Muffin, you are right, this country is ovespending on HC. I, for one, could survive without that ~$1000 MRI, and I am sure that I did not take this MRI from anyone else, STS: there are enogh MRI for anyone and I got it because the docs felt that it was needed medically, because it saved money (I avoided hospitalization for observation), and not because the doc(s) owned stock of GE, which made the machine. But I agree, the waste is tremendous. And “poor” people do not always get the “complete” HC. I do not think that privatization is THE solution. I asked for the positive impact, we all can criticize each other ad infinitum.
I went to http://www.who.org and got lost there. Statistics can be deceptive. For instance, survival of children under 5 could be better in Canada because children born at 6 mos of pregnancy are included in the totals in US and only full term infants are included in Canada, in the national statistics. Just a wild guess. There could be thousands other reasons. I am not sure that all premature babies should be saved at any price. Some prematurity is “nature intended”, and poor babies die after spending a month an a machine. I know this is a very controvercial point of view, but it’s definitely beyond this topic. I am not familiar with “overall level of health”. Could you elaborate?
The positives and negatives go hand in hand. Specifically, Canada in the process of deciding which way our health care system will go: universal or two tiered, government administration or private administration. We learn a lot from other countries’ experiences. Before deciding what path to go down, we need as much criticism of all systems as possible.
Overall level of health starts with the mortality rates and them adjusts them for quality of life. Thus a healthy person who lives the same number of years as a chronically ill person would have a higher overall level of health. This indicator is called the Disability Adjusted Life Expectancy (DALE). DALE summarizes the expected number of years to be lived in what might be termed the equivalent of “full health.” To calculate DALE, the years of ill-health are weighted according to severity and subtracted from the expected overall life expectancy to give the equivalent years of healthy life. The actual fromula is in the 2000 WHO World Health Report.
Years lost due to disability tend to be substantially higher in poorer countries rather than wealthier countries due to injury, blindness, paralysis and tropical diseases such as malaria. Note that the DALE factor becomes even more significant when disability strikes children and young adults, who will face more years of disability than if they were stricken in later life. People in the healthiest regions lose some 9 percent of their lives to disability, versus 14 percent in the worst-off countries.
In terms of DALE, the top 10 nations are Japan, 74.5 years; Australia, 73.2; France, 73.1; Sweden, 73.0; Spain, 72.8; Italy, 72.7; Greece, 72.5; Switzerland, 72.5; Monaco, 72.4; and Andorra, 72.3. Canada is 12th at 72.0 and the US is 24th at 70.0 years.
Here is a pretty scary quote from Christopher Murray, M.D., Ph.D., Director of WHO’s Global Programme on Evidence for Health Policy:
“Basically, you die earlier and spend more time disabled if you’re an American rather than a member of most other advanced countries.”
In light of this, I think Canada needs to look long and hard before adopting the US health care system. A major political party has been pushing for it, and needless to say the health insurance and HMO industry has been lobbying heavily for it, so I think it imortant that the facts get out before decisions are made which will affect the health of my country for generations. It’s not just American bashing – it is a matter of fundamental importance which Canada is presently deciding.
What I would very much like to see is some criticism by folks from some of the countries which are in the top 10 for overall health, and in partiucular from those first world nations who rank in the top 10 for overall health system performance (where Canada lies a dismal 30th and the US is 37th, whereas France is 1st in overall health system performance and 3rd in overall level of health ). So let’s hear it from the folks in France. What is it that you are doing right, and what is it that we in Canada and the US are doing wrong.
Thank you Muffin. Verrry interrresting, indeed. Assuming the statistics are collected based on the same WHO criteria.
One thing caught my eye, though: Spain and Greece. Both cuontries are closer to the bottom of Europrean prosperity scale, than the top. Unless their HC expenditures are disproportionately higher, they spend less per capite than other “healhy” nations. Yet, their folks are healthy. What is their secret? Or is somehow connected to their high per capita olive oil intake? Or something else? And their populations are healthier to begin with? Or am I missing something here?
