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International Comparisons »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. 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 Canada’s National Health Insurance Program 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 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 »Quality of Care Slightly Better in Canada Than U.S. »A Meta-Analysis of Patients Treated for Same Illnesses »(U.S. Studies Included Mostly Insured Patients) »Source: Guyatt et al, Open Medicine, April 19, 2007 »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