Transcript Slide 1

YES !! To Universal Medical
Coverage in Georgia
----The case for
Georgia SecureCare
March 2005
What do General Motors and
Atlanta’s southwest community
have in common?
Hint: …... see items from
recent Atlanta newspapers
January 9, 2005
George Jetson, Meet the Sequel
DETROIT
By DANNY HAKIM
General Motors' latest hydrogen car prototype, called the Sequel, …
… a glimpse of a possible, very different, automotive future.
… it runs on a hydrogen fuel cell, so its only tailpipe emission is water vapor, not the
smog-forming pollutants and greenhouse gases that come out of gasoline-powered cars.
…….
(But)…"There's no sign by General Motors that they have any inclination to act in
the here and now," said David Doniger, policy director of the climate center of the
Natural Resources Defense Council …..
-
…… G.M. is also hamstrung by its obligation to provide health care to
1.1 million Americans, a large number of whom are retirees. The
obligation makes G.M.'s own health no small matter for the United
States, but the nation's medical system puts G.M. at a
disadvantage. Rivals in Japan and Germany, countries with socialized
medical systems, do not have to bankroll retiree health care.
……. G.M. has estimated that it will spend more than $60 billion on
health care for its retirees and current workers after they retire over the
next several decades.
……. By contrast, Toyota has said in financial filings that its retiree
health care liability is not even large enough to require disclosure.
Copyright 2005 The New York Times Company
Southwest Hospital goes out of business
Board hopes facility can reopen
By DAVID A. MARKIEWICZ
The Atlanta Journal-Constitution -- January 9, 2005
…… The shutting of Southwest means the sick and injured who used it, many of
them indigent, will have to go elsewhere for care……
…… Southwest … ran out of cash. One of only a few black-owned or -controlled
hospitals in the country, it has been operating under Chapter 11 bankruptcy
protection since September.
…… Hospital officials said Southwest decided Tuesday to close because of a delay
in receiving $1.45 million in expected government funding ….. a dispute between
the state and three other urban hospitals …. over a formula for dividing more than
$200 million designated for indigent care. The disagreement has delayed
payments to all hospitals.
…… Beyond that, Southwest faced financial problems similar to those of other
small, independent hospitals serving patients who are uninsured,
underinsured or in government programs like Medicaid and Medicare.
The healthcare Americans get:
1/3 are uninsured or underinsured
HMOs deny care to millions more with expensive
illnesses
Death rates higher than other wealthy nations’
Costs per capita (PPP$) are highest in world; in
2002 we spent at more than double the rate of
Netherlands, Sweden, Australia, Italy, UK, Japan
Executives and investors making billions
Destruction of the doctor/patient relationship
Georgians for a Common Sense Health Plan:
GCSHP Goals -----Universal - covers everyone with full choice of
provider
Comprehensive - all needed care, no co-pays*
Single, public payer - simplified reimbursement
Discourage investor-owned HMOs, hospitals, etc.
Improved health planning
Public accountability for quality and cost, but
minimal bureaucracy
Are our ideals realistic for Georgia?
Are Georgians concerned?
Would financing reform in our State be
affordable and sustainable?
‘Feasibility?’: How deep and wide is
Georgia political support?
Grant support from Healthcare Georgia Foundation
Georgia phone survey of 800 households, September 2003
Gender and age
Income
Race
Party identification (ID)
Men 18-49
27%
Men 50 and over
22%
Women 18-49
28%
Women 50 and over
24%
<$30,000
27%
$30-50,000
25%
$50-80,000
19%
>$80,000
17%
Don’t know/refused
13%
White
63%
African-American
28%
Other/Refused
9%
Democrat
38%
Republican
34%
Independent
28%
Difficulty with health care?
Yes
ALL
32%
No
68%
Strongest Subgroup Responses
No health insurance
South GA
<$30,000
Democrat (ID)
Democrat (history)
Employed part-time/both
African-American
$30-50,000
Not registered to vote
Rural
Not married
Children
53%
47%
44%
40%
40%
40%
39%
39%
38%
38%
38%
36%
>$80,000
Republican (history)
Republican (ID)
Men 50+
North GA
Suburban
60 and over
Has health insurance
Metro Atlanta
Married
89%
78%
77%
75%
75%
74%
74%
73%
72%
72%
Concerned about health care or insurance?
