Healthcare systems of Canada and China
Executive summary
The healthcare system of a country plays an integral role in contributing to the prosperity of the economy of that country. Hence, it is the government’s responsibility to develop well-designed health-care systems that are effectively structured, governed and financed. This strong network of health-care will create convenience and feasibility for the target populations and would thereby enhance their standard of living. The report elaborates on the healthcare systems of China and Canada.
The healthcare network of China adheres to the principle of Universal Health Coverage. This system first segments the target population into rural and urban groups and then allocates multiple health insurance schemes and governmental subsidies to each group. The governance of the Chinese healthcare network is led by the central government who then delegates the responsibilities to the other federal and provincial governments. This system allocates a handsome amount to the public health and hence the public sector is a major source of financing. In contrary to this network, the Chinese healthcare network is regulated by the Canadian Health Act of 1984. The Canadian government solely finances the basic medical services, however the other medical expenditures are being financed by a combination of public and private sector expenditure and out of pocket costs. Furthermore, this system is highly decentralized and delegates its operations to the provincial institutions. The Canadian healthcare system allocates around 64.2% of the health-budget to the Public sector, thereby reflecting the importance of the governmental funding.
The Chinese system can further enhance it’s operations by working on the potential of the health bureaucracy system, productively utilizing it’s resources and introducing a voluntary subsidy for senior citizens. The Canadian system can improvise the functioning of the network by subsidizing the premium services, eradicating income disparity and introducing insurance schemes to cover chronic diseases.
Introduction
The health care system in any country holds significant importance to the economy of that country since it has a magnanimous impact on the well-being and the quality of life of the target populations. These health systems can be defined as well-structured networks through which healthcare is organized, financed and delivered to the populations. Furthermore, these systems comprise of public health institutions and other resources that tends to meet and enhance the health-care needs of the target citizens (Petrosyan & Anderson, 2019). Hence, it is the primary responsibility of the government to develop strong and well-designed healthcare networks. When a country has a strong healthcare system, its citizens would be highly facilitated since they would have access to the most effective and quality healthcare services. This would ensure that the economy continues to thrive and progress. Hence, it can be asserted that a strong healthcare system would signal a powerful economy. The economy of France, having a GDP of around 2.8 million USD, can be used as a brilliant example to justify the tremendous impact the healthcare system has on the economy (Lee-Simion, 2017). Furthermore, an efficient healthcare system would also make a significant contribution to the public health sector, which adheres to promoting healthy lifestyle in the entire communities (Shiel, 2018).
Over the years, the healthcare systems have transformed greatly and have upgraded the provision of health services. This transformation can be traced through the achievements in healthcare standards across the globe. A few of the achievements of the healthcare industry includes a dramatic reduction in child mortality, increase of the average life-expectancy at birth, measures to control diseases like tuberculosis, malaria, HIV aids, greater awareness about the global health threats and access to clean water and sanitation (Koppaka, 2011). These progressions have been largely due to the advances in the medical science and reformation in the governance, financing and structuring of the healthcare systems worldwide. The proper governance of the healthcare system ensures an excellent execution of the tasks of planning, organizing, staffing, controlling, directing and decision-making and policy-making. A healthcare system with a hampered governance will never be able to achieve the system’s targets and goals. Furthermore, an exceptional financing system in the healthcare network will ensure proper distribution of financial risks, mobilizations of funds and thorough allocation and utilization of services. Moreover, a proper healthcare structure would ensure proper management and efficient usage of all resources, with the aim of achieving the system’s goals and missions (Hong, 2017). Hence, a productive combination of all these factors will ensure a thriving and a successful health management system.
This report is primarily designed to focus on comparing and contrasting the structuring, financing and governance of the healthcare systems of China and Canada. The pros and cons of both the systems would also be thoroughly discussed in order to assess the effectiveness of both the frameworks. Furthermore, the report would also detail the proportion of health budget allocated to public health within each healthcare framework. The report ends with a general recommendations on how to enhance the workings of these healthcare systems.
