Are we headed for health care hell?

The numbers can look pretty scary. In 2003, Canada spent $124 billion on health care, public and private, according to the Canadian Institute for Health Information. They expect the final figure for 2007 to be $160 billion. That seems like a lot of money, growing very fast. The numbers seem a bit less scary if we take inflation, the rising population, and economic growth into account. The 2003 figure is 10.21% of gross domestic product, the 2007 figure is 10.46%. That's still growing, but does not look so worrisome. Still, we might wonder what's going on. Is the ballooning bureaucracy of our “socialized” health care system running amok, wasting more and more of our precious, hard-earned taxpayer dollars every year?

There are at least two possibilities to explain rising spending which have nothing to do with increased inefficiency. The first is that the average age of Canadians is rising. Old people cost the system more than young people. We can expect this effect to lead to rising health care costs for some time yet, as baby boomers spend more of their lives in hospitals and, eventually, nursing homes.

The other thing that leads to cost increases is the fact that medicine is getting better. Today, you may very well survive a cancer that would have killed you just a few years ago. That's surely good news, but your cure will probably cost the system a lot more than letting you die. Plus, you'll be around to cost it even more in the future.

A major World Health Organization study in 2000 compared the health care systems of its members – most countries of the world. Their main measure of health system outcome is disability-adjusted life expectancy, in which years of life lived with a disability count less, depending on the disability. The top-ranked country is Japan, at 74.5 years, followed by Australia(73.2) and France(73.1). Canada is number 12, at 72.0 years. The USA is number 24, at 70.0 years. But keep in mind that other things like diet, genetics, and pollution surely influence this, and that measurement errors are inevitable. Most top-ranked countries are very close together. It would not be smart to make too much of small differences.

The WHO study also looks at a broader measure of health system attainment, which includes measures of such things as responsiveness to wishes of patients and fairness of the financial contributions. Here, Canada ranks 7th. Finally, they look at how much health systems attain, relative to what they cost. Here, Canada ranks 30th, behind a good many countries that have poorer outcomes but also spend less per capita. The message would seem to be that our system performs well, but could do better, given what we pay for it. The country judged to be getting the best value for its money is France

One area that looks as if it could be improved is planning. The biggest problem at the moment is a shortage of doctors. The Canadian Institute for Health Information attributes this to several factors. The most important of these was an increase in qualification time for new doctors, which delayed their entry into the system. Also, more restrictions were placed on foreign trained doctors and more doctors retired. Yet medical schools cut back enrolment due to a perceived oversupply in the early 1990's.

Such planning failures seem too common. We often have shortages of particular specialists or particular equipment, too. Recognizing that it is challenging to plan a system when it takes years for decisions to have an effect, can we not do better? These problems make our system both less effective and more costly at the same time. Many other countries seem to have fewer such problems.

The book, “Prescription for Excellence”, by Michael Rachlis, describes many initiatives in many places that are improving outcomes and/or reducing costs within our health care system.

Claims that our healthcare system is “unsustainable” and must be scrapped or privatized are just silly. It is not performing badly right now, compared to the best in the world. The costs are growing, as they are in all rich countries, for very good reasons. They are nowhere near overwhelming our ability to pay. We can do many things within the current basic structure to improve it. That should be our focus.

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