Revision of March 16, 1998

Introduction

The efficiency of a health care, among other things, is intricately linked with the issue of human development. For example, the faster a sick worker is made to feel better and can return to work, the more efficient HE is in contributing to other areas of development. It is also easy to imagine how a healthy person who has confidence in their health care system can lead a longer and more fulfilled life. But what criterion should be used to evaluate and compare the efficiency of a country’s health care system with respect to human development? For the purposes of this paper, four simple factors were selected.

Accessibility of services is one of them. This section looks at how available services are to the general public and whether there are discrepancies of age or class. The more accessible health care services are, the more there can be a sense of security. The quality of health care is also important. This includes the quality of services and also of health care facilities. It is useless to have a readily available system but with such poor quality and conditions that the sick would rather stay home. The third factor is the cost, which can indirectly affect accessibility and quality. A high cost will in most cases increase the quality but will invariably limit services to the rich. Too low a cost will often result in a sacrifice of quality and accessibility, although the poor and elderly may benefit. However, no cost at all may encourage waste and inefficiency. Lastly, the problem of longevity and mortality will be discussed. Are these statistics an indicator to the well-being of a country’s health care system? Or does life expectancy and infant mortality have anything to do with it at all? The nest section takes a brief look at the health care systems in Canada, the United States and Mexico. These three systems will then be compared according to the abovementioned criterion and a conclusion made as to which system appears to be most efficient.

Background Information

In Canada, an important foundation of the present health care system, the Medical Care Act, was passed in 1966. This Act included four important aspects of the delivery system: universality, comprehensiveness, portability and public administration. Under this law, the federal government would pay 50% of each province’s cost while the province would pay the remaining 50%. In 1977, in an attempt to help our poorer provinces, a new Act was passed that related how much the federal government would pay to population, GNP and taxes collected. Finally, in 1987, the Canada Health Act was passed, adding "accessibility" to the previous four principles. Currently, health care in Canada is generally available at no charge to patients, although each province has a slightly different policy. These include "taxes" for health care and minuscule yearly user fees.

The United States is one of very few developed countries without a universal health care system. Instead, the system is privately financed by insurance companies, who are often referred to as third-party payers. This system began in the 1930’s with the Blue Cross. The exception to this is Medicaid, which is state funded and Medicare, which is federally funded. These programs, however, are generally for welfare families, the disable and the elderly, although coverage is increasingly extending to those not in these categories. In 1993, the Clinton administration tried to implement national health care reform to provide all citizens with access while limiting costs. This proposal was abandoned within a few months mainly because the administration chose to avoid important questions about the reform.

The situation in Mexico is vastly different: health care is separated into public and private sectors. In the public sector, patients are further classified as either employed or unemployed. The National Institute of Social Services (IMSS) and the Institute for Social Security for State Workers (ISSSTE) were both established for the employed. These institutions offer a multitude of services and exclusive use of its network of hospitals and clinics. The unemployed must seek health services provided by the Department of Health through hospitals and health care centers in most rural and urban areas for a minuscule fee. Generally, these facilities are poorer than those offered by the IMSS/ISSSTE because of uneven government funding, which helps to ensure a healthy labour force. The private sector is for the elite, as fees are high and the medications unusually expensive. However, this compensates for the excellent conditions and services.

Health and Development:

Accessibility

In Canada, all citizens have ready access for any care. This is in accordance with the Canada Health Act of 1987 which defines accessibility as "reasonable access by insured persons to insure health services unprecluded or unimpeded, either directly or indirectly, by charges or other means" (Crichton et al, 1990, p.35). This ensures that health care services are available to everyone, including poor and welfare families.

Health care is generally not accessible to all citizens of the United States. In regards to the lack of a national health care system, critics suggest that the upper classes of society actually favour the status quo and have thus resisted any reform. Presently, about 35-40 million of the 258 million Americans are uninsured or underinsured. This typically includes the poor and immigrants.