ALL
Strongest Subgroup Responses
Very concerned
36%
<$30,000
No health insurance
Democrat (ID)
African-American
Democrat (history)
South GA
Not registered to vote
Not married
Rural
Employed part-time/both
52%
48%
45%
45%
44%
44%
43%
42%
41%
41%
Somewhat concerned
Not very concerned
23%
15%
-Republican (history)
>$80,000
Republican (ID)
$50-80,000
23%
23%
21%
20%
Not at all concerned
25%
>$80,000
60 and over
Independent (ID)
Men
Men 18-49
Men 50+
Republican (history)
North GA
32%
30%
30%
29%
29%
29%
29%
29%
Yes, Georgians are concerned
But … the underlying problem(s) are not
clear to everyone
-- it’s not simply ‘poverty’
Number uninsured/in poverty 1967-2001
Source: Social Security Bul, HIAA, CPS
November 16, 2003
For Middle Class, Health Insurance
Becomes a Luxury
By STEPHANIE STROM
Who Are The Uninsured?
»Children
»25%
»Employed
»50%
»Unemployed
»5%
»*Out of labor
»force
»20%
*Students>18, Homemakers,
Disabled, Early retirees
Source: Himmelstein & Woolhandler - Tabulation from 1999 CPS
Unmet Health Needs of the
Uninsured
Within the USA, adult mortality is related to insurance
status (adjusted for 27-factor propensity score)
McWilliams JM et al. Health Affairs 2004: 23: 223-33
Percent With No Choice
Many with insurance lack choice;
42% are offered only 1 plan
60%
40%
»65%
»53%
»49%
»39%
»35%
<$10K
$10,000$19,999
$20,000$29,999
$30,000$49,999
$50,000$99,999
20%
0%
»Income Group
Note: Those without choice were 70% more likely to give their plan a low rating
Source: Health Affairs 1998; 17(5):184
Illness and medical costs - a major
cause of personal bankruptcy
46% of all personal bankruptcies involve a medical
reason (direct costs, lost income) or large medical debt
--- another 9% attributed to addiction, uncontrolled gambling, birth,
or the death of a family member
Most bankrupted families (2001 sample) initially had
medical insurance, but they commonly lost their
coverage
Source: Himmelstein DU et al. Health Affairs 2005
What has brought us to this
situation in the past 2 decades?
Growth of Registered Nurses
and Administrators, 1970-2002
Growth since 1970
Administrators
RNs
2500%
2000%
1500%
1000%
500%
0%
1970
1975
1980
1985
1990
1995
Source: Bureau of Labor Statistics & Himmelstein/Woolhandler/Lewontin Analysis of CPS data
2001
Growth of Physicians
and Administrators, 1970-2002
Growth since 1970
Administrators
Physicians
2500%
2000%
1500%
1000%
500%
0%
1970 1975 1980 1985 1990 1995 2000
Source: Bureau of Labor Statistics & NCHS
HMOs: good & bad
Three decades ago………
Organization, coordinated, accountable
Prevention or private profit?
Medicaid HMOs:
Poor access and satisfaction
Medicaid HMO
60%
Medicaid F-F-S
53%
40%
20%
45%
28%
16%
21%
14%
0%
Problem
Getting Care
Dissatisfied
with Care
Source: Lillie-Blanton & Lyons. Hlth Affairs 1998; 17(3):238 - Kaiser/Commonwealth Survey
Used ER
Past Year
Inpatient costs as % of FFS Medicare
Medicare HMOs:
The healthy go in, the sick go out
200%
180%
150%
100%
100%
66%
50%
0%
FFS Medicare
* Data are for 12 month period before joining HMO
** Data are for 3 month period after leaving HMO
Source: N Engl J Med 1997; 337:169
Before
Joining HMO*
After
Leaving HMO**
For-Profit HMOs’
increasing dominance, 1985-2000
% of HMO Enrollment
Non-profit
For-profit
100%
75%
50%
25%
0%
1985
Source: Interstudy
1987
1989
1991
1993
1995
1997
1999
Average rate (percent)
Investor-owned HMOs
provide lower quality care
100
75
50
64
72
69
75
69
77
71
59
48
54
62
35
25
0
For-Profit
Not-For-Profit
Source: Himmelstein, Woolhandler, Hellander & Wolfe - JAMA 1999; 282:159
Likelihood Ratio:
Ordering for Diabetic Patients
“Productive” physicians, worse care
1
1
1
1
0.75
0.6
0.53
0.5
0.25
0.25
0
HDL
Testing
Proteinuria
Testing
Physician Practice Style
"Fast" "Slow"
Note: Fast physicians = those seeing more pts./hour than average
Slow Physicians = those seeing fewer pts./hour than average
Source: Arch Int Med 1999; 159:294
Ophthalmology
Referral
Doctors urged to shun the sick
“[We can] no longer tolerate patients
with complex and expensive-to-treat
conditions being encouraged to
transfer to our group.”
