International Update: Canadian Health Spending, Physician Supply. Canada's Single Payer Health Care System

PNHP Newsletter, November 1966

In a recent Wall Street Journal article, Drs. Arnett and Goodman claim that Canadian health care costs are skyrocketing and doctors are fleeing in record numbers (WSJ, 7/12/96). What are the facts?

Canada's health care costs as a portion of GDP actually fell from 10.1% in 1993 to 9.7% in 1994. For Ontario, Canada's largest province with 10 mi11ion people, the comparable figures were 9.9% and 9.5%. Statistics Canada estimates that 1996 Canadian health spending will be 9.1% of GDP. The U.S. spent 13.7% of its GDP on health care in 1994 and it the Commerce Department projected that the costs will be over 14% for 1996 (U.S. Dept. of Commerce, Statistics Canada).

As for fleeing physicians, in fact 27% fewer doctors left Ontario for the U.S. in 1995 than in 1994. In 1995, only 215 of Ontario's 22,000 physicians left. The peak year for Canadian doctor emigration was in 1979. Also, some U.S. physicians move to Canada. According to the Ontario Physician Human Resources Data Center, 26 American physicians moved to Ontario in 1993, a figure that nearly doubled in 1994 and is acknowledged to be conservative. In both countries there are surpluses of doctors in urban areas with shortages in rural com- munities (Statistics Canada, Ontario Physician Human Resources Data Center).

Canadian physicians are rising to defend their system. Dr. Walter Rosser's article on the Canadian system ("Private health care would be a disaster") appeared in a recent Toronto Star (7/11/96). Dr. Rosser, Chair of the Department of Family and Community Medicine at the University of Toronto, wrote: "For some, the lack of private health care [in Canada] is what is wrong . . . The day that Canada allows a private health-care system is the day long lineups will begin." "Canadians can be proud of the accessibility of our system. Some recent U.S. visitors who toured the remarkable new facilities at Toronto's Hospital for Sick Children refused to believe the institution was publicly funded. accusing Canadians of building a facade to impress visitors." "It would be an unthinkable disaster if we lost this remarkable achievement due to pressure to expand the market for U.S. health insurance companies."

• Compared with Americans, Canadians had 19% more physician visits in 1990. Low-income Canadians averaged 26% more visits; more visits were received by low-income Canadians at every level of health status. Among those in the highest income groups (over $45,000), Canadians with "good" or "fair/poor" health status had fewer visits than the same groups in the U.S. ("Physician use in Ontario and the United States," S. Katz et al, AJPH, April 1996).
• Elderly Canadians received 17% more total physician services than elderly Americans in 1992, according to a comparison of utilization in three Canadian provinces with U.S. data from Medicare. Canadians received 44% more management and evaluation services, but 25% fewer procedures. Canadians received fewer procedures for which there is wide variation in use in the U.S., but had almost the same rate for procedures for which there is more clinical consensus. The cost of seniors' care in Canada was about half of U.S. costs (Katz et al., JAMA; 275).
• Researchers at the Manitoba Centre for Health Policy and Evaluation, Winnipeg have developed a population-based health information system (POPULIS) that illustrates the data analysis potential only attainable under a single-payer system. The system is described by Roos et al. in "Population Health and Health Care Use: An information system for policy makers", The Millbank Quarterly, Issue 1, 1996 pps 3-31.

E-mail address for Jim Ramsell: ramselj@peak.org Owner single-payer list: single-payer@peak.org My webpage is: http://www.peak.org/~ramselj

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