Medical professionals
Some of the extra money spent in the United States goes to doctors, nurses, and other medical professionals, all of whom receive higher compensation than their counterparts north of the border. According to health data collected by the OECD, average income for physicians in the United States in 1996 was nearly twice that for physicians in Canada.[65]
The causes of these differences are complex. Factors such as higher cost of living in the United States, lower private cost of medical training in Canada, and high costs of medical malpractice insurance in the United States, contribute to the differences.[citation needed] Which entities exercise market power in each country also influences the differences in compensation. Canadian billing rates for each procedure are set through negotiations between the provincial governments and the physicians' organizations.[citation needed] In the U.S., physicians have greater freedom to set rates according to the local market. Anti-trust regulations prohibit the formation of uniform rates for procedures. Actual compensation to medical professionals in the U.S. is also highly influenced by the discounted rates that publicly funded insurance programs, Medicaid and Medicare, and major health insurance companies, are able to negotiate through the exercise of their market power.[
[65] ^ Health Care Systems: An International Comparison. Strategic Policy and Research Intergovernmental Affairs, May 2001.
Malpractice litigation
In Canada the total cost of settlements, legal fees, and insurance comes to $4 per person each year, but in the United States it is $16.[85]
[85] ^ a b c d Anderson GF, Hussey PS, Frogner BK, Waters HR (2005). "Health spending in the United States and the rest of the industrialized world". Health affairs (Project Hope) 24 (4): 903–14.doi:10.1377/hlthaff.24.4.903. PMID 16136632.
Health Care Outcomes
In the World Health Organization's ratings of health care system performance among 191 member nations published in 2000, Canada ranked 30th and the U.S. 37th, while the overall health of Canadians was ranked 35th and Americans 72nd.[8][90] However, the WHO's methodologies, which attempted to measure how efficiently health systems translate expenditure into health, generated broad debate and criticism.[91]
Researchers caution against inferring health care quality from some health statistics. June O'Neill and Dave O'Neill point out that "...life expectancy and infant mortality are both poor measures of the efficacy of a health care system because they are influenced by many factors that are unrelated to the quality and accessibility of medical care".[92]
Canadians are, overall, statistically healthier than Americans and show lower rates of many diseases such as various forms of cancer. On the other hand, evidence suggests that with respect to some illnesses (such as breast cancer), those who do get sick have a higher rate of cure in the U.S. than in Canada.[93]
Some of the difference in outcomes may also be related to lifestyle choices. The OECD found that Americans have slightly higher rates of smoking and alcohol consumption than do Canadians[94] as well as significantly higher rates of obesity.[96] A joint US-Canadian study found slightly higher smoking rates among Canadians.[97] Another study found that Americans have higher rates not only of obesity, but also of other health risk factors and chronic conditions, including physical inactivity, diabetes, hypertension, arthritis, and chronic obstructive pulmonary disease.[16]
[91] ^ Deber, Raisa, "Why Did the World Health Organization Rate Canada's Health System as 30th? Some Thoughts on League Tables", Longwoods Review 2 (1). Retrieved on 2008-01-09.
[92] ^ O'Neill, J., O'Neill, D. M., "Health Status, Health Care and Inequality: Canada vs. the U.S.", National Bureau of Economic Research, NBER Working Paper 13429, September 2007.
[93] ^ a b c Hussey PS, Anderson GF, Osborn R, et al. (2004). "How does the quality of care compare in five countries?". Health affairs (Project Hope) 23 (3): 89–99. doi:10.1377/hlthaff.23.3.89. PMID 15160806.
[94] ^ a b c "OECD in Figures 2006-2007" (PDF). Organisation for Economic Co-operation and Development. http://www.oecdobserver.org/news/get_file.php3/id/25/file/OECDInFigures2006-2007.pdf. Retrieved on 2007-06-21.
[95] ^ Commonwealth Fund Study
[96]^ Adult obesity in Canada: Measured height and weight
[97] ^ The Joint Canada/United States Survey of Health (JCUSH). CDC - National Center for Health Statistics.
[16]^ a b c d "Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey". American Journal of Public Health 96 (7). 07 2006. http://www.pnhp.org/canadastudy/CanadaUSStudy.pdf. Retrieved on 2007-07-02.
Life expectancy can be affected by factors other than health care. For example, the United States was listed as 37th for life expectancy and 41st in low birth weight.However, if fatal injuries (from suicide, homicide, and other non-health care related injuries) are excluded, then the United States ranks first in the adjusted "natural" life expectancy.[96][97] Similarly, the proportion of low birth weight babies may be affected by factors other than health care. Teen motherhood (a primary cause of low birth weight) is three times higher than Canada. If Canada had the same number of teen pregnancies as the United States, their low birth weight numbers would likely be higher.[98][99][100]
[96] ^ "Natural Life Expectancy in the United States," Political Calculations, September 13, 2007
[97] ^ Robert L. Ohsfeldt and John E. Schneider, [October 17, 2006 "How Does the U.S. Health-Care System Compare to Systems in Other Countries?,"] presentation given at an American Enterprise Instituteconference on October 17, 2006
[98] ^ "Health Care System Grudge Match: Canada vs. U.S.," Healthcare Economist, October 2, 2007
[99] ^ June E. O'Neill and Dave M. O'Neill, (2008), "Health Status, Health Care and Inequality: Canada vs. the U.S.," Forum for Health Economics & Policy, Vol. 10: Iss. 1 (Frontiers in Health Policy Research), Article 3.
