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teleSUR compares the healthcare systems in Canada, the U.S. and Cuba, to find out who is really getting the best deal.

Canada

Healthcare in Canada is delivered through a public healthcare system, which is free for Canadians at the point of use and funded mainly through taxes. The philosophy of the system, known as Medicare, is to provide care “on the basis of need, rather than the ability to pay,” according to the Health Canada government website. All residents of a province or territory within Canada must be accepted for health coverage.

Although it is a public system, only 70 percent of overall healthcare spending in public while the other 30 percent is private. Private spending includes private clinics, and services not listed under the CHA mainly pharmaceuticals and dental care.

The Canadian Healthcare System is considered a national system, but it is not a single national program. Actuality, it is a group of 15 different socialized health insurance plans. Thirteen of these plans are managed by the country’s 10 provinces and three territories, with guidelines set by the federal government. These programs are partially funded by federal government transfers, and partially by taxes or premiums set by the province/territory.

There is also a separate program for indigenous communities on reserves, which is administered by the federal government, and another for members of the Canadian military and their families.

Though the system is public, doctors and other healthcare professionals are not government employees. Healthcare professionals are either self-employed, or belong to unions and other organizations that annually negotiate the fees and rates with the government, then they bill the province or territory on a fee-for-service basis. This is also known as a single-payer system. Doctors still have to deal with an insurer, however they only deal with one provincial/territorial insurer.

Hospitals in Canada also operate privately under their own governance structures, but on a non-profit basis. They are funded either by government stipends or private donations. In reality, the Canadian Healthcare system can best be described as publicly funded but privately provided.

Canada spends less on healthcare than the U.S., France and Germany.

Private for-profit clinics also exist across the country, although they are technically not allowed to offer services that are covered in the Canada Health Act. These private clinics mainly offer minor surgeries and imaging services, such as MRI scans - services where, generally, long wait lists tend to build up in the public sector.

In 2011, 11.2 percent of Canada’s per capita GDP was spent on healthcare. Comparatively, in the U.S. 17.7 percent of their per capita GDP was spent on healthcare in the same year, which makes it difficult to prove that private healthcare models help to diminish costs.

Canada has one of the fastest rising drug costs per capita than all other OECD countries, except the U.S. From 1985 to 2007, drug prices rose an average of 9.2 percent, from $4 billion in 1985 to $26.5 billion in 2007, according to the Canadian Doctors for Medicare.

Despite the public system, private healthcare spending is also rising in Canada. According to a study done by the Canadian Doctors for Medicare, private healthcare spending counted for about 30 percent of all healthcare spending in 2011, whereas in 1975 it was only 24 percent. The factors driving this have been increasing costs particularly in pharmaceuticals and private prescription drug insurance, and also dental care and private dental insurance, since neither one are covered by public healthcare in most provinces.

What does/doesn’t it cover?

Includes:

Primary care

All specialists' services

All hospital services

Dental surgery

Emergency ambulance use

 

Doesn't cover:

Dental services

Optometrist services and prescription eyeglasses

Prescription medications,

Private hospital rooms

Homecare

United States

The health care system in the U.S. operates mainly as a private multi-payer system, with a few public options.

Physicians and hospitals operate privately and charge on a fee-for-service basis. Their rates are determined by the market while government intervention in this process is not allowed. Health insurance in the country is also provided mainly by private health insurers.

People in the U.S. are by and large left to procure health insurance on their own. To do this, they either:

48 percent are insured by their employer

5 percent buy private insurance themselves

32 percent are eligible for one of the government funded insurance programs (Medicaid, the Children’s Health Insurance Program, Medicare, or the Veterans Health Administration)

15 percent have no insurance at all

The public insurance programs in the country include: Medicaid, which is dedicated to helping low-income familie - currently this includes individuals who earn less than US$15,414 annually, or US$31,809 for a family of four; The Children’s Health Insurance Program (CHIP) for children whose parents earn too much to qualify for Medicaid, but who can’t afford to buy private insurance; Medicare, for people over 65; and the Veterans Health Administration, for discharged military, navy or air service members.

