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Bowman, M.L. SFU, 2009
SOME HEALTH STATISTICS
Health spending and Health Outcomes in Six developed countries
See Notes at end
Australia / Canada / France / Germany / UK / USAOECD 2006-7
Data for 2004
A. Health spending
1. Expenditures as % GDP / 9.2 / 9.9 / 10.5 / 10.9 / 8.3 / 15.3
2. Public expenditures as % of total expenditures / 67.5 / 69.8 / 78.4 / 78.2 / 85.5 / 44.7
3. Health expenditures per cap US $ / 2,876 / 3165 / 3159 / 3005 / 2546 / 6102
4. Acute care beds per 1000 / 3.6 / 3 / 3.8 / 6.4 / 3.6 / 2.8
5. Doctors per 1000 / 2.6 / 2.1 / 3.4 / 3.4 / 2.3 / 2.4
6. MRI units per million / 3.7 / 4.9 / 3.2 / 6.6 / 5 / n/a
B. Health Outcomes
1. Life expecty at birth / 80.6 / 79.9 / 80.3 / 78.6 / 78.5 / 77.5
2. Infant mortaliy/1000 live births / 4.7 / 5.3 / 3.9 / 4.1 / 5.1 / 6.9
3. Tobacco use % smoking daily / 17.7 / 15 / 23 / 24.3 / 25 / 17
4. Alcohol use litres per cap age 15+ / 9.8 / 7.9 / 14 / 10.1 / 11.5 / 8.4
WHO 2007 report, data to 2005
1. Healthy life expectancy at birth, males / 71 / 70 / 69 / 70 / 69 / 67
2. Adult (15-60) mortality rate, males / 84 / 90 / 128 / 110 / 101 / 137
3. Probability of dying by age 5 / 6 / 6 / 5 / 5 / 6 / 8
4. Maternal mortality p 100,000 live births / 6 / 6 / 17 / 9 / 11 / 14
5. Age-standrdizd mortality - cardiovascular per 100,000 / 140 / 141 / 118 / 211 / 182 / 188
6. Age-stndrzed mortality-cancer, per 100,000 / 127 / 138 / 142 / 141 / 143 / 134
7. 1-yr olds Immunized for DTP3 as % / 92 / 94 / 98 / 90 / 91 / 96
8. Adult females obesity % / 22 / 13.9 / n/a / 12.3 / n/a / 33.2
Notes
I chose the comparison countries for specific reasons. All are industrialized modern
democracies with varying health care systems.
1. Australia. It is similar to Canada in that it has a vast land-base, a small population
that includes aboriginals, and a highly heterogeneous heavily-immigrant
population. It differs from Canada in having a more forgiving climate compared to
Canada’s vast cold north, which affects access to health care.
2. United Kingdom, France and Germany because Canada’s health care system is
often compared with theirs.
They differ in being much smaller geographically (allowing quicker access to
health services for rural people), in having higher and denser populations, and in
having much more culturally homogeneous populations, although this is changing.
They are similar in that they have prominent public funding in universal
health care.
3. United States because they are close and there is increasing public discussion of
health care there both in recent presidential candidate debates, and arising from the
new movie “Sicko”, inviting comparisons with our system.
Additional Canada- USA comparisons: from a paper I wrote in 2002
Data in that article concerned mostly 1996, the last year for which fully comparable data sets were available for these two countries on most variables of interest. The topic was
confined to Canada – US comparisons for the purposes of that paper. Here are a few sections from the paper:
“ The two countries have health services that include high levels of technology.
There are, however, significant differences in health, in access to treatment, and in
satisfaction with health services. Across virtually all the major indicators of health,
Canadians are considerably better off; as well, mortality is not correlated with
income inequalities as it is in the U.S. ( Wolfson, 1999 ).
Canadians have better physical and mental health than Americans ( Kessler et al.,
1997 ; Starfield, 1991 ); poor Canadians have better health than poor Americans (
Ross et al., 2000 ). In a 1997 international comparison by The Economist Intelligence
Unit , Canada ranked 4th in general health among 27 developed countries, compared
to 13th for the U.S. Canada has lower death rates, maternal mortality rates (
Euromonitor International, 1997 ; Health Canada, 1999 ; Turner, 1998 ), longer life
expectancy ( World Bank, 1999 ), a greater proportion surviving to age 60 ( United
Nations, 1998 ), broader child immunization for polio and measles ( Euromonitor
International, 1997 ; Federal Interagency Forum on Child and Family Statistics, 1999
), more years free of disability, and half the obesity rate (OECD data cited in
Gilmore, 1999). Even in its poorest neighbourhoods, Canada has better infant
mortality rates ( Wilkins & Houle, 1999 ).
