OPINION | Health care abroad: An American in four countries


I am American, have studied and lived in both Canada and England and am now living in Norway.  I am particularly concerned with health care reform in the United States and have been asked to share my experiences regarding health care and the different health care systems in the three countries mentioned above.  Having directly experienced these three health care systems, I feel the most important thing to point out is the stress free aspect of a universal health care system.  I do want to mention that President Obama’s proposed health care plan and those that are being debated in Congress are neither “socialist” nor universal.  However, the countries I have lived and am living in now fit well within these definitions and I am happy to say they all work more efficiently and more effectively than the U.S. system, and more importantly the services are more equal for everyone – those who can and cannot afford them. 

As an American, I have continuously been reminded of the importance of health insurance.  My parents are both self-employed and have always financed our family’s health insurance.  After being taken off my parent’s policy, I began to realize the hassle and stress that comes with health insurance and reality set in.  During my third year of my Bachelor’s degree, I decided to study abroad and do an exchange year at the University of Toronto in Toronto Canada.  I was able to have health insurance under the university policy while studying there.  I do remember talking to people often about health care including good friends of mine living there.  Canada has a publicly-funded health care system, where most of the services are provided by private bodies.  I found Canadian health care very similar to the U.S.; however, in Canada the costs were minimal and the process less stressful.  I cannot emphasize how less stressful it is on the mind and body to know you have guaranteed health care continuously throughout your life.  The thought of getting very sick and finding yourself without health care coverage is a very worrying situation.  In Canada, people never have to experience this. In fact, according to the New England Journal of Medicine and published in 1991, “The administrative structure of the U.S. health care system is increasingly inefficient as compared with that of Canada’s national health program. Recent health policies with the avowed goal of improving the efficiency of care have imposed substantial new bureaucratic costs and burdens (NEJM 1991).” This was published in 1991 and costs have not lowered, but increased.

Having discussed my personal recollection of health care in Canada, I want to move on to the NHS (National Health Service) in England.  The NHS like the Canadian system is free at the point of use, and is a publicly-funded system.  However, the health care system in England is quite different in structure from Canada because it is a single-payer/ single-provider system where both funding and provision of care are by the government. The NHS is funded through taxes and then distributed to care providers. Doctors in the UK are salaried and that pay is based on the number of patients they see. But unlike the American system, General Practitioners are paid extra for keeping their patients healthy, rather than for the amount of tests or services they can bill. Both health care systems in Canada and England place an emphasis on preventive care and early detection.  One example of preventive care is the cervical screening program given to women in England.

All women between the ages of 25 and 64 are eligible for a free cervical screening test every three to five years. In the light of evidence published in 2003 the NHS Cervical Screening Programme now offers screening at different intervals depending on age. This means that women are provided with a more targeted and effective screening programme (NHS. Cervical Screening Program).

These free cervical screening tests given to women between the ages 25 and 64, highlights a very important aspect of universal health care systems – both preventative care and early detection.  I am certain many Americans wait to go to the doctor due to high costs and medical records. As a result, they delay basic routine check-ups and potentially increase the risk of more harmful health issue later.  This being said, getting routine check-ups and early detection are more cost-efficient than a more serious situation later leading to reasons why all publically funded health care systems have a strong focus on preventative health care and early detection.   Both for the health care system and for the individual this is good practice.

Lastly, my final country and experience with health care is in Norway where I am currently living. Norway is the golden example of a low cost, incredibly effective health care system. (George Lakey 2009) discusses the numbers below.

On a per capita basis, Norwegians spend $4,763 per year, and cover everyone, while U.S.’ers spend $7,290.  By various standards of health quality, like life expectancy or rate of preventable deaths, Norway does better than the U.S.  One key measure is physicians per capita: the U.S. has 2.43 physicians compared with Norway’s 4 doctors per 1,000 population, even though Norway spends a third less of its Gross Domestic Product on health care than the U.S. does.  (These numbers are from Bruce Bartlett, Forbes magazine columnist who was a former U.S. Treasury Department economist.) (Lakey 2009).

So, as we can see, in all indicators, Norway outperforms the U.S. Norwegians spend less, have higher standards of health quality, and more physicians per capita.  In addition to this, the U.S. spends more of its GDP on health care than Norway. 

Norway is a welfare state so of course, health care in this country is a basic human right, universal, and publically funded.  In Norway, health care and health research is made a priority; thus Norway’s hospitals rival the best in the world.  Moreover, another important aspect of the Norwegian health care system is not being tied to the employer.  According to (Lakey 2009), this encourages innovation as individuals can change jobs more easily and become entrepreneurs if desired because health insurance is always there; it is a guaranteed right, funded by tax payer’s money through the government.  Norway’s health care system is very direct – if you have a health concern you go to the doctor.  You do not have to worry about insurance, high costs, and medical bills coming later.  Of course, everyone in Norway incurs some cost when seeing a physician but it is nothing compared to the extravagant costs incurred in the U.S.  This makes the stress factor decrease tremendously. 

Every heath care system in the world has its challenges and changes. However, it is in how countries meet these challenges that they either succeed or fail.  I believe the U.S. needs to use other countries for comparisons, look outside the box and change for the good of neither the pharmaceutical or insurance companies, nor the health care industry but the American people.  When we realize that the Americans are the most important piece to this puzzle then maybe our health care system will look more like Canada’s, England’s or even better Norway’s health care systems. As (Emanuel and Fuchs 2005) state, the U.S. political system is not likely to change fast, and when social programs are implemented, it is usually during “times of war, economic depression, or civil unrest.”  Even without times of despair, the time will come when the “inequities, inefficiencies, and costs of the current methods of financing health care will be so intolerable that the public will not only accept but demand comprehensive reform.” AND – that time is now!


Woolhandler, S., and Himmelstein, DU.  1991.  The deteriorating administrative efficiency of the U.S. health care system.  New England Journal of Medicine (NEJM). http://content.nejm.org/cgi/content/abstract/324/18/1253

Emanuel, E.J., and Fuchs, V. R., 2005.  Health Care Vouchers – A Proposal for Universal Coverage.  New England Journal of Medicine (NEJM).   http://content.nejm.org/cgi/reprint/352/12/1255.pdf

Lakey, George. 2009.  Socialist Health Plan? In Norway, Obama’s Plan Not Even Close.  CommonDreams.org. http://www.commondreams.org/view/2009/07/21-12

NHS. Cervical Screening Programme.  http://www.cancerscreening.nhs.uk/cervical/