HCM 3530 Module 2 Americas Systems Written Assignment Example

One Continent, Three Answers to Who Pays: Comparing the Health Systems of the United States, Canada and Brazil

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B.S. in Healthcare Management, Thomas Edison State University

HCM-3530: Comparative Healthcare Systems

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Month Day, Year

One Continent, Three Answers to Who Pays: Comparing the Health Systems of the United States, Canada and Brazil

The Americas contain some of the world's most different approaches to paying for health care. This assignment compares the United States with two neighbors that made opposite choices: Canada, which finances care through tax-funded provincial insurance plans, and Brazil, whose 1988 constitution declared health a right of every citizen and created a unified public system alongside a large private sector. Each system is examined on financing, coverage, delivery and outcomes, using the textbook's comparative approach (Johnson et al., 2018), and the paper ends with what the United States might learn.

Financing and Coverage

American coverage is a patchwork of employer-sponsored private insurance, individually purchased plans, Medicare for older adults and Medicaid for many low-income people. Coverage depends on age, income, employment and state of residence, and 8.0 percent of the population, about 26.4 million people, had no health insurance at any point in 2023 (Keisler-Starkey & Bunch, 2024).

Canada's Medicare is not one national plan but a set of provincial and territorial insurance plans, financed mainly through general taxes and held to common standards by the Canada Health Act of 1984 (Martin et al., 2018). Medically necessary hospital and physician services are free at the point of care for all residents, and coverage moves with people between provinces. The basket is narrow, however: outpatient prescription drugs, dental care and much long-term care fall largely outside it and are paid through private insurance or out of pocket.

Brazil's Sistema Único de Saúde (SUS), created after the 1988 constitution, is financed from taxes at the federal, state and municipal levels and is open to everyone without charge (Paim et al., 2011). Alongside it, roughly a quarter of the population buys private health plans, usually through employers, and many Brazilians use both systems. The result is universal entitlement with a two-tier experience of care.

Delivery

In all three countries most physicians work outside government. American physicians and hospitals are mostly private, paid by many different insurers at different rates. Canadian physicians are also largely private practitioners paid mainly fee-for-service, but they bill a single provincial plan, which simplifies administration. Brazil's distinctive feature is its Family Health Strategy, in which teams of a physician, a nurse, nursing assistants and community health agents are responsible for the health of a defined local population, visiting homes and coordinating care. Paim et al. (2011) describe the expansion of these teams as one of the SUS's most important achievements, bringing primary care to poor and rural areas that had little before.

Outcomes and Costs

Table 1 compares the three countries using World Bank (2026) indicators.

Canada spends less than half as much per person as the United States and achieves longer life expectancy and lower infant and maternal mortality. Its main weakness is timeliness: Martin et al. (2018) identify long waits for elective and specialist care as a persistent problem, along with gaps in drug and home care coverage that leave some patients paying out of pocket. Brazil spends a fraction of either country's amount and has worse outcomes, partly because of deep regional and income inequality that predates the SUS, but those outcomes have improved substantially since the SUS was created, and its out-of-pocket share reflects the parallel private market as much as gaps in the public system.

What the United States Could Learn

Two lessons stand out. From Canada, the United States could learn how much a single payer per region simplifies billing and strengthens bargaining over prices. Moving to a Canadian-style system would require political changes far beyond any one reform, but smaller steps, such as common claim standards and all-payer rate setting in some states, apply the same logic. Canada also shows what to avoid: covering hospital and physician care while leaving drugs outside the system creates gaps that are hard to close later.

From Brazil, the United States could learn from the Family Health Strategy. Community health workers, who visit homes, follow up on chronic disease and connect families to services, are already used in some U.S. programs, but they are rarely paid for on a stable basis. Brazil's experience suggests that assigning teams to defined populations and including community health agents can extend primary care to people who otherwise use emergency departments as their entry point.

Conclusion

The United States, Canada and Brazil answer the question of who pays in different ways: many payers with gaps, provincial single payers with a narrow basket, and a universal public system beside a private one. Canada achieves better outcomes at much lower cost but struggles with waiting times; Brazil has expanded access dramatically from a lower base. Each offers the United States a specific, transferable idea: simpler payment and population-based primary care teams. Neither idea requires copying a whole system, which makes both more realistic in American politics than wholesale reform, and both could be tested first in states or in Medicaid programs, where the federal system already allows variation and evaluation.

References

Johnson, J. A., Stoskopf, C., & Shi, L. (2018). Comparative health systems: A global perspective (2nd ed.). Jones & Bartlett Learning.

Keisler-Starkey, K., & Bunch, L. N. (2024). Health insurance coverage in the United States: 2023 (Current Population Reports P60-284). U.S. Census Bureau. https://www.census.gov/library/publications/2024/demo/p60-284.html

Martin, D., Miller, A. P., Quesnel-Vallée, A., Caron, N. R., Vissandjée, B., & Marchildon, G. P. (2018). Canada's universal health-care system: Achieving its potential. The Lancet, 391(10131), 1718-1735. https://doi.org/10.1016/S0140-6736(18)30181-8

Paim, J., Travassos, C., Almeida, C., Bahia, L., & Macinko, J. (2011). The Brazilian health system: History, advances, and challenges. The Lancet, 377(9779), 1778-1797. https://doi.org/10.1016/S0140-6736(11)60054-8

World Bank. (2026). World development indicators [Data set]. https://databank.worldbank.org/source/world-development-indicators