Does Canada ‘s publicly-funded and single-payer wellness attention system control wellness outgo rising prices better, distribute wellness services more equitably, and present better quality of attention than the private-dominated and multi-payer system of the United States?

Although practically joined at the hip geographically, the wellness attention systems of the U.S. and Canada could non be more disparate. In comparing which theoretical account of funding wellness attention is more effectual, the two states are ever bases for comparing. Due to the lifting unemployment and the addition in the degree of economic uncertainness brought approximately by the recent planetary fiscal crisis, wellness attention as a resource has been a contentiously debated one. Then newly-installed President Barack Obama and his Democratic Alliess in Congress to a great extent campaigned for cosmopolitan wellness coverage and caused a monolithic splash. However, the thought of cosmopolitan wellness coverage had already been floated since the terminal of the Second World War. Until now, among the most advanced economic systems in the universe, the U.S. remains the lone state without cosmopolitan wellness coverage. It besides has the most dearly-won wellness attention in the full universe. On the other manus, its North American neighbour has followed the equity theoretical account in wellness attention proviso of Western European states. Aside from cosmopolitan wellness attention coverage, Canada is said to hold one of the best-performing wellness attention systems in the universe.

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The planetary economic state of affairs calls for another expression at wellness attention. With the recent economic challenges confronting advanced economic systems, states are trying to efficaciously pull off their wellness outgo rising prices as they at the same time try to recognize their wellness attention aims. Not all wellness attention theoretical accounts are created equal, though. Each is developed with its ain set of premises and precedences. Countries design different attacks in the funding, organisation, payment, and ordinance of wellness attention. This basically outputs besides unequal results for all.

But while they may differ in attack, states by and large have three primary aims in head. The first aim is equal entree. With the exclusion of the U.S. , all advanced economic systems today struggle hard to accomplish cosmopolitan coverage. The World Bank recognizes that equal wellness attention is a basic right of peoples ; because wellness is indispensable for endurance and the proper operation of economic systems, most states put a premier on equal entree to quality wellness attention. The 2nd aim of wellness attention systems is cost containment. Pull offing the public costs of wellness attention is another aim of states and a major mark in the overall wellness reform procedure. As the population and its demands grow, the costs of wellness attention take up a bigger ball of the national income. Hence, states must plan policy that will set up effectual budget restraints for wellness by restricting every bit much as possible the authorities ‘s outgos for wellness. The 3rd aim of wellness attention systems is to supply high quality wellness attention. Policy sing the efficient bringing of wellness services involves a inquiry of how the wellness attention system is organized and construction in order to obtain maximal quality of attention ( Hsiao 45 ) .

In comparing the public presentation of a wellness attention system of the U.S. and Canada, this paper uses Hsiao ‘s three aims as a model. First, entree in the wellness attention systems of the U.S. and Canada are examined. Second, the cost containment of both states is investigated with the usage of official statistics to compare wellness outgos and rising prices. Third, a reappraisal of surveies will be made in order to measure the degree of quality of attention for both states. This paper argues that in footings of supplying equal entree, pull offing wellness outgo rising prices, and presenting high-quality attention, Canada has established a better-performing wellness attention theoretical account which the U.S. can larn from.

Models of Public Financing

What influences expenditures in the wellness attention systems in states is the theoretical account or purpose of public policy. Governments exist as entities that levy revenue enhancements on houses and persons, spend revenue enhancements, and modulate several domains of economic activity. Governments intervene in economic activities because of two chief motivations: 1 ) efficiency, and 2 ) equity ( Rosen 32 ) . In the field of economic sciences, efficiency has a clearer significance. There is efficient allotment of resources ( termed Pareto-efficient ) if “ there is no rearrangement of resources ( no possible alteration in production or ingestion ) such that person can be made better off without at the same clip, doing person else worse off ” ( Stiglitz 14 ) . On the other manus, equity is a instead obscure term which has no common definition. The thought of equity is for authoritiess to be able to aggregate the different visions of equity in the population and supply a solution agreeable to all. To most economic experts, the realisation of efficiency is easier than equity. However, equity remains a end for public policy in many states.

The function of the authorities in economic activity has ever been a debated issue. Previously, laissez faire economic sciences dominated the discourse, reasoning that authoritiess must hold a limited function. However, in the aftermath of the Asiatic miracle, many states took a paradigm displacement. Some attributed the growing of the Asiatic markets to a mix of heavy authorities intercession and an every bit heavy trust on the market.

