Who Pays for Health Care?

Health care financing isn't a topic that most people get excited about, but they should. The way that money moves for health care shapes the kind of care that people receive. Health is not driven by people's health needs. You'd expect that, but it's not. People don't know enough about medicine to demand care in specific ways. Instead, health care providers decide what kind of care that patients need. And what they decide is driven by what gets paid for; we've got studies to prove it. If specialist care is the most reimbursed, people get specialist care. If primary health care is reimbursed, they get that.

One thing to look at in health financing is who pays. You can have a single payer system, where a single entity (generally a government body, though I suppose it could be a foundation or private sector fund) pays health care providers and facilities. Or you can have a multi-payer system, where people pay out of pocket, insurance companies, and others pay for health care.

In a single payer system, the single payer has a lot of control over how health care is provided. Reimbursement for providers can be standardized, for example, and dangerous or unproven treatments can be ineligible for reimbursement. In a multi-payer system, different providers will be willing to pay different rates, and reimburse for different kinds of care. It means more options, and less quality control. The American system is a multi-payer system; the Canadian system is single-payer. Personally, I believe that the evidence supports single-payer systems as providing better, cheaper health care. Either system can be used to provide universal health care.