Where is health insurance cooler: in the U.S. or Canada?

Despite mixed opinions about the effectiveness of the system, 94% of Canadians say their health care system is a source of personal and collective pride in their country.

So how different is Canada's health care system from that of the United States. In 2017, Canada spent about 10.4% of its GDP on health care. By comparison, the United States spent about 17.2% of GDP. The Organization for Economic Cooperation and Development (OECD) estimates that Canada spent about $4500 per person in 2017. In the United States, that figure exceeds $10,200 per person. Out-of-pocket spending is also lower in Canada. On average, Canadians spent about $650 per person in 2016; Americans spent nearly $1,100.

In addition to lower health care costs, Canada also has better health outcomes than the United States. But compared to other countries, Canada's health care system has room to grow. Researchers looked at mortality rates that could have been prevented with proper access to health care in 11 countries. Canada ranked seventh on the list, while America ranked worst. We can see the same trends in infant mortality rates. Canada outperforms the United States, but other countries, such as Sweden and Australia, have much lower infant mortality rates than Canada.

Canadians also live longer than Americans. Life expectancy in Canada is one of the highest of any country and is almost four years higher than in the United States. In addition, the maternal mortality rate in Canada is almost four times lower than in the United States, and more Americans die of heart disease and stroke than Canadians.

So how does Canada manage to spend less money than the U.S. with a more efficient health care system?

Canada's Medicare program is designed to provide the same quality services to all citizens regardless of people's ability to pay and to reduce administrative costs. There is some variation in what services are covered depending on the province, but most basic services are equally available to all residents.

Prescription drugs are not covered, nor are dental, psychiatric and optometry services. Therefore, most Canadians also buy private health insurance through their employers to pay out-of-pocket costs. However, they cannot use this private insurance to purchase government-covered services. In 2015, private insurance costs accounted for about 30% of health care spending in Canada.

"If you are prescribed any treatment, procedure, or surgery that is covered by government insurance, you cannot buy it privately. The Canadian government doesn't want rich people to get the best care. In America, it's okay for a rich kid to get better treatment than a poor kid, it's kind of a standard. In Canada, it's taboo. It's a sin," says T. R. Reid, author of Healing America.

Although most health care is publicly funded, most hospitals and doctors' offices are privately owned. Doctors who own their own private practices are considered contractors who bill the government insurance fund for their services. The government is not their boss.

"Physicians are not allowed to practice outside the system. They can either practice entirely within the public health care system or entirely outside it. There are very few places in Canada where a doctor can make a living without taking Medicare patients, and so for most people this is the only choice."

Despite its accessibility, the system has some problems

Waiting times in Canada are longer than in the United States. In a 2016 survey, 53% of Canadians said they couldn't get an appointment the same or next day they were sick and needed medical advice. The United States fared slightly better, with 42% dissatisfied. Of the 11 countries surveyed, Canada had the worst results in this category.

30% of Canadians said they waited two months or longer to see a specialist, compared with 6% in the United States. Nearly one in five Canadians waited four months or longer for elective surgery, compared with only 4% of respondents in the United States.

About 60% of Canadians have difficulty accessing care in the evenings, weekends and holidays. This waiting time can lead to excessive strain on the emergency department. Half of Canadians say they have waited two hours or more when they desperately need help.

"It's a good system, but it doesn't work so well in Canada. There are long lines and people are constantly complaining about waiting to see a doctor. That's because Canadians don't spend enough on health care to have a living system. There are true provincial exceptions, such as Saskatchewan, where the emergency and elective care system works better than in most of the United States," emphasizes T. R. Reid.

Not all health care is covered in Canada, which leads to significant personal expenses, such as prescription drugs. There are social programs that help Canadians pay for medicines, but the benefits vary from province to province. For example, Ontario provides prescription drug coverage for young people under the age of 24 who don't have private insurance. The province also has a prescription drug program for people over 65 years of age.

That said, Canada spends about the same amount as the UK on drugs, despite the fact that the latter has twice the population. Canadians spent about $670 per capita on drugs in 2015, while the U.S. spent $1,000. One in 10 Canadians didn't get a prescription or chose to skip a dose because of the cost. This is significantly better than in the United States, where nearly one in five people chose not to buy medications because of cost.

Despite the problems, Canadians are proud of their health care system, but they recognize that it needs reform. Nearly one in four Canadians worries about whether they will be able to pay for all the services they might need if they ever become seriously ill.

Despite this concern, 45% of Canadians rated the overall quality of health care in Canada as excellent or very good, and nearly three-quarters said they were satisfied with the quality of care received in the past year.

"Citizens are crazy about everyone being treated equally. That's the most important social value in Canada — equal treatment for everyone. The other thing people like about Medicare is that it's a better system than in the U.S. Canadians have a better rate of recovery from illness, a longer life expectancy, and they pay less. That's important for Canadians," T.R. Reid concludes.