Lessons from abroad on healthcare reform. Universal access and cost constraint work in Canada and in Germany

Neither the single-payer Canadian healthcare system nor the multipayer German healthcare system is a totally appropriate model for the United States. But we can learn something by studying both. Nations such as Canada and Germany use global budgetary target approaches, which have been shown to be more effective in controlling healthcare costs than the United States' micromanagement methodology of allocating resources. As Congress decides on a basic comprehensive benefit package, it must keep in mind that a universal, comprehensive plan results in a significant additional demand for healthcare services, as seen in Canada and in Germany. The Canadian and German healthcare systems encourage consumers to select their physicians and hospitals. Germany has a distinct separation of community-based, fee-for-service physicians and hospital-based salaried doctors. This arrangement causes difficulty in providing continuity of patient care.