1. Assembling Canada’s Health System Profile for the European Observatory Monitoring Health Systems Change/Reforms PAHO/WHO Seminar, Belize, 30 May 2006 Gregory P. Marchildon, Ph.D. Canada Research Chair in Public Policy and Economic History Graduate School of Public Policy, University of Regina

2. G.P. Marchildon Graduate School of Public Policy 2

3. G.P. Marchildon Graduate School of Public Policy 3 Comparative Template European Observatory on Health Systems and Policies (WHO Regional Office for Europe) Health Care Systems in Transition (HiT) profiles: focus on Europe but a few exceptions … Australia, New Zealand, and now … Canada Common questions Compulsory tables, figures, and diagrams

4. G.P. Marchildon Graduate School of Public Policy 4 Comparator Countries Canada not part of WHO’s European database Rely on OECD health database (2004) 5 countries selected on basis of history, size, wealth and political or policy considerations –Australia –France –Sweden –United Kingdom –United States

5. G.P. Marchildon Graduate School of Public Policy 5 Systematic Comparisons: Quantitative and Qualitative 1.Health status 2.Organizational structure: governance and management 3.Financial resources: revenues and expenditures 4.Regulation and planning 5.Physical and human resources 6.Provision of services 7.Health care reforms 8.Assessment: public, mixed and private

6. Total Health care expenditures as a share of GDP in Canada and selected countries, 1960 to 2002

7. Public Health Care Expenditures as a share of GDP in Canada and selected countries, 1960 to 2002

8. Comparatives Trends in real PUHE, PRHE, and THE, cumulative % change, 1990-2001

9. Comparative Health Status Indicator Rankings (OECD rankings in brackets) Life Expectancy at Birth (1999) Potential Years of LL per 100,000 (1997) Perinatal Mortality per 100,000 (1999) DPT Immunization % of Children (1997) Measles Immunization % of Children (1998) SWEDEN1 (4)1 (1)2 (7)1 (2)1 (6) CANADA2 (5)2 (8)3 (13)4 (22)2 (7) AUSTRALIA3 (7)3 (9)1 (3)6 (25)5 (18) FRANCE4 (8)5 (15)4 (17)2 (8)6 (19) UK5 (18)4 (10)5 (18)3 (18)4 (15) USA6 (20)6 (22)6 (20)5 (23)3 (13)

10. Malignant Neoplasms (2000) Cerebro- vascular Diseases (2000) Respiratory System Diseases (2000) Ischaemic Heart Diseases (2000) SWEDEN1 (2)5 (11)1 (4)4 (16) CANADA4 (15)1 (2)3 (10)3 (12) AUSTRALIA2 (8)4 (5)4 (12)2 (11) FRANCE5 (18)2 (3)2 (8)1 (3) UK6 (20)6 (18)6 (25)6 (22) USA3 (14)3 (4)5 (22)5 (21) Comparative Disease Indicator Rankings (OECD rankings in brackets), 2000

11. G.P. Marchildon Graduate School of Public Policy 11 Observations and Conclusions Importance of comparative perspective Allows you to ask better questions But rarely provides direct or conclusive answers Health system performance? –Health status –Health care (amenable mortality) –Fiscal performance –Patient/user/citizen satisfaction