For this paper I chose to compare and contrast two countries; that of the United States health care system and Canada’s health care system. The United States is considered to have the most expensive health care system. This system dates all the way back to World War II. In health care, Canada and the United States is different in many ways compared to how they use to be at one time. There are problems in each country that lies within the major stakeholders of the health care system and what things can be done to make it less expensive for patients. Also, in this paper there will be discussions on the statement of the problems, the history of the problems, describing the role of the stakeholders in the problem, sharing how the P.P.A.C.A. and other federal policies have attempted to address this issue, as well as, recommendations on what should be done to address this issue. The first to be done is to discuss the major problem of our health care system which happens to be the price. There was an article written in 2010, which shows that 17% of our Gross Domestic Product (GDP) was spent on health care.
According to this article, it is supposed to increase by 18% by the year 2018 (Crissy, Larimer, Furnas, Spencer, 2010). One may ask the question: What is Gross Domestic Product? As found in the English dictionary, the definition is “the total market values of goods and services produced by workers and capital within a nation’s border during a given period of time” (English Dictionary online). In my opinion this more or less means that the cost of health care is rising, and the coverage is declining. Patients will have a hard time paying out-of-pocket in seeking care for their sickness. Therefore, patients will end up dropping that insurance coverage because of the expensiveness of the insurance. If patients choose to see their provider, it will probably be for emergencies only, which may result in higher medical bills. Then, patients will feel like they have to file bankruptcy due to the rising cost of medical bills. Due to this fact; there will be a domino effect which will hurt the hospitals and providers due to this happening.
As I did research about this matter, if the patient files bankruptcy the hospital and providers are not reimbursed for the care they provided. This in turn will make the hospital or providers go into debt, or the debt will be passed on to patients who are covered and will pay the charges. How did health care in America get to be so expensive? Well, after doing some research, it all started after World War II. What the government did was to put a hold on all wages and companies had to abide by this law. Due to this matter, companies began offering health care benefits to their employees (Allen, 2010). Obviously, it was to have better coverage and least expensive coverage for the employees. Through all of this with the discovery of new technology, new medicines, and different types of vaccines, the price of health care ended up rising. In other words, due to the high priced procedures and medicines, employers/patients that had based insurance premiums along with co-pays which went up for them both.
Due to the rising price people began dropping their coverage (Allen, 2010). This brings up the part to compare and contrast the United States health care system against Canada’s health care system. Perhaps the most troubling dissimilarity between the U.S. and Canadian healthcare systems is the variance amount spent on administration. To access Canada’s health care system one must first apply for a provincial health card. “The accessing of the health care system excludes inmates, the Canadian Armed Forces and certain members of the RCMP. According to Canada’s Health Care Act, all residents of a province or territory have to be accepted for health coverage. There is a waiting period in place for new immigrants that cannot exceed three months” (Rose, Lantz, & House, 2006). There is one large group of physicians in the United States that say they estimate that it spends 12 percent of income collected.
On the other hand, Canada has merely half as many clerical workers per office-based physician. The United States health care overheads are higher because there is a higher number of an uninsured person in the America. When it comes to the GDP of both; the United States stands at 14.6% and Canada is at 9.6% (Spithoven, 2009). In Canada, the health care is universal, meaning everyone is covered regardless of financial status (Spithoven, 2009). Canada is a single-payer health care system. Thus, allowing for “global budgeting and rationing” (Spithoven, 2009). The United States does not guarantee everyone health care coverage. It has a fragmented public-private health care financing system (Spithoven, 2009). Private health insurance in the United States is tax subsidized by federal states. This means Federal tax undermine cost and consciousness. The United States health care expenditure is 100%, whereas Canada’s health care expenditures is at 30.3% (Spithoven, 2009). That is a difference of 69.7%, which is a lot of money! In this section, I will discuss the Insurance companies as being the biggest stakeholders and the biggest reason why the United States spends so much on health care? What insurance companies do is that they set the coverage, premiums and deductibles their consumers will have and pay for. They offer the provider or hospital a “capitated fee” (Sultz & Young, 2012).
