What President Clinton Can Learn from Canada About Price Controls and Global Budgets

Policy Backgrounders | Health

No. 129
Tuesday, October 05, 1993
by Michael Walker & John C. Goodman


Notes

  1. The president outlined his health care plan on September 22, 1993, before a joint session of Congress.
  2. The "Jackson Hole Group" - named for their meeting place and including Alain Enthoven, Paul M. Ellwood and Lynn Etheredge - conceived the idea of "managed competition" based on forming regional health insurance purchasing cooperatives (HIPCs) to negotiate for health care coverage. For a description of their plan, see Ellwood, Enthoven and Etheredge, "The Jackson Hole Initiatives for a Twenty-First Century American Health Care System," Health Economics 1, 1992, pp. 149-68. For Ellwood's reaction to the Clinton plan, see Paul M. Ellwood, "Clinton Forgets His Health Care Allies," Wall Street Journal, August 10, 1993.
  3. "A Health Proposal Headed for Failure," New York Times, September 16, 1993.
  4. Robert Pear, "Agency Faults Plan to Control Insurer's Income," New York Times, September 18, 1993.
  5. Michael Walker (Fraser Institute), "Why Canada's Health Care System Is No Cure for America's Ills," Heritage Foundation grounder, November 13, 1989, pp. 7-8.
  6. The treatment for patients with chronic renal failure and the use of CAT scanners continued its rise in virtually every country throughout the 1980s - an acknowledgement of the medical value of these innovations. Some have argued that the U.S. went too far in its use of pacemaker implants, however. See the discussion in John C. Goodman and Gerald L. Musgrave, "Twenty Myths About National Health Insurance," NCPA Policy Report No. 166, National Center for Policy Analysis, December 1991.
  7. Statistics Canada General Service Survey - Health, 1991.
  8. The discussion in this section is based on Joanna Miyake and Michael Walker, "Waiting Your Turn: Hospital Waiting Lists in Canada, Third Edition," Fraser Forum, May 1993.
  9. Steven Globerman, Waiting Your Turn: Hospital Waiting Lists in Canada (Vancouver: Fraser Institute, 1990.)
  10. General Accounting Office, Canadian Health Insurance: Lessons for the United States, June 1991, Table 4.1, p. 55.
  11. See, for example, Joan Breckenridge, "Grief, Frustration Left in Wake of Man Who Died on Waiting List," Globe and Mail (Ontario), January 25, 1989.
  12. Miyake and Walker, "Waiting Your Turn: Hospital Waiting Lists in Canada, Third Edition."
  13. Ibid.
  14. Ibid.
  15. Ibid.
  16. Hospital admissions as a percent of the total population average 16.1 percent for all OECD countries. The figures are 15.9 percent for the United Kingdom, 13 percent for New Zealand and 14.5 percent for Canada. George J. Schieber, Jean-Pierre Poullier and Leslie M. Greenwald, "Health Systems in Twenty-four Countries," Health Affairs, Fall 1991, Exhibit 4, p. 27.
  17. Health insurance industry officials in the United States report that about 4 percent of the population consumes about 50 percent of health care costs. See Blue Cross/Blue Shield, Reforming the Small Group Health Insurance Market (Chicago: BC/BS, 1991), p. 6.
  18. For example, in Ontario in 1989 the number of people waiting for open-heart surgery equaled more than 25 percent of the total surgeries performed. Because of special efforts to reduce the waiting lists, Ontario achieved a rate of one person waiting for every seven surgeries by January 1991. See C. David Naylor, "A Different View of Queues in Ontario," Health Affairs, Fall 1991, pp. 115-16.
  19. Ibid.
  20. Walker, "Why Canada's Health Care System Is No Cure for America's Ills," p. 9.
  21. "Humans Wait in Pain, Dogs Don't," Daily Mercury, Guelph, Ontario, June 14, 1991.
  22. John K. Iglehart, "Canada's Health Care System Faces Its Problems," New England Journal of Medicine, Vol. 322, No. 8, February 22, 1990, p. 566.
  23. Miyake and Walker, "Waiting Your Turn: Hospital Waiting Lists in Canada, Third Edition."
  24. See Canada/America, Supplememtal Surgical and Diagnostic Health Plan for Canadian Individuals, Canada-America Health Care Corporation, 208-62 Hargrave Street, Winnipeg, Manitoba.
  25. Until the recent change, Ontario paid 75 percent of the standard U.S. hospital charges and the same physician's fee it would have paid had the service been provided in Ontario.
  26. General Office of Accounting, Canadian Health Insurance, pp. 53 ff.
  27. A review of the hospital records of open-heart surgery patients in Toronto found that while physicians generally assigned sensible priorities, there were "many instances of relatively short waits for elective cases while more urgent cases waited inappropriately long periods of time." See Naylor, "A Different View of Queues in Ontario," p. 121.
  28. House Wednesday Group, "Public Health in the Provinces," September 29, 1989, p. 14.