Other points: I understand, that some statistics are used for “overall health system performance”. What is it? Some combined coefficient which incorporates life expectancy, per capita expenditures, number of physicians per 1,000 poeple, etc. I am not asking for exact formula, just how is it arrived to, more or less.
Statistics such as DALE and overall health care system efficiency are important, but they are not all-important. When I hear health care economists tell me that Canada should adopt the system that they have in Cuba (with their polyclinics), I get concerned – I did a medical elective in Cuba and I don’t believe this is what most Canadians would want. When I hear the government say that registered nurse practioners should provide a much bigger role, I don’t know what to think – most of the NPs I have worked with were excellent at what they did, but their job is quite specialized; it hardly stands to reason that it is easier to do a more generalized one. A family doctor working in a small Canadian town has to be many specialists, to some degree. I did an elective in India too, for that matter, and have considerable respect for the WHO. But health care economists and bureaucrats also must shoulder responsibility for providing disasterous advice to previous governments which did undermine our system; such as statistical projections for the number of doctors needed in Canada.
I wish I knew. It is a mystery to me as well.
Overall performance of health systems relates overall health system achievement to health system expenditure. Performance is the ratio between achieved levels of health and the levels of health that could be achieved by the most efficient health system, with the primary factors being a nation’s economy and education. Thus similar nations are weighed against each other.
The matter is discussed at Chapter 2 of the WHO report:
http://www.who.int/whr/2000/en/pdf/Chapter2.pdf
For a better overview of stats angle, refer to the Statistical Annex for Annex Table 10 of the WHO report at:
http://www.who.int/whr/2000/en/pdf/StatisticalAnnex.pdf
As you will see, to get into the meat of it, you are referred to GPE Discussion Papers 29 and 30. I don’t know where they are to be found on the net, or if they are on the net at all, but for an into to this sort of stuff, have a boo at:
http://whqlibdoc.who.int/hq/1999/a68870.pdf
Very, very true.
Thank you Muffin. I have to read the stuff.
There is good cardiological evidence that people who eat a “Mediterranean diet” high in olive oil and fish have substantially lower risk of heart attacks. This is the only diet really proven to work for most people. In theory, a low salt diet should reduce hypertension and a low fat diet should lower cholesterol… in fact, the benefits of salt reduction have probably been overstated for people with working kidneys, and 70% of people with high cholesterol make it endogenously independently of what they eat. Maybe this explains health in Turkey and Greece, I don’t know.
i humbly submit that there are perhaps 2 problems with our health care system.
- rich doctors who don’t feel quite rich enough and so demand more money from an already cash strapped system regardless of the cost of their demands on the people of Canada.
- snivelling politicians who use our once great health care system as a propaganda tool. refer to the endless rhetoric of our recent federal election to see how politicians played on Canadians fear of our collapsing health care system for the sole purpose of gathering votes.
Rich doctors? I saw my tuition triple during my recent trip through medical school. Like most of my classmates, I’m deeply in debt to banks since available student loans did not even cover the cost of our tuition. Some doctors make far too much money for what they do; family docotrs are not renumerated as lavishly as you think. The last time you saw a family doctor, he or she probably made $15 before overhead and taxes. How much do you think doctors make for a work week of 70-100 hours?
Here in Michigan we have a ton of Canadian doctors. They all come down here saying that the Canadian health care system paid them so poorly that they couldn’t even repay their student loans. I’d imagine that the other northern border states have similar situations.
a thousand apologies. perhaps i should qualify point 1 of my previous post. do i believe that doctors deserve to be paid well for the service they provide. of course they do. do i also believe that doctors in Canada need to realize that there is an upper limit to what they can expect from a system of universal health care. of course i do. if you dont feel that you’re making a fair living in return for your services, opt out. but while you’re signing up for the “brain drain” that our country is facing, don’t forget about your osap loans. we all chose careers based on the living it can provide.
Oh? Personally, I chose my career because of the delight it brings me.