What is a capitated fee? According to the text, a capitated fee is defined as “a predetermined per-person charge made by the carrier for benefits available under an insurance plan” (Sultz & Young, 2012). The problem that most of us can face if this were to happen is that if the premiums and co pays are too expensive for the working consumer to afford, then they will choose not to get seen until it is an emergency. Because of the rising cost in health care, coverage is becoming more expensive than ever before for persons, kinfolks, and proprietors. The government database shows the high costs in insurance premiums are being followed unswervingly with the growth of the fundamental medical cost. Therefore, people will be forced to become in medical debt, or claim bankruptcy. Another question that many of Americans may want to ask is “Why is the United States spending so much on health care?
There are several reasons our country spend more on health care and the reasons are as follows: Charges for brand-name drugs are much greater in the U.S., than that of a cheaper product, physicians are compensated more in this country, that is because they live in an expensive economy with a more imbalanced circulation of wages, and with so many new technologies out there some medical device technologies like scanning are more widely used in the U.S; some like hip replacements are not ( I agree with this point because I had a hip replacement in 1994 and it was expensive during that time). Let us talk about Obamacare! Obama wants to make insurance more available to all Americans and change the system so that it is cheaper.
Also, he is making the change so the insurance companies find it harder to get out of not paying for treatments. Obama campaigned on reforming the health care system. He said insurance should be made more available but how can it be done if there is constant talk of Obamacare being a failure. After doing research about the Patient Protection and Affordable Care Act, it was found that this Act comprises nine titles, which addresses an important constituent of reforms. They are as follows:
1. Quality, affordable health care for ALL Americans
2. The role of Public programs
3. Improving the quality and efficiency of health care
4. Prevention of chronic disease and improving public health 5. Health care workforce
6. Transparency and program integrity
7. Improving access to innovative medical therapies
8. Community living assistance services and supports
9. Revenue provisions (www.dpc.senate.gov)
Now let us talk about the proposal of the Patient Protection and Affordable Care Act (P.P.A.C.A.). On March 23, 2010, the P.P.A.C.A was signed into law (www.hhs.gov). This law is to provide the insurance companies a chance to increase their profits, by making it mandatory for everyone to obtain health insurance. The title that is of importance to everyone is the Quality, Affordable health care for all Americans. According to this title, each state established Give-and-take to help people and proprietors acquire treatment. Also, refundable tax credits are available for Americans who has an income falling between one hundred (100) and four hundred (400) percent of the federal policy (www.dpc.senate.gov). The “Congressional Budget Office (CBO) has determined that the Patient Protection and Affordable Care Act is fully paid for, will provide coverage to more than 94% of Americans while staying under the $900 billion limit that President Obama established, bending the health care cost curve, and reducing the deficit over the next ten years and beyond” (http://www.dpc.senate.gov).
This in turn will bring down the cost of health care so everyone is able to afford some type of health coverage. It is supposed to encourage universal medical care coverage through regulated competition among private insurance companies (P.P.A.C.A.). While I may agree with most of the regulations in this act, I still do not see how it is affordable for everyone. I looked up a website for the state I live in, which is Louisiana. They offer different plans for different budgets. However, the lowest plan for an individual is around $294.00 a month, with a $4,500.00 deductible per family member with it not to exceed $6,350.00 (www.healthcare.gov). On this website there are estimates given from many other insurances. This is an estimate from HMO Louisiana. I am not sure how this is supposed to be affordable for any individual. Regardless if there are programs and tax credits to help a person pay for these benefits, a person still has to come up with the funds, first. How is that anywhere near being “affordable” for anyone? I do not think it is. There are people that live off of a set income, like myself.
My recommendation would be implementing some of the suggestions written by Erwin Blackstone and Joseph from their book titled, “Redefining Health Care: Creating Value-Based Competition on Results.” What they suggested was that the United States get back to a “patient-centered system” instead of the “supply-driven system” that our country is currently using (Porter; Lee, 2013). The first step of this process is to “Organize into Integrated Practice Units” (Porter; Lee, 2013). What is meant by this step is that a team of dedicated members of clinical and non-clinical personnel will provide full care for each patient’s condition (Porter; Lee, 2013). This process cut down all out-of-pocket costs, traveling expenses, as well as, the stress endured by finding a physician in the network (Porter; Lee, 2013). Secondly, every patient has to be measured in outcomes and cost individually (Porter; Lee, 2013).