-Letter to faculty from University of
California Irvine Hospital Chief
Source: Modern Healthcare, 9/21/95:172.
HMO overhead & profit
as percent of premium
40%
33%
30%
26%
25%
25%
20%
10%
0%
Source: BestWeek Life/Health Special Report 4/12/99 - from SEC filings
18%
15%
14%
Private insurers’ High Overhead
Why are for-profit hospitals costlier?
Higher administrative and non-personnel costs
Clinical Personnel
All Other Costs
Administration
Cost per hospital stay
$10,000
$8,115
$7,490
$7,500
$2,289
$1,809
$6,507
$1,432
$5,000
$2,872
$2,385
$2,954
$3,296
$2,909
For-Profit
Not-For»Profit
Public
$2,166
$2,500
»$0
Source: Woolhandler & Himmelstein - NEJM 3/13/97 - Analysis of data from 5201 acute care hospitals
Note: Costs are for FY 1994, adjusted for hospital case mix and local wages
Adjusted Death Rate As Percent of
Rate at For-Profit Hospitals
Death rates are higher
at for-profit hospitals
100%
100%
93%
75%
75%
50%
For-Profit
No Teaching
Non-Profit
No Teaching
* 85.5% Non-Profit, 14.3% Government, 0.2% For-Profit
Source: NEJM 1999; 340:293
Major
Teaching*
Investor-owned care
Summary of Evidence
Hospitals: Costs 3%-11% higher, fewer nurses,
higher overhead, death rates 6%-7% higher,
fraud
HMOs: Higher overhead, worse quality,
collaboration with tobacco industry
Dialysis: Death rates 20% higher, less use of
transplants & peritoneal dialysis, fraud
Nursing Homes: More citations for poor quality,
fraud
Rehab Hospitals: Costs 19% higher
Other countries?
Some comparisons with other
industrial democracies
Percent of population with
government-assured insurance
100%
100%
100%
100%
100%
100%
Japan
U.K.
92%
80%
60%
45%
40%
20%
0%
U.S.
Germany France
Canada Australia
Note: Germany does not require coverage for high-income persons, but virtually all buy coverage
Source: OECD, 2002 - Data are for 2000 or most recent year available
Life expectancy for women, 1999
83
82.5
81.6
YEARS
82
80.7
81
80
79.4
79.8
79
78
77
Source: OECD, 2002 - Data on Italy are for 1998
81.7
82
Life expectancy for men, 1999
78
77
76.3
YEARS
76
75
74
74.7
73.9
73
72
71
70
Source: OECD, 2002 - Data for Italy are for 1998
75
75
75.3
76.7
Potential Years of Life Lost per 100,000
people for all causes, 1998/1999
6000
5000
Years Lost
5,232
4000
3,878
3,844
3,803
3,103
3,044
Japan
Sweden
3000
2000
1000
0
U.S.
Germany
Source: OECD, 2002- Data for Canada are for 1998
U.K.
Canada
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
U.S. public spending per capita for health
is greater than total spending in other nations
U.K.
$1,670
Sweden
$1,750
Japan
$1,850
France
$2,230
Canada
$2,430
Germany
$2,620
U.S.
$2,600
$0
$1,000
$1,760
$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 Affairs 2000; 19(3):150
$5,000
… and the PUBLIC fraction continues to expand
(US data, Centers for Medicare & Medicaid Services, Office of the Actuary)
14
PUBLIC, % annual growth
12
PRIVATE, % annual growth
10
8
6
4
2
0
1998
2002
2004
2006
NHE
$ 4098
(per capita)
$ 5317
$ 6040
$ 6830
Heffler S et al. Health Affairs 2005
We’re paying for national health insurance,
but we’re not getting it !
We outspend other societies for health care,
but we don’t provide universal coverage.
Why is this ?
Could it be related to unique circumstances in
US health care ?
Germany
12.1%
16.0%
U.K.
12.5%
15.9%
16.4%
France
15%
Australia
20%
U.S.
