Canada’s healthcare system is often talked about as an alternative to the American system. Is it worth the hype?
It’s yet to be determined what will happen with the future of the American healthcare system. The comparison between healthcare in Canada vs. the U.S. will be a part of the debate.
The Affordable Care Act (also known as the “ACA” or “Obamacare”), the most recent law to significantly reshape American health insurance, was heavily debated before passing Congress in 2010. Today, some politicians hope to repeal and replace the ACA, aiming to cut spending on healthcare by billions of dollars over ten years.
While the American healthcare system’s future is unknown, the present moment gives us an opportunity to evaluate successes and failures in other countries. In particular, the United States is frequently compared to our northern neighbors in Canada. Since we share much in common, one might assume our healthcare systems are similar. However, Americans and Canadians receive medical attention in distinctly different ways.
Where Does Each Country Get Its Health Insurance?
The U.S. Health Insurance System
The Kaiser Family Foundation reported that approximately 9 percent of the population lacked health insurance in 2015. This represents a decrease since 2010, when America’s uninsured rate was almost 16 percent. The ACA is credited for decreasing the uninsured population through a combination of its provisions, like allowing children to stay on their parents insurance until the age of 26 and making it easier to qualify for government-run Medicaid.
Almost half of America gets insurance from an employer. The remaining insured population relies on either on individually-purchased ACA Marketplace plans, or government-run insurance like Medicaid and Medicare. Interestingly, people with Medicare who have either Medigap or Part C may also have Medicare coverage in Canadian hospitals.
A major concern about Republican proposals to repeal the ACA is the estimated increase in the number of uninsured Americans. The Congressional Budget Office estimated that one nearly-adopted strategy would increase the number of uninsured individuals by 22 million people through 2026, bringing the total uninsured population to roughly 15 percent.
The Canadian Healthcare System
Canadians have access to publicly-funded health care, meaning every citizen has access to medical coverage. Canada’s healthcare system is called Medicare (not to be confused with the United States’ version of Medicare, which is only available to a smaller subpopulation). Canadian Medicare covers what Americans would consider to be essential health benefits, but it does not pay for prescription drugs or dental care. Most Canadians purchase private insurance or have to pay for these services out-of-pocket. Approximately two-thirds of Canadians have private health insurance.
Primary responsibility for the administration of health care services lies with each Canadian province. Each province has to follow the regulations that were set in place by the Canada Health Act, which was ratified in 1985. This legislation is used to determine which medical services are essential benefits.
Examining American and Canadian Healthcare Spend
United States Healthcare Spending
The United States regularly receives criticism for being the developed country with highest healthcare spending as a percent of GDP. Not only is America #1 in this regard, but we also have a significant lead over the country with the second-highest spending. The Organization for Economic Co-operation and Development (OECD) recently reported that the United States spent 17.2 percent of its GDP on healthcare in 2016. This is quite a bit more than the next highest OECD country, Switzerland, which spent 12.4 percent.
For U.S. citizens, this means health care costs each person more than $9,000 each year. To break that number down further, OECD data from 2013 showed that for every U.S. citizen:
Canadian Healthcare Spending
Canada and many other developed nations spend much less on healthcare than the United States. Canada spent 10.3 percent of its GDP on healthcare in 2016. Data for health care spending in 2013 showed that health care cost each Canadian citizen $4,569, little more than half of what the cost for U.S. citizens. To break this down further, for every Canadian citizen:
Some of the difference in spending might be explained by the difference in pricing for health-related services. The International Federation of Health Plans reported that in 2013 a CT scan of the abdomen in Canada cost an average of $97, compared to $896 in the U.S.
North American Health Status Indicators
So the U.S. pays more as a country and per person – but surely we’re making up for the extra cost with better health status of our citizens, right? Unfortunately, that isn’t always the case. Below is a comparison of a few key national health determinants.
|OECD data||United States||Canada|
|Life Expectancy||81.2 years for females
76.4 for males
|83.6 years for females
79.4 for males
|Infant Mortality||4.8 deaths per 1,000 live births||6 deaths per 1,000 live births|
|Maternal Mortality||12.7 deaths per 1,000 live births||6.5 deaths per 1,000 live births|
As you can see, major U.S. health outcomes underperform in comparison to Canada. Additionally, even though we spend more, Americans visit the doctor less than Canadians. On average, Americans visited the doctor 4 times in 2013 while Canadians visited nearly 8 times.
Canadian Wait Lists Are A Real Thing
While the U.S. might get grief for spending so much on healthcare, the Canadian health care system is often criticized for the practice of keeping waiting lists. The Fraser Institute reported a median waiting time of 19.8 weeks between referral and receipt of treatment by a specialist in 2018. Since the provinces are responsible for the dispersion and organization of specialty physicians, the wait time can vary greatly from province-to-province.
This is clearly a problem that can cause patients to suffer needlessly. However, it should be noted that there is no waiting list for emergency situations.
American Access to Care Is Controlled By Economic Scarcity
Also, the U.S. doesn’t do much better in practice when it comes to access to care. The Commonwealth Fund found that both the U.S. and Canada had room for improvement when it came to same-day or next-day appointments for doctors or nurses. Only 48 percent of Americans and 41 percent of Canadians had access that care in that timeframe. Slightly under 40 percent of those surveyed in both countries said it was easy to get after-hours care without going to the ER.
Though the U.S. is similar to Canada in many ways, comparing their healthcare systems is like comparing apple trees to maple trees. The two systems are not readily comparable, and it’s not easy to objectively answer who has a better healthcare system. Though both systems may seem set in their ways, change might not be too far away in America.
Healthcare Changes Will Continue for Years to Come
Recently, the Pew Research Center reported growing support for a single payer system in the United States. For the first time, a majority of Americans – 60 percent of those asked – support the idea that the federal government has a responsibility to Americans to provide healthcare coverage. Only 47 percent of those polled agreed with that statement in 2014.
Who knows? The tide might be turning towards maple trees after all.
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