Infant Mortality, 1997 Deaths In First Year Of Life1000 Live Births

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Infant Mortality, 1997Deaths In First Year Of
Life/1000 Live Births
Source OECD, 1999 NCHS
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Life Expectancy For Women, 1997
Source OECD, 1999 NCHS
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Life Expectancy For Men, 1997
Source OECD, 1999 NCHS
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Health Spending, 1990 1998U.S. Costs Rose
More Than Other Nations
Source Health Affairs 2000 19(3)150
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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 340109 Health Aff
2000 19(3)150
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Elderly as Percent of Total Population, 2000
Source Health Affairs 2000 19(3)192
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Americans Lead the World in Hours Worked
Source International Labor Organization, 1999
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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
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On the one hand,

• Greater poverty makes our health care system work
  harder
  
• But on the other hand

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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

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Percent of Population withGovernment-Assured
Insurance, 1997
Note Germany does not require coverage for
high-income persons, but virtually all buy
coverageSource OECD, 1999
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Who Pays For Health Care? Regressivity Of U.S. He
alth Financing
Source Oxford Rev Econ Pol 19895(1)89
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Who Pays For Canada's NHP?Province Of Alberta
Source Premier's Common Future Of Health,
Excludes Out-of-Pocket Costs
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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

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Why are physicians administrative costs lower in
Canada?

• Single payer
• One place to send bills
• One set of rules

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Why are Canadas system administrative costs
lower?

• No need to determine who is eligible for what
• Canadas overall administrative close to
  Medicare (before Medicare Choice), less than
  Medicaid
  
• No marketing of insurance
• No billing or collecting insurance premiums

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Number of Insurance Products
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Private insurers High Overhead
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Physician Visits Per Capita
Source OECD, 1999 - Data are for 1997 or most
recent available year
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Difficulties Getting Needed Care
Source Commonwealth Fund Survey, 1998
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Continuity of Care
Source Commonwealth Fund Survey, 1998
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Minimum Standards For Canada's Provincial Programs

• Universal coverage that does not impede, either
  directly or indirectly, whether by charges or
  otherwise, reasonable access.
  
• Portability of benefits from province to
  province
  
• Coverage for all medically necessary services
• Publicly administered, non-profit program

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Of People With Serious Sx Seeing A Doctor
Before And After Passage Of NHP In Quebec
Source NEJM 1973 2891174
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Infant MortalityU.S. Canada, 1955-1996
FIRST PROVINCE IMPLEMENTS NHP
U.S.
CANADA
Source OECD 1999, Statistics Canada CDF
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Infant Deaths by Income, Canada 1996Even the
Poor Do Better than U.S. Average
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Homeless in TorontoDeath Rate Elevated, But
Lower than In U.S.
Source JAMA 2000 2832152
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Depression Management Better in Canada
Antidepressant prescribed 4 or more
visitsSource JGIM 1998 1377
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Physician Services For The Elderly Canadians
Get More of Most Kinds of Care
Source JAMA 1996 2751410
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Few Canadian Physicians Emigrate
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Applicants per Medical School Place
Source JAMA 282892 Canadian Medical Education
Statistics, 1999150
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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

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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

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U.S. Coalition of Service Industries

• 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.