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Structure, governance and Financing of the systems
The success of the healthcare system of any country can be determined by the structure, governance and the financing of the system. A good healthcare system would also ensure the feasibility, accessibility and the affordability of the healthcare services. Hence, it is the responsibility of every government to develop a well structured, financed and administered healthcare network which is in coherence with the needs and demands of its citizens.
Two healthcare systems have been taken into consideration, the Chinese Healthcare system and the Canadian Healthcare system. A closer look at the Chinese healthcare system, shows that it is a well-designed health care network that underwent a major transformation in 2009. This transformation revolved around the policy of universal coverage and contributed in uplifting the equity of the healthcare network. This combined with the other healthcare reforms strengthened the structure of the Chinese Healthcare network (Li & Fu, 2017). This structure segments the population into two major groups, the urban group and the rural group. The financing of the urban residents group is covered by the Urban Resident medical Insurance, whereas the rural residents group is covered by the New Cooperative Medical scheme (Zhai, et al., 2017). The Urban group is further categorized into three other groups on the basis of the job function. The first group under this category is regulated by the Public Health Administration Act of 1988 and includes those people who are employed in the governmental organizations, the public health sector, the NGOs and the army. This group receives full coverage in terms of the medical expenses. The second group covers the urban enterprise employees and this group’s medical expenses are funded by insurance premiums paid both by the workers and the employers. The third group comprises of unemployed individuals whose healthcare funding is performed via both insurance premiums and governmental subsidies. Lastly, the rural residents’ health care is being funded by insurance premiums complemented with major voluntary insurance schemes set up by the local and central government. (Hougaard, Osterdal, & Yu, 2011).
The Canadian healthcare system, in contrary, is developed on the model of need rather than affordability and is regulated by the Canadian Healthcare Act of 1984, which guarantees the universality and accessibility of the Healthcare facilities. Where the financing of the Chinese system occurs according to the class-wise division of people and adheres to three major sources which includes Public Insurance Schemes, Out of pocket Payments (OOP) and general taxation, the financing of the Canadian setup takes place in three different layers (Si, Palmer, & Chen, 2017). The first layer consists of the public services that are provided via the general tax revenue and is completely free of cost. This service is limited to hospital care and a physician’s services. The second layer includes financing which is done via a mixture of public and private insurance and out of pocket payments. The services included in this layer includes home care, institutional long-term care and prescription drugs. The third layer of financing is done privately and includes premium services like out-patient physiotherapy and dental care etc. (Martin, Miller, Quesnai-Vallee, & Caron, 2018).
The second difference between the Chinese and the Canadian healthcare system concerns the structure. This healthcare structure of the Canadian health system allows all residents to avail healthcare under a single government-funded health insurance plan. This health plan has 13 separate plans that are followed by each of the provinces and all these plans share the same basic principles that are defined under the Canadian Health Act. One of these principles includes universality/accessibility of all health care services and hence this network enables the Canadian citizens to find ease in utilizing the healthcare facilities (Kliff, 2012). This healthcare structure is in contrary to the Chinese healthcare structure which launches multiple insurance plans according to the rural or urban class of living. Furthermore, the Canadian system does not incorporate the the extra costs such as dentistry, surgical and notable pharmaceutical expenses in the Medicare coverage, whereas the Chinese system does not account for these extra costs separately (Blomqvist, 2017).
The third difference in two healthcare systems concern the governance framework. The health system governance of any country is integral in regulating the reforms and policies of the health care in that country. They are also responsible for formulating and implementing the health policy schemes and guiding the purpose, vision, design and strategy of the network (Yuan, Jian, He, Wang, & Balabanova, 2017). In terms of governance, all countries introduce a different range of reforms and policies that may stabilize their healthcare systems. Hence, it can be asserted that the Chinese healthcare governance may differs from that of the Canadian healthcare in multiple aspects. The systems under the Chinese healthcare network has been majorly governed by the central government, which holds the top-most authority in the network. The central government further delegates the tasks and responsibilities to the provincial and local governments, who further assigns tasks to several healthcare agencies. The standards of healthcare received by the residents is dependent on the administrative and fiscal capacities of these agencies. In contrary to the governance standards of China, the governance of the Canadian healthcare system adheres towards major decentralization. Territories and provinces are held responsible for planning and administering health and education services. In many instances, the regional health authorities also tend to deliver the medical services locally. Furthermore, the governance of the health system is regulated by the Canadian Health Act of 1984 which has developed the provincial Healthcare insurance plans. In comparison to this, the Chinese healthcare system is regulated via a scheme of Universal Coverage (Ramesh, Wu, & He, 2014).