Holding either of these public healthcare plans doesn’t guarantee coverage in each hospital or clinic in the country, as the insurance is only recognized at the specifically designated facilities for each plan. The public programs are mainly funded by the state, but also receive stipends from the federal government.

Private insurance coverage varies between insurers and packages. These costs depend on age, health condition, location, income and job status. Under the terms of most plans people are expected to pay premiums and pay for a part of the cost of their treatment. According to an Individual Health Insurance 2009 study, the average premiums paid in 2009 were US$2,985 for a individual, and US$6,328 for a family of three. Additionally, the average out-of-pocket expenditures for the same year were US$4,506 for an individual, and US$9,290 for a family.

Under this system, more than 45 million people- about 15 percent of the population - were left without any kind of health care insurance, according to the 2013 National Health Interview Survey. This is mainly because people are ineligible for Medicaid but are also unable to afford private insurance and the extra costs on their own.

As of January 1, 2014, the Patient Protection and Affordable Care Act (ACA)– also referred to as ObamaCare – came into effect. The resulting changes to the healthcare system will mainly be insurance accessibility. The ACA promises to expand access to healthcare insurance for 25 million U.S. citizens by 2023.

With private insurers, there will now be a cap on the amount of premiums insurance companies can charge, and they aren't allowed to reject the sick or charge extra for women. Insurance companies are also expected to be more competitive and offer lower prices, while the government has also pledged to give subsidies for those families who still cannot afford insurance.

In 2012, 47.8% of overall healthcare spending in the U.S. was public while 52%t was private

One of the strongest critiques of ObamaCare is that people will be forced to buy insurance. ObamaCare has given numerous monetary incentives for people to sign up for health insurance, but those who fail to sign up will have to pay a fee. One of the main criticisms of ObamaCare, mainly from the political right, is that this violates individual rights and freedoms.

The second critique is the increase in taxes that will ensue, given the expansion of Medicaid and other government funded incentives. Taxes are expected to be applied to higher earners.

Another concern is the mandating of companies that have over 50 employees to provide health care coverage for their full time staff. Already some companies have reportedly cut employees hours in order to avoid paying them these benefits, and this issue is expected to get worse.One of the stronger critiques from the political left is that ObamaCare fails to do enough to actually overhaul the system. ObamaCare does more to make sure that people are covered by insurance, but does little to actually address the high cost of health care in the U.S. The average price for surgeries, hospital procedures and pharmaceuticals in the U.S. cost double, or more, of what they do in most other developed countries. According to a study by the International Federation of Health Plans in 2013, the average price of a bypass surgery in the U.S. cost US$75,345, whereas in Australia (the next highest) it cost US$42,130.

According to the OECD the U.S. pays more for health care than other developed nations

The Commonwealth Fund 2013 International Health Policy Survey, also found that administration costs for health care insurance was highest in the U.S., more than doubling administration costs in all other countries in the survey (Canada, Australia, New Zealand, the U.K., Sweden, France, Germany, the Netherlands, Switzerland, Norway). According to the Chicago-based Physicians for a National Health Plan (PNHP), switching to a single-payer health care system would eliminate the high costs of administration.

Despite the U.S.´s high level of healthcare expenditures, they had fewer practicing physicians than the OECD average in 2011; only 2.5 per 1000 the population compared with the OECD average of 3.2. However, in the same year there were 11.1 nurses per 1000 the population, higher than the OECD average of 8.7, according to OECD Health Data 2013.

What does/doesn’t it cover?

Under the ACA, all private options must supply essential health benefits, which include at least the following:

Ambulatory patient services (outpatient care you get without being admitted to a hospital)
Emergency services
Hospitalization (such as surgery)
Maternity and newborn care (care before and after your baby is born)
Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
Prescription drugs
Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services

Public insurance also varies depending on the government-funded programme.

