Health Care: Understanding the Future, a Canadian Perspective by Carolyn Bennett, PC, MP, MD

A Canadian Perspective

Honourable Carolyn Bennett M.D., M.P.

April 14, 2010The Canadian Club of Chicago

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The U.S.A.

Life

Liberty

The pursuit of Happiness

Canada

Peace

Order

Good government

Moniqe Bégin

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Physicians per capita: 2.4/1000 pop.

Nurses: 10.6/1000 Acute care beds:

2.7/1000 MRIs: 19.5/1 million pop. Life expectancy at birth:

78.1 years Infant mortality rate:

6.7/1000 live births Obesity in adults: 34.3%

Physicians per capita: 2.2/1000 pop.

Nurses per capita: 9/1000 Acute care beds:

2.7/1000 MRIs: 6.7/1 million pop. Life expectancy at birth:

80.7 years Infant mortality rate:

5/1000 live births Obesity in adults: 15%

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1947: Saskatchewan’s The Saskatchewan Hospital Services Plan is passed in the Legislature – Hospital universal free coverage.

1957-58: Hospital Insurance and Diagnostic Services Act (HIDS), Provides a 50-50 cost sharing plan to the provinces for everything “hospital”.

1962: Saskatchewan pioneers again with The Saskatchewan Medical Care Insurance Plan Extension of universal, publicly funded insurance to physician services.

1967-68: Medical Care Act – federal legislation providing 50-50 of physician services costs to the provinces.

1976-77: The 50-50 cost-shared arrangements are replaced by a block fund byt theThe Established Programs Financing Act (EPF).

1984: To clarify conditions of federal contributions and keep health care free and universal, Parliament passes unanimously the Canada Health Act (CHA).

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The Canada Health Act (1984):14 pages

Universality: all Canadians and permanent residents are covered

Accessibility: "free" at point of use (added in 1984)

Comprehensiveness: all medically necessary hospital and doctor services

Portability: between the 10 provincial and 3 territorial systems

Public Administration: each province has a public government agency as its single- payer

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Sharing risk getting people the health care they need

when they need it

Keeping people well not just patching them up once they get sick

25% health attributable to health care system 15% biology and genetics 10% physical environment 50% social and economic environments

Patchwork quilt of non- systems

Focus on sickness…and the repair shops

More health …less health care

Service contract ?????? Or longer warranty ????

Versus

The Causes

“The worst thing for a physician is to help someone get well and send them straight back into the

situation that made them sick in the first place.”Sir Michael Marmot

Healthy Canadians Tree: Healthy Canadians Tree: 20052005

A) strong fence at the top of the cliff

B) state of the art fleet of ambulances and paramedics waiting at the bottom ?

A) Clean air

B) Enough puffers and respirators for all

A) a falls program to reduce preventable hip fractures

B) private orthopaedic hospitals and more surgeons

A) how much they spent on the sickness care system

B) the health of their citizens, leaving no-one behind

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U.S.A: Health care =

a market commodity

Medicare and Medicaid

CANADA: Health care =

a universal common good for all citizens of all ages, all conditions

All universities are public and heavily subsidized by both levels of government

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Total HealthExpenditure 2.4 Trillion $160 Billion

Per capita $7,290. $3,895.

% GDP 16.2 10.1

% publicly 45% 70% paid Srs, dis, poor, vets tax, no ext-billing

% privately 55% 30% paid employer/pers insur $ drugs,dent.vis.home

Uninsured/ 47+M universal coverage forUnderinsured 25M doctors and hospitals

U.S. Canada

1.  INSURANCE COMPANIES: 30% of your costs – almost a third – go to

insurance companies. Your patients and taxpayers have to

support massive organizations. These insurers set premiums, design

packages, assess risk, review claims and decide who to reimburse for how much.

But they don’t deliver health care.  

2.  ADMINISTRATION: 

Our single payer system is simpler, allowing us to run the administration of our offices and hospitals with much fewer staff – about 4%.

We don’t have to deal with multiple payers, or chase bad debts.

We don’t have to charge higher fees to compensate for unpaid for procedures  

3.  PHARMACEUTICAL PRICE CONTROLS: Although drug costs are rising in Canada as here, we’re able to exercise more control over the cost of drugs as a result of our Patented Medicine Prices Review Board.  

4.  MALPRACTICE INSURANCE: The not-for-profit Canadian Medical

Protective Association covers medical malpractice for all Canadian physicians with comparatively low premiums.

Doctors’ remuneration does not have to reflect those extra costs and our justice system has successfully kept the awards in a reasonable range.

5.  EVIDENCE-BASED CARE: From vaginal births after C-sections to,

lumpectomy, to x-rays for sprained ankles, applying evidence to determine the appropriateness of tests and procedures translates into fewer unnecessary tests and procedures and less defensive medicine.

We are committed to moving from the error of pure cost-containment approach of the early 90s into true evidence-based cost effective care.

6.  PREVENTION: Diseases are cheaper to treat if they’re

caught early, and since all Canadians are insured, they’re more likely to have pap smears, mammograms and other early detection visits and tests, than US patients who are not covered.

 7.  FAMILY MEDICINE: A long-standing speciality in Canada, family doctors are trained to help patients

navigate their care; we interpret the difference between what

patients think they `want`, and what they actually `need` .

A point of first contact, a trusted coach to explain the evidence and the choices.

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Wait times: the one big complaint. Now addressed with a national plan/special budget.

Adequate supply of physicians and nurses: at long last increasing since 2000.

Capital investment for CTs and MRIs: still lacking.

Pressure by a few lobby groups for more privatization: nothing new here, but relatively strong in Québec and B.C..

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From the federal government: 10 year plan (Wait Times Reduction Fund) $4.5 billion for the first 6 years Began in 2004-05 Regular monitoring and reporting

Provincial governments: special investments through centralized

registries and prioritization systems +++

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Knee replacement: 2 to 6-12 months Hip replacement: 2 to 18 months Cataract surgery: 2 months ± CT (routine) wait: 2 months ± MRI (routine) wait: 2 to 6 months Angioplasty: 12 to 14 days Bypass surgery: 3 w. to 2 months Chemotherapy: 1.4 to 3 weeks Cancer surgery: 5 to 10 weeks Radiation therapy: 1 to 4 weeksCanadian Institute for Health Information, 2008 (2007 Stats)

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R.O.M.P.Collingwood

April 24, 2008Dr. Carolyn Bennett M.P.

The Grey The Grey Tsunami ?Tsunami ?

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OECD study of 10 countries … US least satisfied with the care they receive Canadians 5X more likely to be satisfied with their care

The Nanos Research poll, 12 August 2009: …on the eve of the national convention of the Canadian Medical Association (CMA): shows an overwhelming 86% level of public support for

"public solutions" to improve Canada's national health care system.

The Harris-Decima poll, early June 2009: found 70% of Canadians say the system is working very

or fairly well.

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As a nation, we aspire to a Canada in which

every person is as healthy as they can be – physically, mentally, emotionally and spiritually.

“We are not tinkers, who patch and mend what is broken. We must be watchmen, guardians of the life and health of our generation, so that stronger and more able generations may come after.”

Dr. Elizabeth Blackwellfirst woman physician North

America

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Monique Bégin