The Truth About Canada (3 page)

In February 2007, the Canadian Health Coalition accused the Jean Charest government in Quebec of opening the door to two-tier health care and a major expansion of for-profit surgical clinics.
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Yet in 2006, only British Columbia was fined by Ottawa for violating the Canada Health Act, although private clinics now operate in six provinces. Quebec now has 16 private MRI clinics, but has not been fined over the past 20 years.

Those who advocate a two-tier medical system never can adequately answer the question as to what the impact will be on our universal healthcare system. Where will the doctors, nurses, and technicians that would be needed for private healthcare facilities come from?

A group of senior British doctors has urged their Canadian colleagues not to follow the United Kingdom down the road of privatization. For Dr. Danielle Martin, chair of Canadian Doctors for Medicare,

There is a compelling body of evidence against parallel private insurance in the Canadian context. There is also an inherent conflict of interest for physicians working in dual practice since these physicians could have an interest in promoting longer wait times in the public system to increase use of the more lucrative private system.

Why is the CMA proposing dual practice and private insurance when this would pull nurses, technicians and other needed resources out of the public system?
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Good question. Both the Kirby Senate Report and the Romanow Commission had come out in 2002 saying a two-tier medical system would have a detrimental effect on medicare.

Let’s look at some more numbers to compare costs. In December 2006, the Canadian Institute for Health Information (CIHI) said that per-capita healthcare spending in 2006 in current Canadian dollars was expected to be $4,548, for a total of $148-billion, or 10.3 percent of GDP, with a continuation of the approximate 70-percent-public and 30-percent-private ratio, or $104-billion to $44-billion in 2006.

In contrast to the “runaway” increases often proclaimed by some of the media and conservative healthcare critics, total health expenditures in Canada as a percentage of GDP were 10 percent in 1992, and 14 years later, in 2006, only 10.3 percent. In the United States, it’s now almost 16 percent and increasing, while per-capita healthcare spending is now headed for $7,000 (U.S.). For many years, the United States has spent far more on health as a percentage of GDP than any other country. At this writing, their spending is forecast to reach 20 percent by 2016, while Canada, in a list of the top 30 health spenders, is in eighth place. Some of the countries that traditionally spend more than Canada are Switzerland (11.3 percent), Germany (11.1 percent), Luxembourg, France, Greece, Iceland, and Norway.

Noted American economists Paul Krugman and Robin Wells, writing in the March 23, 2006, edition of
The New York Review of Books
, put the American situation this way:

We spend far more on health care than other advanced countries — almost twice as much per capita as France, almost two and a half times as much as Britain. Yet we do considerably worse even than the British on basic measures of health performance, such as life expectancy and infant mortality.

The United Nations reports that “on a per capita basis the United States spends twice the Organization for Economic Co-operation and Development average on health care … yet some countries that spend substantially less than the United States have healthier populations.” For example,

Malaysia — a country with an average income one quarter that of the United States — has achieved the same infant mortality rate as the United States.

Over 40 percent of the uninsured (in the U.S.) do not have a regular place to receive medical treatment when they are sick, and more than a third say that they or someone in their family went without needed medical care, including recommended treatment or prescription drugs in the last year because of cost.

The uninsured, once in hospital, receive fewer services and are more likely to die than are insured patients. Being born into an uninsured household increases the probability of death before age 1 by about 50 percent.
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In terms of public as opposed to private expenditure as a percentage of all spending on health, all the following OECD countries have a higher proportion of public expenditure than does Canada: Austria, Belgium, the Czech Republic, Denmark, Finland, France, Germany, Hungary, Iceland, Portugal, Luxembourg, New Zealand, Norway, Poland, the Slovak Republic, Sweden, and the United Kingdom.

As indicated above, about 30 percent of all health spending in Canada is private. In 2006, public-sector financing of health expenditures came to 70.3 percent of total spending, while private funding made up 29.7 percent. The highest percentage of private spending is, of course, in the United States, at a huge 56 percent.