The precise function that the authorities undertook in different states has differed. And the functions were non derived from some abstract set of rules, i.e. they were non based on the sorts of ideological premises that have underlaid both laissez faire economic sciences and socialism. The cardinal theorem of public assistance economic sciences asserts that competitory market economic systems are so efficient. Still, many were non convinced: the market economic system did non look to be the Nirvana that advocates of the market economic system claim. To many states, Adam Smith ‘s unseeable manus was non merely unseeable, there was a intuition that it might, after all, be non at that place. Hence the statement that authorities must make something to take to the Pareto improving.

It is possible to turn out, mathematically, that under certain conditions, competitory markets produce efficient results. Under these conditions one could non reason for authorities intercession in the economic system on the evidences that it promotes efficiency. This averment is stated in the Two Fundamental Theorems of Welfare Economics. First Theorem of Welfare Economics Under certain conditions, competitory markets produce an efficient allotment of resources. Second Theorem of Welfare Economics Under certain conditions, any efficient allotment of resources can be achieved with competitory markets. There are two important looks in the statement of the theorems: I ) under certain conditions, two ) competitory markets. Failure of either one, or both, can ensue in inefficient results, and supply grounds for authorities intercession in the economic system.

Efficiency is non the lone standard used to measure resource allotment. Many citizens argue that result should besides be evaluated in footings of equity ; that is in footings of the sensed equity of an result. The job involved with using standards of equity is that individuals differ in their thoughts about equity. Economists normally confine their analyses of inquiries of equity to findings of the impact of alternate policies on such groups as the hapless, the aged, or the kids. In the field of public finance, analysis normally try to find the effects of authorities actions on both resource allotment and the distribution of wellbeing, therefore supplying utile information that citizens can utilize to judge the equity of alternate policies in their ain impressions of equity ( Hyman 69 ) .

The American Health Care System

This subdivision examines the voluntary insurance wellness attention theoretical account of the United States in footings of entree, wellness attention expenditures, and quality.


Unlike other states, the U.S. does non see wellness attention a right guaranteed to all ( Hyman 354 ) . Because it values single freedom and pick, the proviso of wellness attention does non peculiarly value equity ( Hsiao 45 ) . Health insurance coverage in the U.S. is normally based on employment. Those who do non straight receive insurance benefits from employers or do non measure up for either Medicaid or Medicare may take non to acquire insurance. Peoples decide non to be insured because they do non desire to bear the load of the costs of insurance or because the insurance available is non low-cost. The U.S. relies on voluntary private wellness insurance to finance wellness attention. To forestall inauspicious choice, most private wellness insurance is sold to employees through their topographic point of employment, which leaves the aged, unemployed, and the hapless – those who tend to necessitate more wellness attention – without coverage. The authorities has had to finance these uninsured groups: federal Medicare coverage is available for the aged, and the provinces fund Medicaid to cover the hapless. Due to the voluntary nature of wellness insurance in the U.S. , an estimated 50.7 million Americans in 2009 were uninsured, composing about 16.7 % of the population ( Kaiser Fund ) .

Health outgos

Health attention in the United States is paid through a combination of private and public financess. Private financess are comprised of insurance, out-of-pocket monies and monies given through philanthropic gift, while public financess are obtained from Medicare, Medicaid, State Child Healthcare Insurance Program ( SCHIP ) , veteran ‘s plans, province and local plans and workingman ‘s compensation plans. Take together, the sums paid out by these beginnings represent the wellness attention expenditures for the state ( Center for Medicare and Medicaid Services [ CMS ] 2 ) .

Outgos on wellness attention in the United States have been lifting quickly. In 1960, we allocated merely 5.3 per centum of the value of our national merchandises to wellness attention. In 2009, national disbursement, including infirmary attention, professional services, drugs, and a assortment of other wellness services including research and the building of medical installations, amounted to 17.6 per centum of GDP. The portion of GDP has about tripled since 1960. Entire wellness outgos reached $ 2.5 trillion, which translates to $ 8,086 per individual or 17.6 per centum of the state ‘s Gross Domestic Product, up from 16.6 per centum in 2008.

Figure 1. Health Expenditures as a Percentage of the Gross Domestic Product 1960-2009

Beginning: Centers for Disease Control and Prevention, 2011

Entire disbursement on wellness attention per individual in the U.S. amounted to $ 7,538 in 2009. Per capita disbursement for wellness attention by authoritiess was more than $ 4,000 in 2004 – and lifting quickly. Outgos for wellness attention in the US include infirmary services ; professional services ; drugs ; wellness attention equipment ; administrative costs, and research.

