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Canadian Public Healthcare System Compared to the US healthcare System

One of the main differences between the Canadian and U.S. healthcare systems is the amount of funding that goes toward the provision of health-related services. More funding is available in the U.S. At the same time, there is a general consensus that the Canadian system is more equitable in light of the fact that tired policies are offered in the U.S.

Funding and Prices

Canada spends a little over 10 percent of GDP on public healthcare while the U.S. spends over 17 percent. This means that each year about $4,570 is spent for every citizen in Canada compared to about $9,000 in the U.S. This is mainly due to the difference in the prices of medical services and medications in both countries. A report by the International Federation of Health Plans, for example, shows that Nasonex, a medication for nasal allergies, costs $115 in the U.S. and $29 in Canada. An abdominal CT scan costs $896 in the U.S. and just $97 in Canada. And while the U.S. spends significantly more on healthcare, data shows that Americans do not fare much better than Canadians when it comes to health status. Maternal mortality is 6.5 deaths per 1,000 in Canada and 12.7 in the U.S. Life expectancy is also shorter in the U.S. than in Canada, both for males and for females. The number of deaths due to injuries, heart diseases, and non-communicable diseases is also higher in the U.S. than north of the border.

Coverage

In the U.S., close to 50 percent of people have Medicare, Medicaid, or Marketplace health insurance plans. Medicare is federally funded and available to seniors over the age of 65 while Medicaid is a program jointly administered by the state and federal governments to help cover health costs of people in the low-income bracket. Some 50 percent of people are covered by employer-based insurance plans. About 9 percent of people have no coverage, down from over 15 percent in 2007. At the same time, one study shows that medical bills are the main reason for some 50 percent of personal bankruptcies in the U.S. In Canada, all citizens are covered under Medicare, with the exception of dental care, long-term and home care, and prescription drugs. Some 75 percent of Canadians have additional private health insurance coverage.

Wait Lists

Long wait times are a major problem in Canada when it comes to elective surgeries, specialist appointments, after-hours care, and next-day and same-day appointments. The average wait time for specialist appointments is 20 weeks. A report by the Commonwealth Fund reveals that 23 percent of Americans wait for a specialist appointment for four weeks or longer compared to 57 percent of Canadians. At the same time, fewer Canadians complain from healthcare services than Americans. The same is true for duplicate tests and medication, lab, and physician errors.

While wait lists are a serious problem for many people, access to physician and hospital medical services is guaranteed in Canada. Nursing homes and hospitals only charge for extended care. Canadians buy private health insurance to cover costs such as hospital amenities (e.g. private room), cosmetic surgeries, and dental services. At the same time, user charges are a serious burden in the U.S., private insurance is more expensive, and many Americans have no coverage at all.

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Antimicrobial Stewardship in Canada

Antimicrobial stewardship refers to strategies, interventions, and programs to develop medications that help reduce costs and resistance to antibiotics. Resistance to antimicrobial medications is a major problem in Canada and around the world in light of the fact that developing new medications is a complicated process. Today, the focus is on the best method of administration, dosage, and regimen to improve treatment outcomes. The goal is to reduce mortality and improve clinical outcomes in intensive care, oncology, transplant medicine, and surgery.

Healthcare Professionals and Stewardship

Healthcare professionals have a vital role to play in antimicrobial stewardship in that they diagnose, administer treatments, and prescribe medications. Practitioners work across different settings as surgeons, nurses, midwives, pharmacists, and general practitioners.

Antimicrobial Stewardship Strategies

In Canada, a number of strategies and tools are used based on criteria such as program stage, difficulty and priority level. The main strategies include checklists, automatic stop orders, antibiograms, formulary review, formulary restriction, and improved diagnostics. New and improved diagnostic methods are used, for example, rapid diagnostic tests and serum biomarkers. The goal is to improve clinical and prescribing outcomes by way of targeted treatment. The main advantages include shorter treatment duration and lower hospital costs. There are disadvantages as well, one being that improved diagnostic methods require advanced laboratory equipment. Dose optimization is another strategy to improve health outcomes. The proper dose depends on factors such as the type of drug, infection, liver and renal function of the patient. The main advantages of using this strategy include a lower risk of adverse effects, reduced mortality rates, and reduced risk of developing antimicrobial resistance. The main disadvantage is that it is not always possible to obtain information required for dosing, including renal and liver function.

Checklists are also used to adjust and assess treatment methods and outcomes. The main elements include treatment duration, assessment of microbiology results, assessment of route of administration and dose, and indication for treatment. Antibiograms are also used to determine whether infectious agents are susceptible to antibiotics and are useful in the early stages of treatment. The main advantage of using antibiograms is that they provide valuable information about resistance patterns over time. At the same time, this method requires significant resources and microbiology expertise. Therapeutic drug monitoring is another strategy to reduce toxicity and improve clinical outcomes. This strategy is based on monitoring of serum levels, including monitoring of vancomycin, amikacin, and gentamicin. The goal is to minimize the adverse effects of therapies and improve treatment outcomes. The main problem is that therapeutic drug monitoring requires laboratory equipment to perform tests, and not all institutions have equipment onsite. Other stewardship strategies include scheduled antimicrobial assessments, prescriber education, intravenous to oral conversion, and streamlining and de-escalation.

Initiatives and Events

The Canadian Roundtable on Antimicrobial Stewardship was organized in 2016 to develop an action plan and strategies to raise community awareness and to develop strategies to link environmental and animal and human health initiatives. Participants included representatives of the Centers for Disease Control and Prevention, University Hospitals of Geneva, Health Services Regional AMS Program in Alberta. Another initiative is the Canada – UK Partnership on Antibiotic Resistance that brought together experts with a focus on molecular determinants, immune system modulation, etc.

The Federal Framework for Action has been developed by the Canadian government to raise awareness of antimicrobial resistance and overuse as a threat to human and animal health. The goal of the plan is to address antimicrobial resistance by working closely with different stakeholders, including territorial, provincial, and federal partners. Canada also participates in multiple initiatives to address the issue, including the CODEX Intergovernmental Taskforce, GHSA ARM Action Plan. As a member of TATFAR, Canada works in cooperation with Norway, the European Union, and U.S. to improve infection control and prevention strategies.

Advisory bodies and committees have been created to help prevent overuse. The Antimicrobial Stewardship Advisory Committee in Ontario, for example, works to assist Public Health Ontario in setting priority areas. Alberta Health Services has adopted a stewardship program to help optimize treatment and clinical outcomes through appropriate treatment methods and medications, route of administration, and dosing.