Canada is ranked as the second largest country in size but 39th in population (CIA, 2009). These two factors combine to make it quite unique. The Canadian health system is just as unique. Bordering the United States, which has the antithesis of a single payer health system, Canada has maintained one of the most successful health systems in the world for the past 40 years.
With more than 80% of the population living in urban areas, the health system can make primary and acute care accessible to a large population (CIA, 2008)(WHO, 1996). Life expectancy is among the highest in the world for both men and women at 79.6 (StatCan, 2001). The infant mortality rate (IMR) for 2005 was 5.4 per 1000 births, making it one of the lowest in the world (StatCan, 2005). Since life expectancy is so high and IMR is so low, 12% of the population is over the age of 65, a high percentage of older population. Added to the fact that fewer people are having children, this means that Canada is in the fourth stage of a demographic transition.
The Canadian health system has some of the best health outcomes in the world, with death and disease rates lower than most. Still, only 52% of Canadians say they are satisfied (Gallup, 2003). One of the major complaints is long wait times for special services such as MRIs and other high demand treatments.
In 1957, the Hospital Insurance and Diagnostic Services Act (HIDS Act) was passed, establishing single payer insurance that implemented universal coverage for inpatient hospital care. The HIDS Act set into motion a foundation on which the Canadian health system as we know it was built. It evolved into the national health system, which provides universal coverage to 10 geographically and culturally diverse provinces (WHO, 1996).
Funding and Spending
Many people call the Canadian system “socialized medicine” but actually it more closely resembles a Medicare system where the heath insurance is government sponsored. This means that physicians are not hired by the state but are privately employed and are paid fee-for-service by the government using taxpayer dollars (Davis, 1999). In 2006, Canada spent $3,672 per capita, and health costs were 10.0% of Gross Domestic Product (GDP). Seventy percent of total health costs are publically funded (WHO, 2006); thirty percent comes either from private insurance, employer insurance, or out-of-pocket (Davis, 1999).
Structure
The Canadian health care system has two main levels of power. The first is the provincial, in which the health ministries take on the day-to-day management of health services. The ministers of health plan, finance, and evaluate all types of care, e.g. hospital, physician, and public health. Provincial health ministries must also fund all public health activities and negotiate fees (WHO, 1996).
The second level of power is at the federal level. The federal government's role is to set and administer national standards for the health care system. Another federal responsibility is providing health care delivery to veterans, native Canadians living on reserves, military personnel, federal prisoners, and the police. The final function is disease surveillance, prevention, and health promotion (WHO, 1996).
Primary Health Care and Public Health
The lion’s share of primary health care is delivered by a general practitioner or a family doctor. Since they are the first point of contact in the health system they filter access to specialists, admission to hospitals, and other health professionals (WHO, 1996).
The original intent of public health was to control and prevent communicable disease. Since communicable diseases have mostly been ameliorated in Canada, public health has extended its mission to include health promotion and equitable distribution of health services to all members of society, as well as prevention of non-communicable disease and support for mental health services (WHO, 1996).
The Role of the Private Sector
Besides a single payer health system, there also exists a private sector. Canadians might opt to go to the private sector because of dissatisfaction with the public system or to seek an alternative and complementary treatment. The government is not responsible for payment of claims for those who elect to choose that option. There are many doctors, chiropractors, dentists, and such who operate outside of the government provided system. In addition, there are private insurance companies that can supply employers with supplementary health insurance (WHO,1996).
Conclusion
One admirable aspect of the Canadian health system is that it doesn’t rest on its laurels. Building on its foundation of universal coverage, Canada strove even further to insure all of its people. Using the public health system to focus on health promotion and health equity, Canada has achieved some of the best health outcomes in the world. Today’s topsy-turvy economy raises many concerns regarding sustainability. Even in that arena, Canada has created many ways of cost containment, thus promising a continued healthy future for its healthcare system.
References
CIA , World FactBook. (2009). Canada: people.
Retrieved from
https://www.cia.gov/library/publications/the-world-factbook/geos/ca.html
Davis, J B.. (2001). Canada’s health system. Croatian Medical Journal 40(2).
Retrieved from
www.cmj.hr/1999/40/2/400221a.pdf
Gallup. (2009). Healthcare System Ratings: U.S., Great Britain, Canada.
Retrieved from
http://www.gallup.com/poll/8056/healthcare-system-ratings-us-great-britain-canada.aspx
Statistics Canada. (2001). Life expenctancy.
Retrieved from
http://cansim2.statcan.gc.ca/cgi-win/cnsmcgi.pgm
Statistics Canada. (2005). Infant mortality.
Retrieved from
http://cansim2.statcan.gc.ca/cgi-win/cnsmcgi.pgm
World Health Organization (1996). Health Care Systems in Transition: Canada.
Retrieved from
www.euro.who.int/document/e72450.pdf
World Health Organization (2006). Canada: statistics.