17.1%
12.8%
10%
0%
Source: Health Affairs 2000; 19(3):192
Japan
5%
Canada
Percent of Population Older Than 65
Elderly as percent of total population, 2000
Physician visits per capita
Physician Visits
16
15
10
5.4
5.8
6.4
6.4
5
0
Source: OECD, 2002 - Data are for 2000 or most recent available year
6.5
6.5
Hospital inpatient days per capita, 2000
4
Days/person
4
3
2.4
2
1
0
Source: OECD, 2002
0.8
1.1
1.2
2.6
2.7
MRI Units/Million Population,
1999
% 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%
Thanks to Jan Eliot, Stone Soup, 11 Oct 2003
Are our ideals realistic for Georgia?
Are Georgians concerned?
Would financing reform in our State be
affordable and sustainable?
‘Feasibility?’: How deep and wide is
Georgia political support?
Grant support from Healthcare Georgia Foundation
SecureCare: A Georgia health program
single plan operated by the state or a non-profit
replace all existing public and private health
insurance
not connected to your job
choose any primary care doctor you want
no deductibles; -- a $25 co-payment only for
visits to a specialist without a referral
generous, comprehensive coverage, including
hospitals, doctors, emergency care,
prescriptions, dental care, and long-term care.
What would SecureCare look like?
•
everyone receives a health care card assuring payment
for all needed care
•
complete free choice of doctor, hospital, other providers
•
doctors and hospitals remain independent and non-profit,
negotiate fees and budgets with SecureCare
•
local planning boards allocate major capital expenditures
& expensive technology
•
progressive taxes (“premiums”) go to SecureCare Trust
Fund
•
consolidated public agency processes and pays bills
•
accountability and quality control through periodic
reviews (macro patterns)
Long Term Care under SecureCare
•
a universal right to social and medical LTC services
•
coverage for full continuum of home, community &
institutional care
•
spread risk through social insurance
•
consumer choice & quality improvement
•
independent living
•
support informal caregivers
•
for-profit providers phased out
Source: Harrington et al. JAMA 1991; 266:3023
Georgia health spending, 2003,
in millions
Status quo: Total by all payers:
$ 37,150
SecureCare: ↑ utilization
$ 3,840
SecureCare: ↓ administr costs ($ 3,815)
SecureCare: bulk purchasing ($
741)
Net change in health spending:
($
716)
SecureCare: Proposed funding sources
government spending for discontinued health programs
($12.8 billion)
employer payroll tax equal to 9.1% of wages and salaries
for all employees ($14.2 billion)
increase in tobacco taxes of 50¢ per pack with
proportionate increases in taxes for other tobacco taxes
($215 million)
increase in taxes on alcoholic beverages ($52 million)
increase in the state sales tax on non-grocery items of
one % point ($1.25 billion)
income tax payment for all Georgians computed to be
equal to about 22.2% of each taxpayer’s federal income
tax ($6.0 billion)
Change in average family health spending by Age of Family Head
under the Georgia SecureCare program in 2003: after wage effects
$761
$1,000
$592
$384
$500
$0
-$122
- $500
- $1,000
- $537
-$916
- $1,500
- $2,000
- $2,500
- $2,299
- $3,000
Under 24
25 - 34
35 - 44
45 - 54
55 - 64
65 and
Over
Age of Family Head
The Lewin Group, October 2003
Total
Change in average health spending per family under the Georgia
SecureCare program by Family Income in 2003: after wage effects
$10,000
$8,820
$8,000
$6,000
$4,570
$4,000
$2,285
$2,000
$903
$0
-$2,000
-$986
-$1,934
-$1,536 -$1,428
-$957
-$704
-$4,000
Less than $10,000- $20,000- $30,000- $40,000- $50,000- $75,000- $100,000- $125,000- $150,000
$10,000 $19,999 $29,999 $39,999 $49,999 $74,999 $99,999 $124,999 $149,999 or More
The Lewin Group, October 2003
Are our ideals realistic for Georgia?
Are Georgians concerned?
Would financing reform in our State be
affordable and sustainable?
‘Feasibility?’: How deep and wide is
Georgia political support?
Grant support from Healthcare Georgia Foundation
Trial 1: Would you support SecureCare?
