MMHA 6050 Week 7 International System Comparison Example

The United States, Canada and Germany Scored on Access, Cost and Quality

Student Name

Walden University

MMHA 6050: Delivery of Healthcare

Instructor Name

Month Day, Year

The United States, Canada and Germany Scored on Access, Cost and Quality

Choosing the Comparators

This paper compares the United States with two peer systems chosen to represent different financing designs among wealthy countries. Canada finances hospital and physician care through provincial single-payer insurance plans. Germany finances care through statutory health insurance with many competing, tightly regulated sickness funds, alongside a smaller private insurance sector (Tikkanen et al., 2020). Both are wealthy democracies, so differences in performance are more likely to reflect how care is financed and organized than how rich each country is.

The Scoring Scale

Each criterion is scored on three levels, defined before any country is scored. Access: strong means nearly universal coverage and low cost-related barriers to care; moderate means universal coverage with significant waits or coverage gaps for some services; weak means a substantial share of people uninsured or underinsured, with cost a common barrier. Cost: strong means spending per person and as a share of the economy near or below the peer average; moderate means somewhat above; weak means well above. Quality: strong means outcomes, such as deaths preventable by health care, better than the peer average; moderate means near the average; weak means worse.

The domain structure follows the Commonwealth Fund's Mirror, Mirror reports, which group performance into areas such as access to care, care process, administrative efficiency, equity and health outcomes (Blumenthal et al., 2024). This paper keeps to the course's three criteria and does not reproduce the reports' country placements.

The Scored Grid

Table 1 shows the scores and the evidence behind each.

Table 1

Access, Cost and Quality Scores With Basis

Access

The United States scores weakest on access because of its coverage design. Even with the insured share at a record high of about 92.5% in 2023 (Martin et al., 2025), millions lack coverage, and many insured people face deductibles and cost sharing that deter care. Canada's provincial plans cover hospital and physician care for everyone without charges at the point of care, but long waits for specialist and elective care, and gaps in coverage for outpatient prescription drugs, limit access in practice (Tikkanen et al., 2020). Germany combines near-universal coverage with relatively short waits, which earns it the strongest score. Each system's access problem follows from its design: the U.S. problem is coverage and cost, Canada's is capacity and scope, and Germany's is comparatively small, though not absent in rural regions.

Cost

On cost, the United States is an outlier. It spends far more per person than any other OECD country, and its spending share of the economy, about 17.6% in 2023 (Martin et al., 2025), is well above Canada's and Germany's (OECD, 2023). Canada and Germany both spend above the OECD average, but at levels far below the United States. Part of the U.S. difference reflects higher prices for the same services and higher administrative costs associated with many payers and complex billing; Germany's many sickness funds suggest that multiple insurers alone do not explain U.S. costs, since Germany regulates benefits and prices much more tightly. Price regulation, more than the number of payers, appears to separate the two.

Quality

Quality is the hardest criterion to score, because the United States performs well on some care processes, such as certain screening and cancer survival measures, and poorly on population outcomes. Life expectancy in the United States is lower than in Canada and Germany, and deaths that could have been prevented with timely, effective care are more common (OECD, 2023). The U.S. score of weak to moderate reflects that mix. Canada and Germany score moderate, with outcomes near or better than peer averages on many measures.

Limits of This Comparison

The scores rest on national averages, which hide wide variation within each country. Access and quality in the United States differ greatly by state, insurance type and income; a well-insured American in a well-served city may have faster access to specialists than most Canadians, while an uninsured American in a rural county may have far less than anyone in Germany. Canada's waits vary by province and specialty. The three-level scale is also coarse: it separates clear differences but cannot rank close ones, and a reader with different thresholds might score Germany's cost as weak or Canada's quality as strong. Finally, quality measures such as preventable mortality reflect more than health care, including social conditions, diet and violence, which differ across the three countries. These limits do not overturn the broad pattern, which other comparisons, including the Commonwealth Fund's reports, also find, but they caution against reading the grid as a precise ranking. It is a structured way to see where each design tends to succeed and fail, and why.

What the Comparison Shows

The comparison suggests that financing design shapes performance more than whether a system uses one payer or many. Canada and Germany differ sharply in structure but share universal coverage, tight regulation of prices and benefits and lower spending than the United States. For a U.S. health administrator, the lesson is not to copy either system, which national policy would have to do, but to recognize which of the U.S. system's weaknesses an organization can address directly, such as reducing cost-related barriers for its own patients or simplifying administrative processes, and which depend on national financing design beyond any one organization's control.

References

Blumenthal, D., Gumas, E. D., Shah, A., Gunja, M. Z., & Williams, R. D., II. (2024). Mirror, mirror 2024: A portrait of the failing U.S. health system. The Commonwealth Fund.

Martin, A. B., Hartman, M., Washington, B., Catlin, A., & National Health Expenditure Accounts Team. (2025). National health expenditures in 2023: Faster growth as insurance coverage and utilization increased. Health Affairs, 44(1), 12-22. https://doi.org/10.1377/hlthaff.2024.01375

OECD. (2023). Health at a glance 2023: OECD indicators. OECD Publishing.

Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A., & Wharton, G. A. (2020). International profiles of health care systems. The Commonwealth Fund.