Medicare:

Part A includes all of Part B

Part A Part B
Hospital care Clinical research
Skilled nursing facility care Ambulance services
Nursing home care Durable medical equipment
Hospice Mental health: inpatient, outpatient, partial hospitalization
Home health services Second opinion before surgery
  Limited outpatient prescription drugs

What Medicare doesn't cover:

long term care
most dental care, including dentures
Eye examinations and prescription glasses
Cosmetic surgery
Acupuncture
Hearing aids and exams for fitting them
Routine foot care

Cuba

The Cuban Health system is universal, and free for all Cubans without restrictions, as healthcare is considered by Cuban government as one of the most fundamental Human Rights.

The Cuban Constitution states that: “Everyone has the right to health protection and care. The State guarantees this right by providing free medical and hospital care … by providing free dental care; by promoting the health publicity campaigns, health education, regular medical exams, general vaccinations …”

Cuba has developed a network of hospitals and clinics to assure 100 percent of its population can have access to medical attention through three main axis, which includes special attention to children-mother, women and elder, as well as the prevention and control of contagious and non-contagious diseases.

Its model is based on family medicine and guarantees full and free access. Its main organism is the Public Health Ministry, which is in charge of directing, executing and controlling the State’s and government’s health policy, as well as of developing Medical Sciences.

There are no private hospitals or clinics.

In a 2007 study conducted by the World Public Opinion, Cubans were found to be very proud of the achievements made by the government in the healthcare system, given the country’s complicated political history. Seventy-five percent of Cubans said they have confidence in their current healthcare system.

According to the WHO, Cuba has one of the highest doctor per patient ratio in the world with one doctor per 170 people. Doctors in Cuba are also paid very little, however. According to a recent announcements in La Granma, the official newspaper of the Cuban Communist Party, doctors´ salaries will increase to 1.600 pesos (US$64), up from 625 pesos a month (US$25), this June. (The average monthly wage in Cuba is approximately 466 pesos (US$18), according to 2012 numbers.)

Cuba has a longstanding programme of sending medical professionals overseas, particularly doctors. They have a joint medical program with Venezuela aimed to provide medical attention in 14 Latin American and Caribbean countries, while they also have other medical missions in Asia, Africa, and Oceania.

Just outside Havana also lies the Latin American School of Medicine, a school that offers a free six-year medical education to students from rural and marginalized communities in Latin America, Africa, Asia and the U.S. The school was developed after the 1998 Hurricane Mitch devastated many parts of Central America, and Cuba recognized the urgent need for more medical personnel in the area.

Due to the U.S. economic blockade against Cuba, the initial exodus of doctors from the island, and the resulting medical shortages during the “Special Period,” Cuba has had to develop its own equipment and medicines. It produces medicine against embolisms, heart attacks, problems with the immune system, hypertension, cholesterol, some kinds of cancer, and is one of only six countries in the world which produce interferons (an antiviral agent that can fight tumors).

Cuba has also developed its own vaccines (including hepatitis B), and is one of the only countries to produce vaccination against meningococcal meningitis. Along with France, Cuba produces the vaccine pentavalent, a combination of five vaccines in one (diphtheria, tetanus, whooping cough, hepatitis B, and Haemophilus influenza type b).

Cuba has totally eradicated diseases such as poliomyelitis, malaria, diphtheria, measles, pertussis, and rubella.

Mental health is also considered part of the National Health System, making its diagnosis and treatment free for all Cuban citizens. The Cuban National Health System believes in the possibility of rehabilitating people with mental health issues, and has special programs aimed at integrating them in the society, including job searches and training.

What does/doesn’t it cover?

The Cuban healthcare system covers all medical treatments, services as well as medicines. What it does not cover is healthcare accessories such as wheelchairs, crutches, prosthetics and prescription eyeglasses, however the government does provide subsidies to procure them.


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