Comparing Health Systems

Land Acknowledgment
• Langara is on unceded Tradi/onal Coast Salish
lands of the xwməθkwəy̓əm (Musqueam) First
Na/on
Inven%on of Lacrosse by Indigenous people
Invented in the 12th century
At the &me, the game was called baggataway and it was
played with two teams of 100 to 1,000 men on a field that was
half a kilometre to three kilometres long. S
Podcast about it if you are interested in knowing
more

(1) Artist Brian Larney, www.yahvlane.com

Learning Objectives
• Understand the Commonwealth Assessment from 2017
• Dis8nguish where Canada ranks compared to the 11 other developed
countries
• Compare and understand differences between Canada, Norway, and
U.S health care systems.
• Group ac8vity – Look up one other country in the commonwealth
health care system to compare
Terms
• Access to care
• Care process
• Administrative efficiency
• Equity
• Health care outcomes
Commonwealth Assessment 2017
• Conducted a health care system performance in Australia, Canada,
France, Germany, the Netherlands, New Zealand, Norway, Sweden,
Switzerland, the United Kingdom, and the United States. Used
indicators available across five domains:
• Access to care
• Care process
• Administra0ve efficiency
• Equity
• Health care outcomes.

(2)
Overall Rating

• Source: Eric C. Schneider et al., Mirror, Mirror 2021 — Reflecting Poorly: Health Care in the U.S. Compared to Other High-Income Countries (Commonwealth Fund, Aug. 2021).
https://doi.org/10.26099/01DV-H208

(2)
• Source: Eric C. Schneider et al., Mirror, Mirror 2021 — Reflec/ng Poorly: Health Care in the U.S. Compared to Other High-Income Countries (Commonwealth Fund, Aug. 2021). h>ps://doi.org/10.26099/01DV-H208

(2)
Access to Care
• Access to care includes measures of health
care’s affordability and +meliness.
• People in the countries performing the best on the 8meliness
subdomain are more likely to be able to get same-day care and a=er-
hours care
• Overall, the U.S. is #11 — last — on access to care. The U.S. has the
poorest performance on the affordability subdomain, scoring much
lower than even the next-lowest country, Switzerland
• Canada ranks #9

(2)
• Source: Eric C. Schneider et al., Mirror, Mirror 2021 — Reflecting Poorly: Health Care in the U.S. Compared to Other High-Income Countries (Commonwealth Fund, Aug. 2021). https://doi.org/10.26099/01DV-H208

(2)
Care Process
• Care process includes measures of preven+ve care, safe care,
coordinated care, and engagement and pa+ent preferences.
• The U.S. ranks #2 on this performance domain. Canada ranked #4
• New Zealand and the U.S. perform best on the safe care subdomain,
with higher reported use of computerized alerts and rou8ne review of
medica8ons.
• S8ll, in all countries, more than 10 percent of adults report
experiencing a medical or medica8on mistakes in their care.

(2)
Overall Rating

• Source: Eric C. Schneider et al., Mirror, Mirror 2021 — ReflecFng Poorly: Health Care in the U.S. Compared to Other High-Income Countries (Commonwealth Fund, Aug. 2021).
hHps://doi.org/10.26099/01DV-H208

(2)
Administrative Efficiency
• Administrative efficiency refers to how well health systems reduce
documentation (paperwork) and other bureaucratic tasks that
patients and clinicians frequently face during care.
• The top performers are Norway, Australia, New Zealand, and the U.K.
• The U.S. ranks last.
• For nonemergency care, U.S. and Canadian adults are also more likely
to visit the emergency department — a less efficient option than
seeing a regular doctor.
• Canada ranks #7

(2)
Equity
• The assessments analysis of equity focuses on income-related
disparities, based on standardized data across the 11 countries.
• Australia, Germany, and Switzerland rank highest on the equity
domain, meaning these countries had the smallest income-related
disparities in performance based on the included measures
• Equity: Income-Related Disparities Are Largest in the U.S., Canada,
New Zealand, and Norway

(2)
Source: Eric C. Schneider et al., Mirror, Mirror 2021 — Reflec/ng Poorly: Health Care in the U.S. Compared to Other High-Income
Countries (Commonwealth Fund, Aug. 2021). hPps://doi.org/10.26099/01DV-H208 (2)
Health Care Outcomes
• Health care outcomes refer to those health outcomes that are most
likely to be responsive or due to health care.
• On this domain, Australia, Norway, and Switzerland rank at the top of
our 11-nation group
• Norway has the lowest infant mortality rate (two deaths per 1,000
live births), while Australia has the highest life expectancy after age
60 (25.6 years of additional life expectancy for those who survive to
age 60).

(2)
(2)
Overall Rating

• Source: Eric C. Schneider et al., Mirror, Mirror 2021 — Reflecting Poorly: Health Care in the U.S. Compared to Other High-Income Countries (Commonwealth Fund, Aug. 2021).
https://doi.org/10.26099/01DV-H208

(2)
Discussion
• What is most important to you in receiving care?
• Which country has the best ranking from your perspective?

(2)
 In top-performing

performing countries
They reduce the
Results from the top countries, policy is
geared towards
administrative
burdens on patients
ensuring access to
and clinicians that cost
care within
them time and effort
communi8es,
and can discourage
especially those that
access to care,
have been historically
especially for
marginalized.
marginalized groups.

