the School of Public Health at the University of Washington in Seattle. "We spend half of the world's healthcare bill and we are less healthy than all the other rich countries." "Fifty-five years ago, we were one of the healthiest countries in the world," Bezruchka continues. "What changed We have increased the gap between rich and poor. Nothing determines the health of a population [more] than the gap between rich and poor." Gerald Kominski, associate director of the UCLA Center for Health Policy Research, puts the Canadian comparison this way: "Are they richer No. Are they doing a better job at the lower end of the income distribution For lower-income individuals, they are doing a better job." At a meeting last fall of the American Public Health Assn., Dr. Clyde Hertzman, associate director of the Centre for Health Services and Policy Research at the University of British Columbia in Vancouver, analyzed data showing that Canadian women outlive American women by two years and men, by 2 1/2 years. During the last quarter-century, he says, all income groups in Canada also showed gains in life expectancy. During much the same period in the U.S., death rates widened between America's rich and poor, according to a 2002 study in the International Journal of Epidemiology by American and Australian researchers. Infant mortality rates also show striking differences between the U.S. and Canada. To counter the argument that racial differences play a major role, Hertzman compared infant mortality for all Canadians with that for white Americans between 1970 and 1998. The white U.S. infant mortality rate was roughly six deaths per 1,000 babies, compared with slightly more than five for Canadians. Maternal mortality shows a substantial gap as well. According to the Paris-based Organisation for Economic Co-operation and Development (OECD), a 30-nation think tank, there were 3.4 maternal deaths for every 100,000 births among Canadians, compared with 9.8 deaths per 100,000 Americans. And more than half of Canadians with severe mental disorders received treatment, compared with little more than a third of Americans, according to the May-June 2003 issue of Health Affairs. "The summary of the evidence has to be that national health insurance has improved the health of Canadians and is responsible for some of the longer life expectancy," says Dr. Steffie Woolhandler, an associate professor at Harvard Medical School and staunch advocate of a single-payer system. Of course, some causes of death, such as homicide, wouldn't be much affected by having a single payer system. And the U.S. has "the highest homicide rate of all the rich countries," says Bezruchka. "Other things might be differences in seat belt usage," adds Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health. "We are also disproportionate consumers of illegal drugs, much more than Canada, so it's cultural." The health of Americans would be better with universal healthcare, he says. "But there are some things that a single-payer system wouldn't fix - but which would leave one country look healthier in the statistics." In some respects, the healthcare system is "the tail on the dog," says Dr. Arnie Epstein, chairman of the department of health policy and medicine at the Harvard School of Public Health. "It's other aspects of the social fabric of different countries that seem to have a major impact on how long people live," he says. In the U.S., African Americans and Latinos "face problems of housing, stress and low income, which have nothing to do with a single-payer system." Canada has a large number of Asian immigrants, he says, but they, like Asian immigrants in the U.S., tend to do well on healthcare measures. The bottom line is that Canada is doing something right, even if "the reasons are not totally understood," says Kominski of UCLA. References: 1) http://www.informationclearinghouse.info/article5754.htm 2) calnurses.org/media-center/in-the-news/2007/july/page.jsp... - 25k 3) commonwealthfund.org/publications/publications_show.htmdoc_id=482678 4) Szick S, Angus DE, Nichol G, Harrison MB, Page J, Moher D. "Health Care Delivery in Canada and the United States: Are There Relevant Differences in Health Care Outcomes" Toronto: Institute for Clinical Evaluative Sciences, June 1999. (Publication no. 99-04-TR.) 5) Esmail N, Walker M. "How good is Canadian Healthcare: 2005 Report." Fraser Institute July 2005, Vancouver BC. 6) Nair C, Karim R, Nyers C. "Health care and health status. A Canada--United States statistical comparison." Health Rep. 1992;4(2):175-83. PMID 1421020 7)World Health Organization, Core Health Indicators. U.S. government spending was US$2724 vs. US$2214 on a purchasing power parity basis ($2724 and $2121 on a non-adjusted basis); total U.S. spending was US$6096 vs. US$3137 (PPP) ($6096 and $3038 on a non-adjusted basis). 8) Canadian Community Health Survey, 04-06-15 9) U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Retrieved on 2007-06-20 Read More