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How to Achieve a High-Performance Health Care System in the United States
- Richard L. Cruess, MD; and
- Sylvia R. Cruess, MD
- From the Center for Medical Education, McGill University, Montréal, Québec H3A T25, Canada.
TO THE EDITOR:
When comparing the health care system in the United States with the national health plans in other countries, we can learn many lessons about health outcomes and health economics. With no national health plan and an emphasis on market forces, the United States is unprepared for negotiations between government and physicians.
In a national health program, individuals and organizations representing both physicians and patients sit around a negotiating table and hammer out the terms of medical practice. In the United Kingdom, which has a highly centralized system, representatives of the Department of Health—representing society—sit at the table with the British Medical Association, a union to which 80% of practicing physicians belong—representing the medical profession. In Canada, constitutional responsibility for health care rests with the provinces, and each province has its own negotiating table (although the …
