1 Copyright (c) The Fraser Institute 2004 How Good Is Canadian Health Care? n Presentation to the Nassau Institute and the Atlas FOundation n Michael Walker, Executive Director n The Fraser Institute n 23 April, 2004 Copyright © The Fraser Institute, 2004

2 Copyright (c) The Fraser Institute 2004 Why we did this study 1.Lengthening wait lists for health access n Our research over the past decade has been showing:

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5 A Typical Attitude………..? A Typical Attitude………..? “Administrators maintain waiting lists on purpose the way airlines overbook. As for urgent patients on the list who are in pain, the public system will decide when their pain requires care.These are societal decisions. The individual is unable to decide rationally.” “Administrators maintain waiting lists on purpose the way airlines overbook. As for urgent patients on the list who are in pain, the public system will decide when their pain requires care.These are societal decisions. The individual is unable to decide rationally.” Charles Wright, then Vice-president Vancouver Hospital (Source: Readers Digest Interview 1992) Charles Wright, then Vice-president Vancouver Hospital (Source: Readers Digest Interview 1992)

6 Copyright (c) The Fraser Institute 2004 Very or extremely difficult to see a specialist. By income strata, 2001 Source: Commonwealth Fund Survey, 2002

7 Copyright (c) The Fraser Institute 2004 Better Access To Care? Source: Blendon et al. (2002)

8 Copyright (c) The Fraser Institute 2004 Access is Better than 2 Years Ago Source: Commonwealth Fund Survey, 2002

9 Copyright (c) The Fraser Institute 2004 Rated overall medical care as: excellent Source: Commonwealth Fund Survey, 2002

10 Copyright (c) The Fraser Institute 2004 Rated overall medical care as: Fair or Poor Source: Commonwealth Fund Survey, 2002

11 Copyright (c) The Fraser Institute 2004 Change in Citizens’ Approval of Health Care System Source Commonwealth Fund Survey 2002

12 Copyright (c) The Fraser Institute 2004 Change in Citizens’ Demand for Fundamental Reform Source Commonwealth Fund Survey 2002

13 Copyright (c) The Fraser Institute 2004 Angus Reid Polls Medicare in Canada works just fine the way it is now……….37 per cent Agree

14 Copyright (c) The Fraser Institute 2004 Canadian Average Source:Statistics Canada Population Survey

15 Copyright (c) The Fraser Institute 2004 Mortality and Income n “Heart attack patients who live in poorer neighborhoods are dying at a higher rate and experience greater barriers to specialist services than more wealthy Ontarians” n “For every $10,000. Increase in average neighborhood income there was an associated 10% reduction in risk of death” n Source: New England Journal of Medicine, October, 1999

16 Copyright (c) The Fraser Institute 2004 Does Canada have one tiered medicine? n Peter Coyte and University of Toronto Researchers, April 25, 2000 n “Wealthier and more highly educated Canadians are almost 30 percent more likely to see a specialist… n “Removing financial barriers doesn’t necessarily mean that everybody has equal access to health care... n “It appears that a multi-tier health care system exists in Canada even for those services covered under the principle of universal access in the Canada Health Act

17 Copyright (c) The Fraser Institute 2004 Why we did this study 1.Lengthening wait lists for health access 2.Widening gaps between actual and clinically reasonable waiting times for procedures n Our research over the past decade has been showing::

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19 Copyright (c) The Fraser Institute 2004 Why we did this study 1.Lengthening wait lists for health access 2.Widening gaps between actual and clinically reasonable waiting times for procedures 3.Declining relative access to advanced technology n Our research over the past decade has been showing:

20 Copyright (c) The Fraser Institute 2004 What is the state of medical technology in Canada? n A compilation of OECD data n Fraser Institute Survey of Medical Technology n A Canada-U.S. comparison based on direct hospital comparison

21 Copyright (c) The Fraser Institute 2004 Direct Hospital Comparison n Hospitals in Oregon, Washington and British Columbia n Teaching hospitals - availability of technology and procedures n Regional hospitals of comparable size

22 Copyright (c) The Fraser Institute 2004 Some procedures and machines not available at all in B.C….Canada? Based on data developed from comparative surveys made by the Fraser Institute of teaching hospitals and non-teaching hospitals in Oregon, Washington and British Based on data developed from comparative surveys made by the Fraser Institute of teaching hospitals and non-teaching hospitals in Oregon, Washington and British Columbia Columbia

