more life threatening issues such as a hip fracture, their benchmark for a hip fracture repair speeds up to 48 hr and they are at an impressive 88% compliance with the benchmark (Canadian Institute for Health Information, 2018). This illustrates that wait times in Canada are circumvented based on the gravity of a patient's condition, but this solution aggravates the waiting time for less urgent cases. In a geographically vast country with a small population compared to the United States, some Canadians in rural or isolated locales often travel long distances to obtain specialized services (Canadian Institute for Health Information, 2018).
As an example of the comprehensiveness and affordability of the Canadian health care service, a 51‐year‐old Canadian nurse working in the United States recently returned with her spouse and 15‐year‐old child to her home province of Alberta for 1 year. During that time, the family enrolled in the Alberta Health Care Insurance Plan for a cost of $88 per month (Alberta Health and Wellness, 2004). Health care for the nurse included an annual physical examination, lab tests, mammogram, bone density testing, and a routine colonoscopy. The colonoscopy required a 5‐month wait. Her husband underwent elective day surgery, which was booked 7 months in advance. Her daughter was immunized at school, and she was once treated at a community health center for a persistent respiratory infection. Beyond payment of their monthly premium, the family was issued no bills for the health care they received.
Japan
To pay for its national health care system, Japan spends 10.2% of its GDP on health care Papanicolas, (2018). This is less than France, Canada, or the United States, and Japan enjoys the longest life expectancy of all 83.98 years as of 2016 (World Bank, 2018). The government regulates close to all aspects of health care in Japan. The Universal Statutory Health Insurance System (SHIS) requires by law that the national and local governments provide efficient, quality medical care Papanicolas, (2018). Citizens are mandated to enroll in one of the SHIS plans based on age, employment status, or place of residence. Non‐citizens, immigrants, and visitors are not covered. The majority of the Japan has some form of private health insurance, only as a supplementary or complementary role.
All SHIS plans provide the same benefits package that is decided by the government. The package covers hospital, primary, specialty, and mental health care, approved prescription drugs, home care services by medical institutions, hospice care, physiotherapy, and most dental care Papanicolas, (2018). Plan participants have to pay a 30% coinsurance for services and goods received and there are zero deductibles. In 2013, out‐of‐pocket payments for cost‐sharing accounted for 13% of current health expenditures Papanicolas, (2018).
The Japanese health care system provides comprehensive care and is one of the most advanced in the world. Physicians and hospitals are predominantly run as private businesses, and costs for care are reimbursed through the national health care system. Patients' health care costs are reimbursed at a fixed amount determined by the government. Refusal of coverage by insurers is impossible, and personal medical debt is nonexistent.
Factors contributing to lower health care costs in Japan include healthier diets and lifestyles, with a lower incidence of chronic diseases. Reimbursement rates for health care services are low, but reimbursement strategies for quantity rather than quality of services erodes the advantage a healthier lifestyle might have in terms of curbing costs. Despite cost containment efforts, health care expenses are increasing, especially with the earthquakes of 2011. A shortage of physicians also means the wait time to access the health system is an issue. With an aging population and shrinking workforce, concerns as to how access, affordability, and quality will continue in the future are being voiced (National Coalition Health Care, 2008; Reid, 2009).
The Rising Cost of Health Care
Health care costs are measured as part of the U.S. GDP. The GDP is an economic measure of a country's national income and output within a year and reflects the market value of goods and services produced within the country. The GDP is used as a barometer of the national economy. Health care costs in the U.S. were increased by 3.9% percentage points in 2017 (CMS, 2018). Employer‐based health care premiums have doubled since 2000, yet those who are insured incur greater financial burdens as they pay for more out‐of‐pocket expenses.
U.S. national health care expenditures were $3.5 trillion in 2017 (CMS, 2018). Health spending totaled $74.6 billion in 1970. In 2000, health expenditures had increased to about $1.4 trillion, and in 2017 the amount spent on health had more than doubled to $3.5 trillion (CMS, 2018). Health care spending continues to increase faster than the overall U.S. economy and analysts project this number to keep rising.
Factors Contributing to Rising Health Care Costs
There are many factors contributing to the rising costs of health care. The five key factors include population growth, population aging, disease prevalence or incidence, service utilization, and service price and intensity (Dieleman, 2017). Between 1996 and 2013, inflation‐adjusted spending on inpatient, ambulatory, retail pharmaceutical, nursing facility, emergency department, and dental care increased at 3.5% annually, from $1.2 trillion to $2.1 trillion (Dieleman, 2017). The areas with the highest increases were in emergency departments (6.4%) and on medications (5.6%). Diabetes as a whole had the greatest increase in cost at an annual rate of 6.1–7.0%, translating into $57.9–$70.6 billion (Dieleman, 2017). Back and neck pain had the second‐largest increase in spending, at an annual rate of 6.5% (or $57.2 billion) between 1996 and 2013. During the same time frame, the treatment of hypertension rose to $47.6 billion, the treatment of hyperlipidemia to $41.9 billion, and depressive disorders to $30.8 billion annually (Dieleman, 2017).
Aging Population
More and more baby boomers are turning 65, and the average life expectancy is increasing, with the elderly are becoming the largest group in the population. The U.S. Census Bureau (2019) reports:
The number of Americans ages 65 and older is projected to nearly double from 52 million in 2018 to 95 million by 2060.
The older population is becoming more racially and ethnically diverse.
Older adults are working longer. By 2018, 24% of men and about 16% of women aged 65 and older were in the labor force.
Obesity rates among adults aged 60 and older have been increasing, standing at about 41% in 2015–2016.
Wide economic disparities are evident across different population subgroups. Among adults aged 65 and older, 17% of Latinos and 19% of African Americans lived in poverty in 2017—more than twice the rate among older non‐Hispanic whites (7%).
More older adults are divorced compared with previous generations. The share of divorced women aged 65 and older increased from 3% in 1980 to 14% in 2018, and for men from 4% to 11% during the same period.
The aging of the baby boom generation could fuel more than a 50% increase in the number of Americans aged 65 and older requiring nursing home care, to about 1.9 million in 2030 from 1.2 million in 2017.
The number of Americans living with Alzheimer's disease, could more than double by 2050 to 13.8 million, from 5.8 million today.
Increased Utilization of Pharmaceuticals
The CMS (2019) published a National Health Expenditures Report 2018–2027. Prescription drug spending was projected to have grown by 3.3% in 2018. This is due to an increase in new drug introductions. Prescription drug spending growth was projected to increase to 4.6% in 2019, because of faster utilization growth from both existing and new drugs, as well as a modest increase in drug price growth. For the reminder of the projection, 2020–2027, prescription drug spending is projected to grow by 6.1% per year on average, or by 1.5 percentage points more rapidly than in 2019, influenced by new drugs and efforts to encourage patients with chronic conditions to consistently treat their disease (CMS, 2019).
Technological