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Despite Higher GDP, Most Americans Have Less Disposable Income than Canadians
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SUPPLY, DISTRIBUTION AND MIGRATION OF CANADIAN PHYSICIANS, 2005
Over the past five years (2001-20005), the proportion of Canadian physicians moving in and out of the country has decreased by 30.6%. The proportion of physicians returning to the country is now greater than the proportion leaving. In 2001, the ratio of physicians moving abroad to those returning from abroad was 62:38, compared to 43:57 for 2005.
In 2001, 555 Canadian physicians moved abroad while 334 returned to Canada (net loss of 221)compared to 2005 when 186 Canadian physicians moved abroad and 247 returned to Canada (net gain 61). Canada began registering net gains starting in 2004. Overall between 2001 and 2005 the number of physicians in Canada grew by 5.3%, a rate that has kept pace with population growth (4.0%).
The number of family physicians per 100,000 population increased from 95 in 2001 to 98 in 2005 (just over 3%). Meanwhile, the number of specialist physicians per 100,000 population dropped from 93 in 2001 to 92 in 2005 (just over 1%).
For document from Canadian Institute for Health Information (2006 PDF) CLICK HERE |
Most Americans have lower disposable incomes than Americans. Only the very richest Americans (freed from fulfilling their obligations to share a fair tax-burden) enjoy much higher incomes than Americans.
Canada has taxes somewhat higher than the USA but with those taxes it supports national health insurance, more public universities and better welfare and retirement systems than the US has. All Canadians have needed medical care AND few Canadians live in poverty.
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Taiwan NHI's financial problems stem from two factors: people's mindset and
politicians' intervention," said William Hsiao, a professor of economics at
Harvard University who helped design the NHI a decade ago. [problems common to all health
systems in the early 21st century]. "Taiwanese people think that they don't need to pay more since they've got NHI. In fact, the rise of insurance rates is an inevitable trend as the
society grows older, richer and demands more medical care," Hsiao said.
Uwe Reinhardt, a professor of political economy at Princeton University,
agreed that a premium increase would be a good way to sustain the universal
insurance plan. "Taiwanese could pay twice the fee now without hurting its macroeconomics,"
Reinhardt said. Official figures showed that Taiwanese people pay 15.4 visits to physicians
per year and that the country spends about 6 percent of GDP on healthcare --
a relatively low figure compared to the US' 15 percent. Reinhardt said that the real issue is to share the insurance burden and foster a spirit of fraternity.
"While 80 percent of health spending is used on 20 percent of the population
who are severely or chronically ill, it is only natural that not every one
feels their money is fully spent on their own health," he noted. On the sideline of the NHI's financial difficulties, Reinhardt advised Taiwan to steer away from the US example where many families go bankrupt
because of health costs.
"Privatization of health insurance won't solve the financial deficit. It
just sweeps the problem under the rug," he said. "The competition between
insurance companies only makes programs less affordable, [and] over 46
million Americans are not covered." Ref2
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AMERICANS LEAD THE INDUSTRIALIZED NATIONS IN HOURS WORKED
(hours worked per worker for the year, 1997 data)
From the Int’l Labor Organization 1999
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THE MYTH OF CANADIANS STREAMING INTO USA FOR THEIR HEALTH CARE
This report is based on surveys of ambulatory health care providers in the USA near to the Canadian border
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PHYSICIAN SERVICES FOR THE ELDERLY
Canadian rate of care factored over US rate is shown, so that 1.44 means 44% more evaluation and management of the conditions in Canada. Canadians elderly get more of most kinds of care, even though all elderly in the US are covered by US medicare program.
From JAMA 1996 275:1410
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"Waits To See An Emergency Department Physician: U.S. Trends And Predictors, 1997-2004" Wilper A, Woolhandler S, Lasser K, McCormick, Cutrona, Bor D and Himmelstein DU, Health Affairs, March/April 2008; 27(2):w84-w95
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HOW ABOUT THE CANADIAN PHYSICIANS FLOODING THE US BORDER
They can’t wait to emigrate to the USA, right? Let’s see 180 in 2000 out of 57,800 that’s a "mass exodus" of 0.3%. We’d call that a fairly minor movement given the higher salaries and the greater privileges for the wealthy in general in the USA (lower taxes for example).
From Canadian Institute for Health Information
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WHO PAYS FOR CANADA’S NATIONAL HEALTH PROGRAM
Data shown for the Province of Alberta. As a share of family income the wealthiest Canadians pay a bit less than twice as much to have full coverage and services for themselves and their nation, as is paid by Canadians earning less than 15,000 annually. And even the wealthy pay only a bit over 1% of their income.
