December 7, 2006

Canadian Context 2006.12.07

  • A Canadian evangelist denies he has special access to Prime Minister Stephen Harper.

  • Harper recently initiated a motion to reopen the same-sex marriage debate. Mercifully, it was easily defeated in Parliament with MPs voting 175-123.

  • Harper's Conservative government is cutting a safe-tattoo program for federal prisoners, despite concerns the move will increase the spread of AIDS and hepatitis C.

  • Cam McCannell probes Tory values.

  • Allow me to introduce you to Stephane Dion, the new leader of Canada's federal Liberal Party (the official opposition party to the current minority Conservative government). But will he be as green as he claims to be?

  • Medication will be the second largest expense in Canadian health this year — second only to the cost of running hospitals. Broken down: physicians account for 13.1% of total health expenditure, hospitals 29.8% and drugs, both prescribed and non-prescribed, account for 17%. Canadians will spend an estimated $148 billion for health care by the end of 2006.

  • Hospital madness: Montreal's Lakeshore General Hospital quarantined several patients and shut down a ward to contain what officials believe could be an outbreak of the Norwalk virus. In London, Ontario, all surgeries were canceled at University Hospital after fears that medical instruments were contaminated with Creutzfeldt-Jakob disease (tests showed the fears were unfounded). And hospitals in Quebec are slow to respond to heart attack victims.

    Martin Striz said...

    Interesting. Per capita health expenditures in Canada are almost as high as the United States, ~$5600/person/yr in the US, $4600 in Canada.

    Take a look at this graph:

    Unfortunately, the author of that graph committed the 1st Grave Error of Graph Making, which is unlabeled or improperly labeled axes. The x-axis is a bit vague, so let me explain: it plots percentage of total health spending over the "percentage most sick people." Presumably the author came up with some metric to determine "level of sickness."

    What the graph reveals is that in the US the 1% "sickest" people account for 23.7% of all health spending, while the 5% sickest people account for half of all health spending.

    It is well known that as a disease advances, the cost of treating it grows exponentially, while the probability of a successful outcome decreases. The solution, from a health policy perspective, is to focus on health maintenance and prevention. There are two further problems, 1) devising a system where people have access to health care, 2) ensuring patient compliance (since noncompliance is also a source of much wasted health care spending, and noncompliance tends to be really high for maintenance/prevention measures).

    So the common wisdom is that health care spending is high in the United States in part because a large number of people (some 13-15% of the population) don't have regular access to health care, and don't seek treatment until their conditions have become so severe that medical treatment is unavoidable.

    But I'm perplexed as to why it's so high in Canada, where access to health care is more universal. Is it bureaucratic overhead or what?

    George said...

    Hi Martin,

    A couple of quick things come to mind.

    First, I think you're right about the bureaucracy. There are gross inefficiencies in the system that most Canadians are aware of -- and there have been repeated calls for reform (I believe a recent commission said as much). The system could be made much more efficient.

    But I also think that Canadians, unlike Americans, may be more inclined to opt into healthcare simply because the option is there to do it affordably. If you build a universal healthcare system, they will come. I have no statistics to back this claim, it's just a suspicion.