Access to Health Care: A Basic Human Right or Privilege?
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1 Access to Health Care: A Basic Human Right or Privilege? Ervin B. Podgorsak McGill University Montreal, Canada McGill
2 Health Care Financing Models Public (national health service): Financed through government budget (single-payer national system). Private: Financed through private insurance programs. Mixture Public / Private: Financed partially through government budget + private insurance programs (two-tier medicine).
3 Health Care characteristics The most important characteristics of a health care system are: Quality - Cost - Access
4 Health Care in North America 2010 Health care systems in the United States and Canada are in serious trouble, albeit for different reasons.
5 Health Care in the U.S. and Canada The most important characteristics of a health care system are: Quality - Quality of health care is high in both countries.
6 Health Care in the U.S. and Canada The most important characteristics of a health care system are: Quality - Cost - Cost of health care is high in both countries: 16 % of GNP in the U.S. ($7300 per capita) 10 % of GNP in Canada ($3900 per capita)
7 Health Care in the U.S. and Canada The most important characteristics of a health care system are: Quality - Cost - Access Access to health care is problematic in both countries: In the U.S. 50 million people are without health insurance. In Canada access to high technology equipment and to elective surgery is problematic.
8 Health Care in North America 2010 United States and Canada Quality: Cost: Access: Financing: High in both countries Perceived high in both countries Problematic in both countries Different in the two countries
9 Health Care in the U.S. and Canada 2010 Main issue in the United States: How to use government intervention to make the existing health care system universally accessible and more cost-effective.
10 Health Care in the U.S. and Canada 2010 Main issue in Canada: How to ensure universal and timely access to the existing, ever more costly, public health care system.
11 It is no longer acceptable morally, ethically, or economically for so many of our people to be uninsured or seriously under-insured.
12 It is no longer acceptable morally, ethically, or economically for so many of our people to be uninsured or seriously under-insured. Editor-in-Chief: JAMA years later the situation in the U.S. is even worse.
13 United States and Canada Similar economic and social systems. Similar political institutions. Each other s best trading partner. Canada largest supplier of oil to the U.S. Share the world s longest undefended border.
14 United States and Canada Differences between the two countries: World view Americans see themselves as part of the United States. Canadians see themselves as part of the world. Foreign policy Americans see themselves as peace makers. Canadians see themselves as peace keepers. Gun control Organization and financing of health care.
15 Health Care Cost (2010) % GNP % Public Cost per capita Canada U.S
16 North America Canada Pop.: 34 million 2 Area: 9.99 (9.10) million km Federal parliamentary monarchy Federation of 10 provinces and 3 territories USA Pop.: 318 million Area: 9.63 (9.16) million km Federal presidential republic Federation of 50 states 2
17 North America Tenets of the constitution Canada Peace Order Good government USA Life Liberty Pursuit of happiness
18 Wolfe Lake, Ontario (Photo by Michael Kooiman)
19 Comparison Groups United Nations (UN): 192 member states Human Development Index (HDI): ranking of 177 countries Organization for Economic Cooperation and Development (OECD): (34 countries: Premium statistical agency on a wide range of subjects) Australia - Austria - Belgium - Canada - Chile - Czech Republic - Denmark - Estonia - Finland - France - Germany - Greece - Hungary - Iceland - Ireland - Israel - Italy - Japan - Korea - Luxembourg - Mexico - Netherlands - New Zealand - Norway - Poland - Portugal - Slovakia - Slovenia - Spain - Sweden - Switzerland - Turkey - United Kingdom - United States Group of 20: Finance ministers and Central Bank governors of 19 countries and the E.U. : 85 % of global GNP; 80 % of world trade; 67 % of world population Group of 8 countries (G8): representing 65 % of world economy Canada - France - Germany - Italy - Japan - Russia - UK - United States Group of 1
20 Human Development Index (HDI) Serves as an alternative measure of social development, supplementing GNP Accounts for three distinct parameters: - Longevity and health care - Adult literacy rate and education - GNP per capita (real and PPP adjusted) PPP = Purchasing Power Parity UNDP = United Nations Development Programme
21 Human Development Index (HDI) Indicators - Life expectancy at birth (health care) - Education: Literacy of adults (2/3 weight) Attendance at 3 levels of schooling (1/3 weight) - Standard of living (Income) Goals - Life expectancy: 85 years - Education accessible for all - Reasonable income for all
22 HDI: Ranking of countries Canada 1 USA
23 HDI: Ranking of countries Canada USA Top ranking: Canada 8x (last time in 2000) Norway 7x; Japan 3x; Iceland 2x
24 Human Development Index (HDI) 2009 ranking of 179 countries Very high HD: 1 to 42 High HD: 43 to 85 Medium HD: 86 to 127 Low HD: 128 to United Arab Emirates. 47. Kuwait. 53. Libya. 55. Saudi Arabia. 70. Iran. 81. Tunisia. 82. Jordan. 84. Algeria Egypt Morocco
25 Health Care in Canada (2010) Main principles: Public administration. Universal access to hospital care and physicians services without any cost-sharing requirements.
