1. THE FUTURE OF HEALTH CARE IN CANADA September 19, 2000 © Merck Frosst Canada & Co., 2000

2. page 2 OECD Health Data FIle International Health spending (1960-92)

3. page 3 “There is an urgent need to get the costs of Medicare under control” BCMA Forum on Medicare Emergent Theme Medicare (all provinces) Recession Slow economic recovery Year % GDP Canadian Institute for Health Information. Average annual rate of growth in H/C 1975 - 1991 1991 - 1996 1998 - 1999 11.2% 2.6% 5.1% CANADA

4. page 4 1990 1999 chg. C.A.G.R. Hospital Services39.3 31.6 -7.7 +0.7% Physician Services15.1 13.9 -1.2 +2.8% Drugs11.3 15.2 +3.9 +11.1% Other Health Spending 1 10.9 14.1 +3.2 +6.0% Other Professional 2 10.5 12.8 +2.3 +5.3% Other Institution 9.3 9.8 +0.5 +4.2% Capital3.6 2.7 -0.9 +0.2% 1 Includes administration, public health, health research 2 Includes alternative care givers of health services CANADA Canadian Institute for Health Information.

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6. 6 Merck Frosst/NVO Health Care in Canada Survey 1999.

7. page 7 Merck Frosst/NVO Health Care in Canada Survey 1999. Public Perception

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9. 9 èService Integration èFinancial Incentives èHealth Information èHealth Insurance

10. page 10 èChange Delivery System èDisease Management èControl Health Care Use

11. page 11 èGP Fund Holding èPrimary Care Physicians Managing Total Care or a Group of Patients èBudget Holding

12. page 12 è Health Information System è Report Cards è Telemedicine/Telehealth è On-line Info è On-line Adjudication è Universal Classifications

13. page 13 Source: Pricewaterhouse Coopers. HealthCast 2010. 1990 40.5% Gov ’t 1997 46.4% Gov ’t 1990 40.5% Gov ’t 1997 46.4% Gov ’t US Insurance Gov ’t % spending growing  Growth in Medicare  Increased regulation Emerging Insurance System Resulting Trends Emerging Insurance System Resulting Trends  Increased private insurance choice outside US  Increased Public insurance in the US Today 10% Private Tomorrow 5-7% Growth/Year Today 10% Private Tomorrow 5-7% Growth/Year European/Canadian Insurance Private % spending growing  Public dissatisfaction  Increased employer- sponsored insurance

15. page 15 Public Bureaucrats Administrators Providers PatientsTax Payers Provincial Government Federal Government Pharmaceutical Industry

16. page 16 BASELINE MEASURE STANDARDIZED PRACTICES EVIDENCE Operation Results Health Costs Disease Management

17. page 17 è Reform è Performance è Opportunity