This means the team has to track each patient’s medical condition before and after treatment, and the cost each patient may have endured during their care cycle. Thirdly, this step suggests that the United States go to a bundled payment system. Fee-for-service nor global capitation get rewarded for improving their quality of care (Porter; Lee, 2013). With this step, the providers will get paid for the quantity of services they prescribe out, which does not include the value that the patient is getting. Because the United States does not use bundled payments, the providers “benefit from improving efficiency while maintaining or improving outcomes” is at risk. In step four it is suggested to “integrate care delivery systems”. According to this article, in 2011 60% of hospitals in the U.S. were a part of a multisite health organization. This has gone up from 1999, when it was just 51% (Porter; Lee, 2013). However, these multisite organizations are not “true delivery systems, and most duplicate services (Porter; Lee, 2013). In order to achieve this step those who are the leaders in the health care system need to “define the scope of services, concentrate volume in fewer locations, choose the right location for each service, and integrate care across locations” (Porter; Lee, 2013).
The leaders of the health care system have to learn how to give up some of their services and relocate these services in order to improve the quality of care for the patients. I believe that the fifth step is of the utmost importance. It states that specialists should expand their geographic reach in order to see more patients than the ones that are close by (Porter; Lee, 2013). Each IPU satellite facility is established and staffed by the parent organization. I feel that this will keep more focus on the quality of care given to the patient and not the increasing volume given to the facility. Porter & Lee say this type of facility is more common with cancer centers and Children’s Hospitals across the nation. Last but not least, step number five explains that one must “build an enabling information technology platform” (Porter; Lee, 2013). This is what the health care system is trying to achieve, now, by going to electronic medical records. What this platform does is amazing; it follows the patient from the beginning of the care cycle to the end, as well as, implementing a standardized terminology database.
This is a way to make sure that every provider/professional that is caring for that patient is speaking the same language. Also, this system can hold all kinds of patient data, which includes but not limited to notes, images, orders and results of the patients. With this step, every physician or medical personnel has access to the same medical record of each patient. According to Porter/Lee, this system should include orders, medication, and templates so that providers/professionals can quickly input patients’ diagnosis. It should be easy to extract patient information for data tracking measures, as well (Porter; Lee, 2013). In conclusion, I have given information about the variance between two countries; the United States and Canada’s health care system. We, as a whole, know that health care cost is steady rising, in the United States. To top it off this has been happening ever since World War II.
By the rising cost, this has made the United States have the most costly health care system, in the world compared to Canada. There is a history for the ever rising cost. The U.S. is no longer compared to Canada’s health care system, like it used to be. People should know the reasons for the cost of health care rising and will there ever be a better coverage for them. The insurance companies are the biggest stakeholders of all, in this system. The only way the insurance companies’ agreed with the P.P.A.C.A. was due to the fact that they saw an increase in their profit margin. The P.P.A.C.A has some requirements that I agreed with, as well, but there are still improvements to this act that should be implemented. In my opinion, the five steps that Erwin Blackstone and Joseph Fuhr breaks down and explains how they can help with the problem of the health care system will be a good start in bringing down the U.S. health care cost for everyone involved.
https://www.google.com/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=canada’s++medical+system+chart https://www.google.com/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=united+states+medical+system+chart http://www.hhs.gov
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Affordable Care Act, including standards related to exchanges. Final rule. Federal Register. United States, 79, 172, 52994-53006, Sept. 5, 2014. ISSN: 0097-6326. Rose DJ, Lantz PM, House JS, et al. Health care access and the use of clinical preventive services. Paper presented at: Annual Meeting of the American Sociological Association; 2006 Aug 10; Montreal, Quebec. Available from: http://www.uspreventiveservicestaskforce.org/uspstf08/methods/procmanual.htm Spithoven, A.M. (2009) Why U.S. Health Care Expenditures and Ranking on Health Care Indicators Are so Different From Canada’s. International Journal of Health Care Finance andEcoomics,9(1), 1-24 doi http://dx.doi.o hford.edu/10.1007/s10745-008-90440rg.proxy.library.as Sultz, H.A. & Young, K.M. (2012). Health Care USA: Understanding its organization and delivery (7th Ed). San Diego, CA: Bridgepoint Education, Inc.
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