Infant Mortality, 1997Deaths In First Year Of Life/1000 Live

Births

Source: OECD, 1999 & NCHS

»6.0 »5.8»5.3

»4.8 »4.8»4.0

»7.2

»0

»1

»2

»3

»4

»5

»6

»7

»8

»U.S.

»CANADA

»ITALY

»AUSTRALIA

»GERMANY

»FRANCE

»SWEDEN

Life Expectancy For Women, 1997

Source: OECD, 1999 & NCHS

»81.8

»80.3

»82.3

»79.5

»81.3 »81.4

»79.4

»77

»78

»79

»80

»81

»82

»83

»U.S.

»U.K.

»GERM

ANY

»ITALY

»CANADA»SW

EDEN

»FRANCE

» YE

AR

S

Life Expectancy For Men, 1997

Source: OECD, 1999 & NCHS

»74.1 »74.3 »74.6 »74.9»75.7

»76.7

»73.6

»70

»71

»72

»73

»74

»75

»76

»77

»78

»U.S.

»GERMANY

»U.K.

»FRANCE

»ITALY

»CANADA

»SWEDEN

» YE

AR

S

Health Spending, 1990 & 1998:U.S. Costs Rose More Than Other Nations’

Source: Health Affairs 2000; 19(3):150

»$0

»$1,000

»$2,000

»$3,000

»$4,000

»$5,000

»U.S.

»Germ

any

»Can.

»Franc

e

»Sweden

»Japa

n»Ita

ly

»U.K.

» Hea

lth S

pend

ing

Per

Cap

ita» (

1998

U.S

. dol

lars

, adj

uste

d fo

r » p

urch

asin

g po

wer

par

ity)

»1990 »1998

0%

5%

10%

15%

1960

1965

1970

1975

1980

1985

1990

1995

2000

Per

cent

of

GD

P

U.S.

Canada

U.S. Public Spending Per Capita for Healthis Greater than Total Spending in Other

Nations

Note: Public includes benefit costs for govt. employees & tax subsidy for private insuranceSource: NEJM 1999; 340:109; Health Aff 2000; 19(3):150

»$1,450

»$1,780

»$1,820

»$2,120

»$2,250

»$2,400

»$1,530»$2,740

»$0 »$1,000 »$2,000 »$3,000 »$4,000 »$5,000

»U.K.

»Japan

»Sweden

»France

»Canada

»Germany

»U.S.

»$ Per Capita

»Total Spending »U.S. Public »U.S. Private

Elderly as Percent of Total Population, 2000

Source: Health Affairs 2000; 19(3):192

»12.1%»12.8%

»15.9% »16.0% »16.4%»17.1%

»12.5%

»0%

»5%

»10%

»15%

»20%

»U.S

.

» Aus

tral

ia

» Can

ada

» Fra

nce

» U.K

.

» Ger

man

y

» Jap

an» Per

cent

of

Pop

ulat

ion

Old

er T

han

65

Americans Lead the World in Hours Worked

Source: International Labor Organization, 1999

»1399

»1560

»1656

»1731

»1889

»1883

»1966

»0 »250 »500 »750 »1000 »1250 »1500 »1750 »2000

»Norway

»Germany

»France

»U.K.

»Japan

»U.S. (1980)

»U.S. (1997)

»Hours/worker-year - 1997

Poverty Rates, 1997U.S. and Other Industrialized Nations

Source: Luxembourg Income Study Working PapersNote: U.S. figure for 1997, other nations most recent available year

»6%

»8%

»9%

»11%

»11%

»11%

»17%

»0% »5% »10% »15% »20%

»Netherlands

»France

»Sweden

»Canada

»UK

»Germany

»US

»% of Population Below Poverty Level

On the one hand,

• Greater poverty makes our health care system work harder

• But on the other hand …

Poverty-related illness is partly an effect of our health care system

• Our system for health care financing exacerbates the effect of poverty on health

• by making the opportunity cost high for the poor to obtain health care

Percent of Population withGovernment-Assured Insurance, 1997

Note: Germany does not require coverage for high-income persons, but virtually all buy coverageSource: OECD, 1999

»92%»100% »100% »100% »100% »100%

»45%

»0%

»20%

»40%

»60%

»80%

»100%

»U.S. »Germany »France »Canada »Australia »Japan »U.K.

Source: Oxford Rev Econ Pol 1989;5(1):89

Who Pays For Health Care?Regressivity Of U.S. Health Financing

»3

»1.75

»1.31 »1.27 »1.23 »1.15 »1.1 »1.07 »0.99

»0.64

»0

»0.5

»1

»1.5

»2

»2.5

»3

»3.5

»POOREST »RICHEST»INCOME DECILE

» Sha

re o

f H

ealth

Pay

men

ts/S

hare

of

» Inc

ome

Source: Premier's Common Future Of Health, Excludes Out-of-Pocket Costs

Who Pays For Canada's NHP?Province Of Alberta

»0.74 »0.77»0.85

»1

»1.2»1.3 »1.3

»0

»0.5

»1

»1.5

»2

»15,000 »25,000 »35,000 »50,000 »75,000 »100 K »125 K

»FAMILY INCOME

»Sha

re o

f H

ealth

Pay

men

ts/S

hare

» o

f In

com

e

Why are hospital administrative costs less in Canada?