Retrieved from
http://www.who.int/countries/can/en/
Showing posts with label health systems. Show all posts
Showing posts with label health systems. Show all posts
Thursday, November 05, 2009
Thursday, August 13, 2009
Is there an inverse relationship between tradition and regulation? A Comparison between Canada and India
Indian culture is one of the oldest if not the oldest living culture still going strong. Without a doubt, one of the factors that generated that kind of longevity is tradition. Regardless of how we might judge tradition with a 21st century lens, a strict family structure with rigid social and cultural norms has got to be one of the reasons for India’s perseverance.
One of the hardest to understand cultural differences between India and Canada is the tradition of marriage. “Dr. Sanjay” (not his real name) is in his 30’s and a typical upper-caste Indian man. He is very handsome and tall but yet single. He is a senior resident doctor of community medicine at PGI. He led a tour of the community health center in Kheri for a group of doctors from North Koreans and myself. The North Koreans doctors, Dr. Sanjay, and I discussed each of our country’s courtship rituals on our way back to PGI medical center. The North Koreans asked if he was married. He said, “no.” As we were discussing this, a beautiful young rural woman passed by our van. I said, “in Canada, if we found her attractive we could approach her and ask her for a date, and if things worked out it is possible to get married. “ Dr. Sanjay said, “That would be next to impossible here.”
Another part of our tour was to observe a public health class. During the class discussion about private and public health, I was invited by the teacher to speak about the Canadian healthcare system. Being an American who lived without health insurance for many years and who now resides in Canada I had a pretty good personal perspective on each system. After sharing my experiences about the Canadian system, the students discussed the Indian health care system. I was impressed by their description of India’s far-reaching delivery of health to its people, but this interaction prompted me to ask an important question: why does Canada have generally very good health outcomes but India has some really poor outcomes?
I began to try to think of reasons and issues besides the obvious ones like population and colonization. This led me to a peculiar realization. India has one of the most rigid social structures on earth, yet the ability for the people to follow government regulations seems like a monumental task. And paradoxically Canada has very little real tradition, and there is no rigid social system. You can walk out of your house and marry anyone you please, and yet if you drive without a seatbelt or on the wrong side of the road you would be severely punished maybe even lose your license. To me the striking difference is a culture of safety—seemingly simple safety regulations that most people in Canada have no difficulty following are almost non-existent in India.
This difference makes me wonder if the health system is the most important way of preventing mortality. This question led me to develop four ideas that, in theory, could take the burden of prevention out of the hands of the health system. These include 1) a general culture of health awareness, 2) stronger regulations, 3) definite and immediate accountability for infractions, and 4) improved infrastructure like clean water, safer roads, sidewalks, etc.
While these are challenging and sometimes expensive endeavors, I have noticed an improvement in some of these areas since my last trip to India, in 2001, in things like public smoking restrictions and at least minimal seat-beat laws. Changing culture is rarely easy, but it won’t happen without starting somewhere. Public safety has to be assimilated into construction, food production, the work place, transportation and any business where people can be harmed by products.
Canada has great infrastructure. Water for human use is filtered and treated to a high degree of purity, roads are safe, and building construction is highly regulated for safety. Contractors and developers can get arrested if they cut corners on building codes, there are elected officials in charge of checking on zoning and building codes of safety, and they have the authority to stop construction or penalize a contractor if unsafe construction practices are used. These regulations are designed for both the construction phase, to protect workers and the public, and for the completed phase, to ensure that buildings don’t collapse or require nearly immediate repairs.
In addition, driving in India is a high-risk activity. On the 5-hour drive from Chandigarh to the Delhi airport, I saw two immediate wrecks probably involving fatalities, three trucks overturned, and numerous automobiles driving on the wrong side of the road. To a North American observer, this disregard of road safety seems to be a point of pride with many Indians, as if they see any demonstration of fear about daily driving habits to be a sign of weakness. This type of cultural myopia is hard to change. When I discussed road safety with many people, they often laughed at our concern and shrugged off the seriousness of accidents. But road accidents in India are extremely high.
According to a Boston Globe article using World Health Organization statistics, “road accidents now are the number two killer of young people age 5 to 29 worldwide…. [In India], an estimated 270 people die each day from road accidents, and specialists predict that will increase by roughly 5 percent a year.”
Many cars do not have operable seat belts, and children ride on motorcycles and scooters without any protection. In Canada this practice is illegal. In fact, it is also so culturally abhorrent that people would call the police and look down on such a person. Because I am a cultural relativist, I don’t judge Indian people who chose to ride a motorcycle with a child, as I understand there are many factors that influence behaviors. But I am concerned about safety. My biggest fear in India is seeing an accident involving a child being slammed onto the asphalt—if I witnessed such an incident I would never forget it.