In terms of disease, Canadians have 1/39 as many AIDS cases (at a rate that is 75%
less than that in the U.S.), lower incidence and better five-year survival rates for
cancer ( Gorey et al., 1997 ), and lower mortality rates for heart disease ( Jee & Or,
1999 ). Cancer survival rates are correlated with income in the U.S. but not in
Canada ( Gorey et al., 1997 ). Canada has less use of illicit drugs ( Single,
MacLennan, & MacNeil, 1994 ) and a lower prevalence of psychiatric disorders (
Kessler et al., 1997 ).
The better health of Canadians relates to a significant national difference: The use of
taxes for universal health care, which has been in effect since 1970. Health care is
rationed by medical judgments and system funding. Poor Canadians increased their
use of health services after universality ( McDonald, McDonald, Salter, & Enterline,
1974 ) and now use physician services more than rich Canadians ( Johansen &
Millar, 1999 ). In the U.S., health care is a commodity rationed by individual income.
More than 16% of the 1997 population (about 43.3 million; 40% of poor families)
have no health insurance ( Angell, 1999 ).
The costs of the two health care systems also differ significantly. Canadian costs are
relatively stable at about 9% of GDP . U.S. costs are about 50% higher and represent
more than 14% of GDP . Health care costs have risen faster in the U.S. over 30 years (
Passell, 1993 ). The editor of the most prestigious American medical journal
concluded, “The American health care system is at once the most expensive and the
most inadequate system in the developed world…” ( Angell, 1999 , p. 48).
In the past, Canadians have reported more satisfaction with their health care.
Compared to 10 developed countries, Canada had an index score of 7.6 (where the
Netherlands was highest/best at 9.0), and the U.S. index was 0.2 ( Starfield, 1991 ).”
Tables from that paper re 1996-98 data
Health indicators in Canada and the United States, 1996-98
Canada United States
Birth rates per 1000 population / 12 / 14 1Death rates per 1000 / 6.8 / 9
Infant mortality rates per 1000 live births / 5.6 2 / 9.2 3
Maternal mortality rates/ 100,000 live births / <5 / >10 4
Life expectancy at birth: women / 82 / 77
: Men / 76 / 74 5
Percentage expected to reach age 60 / 91% / 87% 6
Disability-free years expected at birth / 60.7 / 58.8
Children with polio immunization, % / 85 / 72 3
Measles immunization by age 7, % / 98 7 / 91 8
Obesity rates as a percentage / 12 / 23 9
Disease Indicators in Canada and the United States / Canada / U S
Cancer incidence rates, age-standardized
per 100,000 / 322 / 507 10
Mortality rates for heart disease /100,000 / 160 / 200 11
Cumulative number of AIDS cases to
December 1997 / 16,235 / 641,986
AIDS rate per 100,000 / 60 / 239
Illicit drug use in past year: cocaine / 0.3% 12 / 2.5% 13
1 (U.S. Census Bureau, 1998)
2 (Health Canada, 1999a)
3 (Euromonitor International, 1997)
4 (Turner, 1998)
5 (World Bank, 1999)
6 (United Nations, 1998)
7 (Health Canada, 1999b)
8 (Federal Interagency Forum on Child and Family Statistics, 1999)
9 OECD data cited in (Gilmore, 1999)
10 (Gorey et al., 1997); his data also show cancer survival rates are poorer in the U.S.
11 (Jee & Or, 1999) despite higher U.S.. rates for aggressive high-technology interventions (e.g., for
angioplasty at 53 per million in Canada vs. 128 in the U.S).
12 (Single, MacLennan, & MacNeil, 1994)
13 (National Survey on Drug Abuse, 1998)
Comments
Many of the important differences between health status outcomes comparing Canada with the US arise from the role of health insurance companies in the US as the gatekeepers for much of actual health services. This has several aspects:
1. The problem of getting insurance.
Most Canadians do not understand that in the US, each insurer has the right
to refuse to take a new individual client into its system, and they actively exercise
this right against individuals who have an elevated risk of needing medical services,
for example, if they have some previous condition or are too old.
e.g., Two examples known to me. A healthy 25-year old American man, a recent PhD in physics from McGill, who wanted to move back to Washington DC where his
parents lived and start looking for a job, could not because no insurance company
would take him on because he had “tennis elbow. Another case involved an 88 year-old
woman whose adult son, a senior professor in Washington wanted to move his
mother from Boston to live with him. He was unable to find any insurance company
to take her on; she had the bad luck to be very old and thus likely to cost some
money soon.