  29. D.H.A. Amoko, R.E. Modrow and J.K.H. Tan, report in the Healthcare Management Forum, Vol. 5, No. 4, pp. 34-39.
  30. Press release by National Citizens Coalition, September 16, 1993.
  31. Edward Neuschler, Canadian Health Care: The Implications of Public Health Insurance (Washington, DC: Health Insurance Association of America, 1989), pp. 17-18 and p. 20.
  32. Ibid.
  33. Rosie DiManno, "Hard Choices Facing Health Care System," Toronto Star, January 28, 1989.
  34. For a discussion covering several countries, see Goodman and Musgrave, "Twenty Myths About National Health Insurance."
  35. See G.M. Anderson, J.P. Newhouse and L.L. Roos, "Hospital Care for Elderly Patients with Diseases of the Circulatory System: A Comparison of Hospital Use in the United States and Canada," New England Journal of Medicine, Vol. 321, No. 21, November 23, 1989, pp. 1443-48; and the discussion in Naylor, "A Different View of Queues in Ontario," pp. 117-18.
  36. See Goodman and Musgrave, "Twenty Myths About National Health Insurance."
  37. Jean-Pierre Thorrez, Peter Foggin and Andre Rannou, "Correlates of Health Care Use: Inuit and Cree of Northern Quebec," Social Science and Medicine, Vol. 30, No. 1, pp. 25-34.
  38. Nationwide Canadian figures are from "Canadian Social Trends," Winter 1989, Statistics Canada. U.S. figures are from "Trends in Indian Health, 1991," U.S. Department of Health and Human Services. The life expectancy at birth in Canada is 62.4 years for male Indians and 71.8 years for male non-Indians, 68.9 years for female Indians and 70.7 years for female non-Indians. In the United States, the figures are 67.1 years for male Indians and 70.7 years for male non-Indians, 75.1 years for female Indians and 78.1 years for female non-Indians.
  39. Arminée Kazanjian et al., Fee Practice Medical Expenditures Per Capita and Full-Time Equivalent Physicians in British Columbia, 1989-90 (Vancouver: University of British Columbia, 1992).
  40. Arminée Kazanjian et al., Fee Practice Medical Expenditures Per Capita and Full-Time Equivalent Physicians in British Columbia, 1987-88 (Vancouver: University of British Columbia, 1989), pp. 121-76.
  41. David Caplan, letter to the editor of the New England Journal of Medicine (July 13, 1989), p. 115. Reprinted in "Public Health in the Provinces," p. 12.
  42. A Canadian observer reports that "Ontario hospitals lag at least a decade behind their U.S. counterparts in expenditure tracking and management information systems." See Naylor, "A Different View of Queues in Ontario," p. 112.
  43. The most recent statistics of the Organization for Economic Cooperation and Development (OECD) are expected to show an occupancy rate of 80.3 percent for acute care hospitals and 82.7 percent for all hospitals in Canada for 1987. See Schieber, Poullier and Greenwald, "Health Care Systems in Twenty-four Countries," Exhibits 4 and 5, pp. 27, 29.
  44. In Canada, the latest estimate is 23 percent. See Neuschler, Canadian Health Care: The Implications of Public Health Insurance, p. 18.
  45. See DiManno, "Hard Choices Facing Health Care System" "Ceiling System Needs Radical Surgery," (Sunday) Toronto Star, March 27,1988; and Robert G. Evans et al., "Controlling Health Expenditures: The Canadian Reality," New England Journal of Medicine, Vol. 320, No. 9, March 2, 1989, p. 574.
  46. See the discussion in Schieber et al., "Health Care Systems in Twenty-four Countries," pp. 28-30.
  47. K. McPherson et al., "Regional Variations in the Use of Common Surgical Procedures: Within and Between England and Wales, Canada and the United States of America," Social Science of Medical Services and Surgical Procedures: A Chartbook (Washington, DC: National Health Policy Forum, 1985). Reprinted in Organization for Economic Cooperation and Development, Financing and Delivering Health Care (Paris: OECD, 1987), Chart 2, p. 18.
  48. Calculations by the Organization for Economic Cooperation and Development, reported in the Vancouver Sun, October 2, 1993.
  49. This analysis is based on Neuschler, Canadian Health Care, pp. 37-53. For a critique of this approach, see Morris L. Barer, W. Pete Welch and Laurie Antioch, "Canadian/U.S. Health Care: Reflections on the HIAA's Analysis," Health Affairs, Fall 1991, pp. 229-36.
  50. This section is based on Dale A. Rublee and Markus Schneider, "International Health Spending: Comparisons with the OECD," Health Affairs, Fall 1991, pp. 187-98. See, however, a critique of this approach in George J. Schieber and Jean-Pierre Poullier, "Advancing the Debate on International Spending Comparisons," Health Affairs, Fall 1991, pp. 199-201.
  51. See Goodman and Musgrave, "Twenty Myths About National Health Insurance."
  52. An exception is Robert Bourassa, the premier of Quebec, who came to the United States twice in 1990, once for consultation and once for an operation.

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