July 22, 2006

Bill of Health

Harvard study examines the costs of public health care

by Chris Arsenault

The Dominion - http://www.dominionpaper.ca

After a day of giving checkups, prescribing drugs and hearing about symptoms, one Canadian family physician wasn't surprised to read a Harvard Medical School study stating that Canada's public health-care system outperformed its US counterpart in economic efficiency and patient well being.

"There's no question a universal health care system is the best one," said Dr. Eva Eros, a Moncton based family physician practicing in Canada for more than twenty years.

The study, published in the July issue of the American Journal of Public Health, found that while US residents spend twice as much per capita on health care, they're 19% more likely to face unmet health needs than Canadian residents.

"I don't see how the market system can be called efficient when more than 40 million Americans are uninsured," said Dr. Eros.

According to the study, U.S. residents are seven times more likely to goi without needed care due to cost as Canadian residents are(7.0% of U.S. respondents vs. 0.8% of Canadians). Uninsured U.S. residents were particularly vulnerable; 30.4% reported having an unmet health need due to cost, according to the study.

Harvard's study analyzes the Joint Canada-U.S. Survey of Health. This was the first-ever health survey carried out jointly by the two nations' official statistics agencies. It involved 3,505 Canadian residents and 5,183 American residents, who were, interviewed between November 2002 and March 2003.

Dr. Eros thinks higher rates of chronic illness south of the border are symptoms of culture, along with economics and public policy. "One of the things they [the report's authors] say, is that the US has higher rates of chronic disease, which doesn't necessarily mean worse treatment. Longer work hours, fast-food, obesity, spending all that time in the car, there are social factors at play beyond the health care system itself," she said.

According to the study, U.S. residents had higher blood pressure (18% of U.S. residents as opposed to 14% of Canadian residents) and higher obesity rates (21% of U.S. respondents reporting obesity versus 15% of Canadian respondents). Canadian residents surveyed were 7% more likely to have a regular doctor.

"These findings raise serious questions about what we're getting for the $2.1 trillion we're spending on health care this year," said Dr. David Himmelstein, Associate Professor of Medicine at Harvard and co-author of the study. "We pay almost twice what Canada does for care, more than $6,000 for every American, yet Canadians are healthier, and live two to three years longer."

Even with the private, for-profit, insurance-driven health model so thoroughly rebuked by top medical institutions (the New England Journal of Medicine published a study in 2003 showing the U.S. model was less efficient and had greater administrative costs) advocates of privatization still lurk in the shadows of Canadian health care policy.

The great game of who controls health care is still in full swing, although the players have likely never been so cynical, so overtly motivated by polling numbers rather than by principle. Stephen Harper devoted a good part of his political life to undermining the public system. For a time, he led the National Citizens Coalition, a group created in 1967 specifically to oppose public health care.

But Mr. Harper has changed his tone, consistently supporting the Canada Health Act, key legislation protecting universal public care. He even rebuked Alberta Premier Ralph Klein in April when Klein tried to implement his 'third way' health model.

Alberta's shelved legislation would have created a new insurance scheme for those willing to pay for quicker access to joint replacements and other procedures. In addition, it would have allowed doctors to practice in both the private and public systems at the same time.
Most political observers don't think Harper will be privatizing health services anytime soon – he's read the polls and knows privatization is deeply unpopular - but it's hard to believe he won't try to put the wheels of privatization into motion the moment he's given the political space to do so.

Dr. Eros has her share of nasty anecdotal evidence which attests to the inadequacy of current Canadian health policy: "I have a patient now who has been waiting six months for hip surgery and she'll probably have to wait another three, she's in chronic pain so this isn't an ideal situation."

But rather than letting the rich jump the queue on essential services, Dr. Eros thinks that "we need to train more specialists to address the long delays for surgery and more family physicians to address the needs of patients who don't have a primary care physician even in this country."

She believes primary care teams including nurse practitioners and public health nurses can do a great deal to improve access to health care. "Primary care helps provide early diagnoses which can fix ailments before they get more expensive and difficult to treat. Hospital admission can be avoided," she said.

The health-care situation in this country isn't perfect but, according to Dr. Eros and Harvard Medical School, it could be a whole lot worse.