Health care is a right in Mexico and by law, there should be universal health coverage. However, 5-7 million Mexicans lack assess to health care. Unlike the US, this problem is not due to a discrepancy of status. Instead, it is due to the fact that there is a lack of health care facilities in rural areas. As the government continues to cut funds to the public sector, it will decrease accessibility to poor rural families.

Quality

The quality of services in Canada is generally satisfactory, although patterns of practice are rarely questioned. Furthermore, there are no formal assessments made of medical practice. The fact that patients are free to choose any hospital or physician has set the standard for performance. Hospital conditions, on the other hand, are evaluated by the Department of National Health and Welfare and by Statistics Canada. There are currently about 1,000 hospitals across Canada, most of which are not-for-profit organizations. Hospitalized patients receive fewer diagnostics procedures per day, require fewer drugs and nurses, and utilize less complex technology than their counterparts in the US. Although this practice may or may not mean a decrease in the quality of services, it definitely results in less health expenditures. Despite this lack of funds spent on health care, however, Canada has the most hospital beds per 1,000 population: about 6.9.

In the US, there are rigorous inspection requirements for both health care services and facilities, which result in enormous investments in both the upkeep of facilities and in the process of collecting and reporting of findings. In many rural and poor areas of the country however, the requirements are more slack and pertain more to sanitation than to the quality. Health care facilities in these areas tend to be small clinics instead of large hospitals. Also, due to lack of funds to these areas, facilities are usually understaffed and lack experienced physicians and care and equipment are typically less up-to-date and are of lower quality. In this country, there are about 5.1 hospital beds per 1,000 people.

In Mexico, only those facilities and services provided by the private institutions can compare with those typically found in Canada and the US. Although hospitals and clinics offered to the employed is generally better, the quality of care and facilities are unsatisfactory for the unemployed. Due to cuts from government funding and the large amount of people who require medical attention, hospitals are frequently overcrowded and the conditions poor. Assessment of conditions and quality of facilities are also much less strict than in Canada or the US. Health care facilities are comprised of only 3,200 rural clinics and 65 million hospitals, with only 1.3 hospital beds for every 1,000 inhabitants. The quality of care in clinics is also especially low, as the physician staff is mainly made up of medical students completing one-year mandatory community service commitments.

Cost

Canada spent 4.5% of its GDP, or $ 25 billion on health care in 1993. The United States spent about 18% of its GDP, or roughly $1000 billion in the same year. Although the US has approximately 10 times more inhabitants as Canada does, the amount spent is significantly more than a comparable tenfold increase. Mexico also spent 4.3% of its GDP in 1993, about $16 billion for its population of only one-third Canada’s. On a per capita basis, Canada seems to be spending the least on health care, followed by Mexico, with the US being the biggest spender.

Longevity and Mortality

Longevity for Canada is the highest of the three countries, 74.2 years for males and 80.7 years for females. Infant mortality is also the lowest, there being only 7.2 deaths per 1000 live births. The United States is a close second with longevity being 72.5 and 79.3 years for males and females respectively. Infant mortality is about 9.2 per 1000 live births. The same information for Mexico is 67.8 and 73.9 years each for males and females and a higher infant mortality rate of 38.1 per 1000 live births. These data are for the year of 1993.

Conclusion

After comparing the health care systems of Canada, the United States and Mexico, which system seems to be most efficient? In terms of accessibility, Canada’s system is most readily available. In terms of quality, however, the US system is on the same level, if not better, than Canada’s. In the last two categories, cost and longevity and mortality, health care in Canada manages to spend the least amount of money per capita but still maintain the highest life expectancy for both males and females and the lowest infant mortality rate. There are a lot of other criteria that could have been used for comparison, and each system has its advantages and disadvantages. However, for the four criteria chosen here, Canada’s health care system seems to be the most efficient and best suited for human development.

COMMENT? If you have any suggestions or comments concerning this paper please send them to the seminar mentioning "health" in the subject line.

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