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


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In April of 2010, the Canada US Business Council (formerly the Canadian Club of Chicago), hosted Dr. Carolyn Bennett, Liberal Critic for Health, Parliament of Canada. This talk gave the Canadian perspective on health care in addition to showing the similarities and differences between the two health care systems.

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

  1. 1. A Canadian Perspective Honourable Carolyn Bennett M.D., M.P. April 14, 2010 The Canadian Club of Chicago
  2. 2. <ul><li>The U.S.A. </li></ul><ul><ul><li>Life </li></ul></ul><ul><ul><li>Liberty </li></ul></ul><ul><ul><li>The pursuit of Happiness </li></ul></ul><ul><li>Canada </li></ul><ul><ul><li>Peace </li></ul></ul><ul><ul><li>Order </li></ul></ul><ul><ul><li>Good government </li></ul></ul>Moniqe Bégin
  3. 3. <ul><li>Physicians per capita: 2.4/1000 pop. </li></ul><ul><li>Nurses: 10.6/1000 </li></ul><ul><li>Acute care beds: 2.7/1000 </li></ul><ul><li>MRIs: 19.5/1 million pop. </li></ul><ul><li>Life expectancy at birth: 78.1 years </li></ul><ul><li>Infant mortality rate: 6.7/1000 live births </li></ul><ul><li>Obesity in adults: 34.3% </li></ul><ul><li>Physicians per capita: 2.2/1000 pop. </li></ul><ul><li>Nurses per capita: 9/1000 </li></ul><ul><li>Acute care beds: 2.7/1000 </li></ul><ul><li>MRIs: 6.7/1 million pop. </li></ul><ul><li>Life expectancy at birth: 80.7 years </li></ul><ul><li>Infant mortality rate: 5/1000 live births </li></ul><ul><li>Obesity in adults: 15% </li></ul>Monique Bégin
  4. 4. <ul><li>1947 : Saskatchewan’s The Saskatchewan Hospital Services Plan is passed in the Legislature – Hospital universal free coverage. </li></ul><ul><li>1957-58 : Hospital Insurance and Diagnostic Services Act (HIDS), Provides a 50-50 cost sharing plan to the provinces for everything “hospital”. </li></ul><ul><li>1962 : Saskatchewan pioneers again with The Saskatchewan Medical Care Insurance Plan Extension of universal, publicly funded insurance to physician services. </li></ul><ul><li>1967-68 : Medical Care Act – federal legislation providing 50-50 of physician services costs to the provinces. </li></ul><ul><li>1976-77 : The 50-50 cost-shared arrangements are replaced by a block fund byt the The Established Programs Financing Act (EPF ). </li></ul><ul><li>1984 : To clarify conditions of federal contributions and keep health care free and universal, Parliament passes unanimously the Canada Health Act (CHA). </li></ul>Monique Bégin
  5. 5. <ul><li>The Canada Health Act (1984) : </li></ul><ul><li>14 pages </li></ul><ul><li>Universality : all Canadians and permanent residents are covered </li></ul><ul><li>Accessibility : &quot;free&quot; at point of use (added in 1984) </li></ul><ul><li>Comprehensiveness : all medically necessary hospital and doctor services </li></ul><ul><li>Portability : between the 10 provincial and 3 territorial systems </li></ul><ul><li>Public Administration : each province has a public government agency as its single- payer </li></ul>Monique Bégin
  6. 6. <ul><li>Sharing risk </li></ul><ul><ul><li>getting people the health care they need when they need it </li></ul></ul><ul><li>Keeping people well not just patching them up once they get sick </li></ul>
  7. 7. <ul><ul><li>25% health attributable to health care system </li></ul></ul><ul><ul><li>15% biology and genetics </li></ul></ul><ul><ul><li>10% physical environment </li></ul></ul><ul><ul><li>50% social and economic environments </li></ul></ul>
  8. 8. <ul><li>Patchwork quilt of non- systems </li></ul><ul><li>Focus on sickness…and the repair shops </li></ul>
  9. 9. <ul><li>More health …less health care </li></ul><ul><li>Service contract ?????? </li></ul><ul><li>Or longer warranty ???? </li></ul>
  10. 11. 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
  11. 12. Healthy Canadians Tree: 2005
  12. 14. <ul><li>A) strong fence at the top of the cliff </li></ul><ul><li>B) state of the art fleet of ambulances and paramedics waiting at the bottom ? </li></ul>
  13. 15. <ul><li>A) Clean air </li></ul><ul><li>B) Enough puffers and respirators </li></ul><ul><li>for all </li></ul>
  14. 16. <ul><li>A) a falls program to reduce preventable hip fractures </li></ul><ul><li>B) private orthopaedic hospitals and more surgeons </li></ul>
  15. 17. <ul><li>A) how much they spent on the sickness care system </li></ul><ul><li>B) the health of their citizens, leaving no-one behind </li></ul>
  16. 18. <ul><li>U.S.A: </li></ul><ul><li>Health care = </li></ul><ul><li>a market commodity </li></ul><ul><li>Medicare and Medicaid </li></ul><ul><li>CANADA: </li></ul><ul><li>Health care = </li></ul><ul><li>a universal common good </li></ul><ul><li>for all citizens of all ages, all conditions </li></ul><ul><li>All universities are public and heavily subsidized by both levels of government </li></ul>Monique Bégin
