International Comparisons

1. International Comparisons

6. 3500 • 3000 • 2500 • 2000 • 3048 • 1500 • Annual Deaths Per 100,000 • 2227 • Men Age 45-64 • 1000 • 1680 • 500 • 730 • 0 • Toronto • Homeless • Boston • Homeless • New York • Homeless • Non-Homeless • Toronto Homeless in TorontoDeath Rate Elevated, But Lower than In U.S. Source: JAMA 2000; 283:2152

11. U.K. • $1,450 • Japan • $1,780 • Sweden • $1,820 • France • $2,120 • Canada • $2,250 • Germany • $2,400 • U.S. • $2,740 • $1,530 • $0 • $1,000 • $2,000 • $3,000 • $4,000 • $5,000 • $ Per Capita • Total Spending • U.S. Public • U.S. Private U.S. Public Spending Per Capita for Healthis Greater than Total Spending in Other Nations Note: Public includes benefit costs for govt. employees & tax subsidy for private insuranceSource: NEJM 1999; 340:109; Health Aff 2000; 19(3):150

23. Canada’s National Health Insurance Program

30. Why are Canada’s system administrative costs lower? • No need to determine who is eligible for what • Canada’s overall administrative % close to Medicare (before Medicare + Choice), less than Medicaid • No marketing of insurance • No billing or collecting insurance premiums

31. Number of Insurance Products

32. Private insurers’ High Overhead

34. Why are hospital administrative costs less in Canada? • Global budgets • Operating budget • Capital investment budget • Negotiated with Province • No bills. • No need to track and bill for individual services and goods

36. Why are physicians’ administrative costs lower in Canada? • Single payer • One place to send bills • One set of rules

43. Quality of Care Slightly Better in Canada Than U.S. A Meta-Analysis of Patients Treated for Same Illnesses (U.S. Studies Included Mostly Insured Patients) Source: Guyatt et al, Open Medicine, April 19, 2007