Transcript Document

Infant Mortality, 1997
Deaths In First Year Of Life/1000 Live Births
»8
»7
»6
»5
»4
»3
»2
»1
»0
»7.2
Source: OECD, 1999 & NCHS
»6.0
»5.8
»5.3
»4.8
»4.8
»4.0
Life Expectancy For Women, 1997
»83
»82.3
»YEARS
»82
»81.3
»81
»80
»80.3
»79.4
»79
»78
»77
Source: OECD, 1999 & NCHS
»79.5
»81.4
»81.8
Life Expectancy For Men, 1997
»78
»76.7
»77
»75.7
»YEARS
»76
»75
»74
»73.6
»73
»72
»71
»70
Source: OECD, 1999 & NCHS
»74.1
»74.3
»74.6
»74.9
»Health Spending Per Capita
»(1998 U.S. dollars, adjusted for
»purchasing power parity)
Health Spending, 1990 & 1998:
U.S. Costs Rose More Than Other Nations’
»1990 »1998
»$5,000
»$4,000
»$3,000
»$2,000
»$1,000
»$0
Source: Health Affairs 2000; 19(3):150
2000
1995
1990
1985
1980
1975
1970
1965
1960
Percent of GDP
15%
10%
U.S.
Canada
5%
0%
U.S. Public Spending Per Capita for Health
is Greater than Total Spending in Other Nations
»U.K.
»$1,450
»Japan
»$1,780
»Sweden
»$1,820
»France
»Canada
»Germany
»U.S.
»$0
»$2,120
»$2,250
»$2,400
»$2,740
»$1,000
»$1,530
»$2,000
»$3,000
»$4,000
»$ Per Capita
»Total Spending »U.S. Public »U.S. Private
Note: Public includes benefit costs for govt. employees & tax subsidy for private insurance
Source: NEJM 1999; 340:109; Health Aff 2000; 19(3):150
»$5,000
»20%
»15.9% »16.0% »16.4%
»15%
»17.1%
»12.5% »12.1% »12.8%
»10%
Source: Health Affairs 2000; 19(3):192
»Japan
»Germany
»U.K.
»France
»Canada
»0%
»Australia
»5%
»U.S.
»Percent of Population Older Than 65
Elderly as Percent of Total Population, 2000
Americans Lead the World in Hours Worked
»1399
»Norway
»1560
»Germany
»1656
»France
»1731
»U.K.
»Japan
»1889
»U.S. (1980)
»1883
»U.S. (1997)
»0
»1966
»250
»500
»750 »1000 »1250 »1500 »1750 »2000
»Hours/worker-year - 1997
Source: International Labor Organization, 1999
Poverty Rates, 1997
U.S. and Other Industrialized Nations
»Netherlands
»6%
»France
»8%
»Sweden
»9%
»Canada
»11%
»UK
»11%
»Germany
»11%
»US
»0%
»17%
»5%
»10%
»15%
»% of Population Below Poverty Level
Source: Luxembourg Income Study Working Papers
Note: U.S. figure for 1997, other nations most recent available year
»20%
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 with
Government-Assured Insurance, 1997
»100%
»100%
»U.S. »Germany »France »Canada »Australia »Japan
»U.K.
»100%
»100%
»100%
»100%
»92%
»80%
»60%
»45%
»40%
»20%
»0%
Note: Germany does not require coverage for high-income persons, but virtually all buy coverage
Source: OECD, 1999
»Share of Health Payments/Share of
»Income
Who Pays For Health Care?
Regressivity Of U.S. Health Financing
»3.5
»3
»3
»2.5
»2
»1.75
»1.5
»1
»1.31 »1.27 »1.23
»1.15 »1.1 »1.07
»0.99
»0.64
»0.5
»0
»POOREST
Source: Oxford Rev Econ Pol 1989;5(1):89
»INCOME DECILE
»RICHEST
»Share of Health Payments/Share
»of Income
Who Pays For Canada's NHP?
Province Of Alberta
»2
»1.5
»1.2
»1.3
»1.3
»100 K
»125 K
»1
»1
»0.74
»0.77
»0.85
»0.5
»0
»15,000 »25,000 »35,000 »50,000 »75,000
»FAMILY INCOME
Source: Premier's Common Future Of Health, Excludes Out-of-Pocket Costs
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
»Physician Visits
»16
»15
»10
»5.9
»6
»6.5
»6.5
»5
»0
Source: OECD, 1999 - Data are for 1997 or most recent available year
»6.6
»6.8
»% finding it extremely, very or somewhat
»difficult to get care when needed
Difficulties Getting Needed Care
»35
»30
»28
»25
»20
»15
»10
»5
»0
Source: Commonwealth Fund Survey, 1998
»21
»18
»15
»15
»Percent with same doctor
»more than 5 years
Continuity of Care
»60%
»52%
»40%
»45%
»20%
»0%
Source: Commonwealth Fund Survey, 1998
»57%
»59%
»59%
Minimum Standards For Canada's
Provincial Programs
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 province
3. Coverage for all medically necessary services
4. Publicly administered, non-profit program
»% WITH DOCTOR VISIT
% Of People With Serious Sx Seeing A Doctor
Before And After Passage Of NHP In Quebec
»73%
»62%
»BEFORE NHP »1 YEAR AFTER NHP
Source: NEJM 1973; 289:1174
Infant Mortality
U.S. & Canada, 1955-1996
»30
»CANADA
»U.S.
»20
»10
FIRST PROVINCE
IMPLEMENTS NHP
U.S.
Source: OECD 1999, Statistics Canada & CDF
»1995
»1990
»1985
»1980
»1975
»1970
»1955
»0
»1965
CANADA
»1960
»Deaths/1000 Live Births
»40
Infant Mortality
Infant Deaths by Income, Canada 1996
Even the Poor Do Better than U.S. Average
9
8
7
6
5
4
3
2
1
0
7.8
6.5
4.7
5.1
5.2
3.9
Wealthiest
20%
Middle
20%
Poorest U.S.
20% Average
»3500
»3000
»2500
»2000
Source: JAMA 2000; 283:2152
»3048
»1680
»2227
»New York
»Homeless
»Boston
»Homeless
»730
»Toronto
»Homeless
»1500
»1000
»500
»0
»Toronto
»Non-Homeless
»Annual Deaths Per 100,000
»Men Age 45-64
Homeless in Toronto
Death Rate Elevated, But Lower than In U.S.
Depression Management: Better in Canada
»U.S. »Canada
»60%
»55%
»40%
»31%
»20%
»15%
»7%
»0%
»Saw Professional
* Antidepressant prescribed + 4 or more visits
Source: JGIM 1998; 13:77
»Appropriate Care*
Physician Services For The Elderly:
Canadians Get More of Most Kinds of Care
»Canadian Rate/U.S. Rate
»2
»1.44
»1.5
»1.18
»1.17
»1
»0.75
»0.5
»0
»All Services
Source: JAMA 1996; 275:1410
»Evaluation/
»Management
»Procedures
»Tests
Few Canadian Physicians Emigrate
Applicants per Medical School Place
6.0
5.5
5.0
4.0
3.0
2.0
2.4
1.0
0.0
United States
: JAMA; 282:892; Canadian Medical Education Statistics, 1999:150
Canada
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) causing
dissatisfaction
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
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.”