Question

Part B: Read the scenario (below), and then respond to the instruction that follows.

Scenario: You are part of an international health conference where health professionals from around the world have gathered. Your role is to provide a greater understanding of the history and current standings of the U.S. healthcare system. The first day of the conference focuses on the history of healthcare. You will have a friendly debate with Germany and Canada on how healthcare has evolved.

Create a table that presents

1. the similarities and differences of the healthcare systems among the U.S., Germany, and Canada. Pertinent information should include but is not be limited to:

a. Total population

b. Gross national income per capita

c. Life expectancy at birth for males and females

d. Total expenditure on health per capita

e. Total gross domestic product percentage (GDP %) expenditure on health

Answer 1

Here is the comparison of healthcare systems of three most industrialized economies of the world, namely, USA, Canada and Germany.

Total Population

USA is having total population of 32.72 crores (2018), Germany is having total population of 8.28 crores (2018) and Canada is having total population of 3.71 crores (2018).

Gross national income per-capita

USA : $63,390- 2018

Canada : $47,490-2018

Germany : $54,89- 2018

Life expectancy at birth

	Male	Female
USA	76 Years	81 Years
Canada	80 Years	84 Years
Germany	77 Years	82 Years

Total expenditure on health per capita

USA- $9,892

Canada- $4,753

Germany- $5,551

Total gross domestic product percentage (GDP %) expenditure on health

USA- 17.9 %

Canada- 11.6%

Germany- 11.5%

Health care system in USA

Unlike many countries, USA has no a single health insurance scheme which has coverage nation wide. Out of total population covered under an insurance 26% is by public and 70% by private insurance companies. Since the cost saving has been related to group planning which can be purchased through an employer, the maximum coverage comes under this which estimated to 61%. There are internal health care plans which avail employer and employee premium, thus there is more preference than purchasing it from an external party. The firms which have full insurance coverage, assume its employees health care costs unlike partially insured firms which purchase  “stop loss” insurance coverage, which protects it from incurring costs over a specified maximum amount. Bit in both cases a third party administer the insurance program.

There are basically two types of MCOs: Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). About 70 percent of employees are currently enrolled in MCOs. HMO is a health care delivery system that combines the insurer and producer functions. HMOs are pre – paid and in return provide comprehensive services to enrollees. PPOs are a third party payer that offers financial incentives such as low out – of – pocket prices, to enrollees who acquire medical care from a preset list of physicians and hospitals.

The two major types of public health insurance, both of which began in 1966 are Medicare and Medicaid. Medicare is a uniform national public health insurance program for aged and disabled individuals. Administered by the federal government, Medicare is the largest health insurer in the country, covering about 13 % of the population.

However, another category of individuals exists: those who are uninsured. Approximately, 16 % of the population is estimated to lack health insurance coverage at any point in time. This does not mean these individuals are without access to health care services. Many uninsured people receive health care services through public clinics and hospitals, state and local health programs, or private providers that finance the care through charity and by shifting costs to other payers.

Government, not – for – profit, and for – profit institutions all play a role in health care markets. Unlike in Canada and Germany, where a single payer – system is the norm, the United States possess a multiplayer system in which a variety of third – party payers, including the federal and state governments and commercial health insurance companies are responsible for reimbursing health care providers.

Health care system in Canada

Canada has a national health insurance program NHI (a government run health insurance system covering the entire population for a well defined medical benefits package). 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).

Canada’s health care system is known as Medicare (the term should not be confused with the Medicare program for the elderly in the U.S.). Physician fees are determined by periodic negotiations between the ministry and provincial medical associations (the Canadian version of the American Medical Association).

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. In 1997 Canada’s 53 MRIs meant one for every 572,000 citizens (contrast that figure to 2046 MRIs in the U.S., one for every 130,800 Americans). Access to open heart surgery and organ transplantation is also restricted.

Health care system in Germany

Germany’s health care system has its origins in the “mutual aid societies” created in the early 19^th century. The government is obliged to provide a wide range of social benefits to all citizens, including medical care, old age pensions, unemployment insurance, disability payments, maternity benefits and other forms of social welfare.

All individuals are required by law to have health insurance. Those earning less than $35,000 (1995) must join one of the sickness funds for their health care coverage (Henderson 495). Sickness funds are private, not – for – profit insurance companies that collect premiums from employees and employers. Those earning more than this limit may choose private health insurance instead. Approximately 74% of the population is compelled to join a sickness fund. Another 14% are members who join voluntarily even though their income exceeds the statutory cutoff. Of the remaining portion, 10% is covered by private insurance and 2% by police officers insurance, student insurance and public assistance. One of every 10 Germans covered by sickness fund insurance also purchases private supplementary insurance to cover co-payments and other amenities.

Individual health insurance premiums for workers are calculated on the basis of income and not age or the number of dependents. Premiums are collected through a payroll tax deduction; the average contribution was 13.4% of workers gross salary in 1993. The social insurance component is organized around some 500 localized sickness funds. The sickness funds are independent and self – regulating. They pay providers directly for services provided to their members at rates that they negotiate with individual hospitals. Regional groups of funds negotiate with regional doctors’ and dentist’ associations for payment for ambulatory and dental care. Payment from these funds represents about 70% of health care spending

In the German health care system, each level of government has specific responsibilities. The central government passes legislation on policy and jurisdiction. State governments are responsible for hospital planning, managing state hospitals, and supervising the sickness funds and physician associations. Local governments manage local hospitals and public health programs.

The German system suffers from several problems that bring into question its ability to contain costs over the long term. Possibly the biggest problem with the system is its reliance on third party payment providing virtually no role for the cost – conscious consumer. Patients have no incentive to limit their demand and medical providers have no incentive to limit their supply. Nothing would lead competitive forces to reduce costs. The only competition is among medical practitioners to attract more patient volume. The ability of the system to control costs depends solely on the relative bargaining power between sickness funds and medical providers. Another problem with the system is its tendency to use resources inefficiently.