comparison of the healthcare systems in canada and the united states comparison of the healthcare systems in canada and the united states a comparison of the healthcare systems in canada and the united states is often made by government, public health and public policy analysts. the two countries had similar healthcare systems before canada changed its system in the 1960s and 1970s. the united states spends much more money on healthcare than canada, on both a per-capita basis and as a percentage of gdp. in 2006, per-capita spending for health care in canada was us$3,678; in the u.s., us$6,714. the u.s. spent 15.3% of gdp on healthcare in that year; canada spent 10.0%. in 2006, 70% of healthcare spending in canada was financed by government, versus 46% in the united states. total government spending per capita in the u.s. on healthcare was 23% higher than canadian government spending. and u.s. government expenditure on healthcare was just under 83% of total canadian spending (public and private). part of a series onhealthcare in canada health canada minister of health health act medicare health transfer non-insured health benefits controlled drugs and substances act history of medicine physicians nursing father of medicare comparison with the us indian hospital hids act topics abortion drug policy euthanasia refugees hiv/aids smoking suicide obesity canada portal health spending per capita, in $us ppp-adjusted, with the us and canada compared amongst other first world nations. for later data see list of countries by total health expenditure per capita. health spending by country. percent of gdp (gross domestic product). 11.7% for canada in 2021. 17.8% for the united states in 2020. development of life expectancy in the united states and canada, 1831 to 2021 studies have come to different conclusions about the result of this disparity in spending. a 2007 review of all studies comparing health outcomes in canada and the us in a canadian peer-reviewed medical journal found that "health outcomes may be superior in patients cared for in canada versus the united states, but differences are not consistent." some of the noted differences were a higher life expectancy in canada, as well as a lower infant mortality rate than the united states. one commonly cited comparison, the 2000 world health organization's ratings of "overall health service performance", which used a "composite measure of achievement in the level of health, the distribution of health, the level of responsiveness and fairness of financial contribution", ranked canada 30th and the us 37th among 191 member nations. this study rated the us "responsiveness", or quality of service for individuals receiving treatment, as 1st, compared with 7th for canada. however, the average life expectancy for canadians was 80.34 years compared with 78.6 years for residents of the us. the who's study methods were criticized by some analyses. while life-expectancy and infant mortality are commonly used in comparing nationwide health care, they are in fact affected by many factors other than the quality of a nation's health care system, including individual behavior and population makeup. a 2007 report by the congressional research service carefully summarizes some recent data and noted the "difficult research issues" facing international comparisons. government involvement in 2004, government funding of healthcare in canada was equivalent to $1,893 per person. in the us, government spending per person was $2,728. the canadian healthcare system is composed of at least 10 mostly autonomous provincial healthcare systems that report to their provincial governments, and a federal system which covers the military and first nations. this causes a significant degree of variation in funding and coverage within the country. history canada and the us had similar healthcare systems in the early 1960s, but now have a different mix of funding mechanisms. canada's universal single-payer healthcare system covers about 70% of expenditures, and the canada health act requires that all insured persons be fully insured, without co-payments or user fees, for all medically necessary hospital and physician care. about 91% of hospital expenditures and 99% of total physician services are financed by the public sector. in the united states, with its mixed public-private system, 16% or 45 million american residents are uninsured at any one time. the u.s. is one of two oecd countries not to have some form of universal health coverage, the other being turkey. mexico established a universal healthcare program by november 2008. health insurance the governments of both nations are closely involved in healthcare. the central structural difference between the two is in health insurance. in canada, the federal government is committed to providing funding support to its provincial governments for healthcare expenditures as long as the province in question abides by accessibility guarantees as set out in the canada health act, which explicitly prohibits billing end users for procedures that are covered by medicare. while some label canada's system as "socialized medicine", health economists do not use that term. unlike systems with public delivery, such as the uk, the canadian system provides public coverage for a combination of public and private delivery. princeton university health economist uwe e. reinhardt says that single-payer systems are not "socialized medicine" but "social insurance" systems, since providers (such as doctors) are largely in the private sector. similarly, canadian hospitals are controlled by private boards or regional health authorities, rather than being part of government. in the us, direct government funding of health care is limited to medicare, medicaid, and the state children's health insurance program (schip), which cover eligible senior citizens, the poor, disabled persons, and children. the federal government also runs the veterans health administration, which provides care directly to retired or disabled veterans, their families, and survivors through medical centers and clinics. the u.s. government also runs the military health system. in fiscal year 2007, the mhs had a total budget of $39.4 billion and served approximately 9.1 million beneficiaries, including active-duty personnel and their families, and retirees and their families. the mhs includes 133,000 personnel, 86,000 military and 47,000 civilian, working at more than 1,000 locations worldwide, including 70 inpatient facilities and 1,085 medical, dental, and veterans' clinics. one study estimates that about 25 percent of