[100] ^ June E. O'Neill and Dave M. O'Neill, (2007) "Health Status, Health Care and Inequality: Canada vs. the U.S.," NBER working paper #13429
Heart attacks in the 1990s
1. A study in the journal Circulation found that Canadian patients whose histories were followed from 1990 to 1993 had a 17% higher risk of dying from heart attacks than did U.S. patients. The five-year mortality rate was 21.4% among the Canadian study participants and 19.6% among U.S. participants. The authors attributed this to the greater use of invasive procedures in the U.S., and in the organization of the Canadian health care system, in which specialized procedures are only available in central hospitals. Almost a third (30%) of American heart attack patients received an angioplasty, versus11% of Canadians, and more than 13% of Americans had bypass surgery, compared with 4% in Canada.[98]
[98] ^ U.S. Tops Canada in Post-Heart Attack Care; More Aggressive Care May Explain Americans Survival Edge, WebMD Medical News, Sept. 20, 2004
Politics of Health
In the US, President Bill Clinton attempted a significant restructuring of health care, but the effort collapsed under public pressure against it. The 2000 U.S. election saw prescription drugs become a central issue, although the system did not fundamentally change. In the 2004 U.S. election health care proved to be an important issue to some voters, though not a primary one.
More radical solutions in both countries have come from the sub-national level. In 2006, Massachusetts adopted a plan that intends to vastly reduce the number of uninsured. It requires everyone to buy insurance and subsidizes insurance costs for lower income people on a sliding scale. The Massachusetts program is now (2009) near bankruptcy and considering terminating coverage for certain populations. In Canada, it is oil-rich Alberta under the conservative government of Ralph Klein that is seen to experiment most with increasing the role of the private sector in health care. Measures have included the introduction of private clinics that are allowed to bill patients for some of the cost of a procedure. After the 2005 Supreme Court of Canada ruling that the Quebec government cannot prevent people from paying for private insurance for healthcare procedures covered under medicare, private healthcare in Quebec began to grow rapidly. Quebec now has the highest number of private clinics delivering publicly funded care as well as whole hospitals and emergency wards that have opted out of the public system.[citation needed]
Private care
The Canada Health Act of 1984 "does not directly bar private delivery or private insurance for publicly insured services," but provides financial disincentives for doing so. "Although there are laws prohibiting or curtailing private health care in some provinces, they can be changed," according to a report in the New England Journal of Medicine.[123] Governments attempt to control health care costs by being the sole purchasers and thus they do not allow private patients to bid up prices.[citation needed] Those with non-emergency illnesses such as cancer cannot pay out of pocket for time-sensitive surgeries and must wait their turn on waiting lists. According to the Canadian Supreme Court in its 2005 ruling in Chaoulli v. Quebec, waiting list delays "increase the patient’s risk of mortality or the risk that his or her injuries will become irreparable."[124] The ruling found that a Quebec provincial ban on private health insurance was unlawful, because it was contrary
[123] ^ Steinbrook R (April 2006). "Private health care in Canada". The New England journal of medicine 354 (16): 1661–4. doi:10.1056/NEJMp068064. PMID 16625005.
[124] ^ Chaoulli v. Quebec (Attorney General), (2005). S.C.R. 791, 2005 SCC 35
[125] ^ Kraus, Clifford (2006-02-26). "As Canada's Slow-Motion Public Health System Falters, Private Medical Care Is Surging.". New York Times.http://www.nytimes.com/2006/02/26/international/americas/26canada.html?ex=1184644800&en=44cca772dc339429&ei=5070. Retrieved on 2007-07-16.
[126] ^ Chaoulli, J. A Seismic Shift: How Canada's Supreme Court Sparked a Patients' Rights Revolution. Cato Institute. Policy Analysis no. 568. May 8, 2006.
What is Avastin?
Avastin is one of a new group of cancer drugs known as monoclonal antibodies. It's usually given along with chemotherapy. Avastin is mostly given to people who have advanced bowel cancer (cancer that has spread to other parts of the body), advanced breast cancer and advanced non-small cell lung cancer.
Although Avastin is licensed and can be prescribed in the UK, it has not been approved for use by the National Institute for Health and Clinical Excellence (NICE). NICE gives advice on which new drugs or treatments should be available on the NHS. As a result, Avastin may not be widely available on the NHS.
Often, new life saving drugs and technology developed in the United States are unavailable in other countries with socialized medicine due to the high costs associated with new medicines. Patients are denied access to these new treatments and must travel to the U.S. for critical healthcare.