Comparison between health system in Canada & Germany - Essay Example

? 16 November Comparison between the Canadian and the German Health Care Systems Introduction The health care system of a country is one of the main factors that determine the quality of living of its citizens. Health care systems in Canada and Germany are two of the most developed systems of health care in countries across the world. This paper draws a comparison and contrast between the Canadian and the German system of health care. The Canadian Health Care System Medicare is the insurance coverage program in Canada. Medicare is funded publicly and offers universal coverage for the hospital services as well as for the physicians. In order to be eligible to access the plans of public insurance, it is imperative that an individual has residency in a territory or province of Canada. The particular requirements of residency vary from one territory to another. No provincial or federal program of health insurance in Canada covers any undocumented immigrants such as the immigrants that stay in Canada more than what they have the legal permit for, the denied refugee claimants, and the people who are living in Canada illegally, though certain provinces such as Ontario do offer certain limited services by means of community health services. Other health services are covered by a combination of different kinds of public programs, tout-of-pocket payments, and supplementary private insurance. Criteria for Qualification The territorial and provincial plans of health insurance should offer the first-dollar coverage of hospital services and the medically required physician for every eligible resident to qualify for the Canada Health Transfer’s federal financial contributions. The territorial and provincial governments in Canada offer different types of supplementary benefits for such groups as social assistance recipients, senior citizens, and children in addition to offering the universal coverage for hospital services and physicians. There is a whole range of supplementary benefits that include but are not limited to vision care, home care, dental care, drug coverage, and aids to the ambulance services and independent living. The federal government of Canada offers some benefits of health care for the veterans, inmates in the federal penitentiaries, refugee claimants, members of the Canadian Forces, the Royal Canadian Mounted Police members, and the First Nations and Inuit. Prescription Drugs The public health insurance program covers all prescription drugs in the hospital setting. Each territory and province offers more coverage for the prescription drugs outside the hospital setting, but such policies vary across the territories and provinces. Some coverage is provided by all territories and provinces for the people aged more than 65 years who may or may not have partial coverage under the private insurance programs. All provinces in Canada offer drug coverage plans for the people who receive social assistance and have low incomes. In the year 2009, 46 per cent of the drug spending was attributed to public expenditure upon the prescription drugs (Thomson et al. 21). Preventive Services The federal government in Canada funds and provides numerous preventive services of health care by means of the Canadian Public Health Agency. The territorial and provincial governments provide both prevention and promotion of public health service in the public plans. Several programs of provincial screening are provided with a variety of delivery approaches and comprehensiveness. Mental Health Care The program of universal public insurance in Canada covers the services related to all kinds of mental health care that is provided by the psychiatrists and family physicians in the hospital and ambulatory settings. However, the legislation that supports the health care system of Canada does not authorize coverage of the services of non-physician mental health such the services provided by the social workers or the psychologists publicly out of the ambulatory or hospital setting. Long-term Care The Canada Health Act (CHA) considers the services related to long-term care such as those that are offered in the community as the extended health services because of which they are not included in the universal health system. Although the provinces are allowed to select the fund services, and in most of the cases, the provinces actually do, yet there is substantial variation in the coverage both within and across the provinces. Optometry and Dental Care The services of optometry and dental care in Canada are not covered publicly in general. In 2008, no more than 5 per cent of the total expenditure on the dental care could be attributed to public spending, whereas 8 per cent of the total spending was done on the vision care. In a vast majority of cases, these services are paid by means of either out-of-pocket payments or private insurance. Decisions of Coverage Most of the decisions regarding public coverage are made at the territorial level or the provincial level. The CHA does not define the specific kinds of services that are required medically although it requires the plans of health care insurance provided at the territorial or the provincial level to offer coverage for all kinds of physician and hospital services that are deemed necessary on medical grounds. The territories and provinces take this responsibility together with the medical profession. Nevertheless, it is important for these decisions to be always consistent with the comprehensiveness criterion requirements established by the CHA. Funding of the Health Care in Canada Publicly Funded Health Care The plans of public health insurance that are