23 Copyright (c) The Fraser Institute 2004 Therapies and procedures not available end of 1998 in B.C…..Canada? n Intraoperative Transesophageal ecocardiography for anesthesia n Echocardiography with harmonic imaging n Radioactive balloon Angioplasty n Emergency Room dedicated ultrasound n GI endoscopic Ultrasound n GI Endoscopic laser n Minilaproscopy (3mm) n Frameless Stereotaxy

24 Copyright (c) The Fraser Institute 2004 More procedures not available n Laparoscopic laser ablation of the Endometrium n 3D guided sinus surgery n Intraoperative CT scans n Open type MRI n MRI breast coil n Pet scan for clinical use n Laser angioplasty n Brachytherapy n Laser prostatectomy

25 Copyright (c) The Fraser Institute 2004 Comparing non-teaching hospitals of comparable size in Canada and the U.S.

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29 Copyright (c) The Fraser Institute 2004 Why we did this study 1.Lengthening wait lists for health access 2.Widening gaps between actual and clinically reasonable waiting times for procedures 3.Declining relative access to advanced technology 4.Long waits for treatment and diagnostic machines n Our research over the past decade has been showing:

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33 Copyright (c) The Fraser Institute 2004 Source: Dr. William McKillop Chief of Oncology Ontario Regional Cancer Centre Kingston, Ont. 1996

34 Copyright (c) The Fraser Institute 2004 Why we did this study 1.Lengthening wait lists for health access 2.Widening gaps between actual and clinically reasonable waiting times for procedures 3.Declining relative access to advanced technology 4.Comparative shortages of treatment and diagnostic machines 5.Disconnection between health spending and access across the provinces n Our research over the past decade has been showing:

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36 Copyright (c) The Fraser Institute 2004 Monopoly hospitals pay too much for their labour

37 Copyright (c) The Fraser Institute 2004 Monopoly hospitals pay too much for their labour

38 Copyright (c) The Fraser Institute 2004 So, That’s why we did the study How Good Is Canadian Health Care? n How much does Canada spend? n How does our access to doctors and technology compare with other equal access OECD countries? n Does the Canadian health care system produce better outcomes than others equal access countries in the OECD? n How does Canadian health policy compare with that in other equal access, publicly funded health care systems? n This comparative study does not include the U.S. since it is not a universal access system

39 Copyright (c) The Fraser Institute 2004 How Much Do We Pay for Health Care Compared to Other Countries? n Spending as a share of GDP in 1999

40 Copyright (c) The Fraser Institute 2004 Age Matters for Health Care Costs n Seniors (over 65) accounted for 12.5% of the population in n Consumed 42.7 percent of total health expenditures that year n Canada has the 7 th lowest proportion of population over age-65

41 Copyright (c) The Fraser Institute 2004 Age-adjusted Health Spending in the OECD 2001 Source: OEC

42 Copyright (c) The Fraser Institute 2004 Do We Get Our Money’s Worth (in an age adjusted way) ? n Doctors? n High-tech machines? n Access to care? n Is our health care system performing better than the rest?

43 Copyright (c) The Fraser Institute 2004 Doctors in the OECD Source: OECD (2003) 16th

44 Copyright (c) The Fraser Institute 2004 MRI Machines in the OECD Source: OECD (2003) 15th

45 Copyright (c) The Fraser Institute 2004 CT Scanners in the OECD 17th Japan: 73.7 Korea: 44.8 Source: OECD (2003)

46 Copyright (c) The Fraser Institute 2004 Radiation Therapy Machines in the OECD Source: OECD (2003) 8th

47 Copyright (c) The Fraser Institute 2004 Lithotripters in the OECD Source: OECD (2003) Korea: th

48 Copyright (c) The Fraser Institute 2004 Comparisons of Age Adjusted Access n 16 th of 23 countries for access to physicians n 15 th of 24 countries for access to MRI machines n 17 th of 23 countries for access to CT scanners n 8 th of 22 countries for access to radiation therapy machines n Last (tie) of 15 countries for access to Lithotripters Source: OECD (2003)

49 Copyright (c) The Fraser Institute 2004 Does it really matter that we don’t have access to doctors or machines? n How do the health outcomes in Canada compare to those in other countries?

