Health Care Systems in UK and Canada
The worlds largest employer
UK National health service - 1.7 million below McDonalds and Walmart
NHS was established in 1948
"It will provide you with all medical, dental and nursing care. Everyone - rich or poor, man, woman or child - can use it. There are no charges... There are no insurance qualifications. But it is not a "charity". You are all paying for it, mainly as taxpayers, and it will relieve your money worries in time of illness."
Oral Health Indicators, US vs Canada
% of adolescences 12-19 years of age with at least on sealant [Larger difference] USA: 38% Canada: 51%
Available treatment under NHS
- All treatment clinically necessary to protect and maintain good oral health is available on the NHS, including: dentures, crowns, bridges - Dental implants and orthodontic treatment, such as braces, are available on the NHS, but only if there's a medical need for the treatment. - NHS dental treatment does not include cosmetic treatments that are not clinically necessary, such as teeth whitening.
Dental services within the Canadian health care system
- Aside from oral surgery provided in hospitals, dental services are not included in Canada Health Act. - Different Provinces have different levels of public dental care. - Aboriginals are covered by federal dental insurance. - Emergency dental service is available for individuals on welfare
Dental Care Plan (DCP) - Public service of Canada
- Available to public servants and employees of a number of separate employers - Most dental services are available. - Benefits Reimbursed at 90% for simple services, and at 50% for more complicated services. "...oralhealthandgeneralhealthshouldnotbe interpreted as separate entities" Surgeon General's Report on Oral Health of America, 2000 However.... "All people visit physicians. Young, healthy, wealthy, well educated people visit dentists".
Cost of NHS treatment
- Band 1 course of treatment - £20.60 ($26) This covers an examination, diagnosis (including X-rays), advice on how to prevent future problems, a scale and polish if needed, and application of fluoride varnish or fissure sealant. - Band 2 course of treatment - £56.30 ($70) This covers everything listed in Band 1 above, plus any further treatment such as fillings, root canal work or removal of teeth. - Band 3 course of treatment - £244.30 ($305) This covers everything listed in Bands 1 and 2 above, plus crowns, dentures and bridges. - Band 4 Urgent care = Band 1 charge ($26).
Access to NHS Dentist
- CCG has a list of NHS dentists - Everyone has the right to see an NHS dentist regardless of race, religion, gender, social class, age, disability, or sexual orientation. - Patients do not have to register with a dentist for a limited period of time
Dental services within NHS
- Dental services was always a part of NHS. - Britain's dentists signed up to deliver treatment on a fee-for-service basis and retained their status as independent businesses. - Care was 100% free for patients. - Patient's charges were introduced.
NHS
- Financed almost 100% from central taxation. - Everyone is eligible for care, even people temporarily resident. People could be referred to any hospital, local or more distant. - Care was entirely free at the point of use, although prescription charges and dental charges were subsequently introduced - Hospital services. The municipal and the voluntary hospitals were brought together in a single system in which all staff was salaried. - Family doctors, dentists, opticians and pharmacists are self-employed under a contract for services - No or minimal third parties involvement (reduced costs), but the system has to handle all clerical, managerial and financial aspects (increased bureaucracy).
The health & care system from April 2013
- NHS commission board - Clinical commissioning group to dentist
Advantages of Canada Medicare
- Private insurance is only minimal, reducing costs and maximizing the percentage of revenues that go directly towards care. - Reduce inequality in access to care. - Public support: in 2009, 86.2% of Canadians supported or strongly supported the system.
Assessment of Dental Services under NHS
- Relatively affordable dental care service. - Reduces financial burden. - Reduces inequality in the utilization of dental services. - Reduces inequality in the provision of different - Patient's charges appear to be a barrier to the use of service for those on low income. - Current payment system may influence treatment decisions. - Two-tier system. - Disparities in oral health still exist.
Canada Background
- Saskatchewan Medical Care Insurance 1962. - Doctors strike and government response. - Universal insurance adopted by the federal government in 1966. - Funded by federal and provincial government, administered by provincial government. - Canada Health Act 1984
Universal coverage reduces inequality in access to services, but.....
- Satisfaction with service varies as the system changes - Waiting time for some specialists appointment and for some procedures could be long.
Conclusions
- The principal philosophy behind the establishment of the current Health Systems in UK and Canada: health is NOT a privilege, everyone should have access to health services when needed regardless of their financial ability. - These systems appear to have a positive impact on access to care, health outcomes and overall cost of the services. - Population health goes beyond health services. The universal health coverage in these two countries, reduces but does not eliminate inequality in health. - The exclusion of dental services care from the Universal Insurance in Canada resulted in greater inequality in access to services.
Who is entitled to free dental care?
- under 18 - under 19 and in full-time education - pregnant, or have had a baby in the 12 months before treatment starts - an NHS inpatient and the treatment is carried out by the hospital dentist - an NHS Hospital Dental Service outpatient. There may be a charge for dentures and bridges - on income or social support (entitled for help with the charges).
Changes to NHS Dentistry since 2013
-Clinical Commissioning Groups (CCG) are now responsible for local NHS dental services - CCG has money that must be used for local dental services - CCG establishes contracts with NHS dentists for services that best meet local needs
Five main principles in the Canada Health Act
1. Public Administration 2. Comprehensiveness 3. Universality 4. Portability 5. Accessibility
Commonality
Everyone is entitled to free health care. Services are mainly financed through taxation. However: Canada: Single-Player Government PAYS for health care UK: National Health Care System Government PROVIDES the health care
Comparison with the USA system
Joint Canada/United States Survey of Health (2002-03). - American are less healthy than Canadians. However, this could be due to the fact that the U.S. has a higher incidence of disease not to differences in access to care. - Does the universal coverage reduce inequality in access and in disease?
Structure of NHS Dentistry
Primary Care - General Dental Practitioners (GDP) - Community Dental Service (CDS) Secondary Care -Hospital Dental Service
Private Health Insurance
Private health insurance covers certain services that are not covered by Universal insurance (e.g., dental services, optometrists, and prescription medications). While private insurance can benefit those with certain needs, many Canadians choose to rely exclusively on the public health system.
The underpinning philosophy to the formation of the NHS
The collective principle asserts that the resources of medical skill and the apparatus of healing shall be placed at the disposal of the patient, without charge, when he or she needs them; that medical treatment and care should be a communal responsibility that they should be made available to rich and poor alike in accordance with medical need and by no other criteria. It claims that financial anxiety in time of sickness is a serious hindrance to recovery, apart from its unnecessary cruelty. Aneurin Bevan, 1959 In 2010, 85% of the English population agree with this principle
