How Does Canadian Health Care Compare Internationally? Eric Schneider, M.D., F.A.C.P. Senior Vice President for Policy and Research November 2015

Transcription

1 How Does Canadian Health Care Compare Internationally? Eric Schneider, M.D., F.A.C.P. Senior Vice President for Policy and Research November

2 Views of the Health Care System Works well, only minor changes Fundamental changes UK US AUS CAN % 20% 40% 60% 80% 100% Percent Source: 2014 Commonwealth Fund International Health Policy Survey of Older Adults, Age 65 and Older in Eleven Countries. 2

3 Outline What is it about our respective health systems that produces these distinct views? Health outcomes Spending The experience of care Hospital and ED capacity Clinician capacity 3

4 Mortality Amenable to Health Care (deaths per 100,000) CAN AUS US UK Source: Mirror, Mirror on the Wall 2014 update. 4

5 Health Care Spending as % of GDP *2012; Notes: GDP refers to gross domestic product. Source: OECD Health Data US (17.1%) CAN (10.7%) AUS (9.4%)* UK (8.8%) 5

6 Current Health Care Spending per capita, by Source of Financing, 2013 a, b 100% 80% 60% 40% 20% 0% CAN AUS* US UK Other Out of Pocket Public * a adjusted for differences in the cost of living B numbers may not sum to total health care spending per capita due to excluding capital formation of health care providers, and some uncategorized spending. Source: OECD Health Data,

7 The experience of care 7

8 Survey Profile of Sicker Adults, Age 65 and older CAN AUS US UK Has 2+ chronic conditions Health care use in past 2 years: Hospitalized Went to ER Taking 4+ prescription medications regularly Source: 2014 Commonwealth Fund International Health Policy Survey of Older Adults in Eleven Countries. 8

9 Percent 100 Waited 2 Hours or more in ER CAN AUS US UK Below-Average Income Base: those going to ER; Source: Mirror, Mirror on the Wall 2014 Update. 9

10 Number of Hospital Beds, Per 1,000 Population CAN* AUS* US UK Source: OECD Health Statistics, 2012 *Estimates 10

11 Could Get Same- or Next-Day Appointment with Doctor or Nurse When Sick or Needed Care Percent CAN AUS US UK Source: 2014 Commonwealth Fund International Health Policy Survey of Older Adults in Eleven Countries. 11

12 Waited 2 months for specialist appointment 50 Percent CAN AUS US UK Below-Average Income Base: needed to see specialist in past 2 years; Source: Mirror, Mirror on the Wall 2014 Update Above-Average Income 12

13 Had medical problem but did not visit doctor because of cost in the past year Percent CAN AUS US UK Below-Average Income Above-Average Income 1 3 Source: Mirror, Mirror on the Wall 2014 update. 13

14 Comparison of Specialists to Generalists, Per Capita, Per 1000 Population Specialist Medical Practitioners Generalist Medical Practitioners CAN AUS* US UK Source: OECD Health Data, 2012; *Does not include other generalist (non-specialist) medical practitioners 14

15 Practice Uses Nurse Case Managers or Navigators for Patients with Serious Chronic Conditions Percent CAN AUS US UK Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. 15

16 Financial Incentives to Enhance Services CAN AUS US UK % reporting they can receive financial incentives* for: Managing patients w/ chronic disease or complex needs Enhanced preventive care activities** Adding non-physician clinicians to practice Making home visits * Including special payments, higher fees, or reimbursements. ** Including patient counseling or group visits. Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. 16

17 Summary o Compared to three peer countries, Canada s health system is o in the middle on mortality amenable to health care, spending o Highest: percent who report waiting o Lowest: hospital beds and specialists per person o Should Canada increase physician capacity? Specialist capacity? o What is potential for nurses/other professionals to extend care capacity? 17

18 Acknowledgements CMWF IHP Survey Team Co-funded by: Australia: New South Wales Bureau of Health Information Canada: Canadian Institute for Health Information, Canadian Institutes of Health Research, Health Quality Ontario, Commissaire à la Santé et au Bien-être du Québec, and Health Quality Council of Alberta, Health Council of Canada, Canada Health Infoway United Kingdom: Health Foundation 20