Figure 2. Health Care Expenditures By Service

Beginning: Centers for Medicare & A ; Medicaid Services, Office of the Actuary, National Health Statistics Group, 2011.

For the twelvemonth 2009, the greatest ball of wellness attention expenditures belonged to hospital attention ( 31 % ) , doctors and clinics ( 20 % ) , others ( 14 % ) , prescription drugs ( 10 % ) , dental services and other professionals ( 7 % ) , administrative costs ( 7 % ) , investing ( 6 % ) , and nursing attention installations ( 6 % ) .

Hospital disbursement increased by 5.1 % to $ 759.1 billion in 2009 ( vs. 5.2 % growing, 2008 ) . Physician and clinical services increased by 4 % in 2009 to $ 505.9 billion. Among the most outstanding additions in disbursement over a 10-year period include prescription drugs which have been increasing by an norm of 10 % yearly. Another outstanding subscriber to wellness attention disbursement is the high administrative costs of 7 % which have since increased steadily since 1995.

The system of wellness attention that has evolved in the US is based chiefly on private proviso of services with a mix of private and authorities wellness insurance plans reimbursing wellness attention suppliers for their services. Although the private sector has slightly of a dominant function, the populace sector besides plays a critical function in the American wellness attention system. Each degree of authorities plays a different portion in funding, forming and supplying wellness attention. The province authoritiess besides finance wellness insurance and wellness attention to hapless households and this, largely through Medicaid, which is a co-financed plan with the federal authorities. Much like the federal authorities, the province authoritiess offer insurance to their employees and their dependants. The local authoritiess are more involved in financing “ safety net suppliers ” and in keeping exigency response services.

Figure 3. Financing Health Expenditures in the United States, 2009

Beginning: Centers of Medicare and Medicaid Services, 2011.

Even though 60 per centum of the American population in 2009 was enrolled in private employment-based wellness insurance programs, these programs absorbed merely 34 % of entire wellness attention costs. This is because many of those enrolled in such programs are comparatively immature and healthy members of the work force. Merely 13 per centum of Americans ‘ wellness attention measures are paid for straight by the persons as out-of-pocket family costs. The pie chart ( Figure 3 ) shows how entire wellness outgos in the US were financed in 2009. Of the entire sum spent, 49 per centum was paid for by authoritiess, with the federal authorities accounting for the largest of entire authorities disbursement in wellness attention. The strong authorities presence in the market for these services has been turning at a rapid rate as has the overall rate of increased disbursement on wellness attention in the state. However, outgos by authoritiess in the US are low compared to wellness attention disbursement by authoritiess in other industrialised states. Most European states have expensive authorities proviso of wellness attention and authoritiess typically got 70 to 90 per centum of the wellness attention measure and finance these cost with revenue enhancements. For case, Norway pays 97.6 per centum of all wellness outgos of Norwegians. Yet at the same clip, Norway allocates merely 10.3 per centum of its GDP to wellness compared to 17.6 per centum in the US.

Quality of Care

For all its disbursement, the US has lower life anticipation than most OECD states ( 78.1 ; norm is 79.1 ) , and is below norm on a broad scope of other steps, including infant mortality, possible old ages of life lost, conformable mortality, and disbursement on results, as many other factors determine mortality. There are many good things to state about the quality of the US wellness system. It delivers attention in a timely mode, waiting lists are unknown, unlike in many OECD states. There is a good trade of pick in the system, both in wellness attention suppliers and, to some extent, the bundle of wellness insurance. The system delivers new merchandises to consumers more rapidly than in any other state. The United States is the major pioneer, both in medical merchandises and processs.

The Canadian Health Care System


Canada gives precedence to universal and equal entree to wellness attention. This is accomplished through a national wellness insurance strategy which offers citizens free medical services ( dental and outpatient drugs are excluded ) . The federal authorities and states jointly fund the cost of national wellness insurance but the plan is established and administered by the states. The provincial wellness insurance program must run into certain criterions set by the federal authorities: coverage must be cosmopolitan, comprehensive, portable, and include “ all medically needed services. ” Patients are free to take doctors and infirmaries but must see a general practician to be referred to specializers. Doctors are paid on a fee-for-service footing. Outgo rising prices is managed by set uping planetary budgets for infirmaries and for doctors ‘ services. Physicians ‘ fees are set by the provincial medical associations through an internal bargaining procedure. This procedure is designed to fulfill the planetary budget cap. To pull off the volume of services, each state monitors the measure of services delivered by each doctor. Because all claim payments are made through one centralised bureau, the states maintain a pattern profile on each doctor and infirmary. Medical associations are responsible for monitoring and training deviant doctors.