administered territorially or provincially are financed by means of the general taxation. The federal transfers made to the territories or the provinces to facilitate the health care services depend upon the population of the respective territories and the provinces. The federal transfers are conditional on the plans of territorial and provincial health insurance that adhere to the specifications laid out by the CHA. In 2009, public funding of health care consumed 71 per cent of the total budget of health care in Canada. “The federal government contributes cash funding to the provinces through the Canada Health Transfer, which makes up about 22 percent of total provincial and territorial health expenditures (although this varies across provinces/territories)” (Thomson et al. 22). Privately Funded Health Care Expenses incurred on the private health care services in Canada constitute almost 30 per cent of the total expenditures on health care. Expenditures related to the private health care services are born through the out-of-pocket payments or private insurances. Almost 66.66 per cent of Canadians acquire supplementary coverage of private insurance, most of which happens through the group plans based on employment that covers a wide range of services that include but are not limited to prescription drugs, dental care, vision care, home care, hospitals and rehabilitation services. There is no availability of option of duplicative private insurance for the hospital services. “About 80 percent of insurers that sell private health care insurance are for-profit health and life insurance companies, and about 20 percent not-for-profit insurance organizations that specialize in health coverage” (Thomson et al. 22). German Health Care System The health care system in Germany constitutes a mix of private medical care and compulsory health insurances. Although every permanent resident or citizen of Germany is entitled to some insurance coverage, the citizens are provided with an option to acquire supplementary health care privately in case the individuals agree to bear the additional costs associated with it. 85 per cent of the German population is covered under the statutory health insurance (SHI) (Busse, Blumel, and Stock 57). The private health insurance covers up to 10 per cent of the German population amongst which the self-employed and the civil servants constitute the largest populations. There are special regimes to cover the remainder of the population that includes the policemen and soldiers. Social security covers the undocumented immigrants particularly in illness. Since 2009, insurance of health has been obligatory for all citizens as well as for the people with permanent residence in Germany both in the private health insurance and the statutory schemes. “All employed citizens (and other groups such as pensioners) earning less than €4,125 (US$5,791) per month or €49,500 (US$69,492) per year (in 2011) are mandatorily covered by SHI and their dependents (nonearning spouses and children) are covered free of charge” (Busse, Blumel, and Stock 57). People in Germany with the gross income in excess of the threshold amount have the flexibility of either choosing to be in the publicly financed scheme voluntarily or buy the private health insurance. SHI in Germany covers a whole range of medical services that include but are not limited to outpatient and inpatient hospital care, mental health care, preventive services, medical aids, prescription drugs, physician services, sick leave compensation, and hospice care. The preventive services included in SHI include check-ups of well children, dental check-ups, examination for chronic diseases, screening for cancer, and basic immunization. SHI covers all kinds of prescription drugs, even the ones that are newly licensed unless certain drugs have been excluded by law explicitly. Since 1995, there has been a different insurance scheme to cover the long-term care and this scheme has been held obligatory for the entire population without exceptions. Funds Management in the German Health Care System The measures of cost control in the German health care system, particularly hospital budgets and budgets for the ambulatory physicians, is relatively crude, though the measures have traditionally been successful and have been modified to improve their efficiency and quality. Since 2009, the government has established a uniform contribution rate. In spite of the fact that contributions have continued to be collected by the sickness funds, every contribution is pooled into a reallocation pool centrally. This pool, in turn, assigns resources to every sickness fund depending upon a capitation formula that is adjusted for risk. This formula involves the use of sex, morbidity, and age from illnesses. Since 2009, the sickness funds in Germany have charged an additional nominal premium to the people with insurance in case the revenue of the sickness funds has been insufficient. On the other hand, the federal subsidy financed by tax has had a growing amount for the insurance extraneous advantages offered by the SHI. “These expenses are considered to be of common interest and are therefore are (partly) covered from general taxes. In 2010, general tax subsidies amounted to €15.4 billion ($21.6 billion), which is equal to about 8 percent of total SHI revenue” (Busse, Blumel, and Stock 58). Sickness Funds All Germans except for the self-employed people earning lesser than euro 3862 a month and the 2 million people who were permanent civil servants in 2004 were required to join a statutory sickness fund. A total of 300 such funds were made available to the citizens. The Germans that were above the threshold of the mandatory