Edited by Chris Harvey. Photo courtesy of the Library of Congress Eastern State Hospital in Williamsburg, Va.
This article has been cited by other articles in PMC. Abstract The purpose of this research paper is to compare health care systems in three highly advanced industrialized countries: The first part of the research paper will focus on the description of health care systems in the above-mentioned countries while the second part will analyze, evaluate and compare the three systems regarding equity and efficiency.
Finally, an overview of recent changes and proposed future reforms in these countries will be provided as well. We start by providing a general description and comparison of the structure of health care systems in Canada, Germany and the United States.
Health insurance coverage is universal. General taxes finance NHI through a single payer system only one third-party payer is responsible for paying health care providers for medical services. Consumer co-payments are negligible and physician choice is unlimited. Production of health care services is private; physicians receive payments on a negotiated fee for service and hospitals receive global budget payments Method used by third party payers to control medical care costs by establishing total expenditure limits for medical services over a specified period of time.
Most of the population lives within miles of the United States border. From the American point of view, Canada provides a good comparison and contrast in terms of the structure of its health care systems.
The Canadian health care system began to take on its current form when the province of Saskatchewan set up a hospitalization plan immediately after WWII.
The rural, low—income province was plagued by shortages of both hospital beds and medical practitioners. The main feature of this plan was the creation of the regional system of hospitals: Inthe federal parliament enacted the Hospital and Diagnostic Services Act laying the groundwork for a nationwide system of hospital insurance.
By all ten provinces and the two territories had hospital insurance plans of their own with the federal government paying one half of the costs.
Since the health care system has moved in different directions. While Canada has had publicly funded national health insurance, the United States has relied largely on private financing and delivery.
During this period, spending in the United States has grown much more rapidly despite large groups that either uninsured or minimally insured. The provisions of the Canada Health Act define the health care delivery system as it currently operates. Under the Act, each provincial health plan is administered at the provincial level and provides comprehensive first dollar coverage of all medically necessary services.
With minor exceptions, health coverage is available to all residents with no out of pocket charges.
Most physicians are paid on a fee for service basis and enjoy a great deal of practice autonomy. Private health insurance for covered services is illegal.
Most Canadians have supplemental private insurance for uncovered services, such as prescription drugs and dental services. As a result, virtually all physicians are forced to participate and each health plan effectively serves all residents in the province Henderson Patients do not participate in the reimbursement process, and reimbursement exclusively takes place between the public insurer the government and the health care provider.
The monetary exchange is practically non-existent between patient and health care provider. The ministry of health in each province is responsible for controlling medical costs. Cost control is attempted primarily through fixed global budgets and predetermined fees for physicians.
Specifically, the operating budgets of hospitals are approved and funded entirely by the ministry in each province and an annual global budget is negotiated between the ministry and each individual hospital.
Capital expenditures must also be approved by the ministry, which funds the bulk of the spending. Physician fees are determined by periodic negotiations between the ministry and provincial medical associations the Canadian version of the American Medical Association.
With the passage of the Canada Health Act ofthe right to extra billing was removed in all provinces. Extra billing or balance billing refers to a situation in which the physician bills the patient some dollar amount above the predominated fee set by third party payer.
For the profession as a whole, negotiated fee increases are implemented in steps, conditional on the rate of increase in the volume of services. If volume per physician arises faster than a predetermined percentage, subsequent fee increases are scaled down or eliminated to cap gross billings — the product of the fee and the volume of each service — at some predetermined target.
The possible scaling down of fee increases is supposed to create an incentive for a more judicious use of resources.
Physicians enjoy nearly complete autonomy in treating patients e. In spite of the differences it is fair to say that each provincial plan is a public — sector monopsony, serving as a single buyer of medical services within the province and holding down medical care prices below market rates.
The key element in the Canadian strategy to control overall spending is the regionalization of high — tech services. Government regulators make resource allocation decisions. This control extends to capital investment in hospitals, specialty mix of medical practitioners, location of recent medical graduates, and the diffusion of high tech diagnostic and surgical equipment.
Access to open heart surgery and organ transplantation is also restricted.Mar 13, · Any successful attempt to reform health care in the United States must accommodate two realities.
Reality 1: The current system is increasingly inaccessible to many poor and lower-middle-class. The health insurance system we have in place today — a mix of private and government payers — has been a century in the making.
Health Care in the United States: An Evolving System. Thomas P. Conklin. Skip other details (including permanent urls, DOI, citation information) Switching from a private and public insurance model to a national health insurance system.
A review of the health care systems of five different countries suggests that the United States. The history of health care reform in the United States has spanned many years with health care reform having been the subject of political debate since the early part of the 20th century.
Recent reforms remain an active political issue. Healthcare Delivery Midterm Study Guide. STUDY. Which country spends the most in adminstrative health care costs?
a. United States b. Germany c. UK d. Australia. a. Preferred Provider System b. Primary Physician System c. Private Practice System d. Prospective Payment System. Between the years and , healthcare in the United States evolved from a simple system of home remedies and itinerant doctors with little training to a complex, scientific, insurance to cover the rising costs of medical care.
While private health insurance emerged prior to World War I, it was not until well after.