Healthcare for Pregnant Women Comparison: U.S., Switzerland and Canada
A Comparison of Healthcare Options Pregnant Women in United States, Canada and Switzerland
The healthcare systems in Western societies do not assume that a woman requires health information; however, collectively, it has become well recognized that good information is necessary to a pregnant woman, and that understanding the stages of pregnancy, labor, and delivery is important to good perinatal care (Crook, 1995). This paper provides a comparison of the healthcare options available to pregnant women according to their income and insurance resources in the United States, Canada and Switzerland. A comparison of the respective healthcare systems for these nations will be provided in the summary, and a critique of the United States healthcare system will be provided in the conclusion.
Review and Discussion
Healthcare Options -- United States. The U.S. spends a larger percentage of its GDP on healthcare than does any other nation in the world, and it spends more on a per person basis as well; further, not only are expenditures high, but for many years these allocations have increased faster than GDP. Yet, quality healthcare remains out of reach for many pregnant U.S. women (McGarry, 2002). Discussions of medical care for the poor frequently invoke the phrase two-tier medicine; while this approach may appear fundamental inequitable, some advocates have maintained an explicit two-tier system would serve the U.S. poor better than does the present jumble of services that range from no care (e.g., prenatal) to the most sophisticated (e.g., neonatal intensive) (Ginzberg & Rogers, 1993). A frequent conclusion of health policy discussions in the United States is that everyone should have access to "basic" medical care. "The basic care package will constantly have to change to include 'whatever the custom of the country renders it indecent for creditable people, even of the lowest order, to be without'" (Ginzberg & Rogers, 1993, p. 18). The question of efficient provision of care to low-income pregnant women is further complicated by the fact that there may be gross inefficiencies in the quality of medical care that is provided to the affluent who do enjoy robust insurance plans such as overtesting, inappropriate surgeries, and so forth (Collins & Williams, 1995).
Healthcare Options -- Canada. According to Mhatre & Derber (1992), the 1984 Canada Health Act stated that: "The primary objective of Canadian health care policy is to protect, promote and restore the physical and mental well being of residents of Canada, and facilitate reasonable access to health services without financial or other barriers" (p. 645). While the principle of accessibility promotes universal health care coverage, equitable access to health services is not always the case in practice (Morton & Loos, 1995). In the second-largest country in the world, geographic proximity to tertiary healthcare facilities is one of the most important factors in the provision of quality of healthcare services (Benoit, Carroll & Millar, 2002). In Canada, universal healthcare is provided for all citizens and the ability to pay for healthcare is not supposed to be a factor; however, there is still prejudice against poverty. "The poor receive less instruction and have fewer options than the rich, and even with 'universal' health care the insurance will not pay for 'elective' medical care (that is, the medical care that the medical industry does not think is necessary) (Crook, 195). Today, many Canadian women are looking for ways to have babies that are more comfortable, more self-controlled, and less technical than the present "average" hospital experience. Further, although the Canadian healthcare system maintains a number of youth clinics, particularly for birth control and abortion information, the quality at these centers varies considerably. At these centers, adolescent females receive information, counseling, and practical help concerning birth control and pregnancies. In some remote areas of Canada, the Red Cross Outpost Station provide these services for the teen population; Crook suggests that some are excellent but some are not: "In one-nurse stations, health education is limited by the knowledge and attitudes of that one nurse. If she is competent, she gives information, pamphlets, books, and phone numbers to the teen. If she is not, she gives cursory and sometimes incorrect advice" (Crook, 1995, p. 35). Recent changes in some provinces and states to again allow midwives to practice is encouraging. Nurse midwives are legally licensed to practice in all states. There are nurse midwifery schools in 17 states and certification programs in others. British Columbia and Ontario have passed laws that make midwifery legal. There are also nonmedical home births and birthing centers in some areas where only emergency or high-risk mothers are sent for medical care. Finally, there are active organizations attempting to transfer some of the responsibility for neonatal care away from the hands of the medical industry and into the hands of Canadian mothers (Crook, 1995).
Healthcare Options -- Switzerland. The citizens of Switzerland enjoy one of the highest standards of living in the world as well as a sophisticated and high-quality healthcare system that, like its counterpart in Canada, provides universal healthcare services. There were some problems noted, though, in the provision of neonatal services to the large migrant population (McDowell, 1996). Health insurance in Switzerland is compulsory and regulated by federal law; the healthcare system is financed in each canton by varying individual contributions, and is supplemented by federal and cantonal subsidies for the indigent (Diem, 2004).
Summary. The U.S. spends more per capita on healthcare than Switzerland, Canada, and practically all advanced nations, but these other countries provide better healthcare than the United States as indicated by the output measures of longevity and infant mortality; furthermore, these services at generally provided at a much lower cost (Stewart, 1995). Socioeconomic status has consistently been found to be a controlling factor in gaining access to quality healthcare facilities for pregnant women in the United States (Collins & Williams, 1995). The research showed that superior medical care is available for pregnant women in all three of the Western nations reviewed above; however, access to the very best medical care is generally restricted to the affluent in the United States, and such care is constrained by regulatory, geographic proximity, and social issues in Canada and Switzerland; however, the U.S. continues to experience higher rates of teenage pregnancies than these, or any other industrialized nation in the world (Barnes, 2002). A comparison of per capita healthcare expenditures for these countries is shown in Table 1 at Appendix A; GDP share is graphically shown in Figure 1 at Appendix A; the respective infant mortality rates for these three countries is shown in Figure 2 at Appendix B.
Conclusion and Critique.
The health of the mother during pregnancy, delivery and the postpartum period has been directly linked with the health of her newborn, reinforcing the need to integrate maternal and neonatal health care strategies (Darmstadt, Lawn, & Costello, 2003). According to Ginzberg and Rogers (1993), in order to make rational allocations of resources to alleviate the health problems of the poor, it is necessary to know the relative importance of the problems. The research showed that the population of expectant mothers in the United States is younger and probably less mature, experienced, and financially stable; the U.S. also has higher fertility rates and overall percentage of pregnancies aborted. Adolescent-specific rates, such as pregnancy, abortion rates, and the percentage of delivering mothers younger than 20 years old were also notably higher in the United States (Thompson, Goodman & Little, 2002).
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