They invest in primary

care systems to ensure
They invest in social
that high-value
services that increase
services are equitably
equitable access to
available locally in all
nutri8on, educa8on,
communities to all
child care, community
people, reducing the
safety, housing,
risk of discrimination
transporta8on
and unequal
treatment. (2)
Comparing countries
Canada
• Does this country have universal Health coverage?
• Yes
• What health services are covered publicly by the government?
• medically necessary physician, diagnos3c, and hospital services, public health and preven3on services (including immuniza3ons)
• coverage varies across provincial insurance plans
• Are there services that aren’t covered that ci;zens must pay for?
• dental services over 18, vision care, outpa3ent prescrip3on drugs, physiotherapy, psychologist visits, long-term/home care, some medical equipment and
cosme3c or plas3c surgery.
• Is there an op;on to pay for private insurance to get care faster
• No, not really.
• How are physicians usually paid in this country?
• Fee-for-service is the primary form of physician payment
• Is there a gatekeeper model
• Yes, general prac33oners must refer pa3ents to specialists
• What is one ac;on being done in this country to reduce dispari;es
• No formal or periodic process exists to measure dispari3es; however, several P/T governments have departments and agencies devoted to addressing
popula3on health and health inequi3es.
• Health dispari3es between indigenous and nonindigenous Canadians are a concern for government at both the federal and the P/T level. The 2018 federal
budget offers new funding39of CAD 5 billion for Indigenous people. The money is earmarked for educa3on, the environment (for example, water quality), and
health and social services.
U.S.
• Does this country have universal Health coverage?
• No
• Medicare. Medicare ensures a universal right to health care for persons age 65 and older.
• Medicaid. The Medicaid program provides health care services to low-income families, and individuals with disabilities.
• Children’s Health Insurance Program. a public, state-administered program for children in low-income families that earn too much to qualify for Medicaid but that are unlikely to be able to afford private insurance
• Affordable Care Act.

• What health services are covered publicly by the government?

• There is no nationally defined benefit package; covered services depend on insurance type:
• Medicare. People enrolled in Medicare are entitled to hospital inpatient care (Part A), which includes hospice and short-term skilled nursing facility care.
• Medicare Part B covers physician services, medical equipment, and home health services. Medicare covers short-term post-acute care, such as rehabilitation services in skilled nursing facilities or in the home, but not long-term care.
• Medicaid. covers inpatient and outpatient hospital services, long-term care, laboratory and diagnostic services, family planning, nurse midwives, freestanding birth centers, and transportation to medical appointments.

• Are there services that aren’t covered that citizens have to pay for
• It depends which insurance plan you are on
• The average cost of health insurance is $539 per month

• Is there an option to pay for private insurance to get care faster?

• Over 65% of Americans have private insurance (primary health coverage)

• How are physicians usually paid in this country?

• Combination of methods, including negotiated fees (private insurance), capitation (private insurance and some public insurance), and administratively set fees (public insurance).
• The majority (66%) of primary care practice revenues come from fee-for-service payments.

• Is there a gatekeeper model?

• Depends what health insurance plan you have

• What is one action being done in this country to reduce disparities?

• African Americans, American Indians, Alaska Natives, Native Hawaiians, and Pacific Islanders received worse care than whites according to about 40 percent of quality measures. Hispanics and Asian Americans received worse care per
35 percent and 28 percent of measures, respectively.
• The Office of Minority Health is tasked with developing policies and programs to eliminate disparities among racial and ethnic minority groups
Norway
• Does this country have universal Health coverage?
• Yes
• What health services are covered publicly by the government?
• primary, ambulatory, , mental health, and hospital care, rehab, as well as select outpatient prescription drugs.
• dental care for children up to age 18, people with chronic diseases, nursing home residents, and other prioritized groups, as well as partial
dental coverage for young adults ages 19 and 20 and dental braces for children.
• Are there services that aren’t covered that citizens have to pay for?
• Long-term care, glasses or contacts, cosmetic surgery
• Is there an option to pay for private insurance to get care faster?
• Yes, About 10 percent of the population has private insurance, mainly to gain quicker access to and greater choice of private providers.
• How are physicians usually paid in this country?
• GPs receive 35 percent of their income from the municipalities, 35 percent on a fee-for-service basis from the central government, and 30
percent from out-of-pocket payments from patients.
• Is there a gatekeeper model?
• GPs function as gatekeepers. A GP referral is required for coverage of specialist treatment.
• What is one action being done in this country to reduce disparities?
• Nothing
• Recent demographic studies of mortality differences between immigrant and Norwegian populations reveal no disadvantage for immigrants.
Disparities between the 18
indigenous people of northern Europe, the Sami, and Norwegian populations are studied through the SAMINOR
population-based study. So far, there is little evidence for health disparities between the two.
Discussion
• What differences between these three countries health structures are
contributing to worse or better health outcomes?

• Do you think there would be any challenges if every country switched

to Norway’s model?
Group AcLvity –
• International Health Care System Profiles
• Groups of 3-4
• We will share if there is time.

Choose one country that is not on the Commonwealth assessment. Look at their
international health care system profile and answer these questions:
• Does this country have universal health coverage?
• What health services are covered publicly by the government?
• Are there services that aren’t covered that citizens have to pay for?
• Is there an option to pay for private insurance to get care faster?
• How are physicians usually paid in this country?
• Is there a gatekeepers model?
• What is one action being done by the country to reduce disparities among the population?
References
1. https://www.musqueam.bc.ca/wpcontent/uploads/2019/07/NEWS
LETTER-JULY-26-2019-PDF.pdf
2. Mirror, Mirror 2021: Reflecting Poorly [Internet]. 2021 [cited 2023
Nov 28]. Available from:
https://www.commonwealthfund.org/publications/fund-
reports/2021/aug/mirror-mirror-2021-reflecting-poorly