Health Outgos

Entire disbursement on wellness attention in Canada is expected to make $ 191.6billion this twelvemonth, turning an estimated $ 9.5 billion, or 5.2 % , since 2009, harmonizing to new figures released today by theA Canadian Institute for Health InformationA ( CIHI ) . This represents an addition of $ 216 per Canadian, conveying entire wellness outgo per capita to an estimated $ 5,614. After taking the effects of rising prices and population growing, wellness attention disbursement per individual is expected to increase by 1.4 % in 2010, the lowest one-year growing rate seen in 13 old ages.

When examined as a portion of Canada ‘s overall economic system, wellness attention disbursement is expected to make 11.7 % of the gross domestic merchandise ( GDP ) in 2010, a diminution from the estimated portion of 11.9 % in 2009, but still higher than it was in 2008, at 10.7 % . The figures released today are from CIHI ‘s one-year study, A National Health Expenditure Trends, 1975 to 2010, Canada ‘s most up-to-date and comprehensive beginning of information tracking how dollars are spent on wellness attention in this state.

Figure 4. Health Expenditure in Canada from 1975-2010

Beginning: Canadian Institute for Health Information, 2011.

“ Legal powers have been working to command lifting costs, and the lag in the growing in wellness attention disbursement may be, in portion, a contemplation of that, ” says John Wright, CIHI ‘s President and CEO. “ However, wellness attention remains a precedence for Canadians, and we continue to see investing in the system, with wellness disbursement turning at a faster rate than population growing. It besides continues to stand for an of import portion of our overall economic activity. ”

In 2010, authorities disbursement on wellness attention is expected to make $ 135.1 billion, while private-sector disbursement, which includes both private insurance and out-of-pocket disbursals, will make an estimated $ 56.6 billion. For more than a decennary, public- and private-sector wellness disbursement in Canada has been turning at about the same rate, with the populace sector accounting for approximately 70 % of the entire wellness attention measure and the private sector for 30 % .

Figure 5. Beginning of Health Care Financing in Canada, 2009

Beginning: CIHI, 2011.

Spending highest on seniors, but impact of population aging minimum over clip While Canadians older than age 65 history for less than 14 % of the Canadian population, they consume about 44 % of all wellness attention dollars spent by provincial and territorial authoritiess. In 2008, the latest available twelvemonth for informations broken down by age group, provincial and territorial authoritiess spent an norm of $ 10,742 per Canadian age 65 and older, compared to $ 2,097 on those between age 1 and 64. Within the senior population, passing varies widely by age group, with wellness attention outgo on seniors age 80 and older, at an norm of $ 18,160 per capita, more than three times higher than for seniors younger than age 70 ( $ 5,828 per individual on norm ) .

However, CIHI figures show that the portion spent on Canadian seniors has non changed significantly over the past decade-from 43.6 % in 1998 to 43.8 % in 2008. “ While it is true that attention is costlier for people who are 65 and older, we have non seen a rise in the proportion we spend on seniors, ” says Jean-Marie Berthelot, Vice President, Programs, at CIHI. “ An aging population may hold an impact on wellness attention disbursement, but so far the mean outgo on seniors has non risen faster than for younger Canadians. ”

Variations in provincial/territorial disbursement on wellness

Entire wellness attention disbursement continues to change by state, with disbursement per individual expected to be highest in Alberta and Manitoba at $ 6,266 and $ 6,249, severally. British Columbia and Quebec are forecast to hold the lowest wellness outgo per capita at $ 5,355 and $ 5,096, severally.

Health attention continues to stand for one of the most of import budget points for states and districts, stand foring an norm of 39.2 % of entire provincial and territorial authorities plan disbursement in 2009, the latest information available. Ontario and Manitoba spent the highest proportion of their budgets on wellness in 2009 ( 45.7 % and 43.7 % , severally ) while Newfoundland and Labrador and Quebec spent the lowest ( 33.8 % and 33.1 % , severally ) . While wellness attention disbursement as a portion of entire plan disbursement grew across Canada between 2000 and 2004, it has remained stable on norm for the past four old ages.