26 Health Care in Canada (2010) is financed publicly (70 %) and privately (30 %) has three primary players: Provincial governments Federal government (Canada Health Act) Private physicians has a single payer: Provincial government The single payer public component is shared between provinces (75 %) and the federal government (25 %). Services insured publicly (hospital stay, physician services) cannot be insured privately.
27 Health Care in Canada 2010 Assertions and myths about the Canadian publicly run, single payer health care system.
28 Health Care in Canada 2010: Assertion 1 Expenditures for health care in Canada are rising at an unsustainable rate. Expenditures tripled in the decade from 1975 to Expenditures more than doubled from 1985 to Expenditures increased 10-fold from 1975 to 2005.
29 HCCI Health Care Cost Index tripled doubled increased 10 fold
30 HCCI Health Care Cost Index CPI Consumer Price Index PI Population Index
31 HCCI Health Care Cost Index CPI Consumer Price Index AHCCI Adjusted Health Care Cost Index PI Population Index
32 Assertion 1: Facts Most of the increase in health care cost can be explained by inflation and population growth. Per capita expenditures for health care in constant dollars increased by about a factor of 2 in the past 35 years.
33 Health Care in Canada 2010: Assertion 2 Public administration is the major cause for the increased health care spending. Governments will be unable to raise the required revenues in the near future. Taxes in Canada are already too high and are adversely affecting the economy.
34 Assertion 2: Facts Canada has tax rates similar to those in other developed countries, except for the U.S.
35 Assertion 2: Facts Since 1975, Canada s expenditures for health care as a percentage of the GNP have been reasonably stable in comparison with other sectors of the economy, such as Transportation Communications Recreation Entertainment Financial services that have all undergone a major growth.
36 Assertion 2: Facts If government programs are bad what about: Fire and Police Protection Road works Sewers Educational services Post office These are all government programs with significant success and public support.
37 Health Care in Canada 2010: Assertion 3 Private sector is always more efficient than the public sector as a result of: Better management Market forces controlling costs Higher labor productivity
38 Assertion 3: Facts Canada spends about 12 % of its total health care costs for administration. U.S. spends: About 25 % of its health care costs on administration of its private medicine. About 5 % on administration of its public system (Medicare and Medicaid).
39 Health Care in Canada 2010: Assertion 4 Health care in the U.S. is superior to that in Canada. FACTS Standards of care: Health indicators: Cost: Access: Similar in both countries. Canada outperforms the U.S. Canada outperforms the U.S. Problems in both countries.
40 Health Care Indicators Accessibility Per capita spending on health care Percentage of GNP spent for health care Life expectancy Infant mortality rate Maternal mortality rate Waiting lists for diagnostic and therapeutic procedures Access to high technology equipment
41 Infant Mortality Ranking 1 Singapore
42 Infant Mortality Ranking 1 Singapore 2 Sweden 3 Hong Kong 4 Japan 5 Iceland 6 Finland 7 Norway 8 Malta 9 Czech Republic 10 Andorra
43 Infant Mortality Ranking 1 Singapore 2 Sweden 3 Hong Kong 4 Japan 5 Iceland 6 Finland 7 Norway 8 Malta 9 Czech Republic 10 Andorra 11 Germany 12 France 13 Switzerland 14 Macau 15 Spain 16 Slovenia 17 Denmark 18 Austria 19 Belgium 20 Australia
44 Infant Mortality Ranking 1 Singapore 2 Sweden 3 Hong Kong 4 Japan 5 Iceland 6 Finland 7 Norway 8 Malta 9 Czech Republic 10 Andorra 11 Germany 12 France 13 Switzerland 14 Macau 15 Spain 16 Slovenia 17 Denmark 18 Austria 19 Belgium 20 Australia 21 Liechtenstein 22 Guernsey 23 Canada 24 Luxembourg 25 Netherlands 26 Portugal 27 Gibraltar 28 United Kingdom 29 Jersey 30 Ireland 31 Monaco 32 Greece 33 San Marino 34 New Zealand 35 Aruba 36 Isle of Man 37 Italy 38 Faeroe Island 39 Cuba 40 Taiwan
45 Infant Mortality Ranking 1 Singapore 2 Sweden 3 Hong Kong 4 Japan 5 Iceland 6 Finland 7 Norway 8 Malta 9 Czech Republic 10 Andorra 11 Germany 12 France 13 Switzerland 14 Macau 15 Spain 16 Slovenia 17 Denmark 18 Austria 19 Belgium 20 Australia 21 Liechtenstein 22 Guernsey 23 Canada 24 Luxembourg 25 Netherlands 26 Portugal 27 Gibraltar 28 United Kingdom 29 Jersey 30 Ireland 31 Monaco 32 Greece 33 San Marino 34 New Zealand 35 Aruba 36 Isle of Man 37 Italy 38 Faeroe Island 39 Cuba 40 Taiwan 41 United States 42 Croatia 43 Lithuania 44.