insurance had an option of opting out of the state system and purchasing private insurance rather than the statutory state funds, though many amongst them preferred to remain within the system established for the state and almost 10 per cent of the total population of Germany has acquired insurance voluntarily. The sickness funds in Germany are needed to be self-sufficient in terms of finances whereas the premiums have been established as the income’s percentage that changes from one fund to another by an average percentage of 14 per cent to 13 per cent. The deduction of the premiums happens from the pay packets in which both the employee and the employer pay equally. Public and Private Health Care in Germany Hospitals in Germany are placed under different kinds of ownership, which plays a big role in enhancing the competition among the hospitals and in effect, improves the quality of care. In 2002, the public sector contained almost 54 per cent of the hospital beds whereas 38 per cent of hospital beds were in the private sector organizations that were non-profit and another 8 per cent of the hospital beds were in the private profit organizations. If you walk along a typical British high street in search of healthcare professionals you might see an optician, probably a pharmacy, and maybe a dentist, but to see a heart specialist, a dermatologist, an ear, nose and throat specialist, or a paediatrician, not to mention a smattering of GPs, nestled in between Macdonald's, Dixon's and W.H. Smith's would be unusual unless you shop in Harley Street. Not so in Germany, where queueing up in a hospital outpatient department to see a specialist is largely unknown (Green, Irvine, and Cackett). Comparison of Health Care System between Canada and Germany Thomson et al. draw a detailed comparison between the coverage and financing of the Canadian and German health care system along with twelve other countries (6). In Canada, Medicare serves as the universal program of public insurance that is administered regionally. Health care system is financed by means of provincial or federal tax revenues. The buy coverage for the additional benefits from private insurance is 67 per cent. There are no caps upon the out-of-pocket expenditure. The health system in Canada offers certain cost share exemptions that vary between one province and another. The health care system in Germany is based on a statutory system of health insurance. There are 180 SHI insurers that compete in the sickness funds. The private coverage can be opted out by means of high income. In the public system financing, the general tax revenue is gained from the employer or employee payroll tax. The private insurance role offers amenities and cost sharing up to 20 per cent. The core advantages of private insurance role include extra benefits and cost-sharing. Caps upon the out-of-pocket expenditure make up to 2 per cent of the income. The low income protection and exemptions in the German health care system include but are not limited to insurance contributions related to income, and exemption of children. “Canadians lament that they have few national myths. But as the health-care debate shows, an absence of myths makes policy-making easier” (Kay as quoted in Alpert). Both Canada and Germany entitle almost every permanent resident or citizen of their country to health coverage. More than the health care, the image of community, equity, and solidarity matters and determines how the health care is to be delivered. The demand of human dignity is to allow equal access to everybody to seek the medical care despite all financial adversities. Although both countries cover the services that are appropriate and medically necessary, they impose restrictions on the coverage of health care that is publicly defined. For instance, in Canada, drugs and the home health care is not included into the public system. In both Canada and Germany, the national government has established a statutory framework to finance the health care’s universal coverage; though in Canada, it is compulsory for the provinces to meet the conditions of participation in the arrangements of fund sharing that have been centrally defined. However, the way money is raised differs between the two countries. While 70 per cent of the health bill in Canada is obtained from the provincial and national general revenues, the health care system in Germany depends mainly upon the contributions made by the work-based social insurance. Although both Canada and Germany spend lesser on health care out of the national resources as compared to the United States, in both countries, cost containment has been a preoccupation for a long time. In Canada, the budget of public health care is a ceiling. Rationing is not an issue in the health care system of Germany. Both Canada and Germany display curiosity regarding the analytic tools such as technology assessment, medicine based on evidence, cost-effectiveness analysis, and report cards so that these tools can be employed by the policymakers in the assessment of the performance of the systems of health care and provide them with ways of their improvement. Works Cited Alpert, Emily. “Europeans, Canadians Baffled by U.S. Furor on Healthcare.” Los Angeles Times 28 June 2012. Web. 14 Oct. 2012. . Busse, Reinhard, Miriam Blumel, and Stephanie Stock. “The German Health Care System, 2011.” International Profiles of Health Care Systems, 2011. 2011. Web. 15 Nov. 2012. . Green, David G., Ben Irvine, and Ben Cackett. “Health Care in Germany.” 2005. Web. 16 Nov. 2012. . Thomson, Sarah, Robin Osborn, David Squires, and Sarah J. Reed. “International Profiles of Health Care Systems, 2011.” 2011. Web. 14 Oct. 2012. . Read More