ining comparative costs, access, and satisfaction
in Canada and the United States.
Crichton, Anne, David Hsu, and Stella Tsang.Can-
ada’s Health Care System: Its Funding and Organiza-
tion.Rev. ed. Ottawa, Ont.: CHA Press, 1994. Eval-
uates the organization and evolution of the
Canadian health care system.
McFarland, Lawrie, and Carlos Prado.The Best-Laid
Plans: Health Care’s Problems and Prospects.Mon-
treal: McGill-Queen’s University Press, 2002. Crit-
ical analysis of past and present plans to reform
Canada’s health care system.
Sutherland, Ralph W., and M. Jane Fulton.Health
Care in Canada: A Description and Analysis of Cana-
dian Health Services.Ottawa, Ont.: Health Group,
- Detailed description of Canada’s health sys-
tem in the 1980’s.
Milton Berman
See also Business and the economy in Canada;
Business and the economy in the United States; Can-
ada Health Act of 1984; Health care in the United
States.
Health care in the United
States
Definition Delivery of medical services to the U.S.
public
The 1980’s was a decade of expansion, medical advances,
rising costs, and the growth of HMOs.
Diverse health care systems exist in the world today,
the most advanced and most effective being found in
Western Europe (Great Britain, France, Switzerland,
and Norway) and North America (Canada and the
United States). Americans often pride themselves in
having the most effective health care system. While
comparative research on developed countries indeed
shows the U.S. system to be the most sophisticated,
however, it is by far not the world’s best when such is-
sues as health insurance, health affordability and ac-
cessibility, and doctor-patient quality consultation are
weighed against Canada, France, and Sweden, whose
systems U.S. politicians derogatorily label “socialized
health care,” “socialized medicine,” or “social welfare
engineering.”
The health care system in the United States is a re-
sult of the major changes that occurred during the
early twentieth century, when the so-called epidemi-
ological transition or the impact and prevalence of
communicable diseases (measles, mumps, smallpox,
syphilis, yellow fever, malaria, and polio) began to be
surpassed by the burden and high mortality rates
from chronic diseases (stroke, cancer, cardiovascu-
lar disease, and diabetes). Further milestones oc-
curred during the 1940’s and 1950’s, spurred by the
needs of wounded American soldiers during World
War II (1939-1945); the establishment of medical
boards to certify and employ physicians and advance
the code of ethics in medicine, including the Ameri-
can Board of Pediatrics (1933), the American Board
of Internal Medicine (1936), the American Board
of Surgery (1937), and the American Board of Neu-
rological Surgery (1940); and the creation of the
Centers for Disease Control and Prevention (CDC)
during the 1950’s.
The current state of health care in the United
States is a result of the medical revolution of the
1980’s, with a vast number of physicians, nurses,
hospitals, nursing homes, and health maintenance
organizations (HMOs); sophisticated and available
drugs, antibiotics, and hormone therapy; scanning
and diagnostic equipment such as magnetic reso-
nance imaging (MRI); and advanced procedures
including kidney dialysis, mechanical ventilation,
open heart surgery, organ transplant surgery, and
hip and knee replacement. Age-adjusted death rates
were reduced from 308 per 100,000 in 1950 to 184
per 100,000 in 1984.
With improvements in health care delivery, how-
ever, came high health care costs, rising from $40 bil-
lion in 1965 to $250 billion in 1980 and almost $700
billion in 1990, representing 6 percent, 9 percent,
and 12 percent of the U.S. gross domestic product
(GDP), respectively. The expenditures would rise to
more than $1 trillion by 2000, accounting for about
14 percent of the country’s GDP. Thus, it is no won-
der that, during the 1980’s, 60 percent of Americans
grew alarmed by the high rise in health care costs,
while 10 percent were dissatisfied with the quality of
care, preventing many from switching jobs in fear of
losing their expensive health benefits. At least one-
third of the American population were left at the pe-
riphery of the most successful medical advances of
modern times.Organization The health care system in the United
States can be characterized as complex and diffuse448 Health care in the United States The Eighties in America