ALL
Strongest Subgroup Responses
Strongly support
52%
African-American
<$30,000
No health insurance
Democrat (ID)
Not registered to vote
Democrat (history)
Not married
South GA
Urban
Employed part-time/both
Rural
Women 18-49
69%
67%
66%
65%
65%
63%
61%
59%
58%
58%
57%
57%
Somewhat support
20%
$50-80,000
24%
Somewhat oppose
5%
Strongly oppose
13%
>$80,000
Republican (history)
Republican (ID)
Men 50+
White
Married
27%
25%
23%
17%
17%
17%
Don’t know
11%
Women 50+
60 and over
No partisan vote pattern (history)
16%
15%
15%
--
Trial 2: Would you support SecureCare?
ALL
Strongest Subgroup Responses
Strongly support
33%
No health insurance
Democrat (ID)
<$30,000
African-American
Democrat (history)
Not registered to vote
South GA
Not married
Children
Employed part-time/both
Rural
18-39
$30-50,000
52%
45%
44%
43%
42%
42%
42%
40%
39%
39%
38%
38%
38%
Somewhat support
29%
$50-80,000
Urban
Women 18-49
$30-50,000
37%
35%
34%
33%
Somewhat oppose
Strongly oppose
9%
17%
->$80,000
Republican (history)
Republican (ID)
Men 50+
Married
29%
28%
25%
22%
22%
Don’t know
13%
60 and over
Women 50+
26%
24%
Change in private employer health spending per worker by firm size and current
insuring status under the Georgia SecureCare program in 2003: before wage effects
Currently Offer Coverage
Currently Do Not Offer Coverage
$3,500
$2,643
$2,595
$3,000
$2,453
$2,417
$2,152
$2,069
$2,500
$1,966
$2,000
$1,112
$1,500
$668
$829
$1,000
$122
$246
$500
$21
$0
10
- 24
25
- 99
100
- 499
500
- 999
$-115
Under 10
1,000 or
More
All
Workers
Harris Poll: “Government should provide
quality medical coverage to all adults . . .”
Percent agreeing
80%
77%
60%
53%
52%
47%
40%
20%
0%
General
Public
Source: USA Today/Harris Poll - 11/23/98
Employers
State
Legislators
Congressional
Aides
56% of medical students & faculty
favor single payer ;
Majority of med school deans concur
“What is the best health care system for the most people?”
56%
22%
3%
19%
Managed Care
No Preference
Source: NEJM 1999; 340:928
Single Payer
Fee-for-service
How do we know it can be done?
Every other industrialized nation has a
healthcare system that assures medical
care for all
All spend less than we do; most spend
less than half
Most have lower death rates, more
accountability, and higher satisfaction
We have what it takes:
Excellent hospitals, empty beds
Enough well-trained professionals
Superb research
Current spending is sufficient
Thanks for your attention!
Some useful websites:
www.commonsensehealthplan.org
www.physiciansproposal.org
www.pnhp.org
Medical Savings Accounts: No savings
Sickest 10% of Americans use 72% of care. MSA's
cannot lower these catastrophic costs
The 15% of people who get no care would get
premium “refunds”, removing their cross-subsidy for
the sick but not lowering use or cost
Discourages prevention
Complex to administer - insurers have to keep track
of all out-of-pocket payments
Congressional Budget Office projects that MSAs
would increase Medicare costs by $2 billion.
What's wrong with
tax subsidies and vouchers?
• Taxes go to wasteful private insurers, overhead
•
•
•
•
•
>13%
Amounts too low for good coverage, especially for
the sick
High costs for little coverage - much of subsidy
replaces employer-paid coverage
Encourages shift from employer-based to individual
policies with overhead of 35% or more
Costs continue to rise (e.g. FEHBP)
Many are unable to purchase wisely - e.g. frail
elders, severely ill, poor literacy
Thanks to Jan Eliot, Stone Soup, 20 Oct 2003
Thanks to Jan Eliot, Stone Soup, 21 Oct 2003
Out-of-Pocket Payments, 2000
Ackermann & Carroll, Ann Int Med, 18 Nov 2003
Ackermann & Carroll, Ann Int Med, 18 Nov 2003
1. For millions of Americans, insurance coverage is sporadic.
During a recent 2-year span 1 out of every 3 Americans younger
than age 65 years lacked coverage for at least 1 month.
2. Approximately half of uninsured persons are of white, non-Hispanic
ethnicity.
Members of minority groups have a higher overall risk for lacking
coverage.
3. Uninsured adults are less likely to obtain preventive care, primary care,
and the chronic disease treatment they need.
They tend to be sicker and to die sooner than people with health
insurance.
Institute of Medicine's Committee on the Consequences of Uninsurance, January 2004
4. Uninsured women receive fewer prenatal care services and have
poorer birth outcomes.