• Global budgets

– Operating budget

– Capital investment budget

• Negotiated with Province

• No bills.

• No need to track and bill for individual services and goods

Why are physicians’ administrative costs lower in Canada?

• Single payer

• One place to send bills

• One set of rules

Why are Canada’s system administrative costs lower?

• No need to determine who is eligible for what– Canada’s overall administrative %

close to Medicare (before Medicare + Choice), less than Medicaid

• No marketing of insurance• No billing or collecting insurance

premiums

Number of Insurance Products

Private insurers’ High Overhead

Physician Visits Per Capita

Source: OECD, 1999 - Data are for 1997 or most recent available year

»5.9 »6.5 »6.5 »6.6 »6.8

»16

»6

»0

»5

»10

»15

»U.K.

»U.S.

»GERMANY

»FRANCE

»AUSTRALIA

»CANADA

»JAPAN

» Phy

sici

an V

isits

Difficulties Getting Needed Care

Source: Commonwealth Fund Survey, 1998

»21»18

»15 »15

»28

»0

»5

»10

»15

»20

»25

»30

»35

»U.S.

»Canad

a

»New Z

ealan

d

»Austra

lia»U.K

.

» % f

indi

ng it

ext

rem

ely,

ver

y or

som

ewha

t » d

iffic

ult

to g

et c

are

whe

n ne

eded

Continuity of Care

Source: Commonwealth Fund Survey, 1998

»52%»57% »59% »59%

»45%

»0%

»20%

»40%

»60%

»U.S.

»New Z

ealan

d

»Canad

a

»Austra

lia»U.K

.

» Per

cent

with

sam

e do

ctor

» mor

e th

an 5

yea

rs

1. Universal coverage that does not impede, either directly or indirectly, whether by charges or otherwise, reasonable access.

2. Portability of benefits from province to province3. Coverage for all medically necessary services4. Publicly administered, non-profit program

Minimum Standards For Canada's Provincial Programs

Source: NEJM 1973; 289:1174

% Of People With Serious Sx Seeing A Doctor Before And After Passage Of NHP In Quebec

»62%

»73%

»% W

ITH

DO

CT

OR

VIS

IT

»BEFORE NHP »1 YEAR AFTER NHP

Infant MortalityU.S. & Canada, 1955-1996

Source: OECD 1999, Statistics Canada & CDF

CANADA

U.S.FIRST PROVINCE IMPLEMENTS NHP

»0

»10

»20

»30

»40

» 195

5

» 196

0

» 196

5

» 197

0

» 197

5

» 198

0

» 198

5

» 199

0

» 199

5

» Dea

ths/

1000

Liv

e B

irths

»CANADA»U.S.

Infant Deaths by Income, Canada 1996Even the Poor Do Better than U.S. Average

3.94.7 5.1 5.2

6.5

7.8

0123456789

Wealthiest20%

Middle20%

Poorest20%

U.S.Average

Infa

nt

Mo

rtali

ty

Homeless in TorontoDeath Rate Elevated, But Lower than In

U.S.

Source: JAMA 2000; 283:2152

»730

»1680»2227

»3048

»0

»500

»1000

»1500

»2000

»2500

»3000

»3500

» Tor

onto

» Non

-Hom

eles

s

» Tor

onto

» Hom

eles

s

» Bos

ton

» Hom

eles

s

» New

Yor

k» H

omel

ess

» Ann

ual D

eath

s P

er 1

00,0

00

» Men

Age

45-

64

Depression Management: Better in Canada

* Antidepressant prescribed + 4 or more visitsSource: JGIM 1998; 13:77

»31%

»55%

»15%»7%»0%

»20%

»40%

»60%

»Saw Professional »Appropriate Care*

»U.S. »Canada

Physician Services For The Elderly: Canadians Get More of Most Kinds of Care

Source: JAMA 1996; 275:1410

»1.17

»1.44

»0.75

»1.18

»0

»0.5

»1

»1.5

»2

»All Services »Evaluation/»Management

»Procedures »Tests

» Can

adia

n R

ate/

U.S

. R

ate

Few Canadian Physicians Emigrate

Applicants per Medical School Place

2.4

5.5

0.0

1.0

2.0

3.0

4.0

5.0

6.0

United States Canada

Source: JAMA; 282:892; Canadian Medical Education Statistics, 1999:150

What's OK in Canada? Compared to the U.S….

• Life expectancy 2 years longer

• Infant deaths 25% lower

• Universal comprehensive coverage

• More MD visits, hospital care; less bureaucracy

• Quality of care equivalent to insured Americans’

• Free choice of doctor/hospital

• Health spending half U.S. level

What's the Matter in Canada?

• The wealthy lobby for private funding and tax cuts; they resent subsidizing care for others

• Result: government funding cuts (e.g. 30% of hospital beds closed during 90s) causingdissatisfaction

• U.S. and Canadian firms seek profit opportunities in health care privatization

• Conrad Black, foe of public services, owns 2/3 of Canadian newspapers

• Misleading waiting list surveys by right wing group

“We believe we can make much progress in the [WTO] negotiations to allow the opportunity for U.S. businesses to expand into foreign healthcare markets... public ownership of healthcare has made it difficult for U.S. private-sector healthcare providers to market in foreign countries.”

U.S. Coalition of Service Industries