50 Copyright (c) The Fraser Institute 2004 Disability Free Life Expectancy in the OECD Source: OECD (2003); WHO (2000) 14th

51 Copyright (c) The Fraser Institute 2004 Infant Mortality in the OECD Source: OECD (2003) 16th Poland, Hungary, and Turkey not shown

52 Copyright (c) The Fraser Institute 2004 Perinatal Mortality in the OECD Source: OECD (2003) 12th

53 Copyright (c) The Fraser Institute 2004 Mortality in the OECD Source: OECD (2003) 9th

54 Copyright (c) The Fraser Institute 2004 Potential Years of Life Lost in the OECD Source: OECD (2003) 9th Czech Republic, Portugal, Poland, Slovak Republic, and Hungary not shown

55 Copyright (c) The Fraser Institute 2004 Mortality Amenable to Health Care in Select OECD Countries Source: Nolte and McKee (2003) 8th

56 Copyright (c) The Fraser Institute 2004 Breast Cancer Mortality in the OECD Source: Ferlay et al. (2001) 6th

57 Copyright (c) The Fraser Institute 2004 Colon/Rectum Cancer Mortality in the OECD Source: Ferlay et al. (2001) 1st!

58 Copyright (c) The Fraser Institute 2004 How do Canadian Health Outcomes Compare to other Equal Access Countries? n Disability Adjusted Life Expectancy, 14th n Infant and Perinatal Mortality, 16th and 12th n Mortality from all causes not external or ill defined, 9th 1. Preventable Years of Life Lost 9th 2. Mortality Amenable to Health Care 8th 3. Surviving Breast Cancer 6th 4. Surviving Colon/Rectum Cancer 1st

59 Copyright (c) The Fraser Institute 2004 Why Are We first in the Spending Column but not in the Access or Health Care Outcomes Columns? n There are three reasons n Policy n POLICY n POLICY!

60 Copyright (c) The Fraser Institute 2004 What do Sweden, France and Australia have that Canada does not? 1. Lower cost health care 2. User fees at the point of access to healthcare 3. Parallel private medical insurance 4. Parallel private hospitals 5. Parallel private for-profit health care delivery

61 Copyright (c) The Fraser Institute 2004 How Does Canada Compare in Health Care Policies that Affect Health Care System Performance?

62 Copyright (c) The Fraser Institute 2004 Cost Sharing – User Fees, Deductibles and Co-payments - in the OECD

63 Copyright (c) The Fraser Institute 2004 Providers of Public Health Care in the OECD.

64 Copyright (c) The Fraser Institute 2004 But, don’t forget n Every single one of the OECD countries, except Canada and the Czech Republic have a PRIVATE ALTERNATIVE so you don’t have to wait if you don’t want to.

65 Copyright (c) The Fraser Institute 2004 Private Parallel Health Care in the OECD

66 Copyright (c) The Fraser Institute 2004 Is Canada Unique? n Only two of the 27 countries surveyed have no comprehensive private provision of care: Canada and the Czech Republic. n Canada is the only country to have full public management of hospital resources and no private parallel insurance system. n Canada is the only country to effectively outlaw private parallel health care.

67 Copyright (c) The Fraser Institute 2004 n Rank middle of the road in health care outcomes n Rank at the bottom in access to care, supply of technologies, supply of physicians n Rank at the very top in spending So… How Good Is Canadian Health Care?

68 Copyright (c) The Fraser Institute 2004 Lessons Learned… n The models that produce superior results and cost less than Canada’s have: n User fees n Alternative, comprehensive, private insurance n Private for-profit hospitals

69 Copyright (c) The Fraser Institute 2004 The lesson from Canada for Bahamian Health Care Reformers n Canada is only one of many Universal Access Health Care models in the OECD n Canada has been able to provide reasonably comprehensive insurance – though some remain uncovered n Canada has not solved the health care access problem in general or for low income people n Some combination of public and private provision system as in Sweden, France or Australia is likely to be the best option for the Bahamas

70 Copyright (c) The Fraser Institute 2004 Health and Economic Freedom n Economic Freedom of the World Project n Economic Freedom Network n The Nassau Institute

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75 Copyright (c) The Fraser Institute 2004 Available at

76 Copyright (c) The Fraser Institute 2004 The End……phew!