Much of India’s charm is its stalwart retention of its culture, even in the face of westernization. In Canada, without the long tradition and strong culture, sometimes there is a loss of identity, as people seem to be grasping for something to believe in. Also, such stringent regulations can sometimes be claustrophobic and create a backlash. It is precisely in this dilemma where the public health worker inside me, who believes in safety and longevity as a human right, and the dedicated traveler, who believes that culture is what makes us unique, collide. But I do think a happy medium can be achieved slowly.
One of the hardest to understand cultural differences between India and Canada is the tradition of marriage. “Dr. Sanjay” (not his real name) is in his 30’s and a typical upper-caste Indian man. He is very handsome and tall but yet single. He is a senior resident doctor of community medicine at PGI. He led a tour of the community health center in Kheri for a group of doctors from North Koreans and myself. The North Koreans doctors, Dr. Sanjay, and I discussed each of our country’s courtship rituals on our way back to PGI medical center. The North Koreans asked if he was married. He said, “no.” As we were discussing this, a beautiful young rural woman passed by our van. I said, “in Canada, if we found her attractive we could approach her and ask her for a date, and if things worked out it is possible to get married. “ Dr. Sanjay said, “That would be next to impossible here.”
Another part of our tour was to observe a public health class. During the class discussion about private and public health, I was invited by the teacher to speak about the Canadian healthcare system. Being an American who lived without health insurance for many years and who now resides in Canada I had a pretty good personal perspective on each system. After sharing my experiences about the Canadian system, the students discussed the Indian health care system. I was impressed by their description of India’s far-reaching delivery of health to its people, but this interaction prompted me to ask an important question: why does Canada have generally very good health outcomes but India has some really poor outcomes?
I began to try to think of reasons and issues besides the obvious ones like population and colonization. This led me to a peculiar realization. India has one of the most rigid social structures on earth, yet the ability for the people to follow government regulations seems like a monumental task. And paradoxically Canada has very little real tradition, and there is no rigid social system. You can walk out of your house and marry anyone you please, and yet if you drive without a seatbelt or on the wrong side of the road you would be severely punished maybe even lose your license. To me the striking difference is a culture of safety—seemingly simple safety regulations that most people in Canada have no difficulty following are almost non-existent in India.
This difference makes me wonder if the health system is the most important way of preventing mortality. This question led me to develop four ideas that, in theory, could take the burden of prevention out of the hands of the health system. These include 1) a general culture of health awareness, 2) stronger regulations, 3) definite and immediate accountability for infractions, and 4) improved infrastructure like clean water, safer roads, sidewalks, etc.
While these are challenging and sometimes expensive endeavors, I have noticed an improvement in some of these areas since my last trip to India, in 2001, in things like public smoking restrictions and at least minimal seat-beat laws. Changing culture is rarely easy, but it won’t happen without starting somewhere. Public safety has to be assimilated into construction, food production, the work place, transportation and any business where people can be harmed by products.
Canada has great infrastructure. Water for human use is filtered and treated to a high degree of purity, roads are safe, and building construction is highly regulated for safety. Contractors and developers can get arrested if they cut corners on building codes, there are elected officials in charge of checking on zoning and building codes of safety, and they have the authority to stop construction or penalize a contractor if unsafe construction practices are used. These regulations are designed for both the construction phase, to protect workers and the public, and for the completed phase, to ensure that buildings don’t collapse or require nearly immediate repairs.
In addition, driving in India is a high-risk activity. On the 5-hour drive from Chandigarh to the Delhi airport, I saw two immediate wrecks probably involving fatalities, three trucks overturned, and numerous automobiles driving on the wrong side of the road. To a North American observer, this disregard of road safety seems to be a point of pride with many Indians, as if they see any demonstration of fear about daily driving habits to be a sign of weakness. This type of cultural myopia is hard to change. When I discussed road safety with many people, they often laughed at our concern and shrugged off the seriousness of accidents. But road accidents in India are extremely high.
According to a Boston Globe article using World Health Organization statistics, “road accidents now are the number two killer of young people age 5 to 29 worldwide…. [In India], an estimated 270 people die each day from road accidents, and specialists predict that will increase by roughly 5 percent a year.”
Many cars do not have operable seat belts, and children ride on motorcycles and scooters without any protection. In Canada this practice is illegal. In fact, it is also so culturally abhorrent that people would call the police and look down on such a person. Because I am a cultural relativist, I don’t judge Indian people who chose to ride a motorcycle with a child, as I understand there are many factors that influence behaviors. But I am concerned about safety. My biggest fear in India is seeing an accident involving a child being slammed onto the asphalt—if I witnessed such an incident I would never forget it.
Much of India’s charm is its stalwart retention of its culture, even in the face of westernization. In Canada, without the long tradition and strong culture, sometimes there is a loss of identity, as people seem to be grasping for something to believe in. Also, such stringent regulations can sometimes be claustrophobic and create a backlash. It is precisely in this dilemma where the public health worker inside me, who believes in safety and longevity as a human right, and the dedicated traveler, who believes that culture is what makes us unique, collide. But I do think a happy medium can be achieved slowly.
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