the uninsured in the u.s. are eligible for these programs but remain unenrolled; however, extending coverage to all who are eligible remains a fiscal and political challenge. for everyone else, health insurance must be paid for privately. some 59% of u.s. residents have access to health care insurance through employers, although this figure is decreasing, and coverages as well as workers' expected contributions vary widely. those whose employers do not offer health insurance, as well as those who are self-employed or unemployed, must purchase it on their own. nearly 27 million of the 45 million uninsured u.s. residents worked at least part-time in 2007, and more than a third were in households that earned $50,000 or more per year. funding despite the greater role of private business in the us, federal and state agencies are increasingly involved, paying about 45% of the $2.2 trillion the nation spent on medical care in 2004. the u.s. government spends more on healthcare than on social security and national defense combined, according to the brookings institution. beyond its direct spending, the us government is also highly involved in healthcare through regulation and legislation. for example, the health maintenance organization act of 1973 provided grants and loans to subsidize health maintenance organizations and contained provisions to stimulate their popularity. hmos had been declining before the law; by 2002 there were 500 such plans enrolling 76 million people. the canadian system has been 69–75% publicly funded, though most services are delivered by private providers, including physicians (although they may derive their revenue primarily from government billings). although some doctors work on a purely fee-for-service basis (usually family physicians), some family physicians and most specialists are paid through a combination of fee-for-service and fixed contracts with hospitals or health service management organizations. canada's universal health plans do not cover certain services. non-cosmetic dental care is covered for children up to age 14 in some provinces. outpatient prescription drugs are not required to be covered, but some provinces have drug cost programs that cover most drug costs for certain populations. in every province, seniors receiving the guaranteed income supplement have significant additional coverage; some provinces expand forms of drug coverage to all seniors, low-income families, those on social assistance, or those with certain medical conditions. some provinces cover all drug prescriptions over a certain portion of a family's income. drug prices are also regulated, so brand-name prescription drugs are often significantly cheaper than in the u.s. optometry is covered in some provinces and is sometimes covered only for children under a certain age. visits to non-physician specialists may require an additional fee. also, some procedures are only covered under certain circumstances. for example, circumcision is not covered, and a fee is usually charged when a parent requests the procedure; however, if an infection or medical necessity arises, the procedure would be covered. according to dr. albert schumacher, former president of the canadian medical association, an estimated 75 percent of canadian healthcare services are delivered privately, but funded publicly. frontline practitioners whether they're gps or specialists by and large are not salaried. they're small hardware stores. same thing with labs and radiology clinics ... the situation we are seeing now are more services around not being funded publicly but people having to pay for them, or their insurance companies. we have sort of a passive privatization. coverage and access there is a significant difference in coverage for medical care in canada and the united states. in canada, all citizens and permanent residents are covered by the health care system, while in the united states, studies suggest that 7% of u.s. citizens do not have adequate health insurance, if any at all. in both canada and the united states, access can be a problem. in canada, 5% of canadian residents have not been able to find a regular doctor, with a further 9% having never looked for one. in such cases, however, they continue to have coverage for options such as walk-in clinics or emergency rooms. the u.s. data is evidenced in a 2007 consumer reports study on the u.s. health care system which showed that the underinsured account for 4% of the u.s. population and live with skeletal health insurance that barely covers their medical needs and leaves them unprepared to pay for major medical expenses. the canadian data comes from the 2003 canadian community health survey, in the u.s., the federal government does not guarantee universal healthcare to all its citizens, but publicly funded healthcare programs help to provide for the elderly, disabled, the poor, and children. the emergency medical treatment and active labor act or emtala also ensures public access to emergency services. the emtala law forces emergency healthcare providers to stabilize an emergency health crisis and cannot withhold treatment for lack of evidence of insurance coverage or other evidence of the ability to pay. emtala does not absolve the person receiving emergency care of the obligation to meet the cost of emergency healthcare not paid for at the time and it is still within the right of the hospital to pursue any debtor for the cost of emergency care provided. in canada, emergency room treatment for legal canadian residents is not charged to the patient at time of service but is met by the government. according to the united states census bureau, 59.3% of u.s. citizens have health insurance related to employment, 27.8% have government-provided health-insurance; nearly 9% purchase health insurance directly (there is some overlap in these figures), and 15.3% (45.7 million) were uninsured in 2007. an estimated 25 percent of the uninsured are eligible for government programs but unenrolled. about a third of the uninsured are in households earning more than $50,000 annually. a 2003 report by the congressional budget office found that many people lack health insurance only temporarily, such as after leaving one employer and before a new job. the number of chronically uninsured (uninsured all year) was estimated at between 21 and 31 million in 1998. another study, by the kaiser commission on medicaid and the uninsured, estimated that 59 percent of uninsured adults have been uninsured for at least two years. one indicator of the consequences of americans' inconsistent health care coverage is a