International Comparisons

Homeless in TorontoDeath Rate Elevated, But Lower than In U.S.Source: JAMA 2000; 283:2152

U.S. Public Spending Per Capita for Healthis Greater than Total Spending in Other NationsNote: Public includes benefit costs for govt. employees & tax subsidy for private insurance Source: NEJM 1999; 340:109; Health Aff 2000; 19(3):150

Canadas National Health Insurance Program

Why are Canadas system administrative costs lower?No need to determine who is eligible for whatCanadas overall administrative % close to Medicare (before Medicare + Choice), less than MedicaidNo marketing of insuranceNo billing or collecting insurance premiums

Number of Insurance Products

Private insurers High Overhead

Why are hospital administrative costs less in Canada?Global budgetsOperating budgetCapital investment budgetNegotiated with ProvinceNo bills.No need to track and bill for individual services and goods

Why are physicians administrative costs lower in Canada?Single payerOne place to send billsOne set of rules

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

Source: Oxford Rev Econ Pol 1989;5(1):89Who Pays For Health Care?Regressivity Of U.S. Health Financing

Source: Premier's Common Future Of Health, Excludes Out-of-Pocket CostsWho Pays For Canada's NHP? Province Of Alberta

*Homeless in TorontoContrary to American stereotypes, Canada is an increasingly diverse society. Immigrants make up a larger fraction of the population in Canada than in the U.S. Moreover, Canada is not without social problems. Alcoholism is more prevalent than in the U.S., and Canadian cities have substantial numbers of homeless people. The homeless in Toronto have death rates more than twice Toronto's housed population. Yet universal access to health care appears to partially ameliorate the medical problems of Toronto's homeless, whose death rates are well below those of America's homeless.

*U.S. Public Spending Per Capital for Health is Greater than Total Spending in Other Nations Government plays a much larger role in financing health care in the U.S. than is commonly acknowledged. In fact, government health spending in the U.S. - $2544 per capita in 1997 - exceeded total health spending in any other nation except Switzerland. Government spending includes Medicare, Medicaid, Veterans Administration programs, as well as insurance premiums for government employees and tax subsidies for private insurance. Americans already pay enough in taxes to fully fund a national health insurance system more generous than Canada's. Then we pay an additional $1551 per capita out-of-pocket and to private insurers.

*Who Pays for Health Care?The Regressivity of U.S. Health FinancingThis chart displays the pattern of overall health financing under the current U.S. system. The 10% of the population with the lowest incomes is shown on the far left, and the highest earning 10% on the far right. The intervening bars represent the other 8 income deciles. The height of each bar indicates the proportion of income devoted to health spending for persons in that income decile (relative to the society-wide average). The poorest 10% of the population pays approximately 6 times more, as a proportion of their income, for health care as the wealthiest 10%. In the U.S., wealthier people pay a far smaller proportion of their income for medical care than do the poor. This results from several factors. A large part of health costs in the U.S. is paid by individuals. Any given fixed cost (e.g. payment for a prescription, individual purchase of a policy) will represent a larger share of the income for a poor person than for a rich person. In addition, the large government subsidy for private health insurance goes mostly to the wealthy. Moreover, higher income workers receive more generous insurance benefits from their employers, minimizing out-of-pocket costs.The question of who pays for health care underlies much U.S. health policy debate, though it is rarely made explicit. Maintaining the current, regressive financing pattern favors the wealthy, while a tax-funded system would aid lower income individuals.

*Who Pays for Canada's NHP?Because Canada's health care is largely tax-funded, and the tax system takes a larger share of income from wealthy individuals than from the poor, the financing of Canada's system is progressive. The wealthy pay a higher share of their incomes, while the poor pay less.Moreover, Canada's system assures a larger cross subsidy from the healthy to the sick than in the U.S. In Canada, the sick pay no more for their insurance coverage than the healthy, and out-of-pocket costs are low. In contrast, in the U.S., insurance premiums for the sick are often sky high, and serious illness brings huge out-of-pocket bills, even for those with coverage.