46 Assertion 4: Facts HDI indicators U.S. Canada KSA OECD Life expectancy (years) Infant mortality (per 1000 live births) Maternal mortality (per live births) Median age (years)
47 WHO ranking of health care systems WHO ranking was last produced in 2000 ranking health care systems of 190 countries. The ranking is no longer produced because of complexity of the task. 1. France 36. Costa Rica 2. Italy 37. USA Slovenia 10. Japan 39. Cuba Germany 41. New Zealand 26. Saudi Arabia 42. Bahrain 27. United Arab Emirates Morocco 30. Canada 31. Finland ---
48 Health Care in Canada 2010: Assertion 5 Privatization is the only solution for the current impasse in the Canadian Health Care debate. Current buzzword in health care bureaucracy is PPP or P3 standing for Public-Private Partnership.
49 Public vs Private Component Proportions of total health expenditures Public (%) Private (%) Canada United States KSA OECD average SOURCE: OECD
50 Assertion 5: Facts Over the past 25 years the greatest increases in health care spending have occurred in areas covered by the private sector: Dental services Visual services Prescription drugs
51 Public-Private Partnerships (P3s) Promise to deal with design, construction, financing, maintenance, and capital renewal. Have been used successfully to build highways, bridges, prisons, public buildings, water treatment facilities, etc. Have had questionable success in building hospitals. Partnership? - The public pays, the private sector profits. Should be called P4: Public-Private Partnership for Profit.
52 Health Care in Canada 2010: Assertion 6 Canada devotes too much of its GNP and an ever-increasing portion of its GNP to health care. If this trend is left unchanged, economic ruin will result.
53 Health Care Cost (2010) % GNP % Public Cost per capita Canada U.S KSA OECD France: 11 % Switzerland: 10.8 % Germany: 10.4 % Luxembourg: 90% U.K.: 86% Sweden: 85% Iceland: 84% Norway: 84% Ireland: 80% Norway: 4800 Switzerland: 4400 Austria: 3800 France: 3600 Holland: 3500
54 HEALTH CARE COST as percentage of GNP
55 Health Care Service (2007) Physicians Nurses MRI per CT per per 1000 per 1000 million pop. million pop. Canada U.S OECD Greece: 4.9 Italy: 4.2 Belgium: 4.0 Holland: 3.6 Austria: 3.5 Norway: 3.5 Japan: 35.3 Iceland: 17.1 Austria: 15 Switzerland: 14.3 Finland: 14 Korea: 11 Korea: 1.6 Mexico: 1.6 Turkey: 1.4
56 Health Care Service (2007) Physicians Nurses MRI per CT per per 1000 per 1000 million pop. million pop. Canada OECD To attain OECD average Canada needs: physicians (current number: ) +162 MRI machines (current number: 162) +323 CT scanners (current number: 356)
57 Health Care Service (2007) Physicians Nurses MRI per CT per per 1000 per 1000 million pop. million pop. U.S OECD To attain OECD average the U.S. needs: physicians (current number: ) MRI machines (current number: 7800) CT scanners (current number: 9600)
58 Medical Schools in the U.S. and Canada Accredited by: Liaison Committee on Medical Education (LCME) United States : 125 Canada : 17 Medical Graduates per 1000 practicing Physicians Canada 25.8 U.S. 26.5
59 Canada / KSA Cooperation 3500 Saudi medical doctors have completed post-graduate studies in Canada. 800 Saudi medical doctors are currently studying in Canada Canadian medical doctors are currently working in KSA health care institutions. Student visa requirements for study in Canada have been simplified.
60 Health Care in the U.S.: Conclusions U.S. health care costs at 16 % of GNP are very high, yet 50 million residents have no insurance. 1 in 3 Americans is un-insured or under-insured. HMOs deny care to patients with expensive and pre-existing illnesses. U.S. health indicators are generally lower than those in other developed countries. Doctor - patient relationship is deteriorating. Malpractice insurance is significant problem.
61 Health Care in Canada: Conclusions Canada, at 10 % of GNP, devotes a lower portion of its GNP to health care than do several other OECD countries. There is nothing magic about the 10 % of GNP, Canada could afford to spend 11 % or 12 % of GNP to solve the problems with access to health services caused by: Shortages in health care personnel. Shortages in high technology equipment. For all health care indicators: Attaining the OECD average should be the norm. Exceeding the OECD average should be the goal.
62 Health Care : Conclusions Health care should not be treated like an ordinary market commodity. Access to health care is not a privilege; rather, it is a basic human right. Public administration is the best vehicle for ensuring equal and timely access to health care.
63 A healthy man has a thousand wishes, a sick man has only one. Slovenian proverb
64
41 T Korea, Rep. 52.3. 42 T Netherlands 51.4. 43 T Japan 51.1. 44 E Bulgaria 51.1. 45 T Argentina 50.8. 46 T Czech Republic 50.4. 47 T Greece 50.
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