Total per-capita health spending in the United States is almost two and a half times the OECD average. In Canada, it is one and a quarter times the OECD average.
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Iceland, Luxembourg, Norway, Switzerland
and the Unites States have higher per-capita total spending than Canada.

If you look at total public-health spending in the OECD and include long-term care expenditures, Iceland, Sweden, Denmark, France, and Germany had higher expenditures in 2005 as a percentage of GDP than did Canada, and 24 countries spent less. The Canadian Institute for Health Information estimates that our total health expenditure, in current dollars, was $131.4-billion in 2004, $139.8-billion in 2005, and $148-billion in 2006, and that total real growth after adjusting for inflation was around 3.7 percent in 2005 and 2006.

Between 1990 and 2002, Germany’s public healthcare spending was the highest in the OECD, at 8.6 percent of GDP. Canada, at 6.7 percent of GDP, was in eighth place in public healthcare spending, behind Germany, Iceland, France, Sweden, Denmark, Norway, and the Czech Republic.

During these years, in terms of private healthcare spending as a percentage of GDP, the United States, at 8.1 percent, was far ahead of all other OECD countries. But Canada was up in sixth place as one of the top private spenders, behind only the United States, Switzerland, Greece, New Zealand, and Mexico. Or, to put it another way, 21 countries have higher public healthcare funding as a percentage of GDP than Canada, and 23 have a lower share of private funding than Canada. While Canada is at about 30 percent, 16 of the OECD countries have less than 5 percent of their healthcare expenditures privately funded.

Looking at total health expenditures as a percentage of GDP, as indicated earlier the United States spends far more than any other OECD country, almost 16 percent. Switzerland in 2003 was next, at 11.5 percent, followed by Germany at 11.1 percent, Iceland at 10.5 percent, Canada and Norway at 10.3 percent, and France at 10.1 percent. The OECD average in 2003 was 8.8 percent. Some of the countries below the OECD average were Italy, New Zealand, Japan, Spain, the United Kingdom, Austria, Finland, and Ireland. Korea, at only 5.6 percent, was at the bottom of the list.

Only the United States, Norway, Switzerland, Luxembourg, and Iceland have higher per-capita health spending than Canada, while 24
OECD countries have lower spending, including countries such as Japan and Korea, which nevertheless have so many impressive health indicators.

LIFE EXPECTANCY AT BIRTH

This is one of the most frequently quoted indicators when comparative health figures are measured. And it’s very revealing.

In 1851, the average life expectancy in Canada was only 42.9 years. By 1951, that had increased to 68.7 years, and by 2004 it was 80.2 years. In terms of life expectancy at birth for the period 2005 to 2010, Canada is expected to be in eighth place in the world, at 80.7 years. Japan is forecast to be tops, at 82.8 years, followed by Hong Kong at 82.2, Iceland at 81.4, Switzerland at 81.1, Australia at 81.0, and Sweden at 80.8. The United States is well down the list in 29th place, at 77.9 years. So the average Canadian can be expected to live 2.8 years longer than the average American.

In a list of 50 developed countries, the populations of 42 are expected to have shorter average life spans than that of Canadians, including such countries as Norway, Spain, France, New Zealand, Belgium, Finland, Germany, the Netherlands, the United Kingdom, Ireland, and Denmark.
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(In OECD countries, there is a “gender gap,” whereby women on average live almost six years longer than men.)

Average life expectancy in the least developed countries is only 52 years; in sub-Saharan Africa it is just over 46 years.

In Harlem, New York City, the life-expectancy rate is lower than it is in Bangladesh. Greece, with half of the U.S. per-capita GDP, has a longer life expectancy rate than the United States. While there are several hotly debated explanations for this, it’s interesting to note that so many of the countries with much longer lifespans than those of Americans spend a great deal less than the United States does on health care as a percentage of their GDP.