“ Health attention remains the individual largest plan administered by provincial and territorial authoritiess, ” explains Wright. “ Although wellness attention disbursement has been on the rise for the past 10 old ages, the portion of authorities budgets devoted to wellness attention appears to hold stabilized overall, though the state of affairs may change by state. ”

Doctors account for lifting portion of wellness dollars

Hospitals, drugs and doctor services, in that order, continue to account for the largest portion of wellness dollars. In 2010, passing on infirmaries is expected to make $ 55.3 billion, passing on drugs will turn to an estimated $ 31.1 billion and passing on doctors is forecast at $ 26.3 billion. For the past two decennaries, there has been an addition in the portion of disbursement on drugs and a lessening in the portion of disbursement on infirmaries. However, more recent tendencies show passing forms may be switching.

For the 4th twelvemonth in a row, growing in physician disbursement has outpaced growing in infirmary and drug disbursement ; it is expected to turn by an estimated 6.9 % this twelvemonth. Spending on infirmaries in 2010 is estimated to turn by 6.2 % , while drug disbursement growing is forecast at 4.8 % . As a consequence, the portion of entire wellness dollars spent on doctors is forecast to increase this twelvemonth ( up 1.5 % ) while the portion spent on drugs is expected to diminish ( down 0.4 % this twelvemonth ) .

Quality of Care

The concealed costs include the hapless quality of services, and the costs imposed on clients ( competently called “ patients ” in this instance ) who have to wait in waiting lines.

Quality is subjective and can merely be evaluated through consumer picks, but the authorities wo n’t allow consumers do picks and ballot with their pess if they are non satisfied. Anecdotal grounds of questionable quality is everyplace. In a recent piece in Montreal’sA Gazette, a Canadian related her ain experience, and contrasted the “ kindness, discretion and professionalism ” of staff in U.S. infirmaries, with the frequent discourtesy of nonionized forces in the Canadian system.

Long waiting lines are a fixture of the system. The Fraser Institute, a Vancouver think armored combat vehicle, has calculated that in 2003, the mean waiting clip from referral by a general practician to existent intervention was more than four months. Waiting times vary among fortes ( and, less wildly, among states ) , but remain high even for critical diseases: The shortest average delay is 6.1 hebdomads for oncology intervention ; excepting radiation, which is longer. Extreme instances include more than a twelvemonth ‘s average delay for neurosurgery in New Brunswick. The average delay for an MRI is three months. Since 1993, waiting times have increased by 90 % .

Waiting lines enforce a existent cost, which is approximated by what persons would be willing to pay to avoid them. Waiting costs include wellness hazard, lost clip ( particularly for persons whose clip is most valuable ) , hurting and torment. Socialistic systems are notoriously unmindful to anguish, uncomfortableness, humiliation and other subjective factors which administrative officials can non mensurate or do n’t value the same manner as the patient does.

Comparison of U.S. and Canadian Health Care Models

Table 1. United States and Canada: Health Expenditure and Results

Per Capita GNP, on 2009 Palatopharyngoplasty


Percent GDP Spent on Health

Level of Health Status

Hazard Protection



Life Expectancy

Infant Mortality Rate ( per 1,000 unrecorded births )

Under age 5 Mortality Rate ( per 1,000 )





16.7 % of population uninsured




Table 2. Comparison of Performance

Equity in

Cost-effectiveness in bring forthing better wellness and risk-protection

Outgo rising prices control

Level of Health Status

Equal Access to Service

Degree of Risk-Protection

Schemes and Consequences


Schemes and Consequences



F: Employment-based insurance for working population ; General gross finance for the hapless ( Medicaid ) and the aged ( Medicare )

Unequal degree of wellness position between the uninsured and insured and by income categories


F: Ration by monetary value and pick of suppliers

Uninsured deficiency equal entree

Multiple grades of quality


Modest: 16.7 % of dad. Uninsured but they have some protection from unsalaried attention

High disbursement ( high dealing costs ) , below norm in wellness result, 16.7 % of population has no at-risk protection


Correct market failures by structuring powerful buyer groups. Create viing Managed Care plans

Effective in the earlier old ages but uneffective in the long-run


F: General gross financed national wellness insurance

Modest difference in degree of wellness by provinces and by part


F: Implicit ration through conservative medical patterns

Equal entree to equal quality of services


High: cosmopolitan insurance coverage

Medium disbursement, good wellness result, and cosmopolitan coverage

Federal gov’t makes provincial gov’t wage medical coverage

Provincial gov’t negotiates planetary budget with infirmaries and medical associations

Effective in pull offing rising prices


The United States wellness outgo is much higher than in any other developed states.