2. The problem of getting the insurance companies to pay for necessary services.
The problem is that payouts for health care put these insurance companies in
a direct conflict of interest, with the interests of their putative patients directly
contrary to the interests of their shareholders.
3. The problems of the working poor in getting health care.
The latest figures are 44-47 million in the US with no health insurance because
they are not poor enough to qualify for Medicaid; they may be employed or
temporarily unemployed..
The professional classes in USA typically have virtually automatic coverage
with their employers and don't really understand what goes on in the lives of less
elevated folk with erratic or small employers who cannot afford insurance coverage
for their staff. The upshot is that these working poor do get access to Emergency
care at hospital Emergency clinics, briefly, during a crisis, but cannot get ongoing
care for ongoing diseases and disorders, like cancer treatments, heart disorders etc.
They just die early, as shown in the very high adult mortality rates.
This large pool of individuals totally outside any health care system in the US
is probably the main explanation for the especially poor US statistics on infant
mortality and maternal mortality, which only began to improve in this new century.
The data to 1996 were especially shocking. Those poor mothers simply get no
prenatal care, so if the pregnancy is high-risk, no-one even knows about it until a
crisis erupts during the delivery. In Canada there is a complex system that identifies
high-risk pregnancies all across the far North and other remote rural areas, and flies
these mothers to big cities in the south prior to childbirth; this ensures that even the
most backwoods mothers get skilled care if they need it.
References
Angell, M. (1999). The American health care system revised — a new series.
New England Journal of Medicine, 340 (1), 48 (1987-11579-001)
Euromonitor International. (1997). International marketing data and statistics
1997 (21 ed.). Chicago IL: Author.
Federal Interagency Forum on Child and Family Statistics. (1999). America's
Children: Key National Indicators of Well-Being. Washington DC: U.S. Government
Printing Office.
Gilmore, J. (1999). Body mass index and health. Health Reports, 11(1), 31-43.
Gorey, K. M., Holowary, E. J., Fehringer, G., Laukkanen, E., Moskowitz, A.,
Webster, D. J., et al. (1997). An international comparison of cancer survival: Toronto,
Ontario, and Detroit, Michigan, metropolitan areas. Am J Public Health, 87(7), 1156-
1163.
Health Canada. (1999a). Measuring Up: Infant Mortality (June 16 No.
gc.ca/hpb/lcdc/brch/measuring/mu_c_e.html): Laboratory Centre for Disease
Control, Health Protection Branch, Ottawa.
Health Canada. (1999b). Update on the elimination of measles in Canada,
1998. CCDR, 25(5).
Jee, M., & Or, Z. (1999). Health outcomes in OECD countries. VII(3).
National Survey on Drug Abuse, -. (1998). Prevalence of substance use among racial and
ethnic subgroups in the United States: SAMHSA, Office of Applied Studies,
Washington DC.
Johansen, H. & Millar, W.J. (1999). Health care services: recent trends. Health
Reports, 11 (3), 91-109.
Kessler, R.C., Frank, R.G., Edlund, M., Katz, S.J., Lin, E. & Leaf, P. (1997).
Differences in the use of psychiatric outpatient services between the United States
and Ontario. New England Journal of Medicine, 336, 551-557. (1997-03441-001).
McDonald, A.D., McDonald, J.C., Salter, V. & Enterline, P.E. (1974). Effects of
Quebec medicare on physician consultation for selected symptoms. New England
Journal of Medicine, 291 (13), 649-652.
Passell, P. (1993, May 16). Health care's fever: Not so high to some. New York
Times, E3
Single, E., MacLennan, A., & MacNeil, P. (1994). Horizons 1994: Alcohol and
other drug use in Canada: Health Canada: Health Promotion Directorate, Ottawa.
Starfield, B. (1991). Primary care and health: A cross-national comparison.
Journal of the American Medical Association, 266, 2268-2271.
Turner, L. (1998). Report on maternal mortality in Canada (No.
gc.ca/hpb/lcdc/brch/reprod/matmorte.html): Health Canada, Health Protection
Branch, Laboratory Centre for Disease Control, Ottawa.
U.S. Census Bureau. (1998). International Data Base: Canada and US
Demographic Indicators: 1998 and 2010 (No. IDB Summary Data): Bureau of the
Census, Washington.
United Nations. (1998). Human development report (Vol. 9). New York: Oxford
University Press.
Wilkins, R. & Houle, C. (1999). Health status of children. Health Reports, 11
(3), 25-34.
World Bank. (1999). World development report for 1998/99. New York: Oxford
University Press.
Wolfson, M. (1999). Income inequality and mortality among working-age
people in Canada and the US. Health Reports, 11 (3), 77-82.