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Next door but worlds apart on health care

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The United States and Canada share a several thousand-mile border, and the differences in the two countries' health care systems are just as vast.

In Canada, health care coverage has been universal for decades and is largely provided through the country's provinces and funded mostly through taxes.

In the United States, even after the passage of 2010 legislation that authorized federal premium subsidies to lower-income individuals obtaining coverage in public exchanges, about 33 million people, or more than 10% of the population, remain uninsured.

In Canada, health care costs account for just over 10% of the gross domestic product, while health care spending in the United States in 2014 hit a record 17.4% of GDP.

In the United States, employers are the primary source of health plan coverage for Americans younger than 65.

In Canada, the role of employers is much narrower, with employers typically providing such coverage as dental and vision care, as well as prescription drugs typically not offered by provinces. Employers also frequently enhance provincial coverage to allow their employees to have private or semi-private rooms for hospital stays rather than multipatient wards.

Another big difference: In the United States, individuals increasingly face significant copayments and deductibles for physician services and hospital care as more employers adopt consumer driven health plans. In Canada, patients have no such charges.

But perhaps what stands out about the Canadian health care system is its popularity. Public opinion polls consistently show widespread support — often at 90% — for the system.

“Most people here are proud of the fact that we have universal coverage. This defines us as nation,” said Brian Lindenberg, leader of Mercer L.L.C's Health and Benefits practice in Calgary, Alberta.

“Generally, Canadians have a sentimental and emotional attachment for their health care system. They are quite happy with it,” said Tim Clarke, chief innovation officer, Health & Benefits Consulting at Aon Hewitt in Toronto.

Still, Canadian benefits experts say, the country's health care system is not without problems, the biggest being long wait times to see family physicians or to have elective medical procedures.

“Wait times are a significant concern,” said Karen Millard, a senior consultant with Willis Towers Watson P.L.C. in Toronto.

“The quality of health care services is quite good. What annoys people is the lack of immediate access” for some services, said Mercer's Mr. Lindenberg.

“In the United States, you have relatively immediate access to providers. In Canada, that is not always the case. You may have to, for example, hunt around for a GP who will accept new patients,” Mr. Lindenberg added.

Still, “if you are seriously ill, you get care quickly,” said Lizann Reitmeier, health practice leader with Xerox HR Services in Toronto.

While the Canadian health care system is often called national health insurance, that is misleading, experts say.

Physicians, for example, are not employed by the government, but, like in the United States, have their own practices. In addition, provider fees are not dictated by the government but are negotiated between medical provider groups and provincial officials.

In addition, Canada's provinces have considerable flexibility in determining coverage beyond basic physician and hospital services.

Take vision care. In Manitoba, the provincial plan covers one routine eye exam over a 24-month period for residents younger than 19 and for those 65 and older; coverage is not provided for those age 19 through 64, unless medically necessary.

The Ontario plan covers one eye exam annually for children age 19 and younger and for adults 65 and older. No coverage is provided for those between 19 through 64 unless they have a medical condition, such as glaucoma, affecting the eyes.