Uninsured children are less likely to obtain needed health
screenings, medical services, or prescription medications than
insured children.
Failure to detect correctable problems in early childhood can
adversely affect language development, school performance, and
ultimately success in life.
5. When even 1 member of a family lacks health insurance, the entire family
is exposed to the health and financial consequences of a catastrophic
illness or injury.
Ironically, the uninsured are often charged more for the same health
service because they don't have a large insurer to negotiate
discounts.
Institute of Medicine's Committee on the Consequences of Uninsurance, January 2004
6. In communities with high rates of uninsurance, rising levels of
uncompensated care can lead to the loss or reduced availability of key
hospital services, loss of "on-call" specialist coverage, relocation of
physician practices, and cutbacks in essential public health programs.
These adverse effects can have consequences for everyone in the
community, not just those who are uninsured.
7. On average, uninsured persons suffer an annual health loss valued at
between $1600 and $3300 per person.
This equates to an annual societal cost of between $65 and $130
billion per year
Institute of Medicine's Committee on the Consequences of Uninsurance, January 2004
Gruen RL, … Physician-Citizens- Public Roles and Professional Obligations. JAMA 2004; 291: 94-8.
We encourage consideration of professional
responsibilities in 2 main areas…..
1. …… to promote systems of care that
ensure that all patients in their community
have access to needed care.
2. …… involvement in addressing
socioeconomic factors most directly
associated with poor health outcomes.
Gruen RL, … Physician-Citizens- Public Roles and Professional Obligations. JAMA 2004; 291: 94-8.
Woolf SH. Patient safety is not enough --. Ann Intern Med 2004; 140: 33-6
The urgency may be less palpable to those …. whose narrower
perspective may obscure larger priorities. Clinicians or
researchers battling a single disease may not consider whether
expending the same effort on more threatening conditions or
solving deeper, systemic root causes may be more beneficial……
… by not addressing larger deficiencies in quality,
(physicians) may fix problems in the branches and twigs
while preserving proximal disease in the trunks. The
greatest good for the health of the population comes from a
global perspective that views the system as a whole,
judges its performance by its effect on population health, …..
and prioritizes interventions in a rational scheme to optimize
outcomes
Woolf SH. Patient safety is not enough --. Ann Intern Med 2004; 140: 33-6
CANADA'S NHP ENACTED
CANADA
U.S.
2000
1995
1990
1985
1980
1975
1970
NHP FULLY IMPLEMENTED
1965
15
14
13
12
11
10
9
8
7
6
5
1960
% of GNP
HEALTH COSTS AS % OF GNP:
U.S. & CANADA, 1960-2001
Source: Statistics Canada, Canadian Inst. for Health Info., & NCHS/Commerce Dept
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
Foes of public services control many Canadian
newspapers
Misleading waiting list surveys by right wing
group
Hospital billing & administration
United States & Canada, 2000
$ PER CAPITA
$500
$400
$372
$300
$200
$68
$100
$0
U.S.
CANADA
Source: Woolhandler/Himmelstein NEJM 1991; 324:1253 & 1993; 329:400 (updated)
Physicians' billing & office expenses
United States & Canada, 2000
$500
$430
$ PER CAPITA
$400
$300
$200
$102
$100
$0
U.S.
Source:Woolhandler/Himmelstein NEJM 1991;324:1253 (updated)
CANADA
Infant mortality
U.S. & Canada, 1955-1999
Deaths/1000 Live Births
40
30
CANADA
U.S.
20
FIRST PROVINCE
IMPLEMENTS NHP
10
U.S.
Source: OECD 1999, Statistics Canada & CDF
1995
1990
1985
1980
1975
1970
1965
1960
0
1955
CANADA
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
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
Few Canadian Physicians
Emigrate
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*
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
15,000
25,000
0.85
0.5
0
35,000
50,000
75,000
FAMILY INCOME
Source: Premier's Common Future Of Health, Excludes Out-of-Pocket Costs
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
1.31 1.27 1.23
1.15
1.1
1
1.07 0.99
0.64
0.5
0
POOREST
Source: Oxford Rev Econ Pol 1989;5(1):89
INCOME DECILE
RICHEST
Difference in Health Spending
Per Capita, U.S. vs. Canada, 2000
Bureaucracy
All Other
$1604
$857
Source: Woolhandler/Himmelstein NEJM 1991; 324:1253 & 1993; 329:400 (updated)