While the differences between these two healthcare systems exist, it has also been found out that these systems also share a few features. Firstly, both the systems comprise of vast networks of governance with the operations of small towns and provinces being catered by small institutions that lie at the edge of the network. Furthermore, both the healthcare systems operate on financing setups which comprise of both private and public spending and out of pocket expenses. Moreover, both the systems are being regulated by healthcare policies and reforms that are introduced by the government. The Canadian healthcare Act of 1984 and the Public Administration Health Act of 1987 in China are potential examples. Furthermore, both the systems operate on the principle of universal coverage and accessibility of the medical services. These norms ensure the effectiveness of both the systems. Hence, it can be affirmed that there potential similarities between these two healthcare networks (Ridic, Gleason, & Ridic, 2012).
Advantages and disadvantages of the system
The Chinese healthcare network has greatly developed and strengthened over the years and hence, it bears multiple benefits for the society and the target population. From 2000 to 2017, the financial contributions for healthcare has been majorly funded by the government and the social health insurance systems rather than being out-sourced. Furthermore, low income countries and provinces received additional health subsidies by the government. Moreover, during the period of healthcare reformation, public health service packages and Social health insurance schemes were extended to all the citizens. This depicts the greater strength of the healthcare system. The diagram below depicts the increase in the public funding for health (Meng, Mills, & Wang, 2019)
Figure 1 (Meng, Mills, & Wang, 2019)
Furthermore, the system also enabled healthcare to be more accessible and affordable by providing an extended coverage through the social health insurance schemes. The existent health disparities in the country also dramatically reduced. For instance, the difference between the infant mortality rates in urban and rural areas decreased from 25.2% in 2000 to 3.8 % in 2017. This shows that there were substantial initiatives taken to upgrade the working of the Chinese Healthcare system (Meng, Mills, & Wang, 2019).
Despite the wave of reformation, the Chinese healthcare system still faces multiple challenges that tends to weaken the stronghold of the network. In China, health care is not considered as one of primary agendas in many areas of the country due to the greater focus on economic development. This fact deters the effective implementation of many of the health reforms by the municipal and the local governments, thereby weakening the foundations of the network. Furthermore, China being a poor country in terms of the per capita resources, faces issues in mobilizing and sustaining the resources for the healthcare system. This gives birth to an imbalance between the resources, power and responsibilities of the users and providers in the healthcare system (Shenglan & Qingye, 2013). Furthermore, the Chinese health system’s bureaucracy also lacks the relevant organizational and analytical capacity to impose an authority over the providers. This can be evidenced by the consistently inflating drug prices (Ramesh, Wu, & He, 2014). Lastly, the country’s health delivery systems are fragmented and need to be cost effective and integrated.
The Canadian healthcare system is a well-structured system that has facilitated the Canadian citizens greatly. One of the significant factors concerning the system is the fact that 70 percent of this system is public, which has made the health care accessible and affordable for the entire population. This accessibility is reinforced by the Canadian Health Act of 1984, which guarantee the universality of the Healthcare. Moreover, the services of the health network are highly decentralized, making the territories and provinces responsible for planning and administering medical and healthcare services (Valle, 2016).
Despite the multiple achievements, the system also faces some potential challenges that defines loopholes in the network. The system does not grant health cost waivers to those who do not have an employer-based supplemental private insurance. These people include the youth, women and the low-income individuals. Hence, these individuals are unable to avail the advantages that the healthcare system offers. Furthermore, the Medicare services also do not include medical treatments pertaining to health professionals who are not physicians. This will enable healthcare outside the medicare basket to be inaccessible and thereby, it will create inconvenience for the Canadian citizens. Thus it can be asserted that the system has a deeply embedded existence of inequities in health outcomes. The second disadvantage of this system is, that the timing for elective care like knee replacements is too long, which creates a problematic circumstance for the patient. Research has shown that this waiting time is amongst the worst in all OECD countries. Lastly, the Canadian health care is a subject to income disparities, social exclusion and persistent racism, which leads to the birth of an unequal healthcare framework (Martin, Miller, Quesnai-Vallee, & Caron, 2018).
