Infant Mortality, 1997 Deaths In First Year Of Life/1000 Live Births Source: OECD, 1999 & NCHS »6.0 »5.8 »5.3 »4.8 »4.0 »7.2 »0»0 »1»1 »2»2 »3»3 »4»4 »5»5 »6»6 »7»7 »8»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. »GERMANY »ITALY »CANADA »SWEDEN »FRANCE »YEARS

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 »YEARS

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. »Germany »Can. »France »Sweden »Japan »Italy »U.K. »Health Spending Per Capita »(1998 U.S. dollars, adjusted for »purchasing power parity) »1990»1998

U.S. Public Spending Per Capita for Health is Greater than Total Spending in Other Nations Note: Public includes benefit costs for govt. employees & tax subsidy for private insurance Source: 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. »Australia »Canada »France »U.K. »Germany »Japan »Percent of Population Older Than 65

Americans Lead the World in Hours Worked Source: International Labor Organization, 1999 »1399 »1560 »1656 »1731 »1889 »1883 »1966 »0»0»250»500»750»1000»1250»1500»1750»2000 »Norway »Germany »France »U.K. »Japan »U.S. (1980) »U.S. (1997) »Hours/worker-year

Poverty Rates, 1997 U.S. and Other Industrialized Nations Source: Luxembourg Income Study Working Papers Note: U.S. figure for 1997, other nations most recent available year »6% »8% »9% »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 with Government-Assured Insurance, 1997 Note: Germany does not require coverage for high-income persons, but virtually all buy coverage Source: OECD, 1999 »92% »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»3 »1.75 »1.31 »1.27 »1.23 »1.15 »1.1 »1.07 »0.99 »0.64 »0»0 »0.5 »1»1 »1.5 »2»2 »2.5 »3»3 »3.5 »POOREST»RICHEST »INCOME DECILE »Share of Health Payments/Share of »Income

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 »1.2 »1.3 »0»0 »0.5 »1»1 »1.5 »2»2 »15,000»25,000»35,000»50,000»75,000»100 K»125 K »FAMILY INCOME »Share of Health Payments/Share »of Income

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, Data are for 1997 or most recent available year »5.9 »6.5 »6.6 »6.8 »16 »6»6 »0»0 »5»5 »10 »15 »U.K.»U.S. »GERMANY »FRANCE »AUSTRALIA »CANADA »JAPAN »Physician Visits

Difficulties Getting Needed Care Source: Commonwealth Fund Survey, 1998 »21 »18 »15 »28 »0»0 »5»5 »10 »15 »20 »25 »30 »35 »U.S. »Canada »New Zealand »Australia »U.K. »% finding it extremely, very or somewhat »difficult to get care when needed

Continuity of Care Source: Commonwealth Fund Survey, 1998 »52% »57% »59% »45% »0% »20% »40% »60% »U.S. »New Zealand »Canada »Australia »U.K. »Percent with same doctor »more than 5 years

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 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% »% WITH DOCTOR VISIT »BEFORE NHP»1 YEAR AFTER NHP

Infant Mortality U.S. & Canada, Source: OECD 1999, Statistics Canada & CDF CANADA U.S. FIRST PROVINCE IMPLEMENTS NHP

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

Homeless in Toronto Death Rate Elevated, But Lower than In U.S. Source: JAMA 2000; 283:2152 »730 »1680 »2227 »3048 »0»0 »500 »1000 »1500 »2000 »2500 »3000 »3500 »Toronto »Non-Homeless »Toronto »Homeless »Boston »Homeless »New York »Homeless »Annual Deaths Per 100,000 »Men Age 45-64

Depression Management: Better in Canada * Antidepressant prescribed + 4 or more visits Source: 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 »0.5 »1»1 »1.5 »2»2 »All Services»Evaluation/ »Management »Procedures»Tests »Canadian Rate/U.S. Rate

Few Canadian Physicians Emigrate

Applicants per Medical School Place 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) 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

“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