Many believe that the US disbursement is more than any other develop state due to aging, nevertheless is non true.

Health outgo can be broken down into different classs of disbursement: in-patient, out-patient, pharmaceuticals, etc. every bit good as those services allocated to the whole community, such as public wellness and disposal of health care.

The administrative costs in the US wellness system are really expensive and high

Logically, wellness outgo must be the sum of wellness services multiplied by the monetary value of these services. This is true both in general and for each sub-category of outgo ( in-patient, pharmaceuticals, and so on ) . If the US spends more on same-day surgery than other states, this must be either because there is more such surgery, or it is more expensive, or some combination of the two.

Comparing with other states, the US depend more on the trade name name prescription drugs, while disregarding the generic trade name which is the same. Driving up the costs of wellness attention outgo.

Health attention outgos are increasing ensuing in the wellness insurance premiums to increase, lifting four clip faster than rewards, and more than duplicating in a decennary.

Health attention is a scarce resource, and all scarce resources are rationed in one manner or another. In the United States, most wellness attention is in private financed, and so most rationing is by monetary value.


There are many good things to state about the quality of the US wellness system.

It delivers attention in a timely mode

There is a good trade of pick in the system, both in wellness attention suppliers and, to some extent, the bundle of wellness insurance

The system delivers new merchandises to consumers more rapidly than in any other state

The United States is the major pioneer, both in medical merchandises and processs.

Canada ( 4 )


Entire disbursement on wellness attention in Canada is expected to make $ 191.6billion this twelvemonth, turning an estimated $ 9.5 billion, or 5.2 % , since 2009, harmonizing to new figures released today by the Canadian Institute for Health Information ( CIHI ) .

The last biennial of seniors are known to be the most expensive. So the disbursement on seniors are the highest, which impact the population aging minimum over clip.


In 2008, at the national degree, infirmaries and doctors were chiefly financed by the populace sector, while drugs and other professionals were chiefly financed by the private sector

Since1997, the public-sectors areoftotalhealthexpenditurehasremainedrelatively stable at around 70 % . In 2008, the public sector spent $ 121.1 billion on wellness attention, accounting for 70.5 % of entire wellness outgo. It is forecast to be $ 128.6 billion in 2009 and $ 135.1 billion in 2010, accounting for 70.6 % and 70.5 % of entire wellness disbursement, severally.

Empirical/statistical facet:

Canada is expected to pass $ 191.6 billion on wellness attention in 2010, up from an estimated $ 182.1 billion in 2009 and $ 171.8 billion in 2008.

Health attention disbursement is forecast to make $ 5,614 per Canadian in 2010, up from an estimated $ 5,397 in 2009 and $ 5,154 in 2008.

Spending on wellness attention is expected to account for 11.7 % of Canada ‘s gross domestic merchandise ( GDP ) in 2010, a little diminution from the estimated portion of 11.9 % in 2009.

Since 1997, the public/private split of entire wellness outgo has remained stable, with authoritiess passing 70 % of the entire wellness attention measure and the private sector disbursement 30 % .

Entire wellness attention disbursement continues to change by state, with disbursement per individual expected to be highest in Alberta and Manitoba at $ 6,266 and $ 6,249, severally. British Columbia and Quebec are forecast to hold the lowest wellness outgo per capita at $ 5,355 and $ 5,096, severally.

Spending on seniors has remained comparatively stable for the last decennary, accounting for 44 % of all provincial and territorial authorities wellness attention disbursement.

In 2008, the latest twelvemonth for which information is available, per capita disbursement on wellness attention remained highest in the United States ( US $ 7,538 ) , when comparing 26 states with similar accounting systems in the Organization for Economic Co-operation and Development ( OECD ) . The U.S. was followed by Norway ( US $ 5,003 ) , Switzerland ( US $ 4,627 ) and Luxembourg ( US $ 4,210 ) . At around US $ 4,079 per capita, Canada was in the top fifth, with disbursement similar to several other OECD states, including the Netherlands ( US $ 4,063 ) , Austria ( US $ 3,970 ) , Germany ( US $ 3,737 ) and France ( US $ 3,696 ) .


Canadian wellness attention outgos are more controlled and if the United States wellness attention system follows the Canadian wellness attention system tendencies, they might hold a better opportunity at equilibrating their outgos leting them to reapportion their fundss to another sector.