Proportion of the health Budget allocated to public Health in both systems
The Expenditure on healthcare in a country is financed by multiple sources which may range from private to public expenditures and out of pocket expenses. The Canadian and the Chinese governance have also designed their healthcare frameworks in a manner in which they are able to allocate a certain portion of the expenditure to each source in the overall Health budget. The most important of these sources is the public-sector spending, which reflects the expenditure by the government and the other government-related agencies. Between 2001 and 2016, this public financing of healthcare services increased by 116.4 percent (Barua, Palacios, & Emes, 2017). Furthermore the healthcare statistics of 2018 reveals that the Canadian government generated a health budget which granted 64.2% of the total budget to the public-sector funding. Moreover, 4.8% of the total healthcare financing came from other sources. This displays the strong dependency of the healthcare system on public-health funding (Effective Public Healthcare Panacea Project, 2019).
Furthermore, a look at the Chinese health-sector financing also showed that the financial contributions from the government and via the social health-care security systems have dramatically increased. The public-sector funding rose by 100-150 bn yen every year between 2009 and 2017. Furthermore, the social health insurance accounted for around 42% of the total spending in healthcare. The Low income provinces and countries received 100% of the funding from the high-level governments. Hence, it can be asserted that the Chinese government has also contributed substantially in enhancing the health-care standards of the country (Liu, Yuan, Ma, Fang, & Meng, 2019).
Conclusion
In conclusion, it can be asserted that the healthcare systems of both Canada and China are well-structured and have greatly progressed. The principle of accessibility that has been incorporated in the healthcare networks have greatly enhanced the provisions of healthcare facilities. It has also improvised the healthcare equity and it serves as a huge step in moving towards a progressive society. Furthermore, the greater extent of governmental financing in the health budget has also further stabilized the health network. However, there are certain improvements that both the countries can adapt in order to further enhance the structure, governance and the financing of these systems.
The Chinese healthcare network should work towards enhancing the organizational and the analytical capacities of the health bureaucracy system. This would enable the system to stay updated on market trends like the inflated medicine prices and thereby have an influence on controlling these prices. This step is integral in fulfilling the rising demand of all healthcare facilities. Furthermore, the government of China should introduce a special voluntary subsidy for the treatment of senior citizens. This would enable the ageing population to access all the healthcare facilities with ease, thereby enhancing their standard of living. Moreover, the country should work towards developing a cost-effective and an integrated health delivery system that would enable a universal coverage of all medical facilities. The healthcare system should also focus towards balancing the power, resources and responsibilities of the users and providers in the system. This would enable the network to productively utilize it’s resources and thereby create a healthy and a strong healthcare system.
The Canadian healthcare system should also work towards modifying a few aspects of it’s structure. Firstly, the country should work towards subsidizing the cost of premium services like dental care and surgical treatments for citizens residing in the lower category provinces. This would enable them to avail these medical facilities without fear of bearing the higher expenditures. Moreover, this would serve as a potential step towards eradicating the existent income disparities in the healthcare system and hence, this initiative would greatly enhance the workings of this vast health-care network. Furthermore, the health-care system should grant limited health-cost waivers to those who do not possess the employer-based supplemental private insurance. This would serve as a bold step in enhancing the accessibility of the healthcare facilities to this class of citizens. Secondly, the rise in chronic diseases like breast cancer etc. calls for the government to design special insurance schemes pertaining to these deadly diseases. The introduction to these schemes would generate greater awareness of these chronic diseases, while encouraging the people to prepare for an unfortunate bigger expenditure. These suggestions when incorporated, will lead to the development of a well-designed and a convenient health care system.
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