From the Premier’s "common Future of Health" excluding out-of-pocket costs
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AND WHO PAYS FOR US HEALTH CARE?
In the USA the land where our greatest ideal is individual responsibility (supposedly) the poorest Americans pay about 5-fold more as a percentage of income into the monies spent on the nation’s health care, than the share paid by the richest Americans. Note that the largest sector of the nation’s uninsured are low-income Americans who get very little benefit from the system despite the fact that they shoulder the heaviest load in paying for the nation’s health care.
From Oxford Rev Econ Pol 1989 5(1):89
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MEDIAN WAITING TIME
The median waiting time for non-emergency surgery in Canada across all provinces was 4.3 weeks in 2003, according to Statistics Canada, the counterpart of the U.S. Census Bureau. The median waiting time to see a specialist was 4.0 weeks (wwwstatcan.ca). This refutes the 17.8 weeks figure for surgery or specialty care heavily publicized by the ultraconservative Fraser Institute.
The full critique of the Fraser data can be found in the Canadian Health Services Research Foundation Newsletter, Vol. 1 No. 4, available at CLICK HERE .
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LEARNING FROM TAIWAN: EXPERIENCE WITH UNIVERSAL HEALTH INSURANCE
Life expectancy before and after the introduction of national health insurance, as well as changes in health disparities were studied in Taiwan. Implemented in 1995, Taiwan's system has increased health insurance coverage from 57% to 98% of the population. It has also expanded access by waiving copayments for the very poor, veterans, and aboriginal populations. While the rise in life expectancy overall has been modest, Taiwan has seen significant improvement for individuals who were most at risk prior to national health insurance. In 10 years, the poorer, previously uninsured group improved their life expectancy more substantially than the more affluent and insured.
For the USA, which already devotes 16% of GDP to health care, one significant barrier to universal health care is the potential increase in costs. In this regard, Taiwan provides some reassurance. Health spending has remained almost unchanged, at 5% to 6% of GDP.
Taiwan's success in improving life expectancy -particularly for people who are more vulnerable -lends credence to arguments calling for the USA to join other industrialized nations in ensuring universal health coverage. It also underscores the importance of adequate financing and having a strategy that addresses access, quality, and efficiency.
K. Davis and A. T. Huang Annals of Internal Medicine, February 19, 2008 148(4):313-14
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THE SWISS AND DUTCH HEALTH INSURANCE SYSTEMS: UNIVERSAL COVERAGE AND REGULATED COMPETITIVE INSURANCE MARKETS
Universal coverage attained through a mandate that every individual purchase a basic insurance plan:
Building on a previous system of social and private insurance, the individual mandate in the Netherlands took effect in 2006. The Swiss have operated with a mandate since 1996. In both countries uninsured rates are low (estimated at about 1.5% of the population in the Netherlands and below 1% in Switzerland).
In Switzerland , some people who are nominally covered are not paying their premiums. Since 2005, insurers have been permitted to suspend payments on behalf of such people, meaning that providers are left with unpaid bills or consumers are denied services. These suspensions can last 8 to 24 months, because of the time it can take to ascertain whether a consumer is unable to pay the premium (in which case cantons or communities will often assume financial responsibility) or is simply unwilling to pay. About 120,000 people, or 1.6% of the population, were affected by suspensions in 2006.
In the Netherlands, before the new Health Insurance Act, there was a fear that, despite the mandate, many individuals would opt not to obtain coverage. In fact, the number of uninsured at the end of 2006 was about the same as before the new mandate took effect -241,000 people, or 1.5% of the population. As of the end of 2007, almost an equal number of people -240,000 - were enrolled with an insurer but were not paying their premiums. Beginning July 1, 2007, insurers were allowed to expel enrollees who have not paid premiums, but these enrollees simply switched to other insurers and failed to pay them as well. There is also a proposal to allow garnishing of wages or unemployment or disability benefits.
THE SWISS AND DUTCH HEALTH INSURANCE SYSTEMS: UNIVERSAL COVERAGE AND REGULATED COMPETITIVE INSURANCE MARKETS, The Commonwealth Fund, January 2009 By Robert E. Leu, Frans F. H. Rutten, Werner Brouwer, Pius Matter, and Christian Rütschi
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1 From "Health
Affairs", May/June 2003
"Does Universal Health Insurance Make Health Care Unaffordable? Lessons From Taiwan" by Jui-Fen Rachel Lu and William C. Hsiao
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Ref 2 Taipei Times of Mar 19, 2005 "Experts call for health premium hikes"
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