  17. 19. Total Health Expenditure 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 for Underinsured 25M doctors and hospitals U.S. Canada
  18. 20. <ul><li>1.  INSURANCE COMPANIES: </li></ul><ul><li>30% of your costs – almost a third – go to insurance companies. </li></ul><ul><li>Your patients and taxpayers have to support massive organizations. </li></ul><ul><li>These insurers set premiums, design packages, assess risk, review claims and decide who to reimburse for how much. </li></ul><ul><li>But they don’t deliver health care.   </li></ul>
  19. 21. <ul><li>  </li></ul>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  
  20. 22. <ul><li>  </li></ul>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.  
  21. 23. <ul><li>  </li></ul><ul><li>4.  MALPRACTICE INSURANCE: </li></ul><ul><li>The not-for-profit Canadian Medical Protective Association covers medical malpractice for all Canadian physicians with comparatively low premiums. </li></ul><ul><li>Doctors’ remuneration does not have to reflect those extra costs and our justice system has successfully kept the awards in a reasonable range. </li></ul>
  22. 24. <ul><li>5.  EVIDENCE-BASED CARE: </li></ul><ul><li>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. </li></ul><ul><li>We are committed to moving from the error of pure cost-containment approach of the early 90s into true evidence-based cost effective care. </li></ul>
  23. 25. <ul><li>6.  PREVENTION: </li></ul><ul><li>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. </li></ul>
  24. 26. <ul><li>  </li></ul><ul><li>7.  FAMILY MEDICINE: </li></ul><ul><li>A long-standing speciality in Canada, </li></ul><ul><li>family doctors are trained to help patients navigate their care; </li></ul><ul><li>we interpret the difference between what patients think they `want`, and what they actually `need` . </li></ul><ul><li>A point of first contact, a trusted coach to explain the evidence and the choices. </li></ul><ul><li>  </li></ul>
  25. 27. <ul><li>Wait times : the one big complaint. Now addressed with a national plan/special budget. </li></ul><ul><li>Adequate supply of physicians and nurses: at long last increasing since 2000. </li></ul><ul><li>Capital investment for CTs and MRIs: still lacking. </li></ul><ul><li>Pressure by a few lobby groups for more privatization: nothing new here, but relatively strong in Québec and B.C.. </li></ul>Monique Bégin
  26. 28. <ul><li>From the federal government: </li></ul><ul><ul><li>10 year plan (Wait Times Reduction Fund) </li></ul></ul><ul><ul><li>$4.5 billion for the first 6 years </li></ul></ul><ul><ul><li>Began in 2004-05 </li></ul></ul><ul><ul><li>Regular monitoring and reporting </li></ul></ul><ul><li>Provincial governments : </li></ul><ul><ul><li>special investments through centralized registries and prioritization systems +++ </li></ul></ul>Monique Bégin
  27. 29. <ul><li>Knee replacement: 2 to 6-12 months </li></ul><ul><li>Hip replacement: 2 to 18 months </li></ul><ul><li>Cataract surgery: 2 months ± </li></ul><ul><li>CT (routine) wait: 2 months ± </li></ul><ul><li>MRI (routine) wait: 2 to 6 months </li></ul><ul><li>Angioplasty: 12 to 14 days </li></ul><ul><li>Bypass surgery: 3 w. to 2 months </li></ul><ul><li>Chemotherapy: 1.4 to 3 weeks </li></ul><ul><li>Cancer surgery: 5 to 10 weeks </li></ul><ul><li>Radiation therapy: 1 to 4 weeks </li></ul>Canadian Institute for Health Information, 2008 (2007 Stats) Monique Bégin
  28. 30. R.O.M.P. Collingwood April 24, 2008 Dr. Carolyn Bennett M.P. The Grey Tsunami ?
  29. 32. <ul><li>OECD study of 10 countries … </li></ul><ul><ul><li>US least satisfied with the care they receive </li></ul></ul><ul><ul><li>Canadians 5X more likely to be satisfied with their care </li></ul></ul><ul><li>The Nanos Research poll, 12 August 2009: …on the eve of the national convention of the Canadian Medical Association (CMA): </li></ul><ul><ul><li>shows an overwhelming 86% level of public support for &quot;public solutions&quot; to improve Canada's national health care system. </li></ul></ul><ul><li>The Harris-Decima poll, early June 2009: </li></ul><ul><ul><li>found 70% of Canadians say the system is working very or fairly well. </li></ul></ul>Monique Bégin
  30. 33. <ul><li>As a nation, we aspire to a Canada in which every person is as healthy as they can be – </li></ul><ul><li>physically, </li></ul><ul><li>mentally, </li></ul><ul><li>emotionally and </li></ul><ul><li>spiritually. </li></ul>
  31. 34. <ul><li>“ 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.” </li></ul><ul><li>Dr. Elizabeth Blackwell </li></ul><ul><li>first woman physician North America </li></ul>
  32. 35. Monique Bégin