The Economic Policy Institute, based in Washington, D.C., points out that Ireland, Austria, and Finland spend about half as much as does the United States on health care as a percentage of GDP, yet cover 99 to
100 percent of their respective populations with health insurance. OECD figures indicate that life expectancy in the United States is lower than it is in 22 OECD countries. Moreover, in the United States, a steadily rising number of men, women, and children (currently 47 million) have no healthcare insurance and many millions more have totally inadequate insurance. In the words of
The Economist:

That so many people should be without medical coverage in the world’s richest country is a disgrace. It blights the lives of the uninsured, who suffer by being unable to get access to affordable treatment at an early stage. And it casts a shadow of fear well beyond, to America’s middle classes who worry about losing not just their jobs but also their healthcare benefits. It is also grossly inefficient.
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INFANT MORTALITY

Measurements of this key health indicator are based on the number of deaths of children under one year of age per 1,000 live births. In 1983, Canada’s infant mortality rate was 8.5 per 1,000 live births. By 1992, it was down to 6.1, and by 2003 it was 5.3. However, the Canadian record is still disgraceful. Only four of a UN list of 25 OECD countries have a worse record than Canada.
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Only one has a record worse than that of the United States (7.0 per 1,000 live births). Not on the list, the very worst numbers come from the poor countries such as Turkey, a terrible 29.0 per 1,000 live births, and Mexico at 20.1. That affluent countries such as the United States and Canada should have such high infant mortality rates is shameful.

The OECD comments on infant mortality are worth noting:

The fact that some countries with a high level of health expenditures, such as the United States, do not necessarily exhibit low levels of infant mortality has led to the conclusion that more health spending is not necessarily required to
obtain better results. A whole body of research suggests that many factors outside of the quality and efficiency of the health system, such as income inequality, the social environment, and the individual lifestyles and attitudes are all factors influencing infant mortality rates.

Around two-thirds of the deaths that occur during the first year of life are neonatal deaths (i.e., during the first four weeks).

The lowest infant mortality rates are in Iceland (2.4 per 1,000 live births), Japan (3.0), Finland (3.1), and Sweden (3.1). All the following have rates less than five per 1,000 live births: Norway, the Czech Republic, France, Portugal, Spain, Germany, Belgium, Italy, Switzerland, Denmark, Austria, Australia, Greece, the Netherlands, and Luxembourg.
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That Canada has a much higher GDP per capita than many of these countries and at the same time a much worse infant mortality rate should be of great concern. Several leading Canadian healthcare authorities attribute Canada’s poor showing to our relatively large aboriginal population compared to the aboriginal population in most other OECD nations.

While the gap has narrowed as overall aboriginal health has improved, infant mortality among aboriginal peoples in Canada is still about one and a half times the non-aboriginal rate, while the aboriginal birth rate continues to be much higher. Setting aside the high infant mortality rate among aboriginal peoples allows Canada’s record to compare favourably with the top OECD countries, but our treatment of our aboriginal people can only be described as disgraceful.

Projections for infant mortality rates in the period from 2005 to 2010 place Canada down in 19th place, at 4.8 deaths per 1,000 live births. The lowest projected rates include Singapore at 3.0, Iceland and Japan at 3.1, Sweden at 3.2, Norway at 3.3, South Korea at 3.6, Finland and Hong Kong at 3.7. Put another way, 18 OECD countries are expected to have a lower infant mortality rate than Canada.

Recent comparisons indicate that if the United States had an infant mortality rate as low as Cuba’s, an additional 2,200 American babies would
be saved every year. If the American rate was as good as Singapore’s, 18,900 babies a year would be saved.

Just over 0.5 percent of U.S. newborns die in their first month. Of all industrialized nations, only Latvia has a higher rate.

UNDER-FIVE MORTALITY AND LOW-BIRTH-WEIGHT INFANTS

In 2004, all the following countries had lower under-five mortality rates than Canada: Austria, Belgium, Cyprus, Denmark, France, Germany, Greece, Italy, Liechtenstein, Monaco, Portugal, Spain, Switzerland, the Czech Republic, Finland, Japan, Norway, San Marino, Slovenia, Sweden, Iceland, and Singapore.
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Which puts Canada way down in 23rd place.