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Rich countries spend more than poor countries. Chart 3 shows that for nearly every country, if you know

how rich they are, you can predict their health spending per person per year to within a few hundred

dollars. The United States is an exception – Americans spend nearly $3000 per person per year more than

Swiss people, even though Swiss people have about the same level of income.

Spending on Public Health and Administration is particularly high – more than two-and-a-half times

the average. Administration of the US health system alone accounts for about 7% share of total

spending. This is on a par with other systems such as France and Germany which also have multipayer

systems (even if in some of them there is no or little competition across payers). In comparison,

Canada and Japan devote around 4% of health spending on administration.

A 2010 OECD study (Koechlin et al., 2010) found the US price level of hospital services to be over 60%

higher than the average of 12 other OECD countries in 2007.1

Looking at specific interventions, Table 1 shows that the price of a normal delivery in the United States

was estimated to be more than 50% higher than in France or Canada, while the price of a caesarean section

was 30% higher than in France and more than 50% higher than in Canada. The price of a knee

replacement was about 20% higher in the United States than in France and 50% higher than in Canada,

while a hip replacement costed 45% more in the United States than in these two countries.

More health care is not always better health care – sometimes treatments are provided which are

unnecessary, or even undesirable. There are enormous differences in how much health care different

health systems supply. However, it is very difficult to say whether a country does too much, or too little.

But what can be done is to indicate whether the United States does more or less than other countries.

Table 2 shows where it does less. It does not have many physicians relative to its population; it does not

have a lot of doctor consultations; it does not have a lot of hospital beds, or hospitals stays, when compared

with other countries, and when people go to hospital, they do not stay for long. All these data on health

care activities suggest that US health spending should be low compared with other countries.

On the other hand, the US health system does do a lot of interventions. Table 3 shows that it has a lot of

expensive diagnostic equipment, which it uses a lot. And it does a lot of elective surgery – the sort of

activities where it is not always clearcut about whether a particular intervention is necessary or not.

Hence overall the picture about whether the US spends more than other countries because its system does

more than other countries is mixed. It does more of some activities, but less of others. Overall, it seems

that high prices are probably a more important cause of high spending than high provision of services.

Health at a Glance 2011 presents a set of indicators related more specifically to the quality of health care. The United States

performs well in some subsystems such as cancer care and treating acute conditions in hospitals, but does not perform well in

primary care and in preventing costly hospital admissions for chronic conditions.

http://www.oecd.org/unitedstates/49084355.pdf

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Despite having the most expensive health care system, the United States ranks last overall compared to six other industrialized countries—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—on measures of health system performance in five areas: quality, efficiency, access to care, equity and the ability to lead long, healthy, productive lives, according to a new Commonwealth Fund report. While there is room for improvement in every country, the U.S. stands out for not getting good value for its health care dollars, ranking last despite spending $7,290 per capita on health care in 2007 compared to the $3,837 spent per capita in the Netherlands, which ranked first overall.

On measures of quality the United States ranked 6th out of 7 countries. On two of four measures of quality—effective care and patient-centered care—the U.S. ranks in the middle (4th out of 7 countries). However, the U.S. ranks last when it comes to providing safe care, and next to last on coordinated care. U.S. patients with chronic conditions are the most likely to report being given the wrong medication or the wrong dose of their medication, and experiencing delays in being notified about an abnormal test result.

On measures of efficiency, the U.S ranked last due to low marks when it comes to spending on administrative costs, use of information technology, re-hospitalization, and duplicative medical testing. Nineteen percent of U.S. adults with chronic conditions reported they visited an emergency department for a condition that could have been treated by a regular doctor, had one been available, more than three times the rate of patients in Germany or the Netherlands (6%).

On measures of access to care, people in the U.S. have the hardest time affording the health care they need—with the U.S. ranking last on every measure of cost-related access problems. For example, 54 percent of adults with chronic conditions reported problems getting a recommended test, treatment or follow-up care because of cost. In the Netherlands, which ranked first on this measure, only 7 percent of adults with chronic conditions reported this problem.

On measures of healthy lives, the U.S. does poorly, ranking last when it comes to infant mortality and deaths before age 75 that were potentially preventable with timely access to effective health care, and second to last on healthy life expectancy at age 60.

On measures of equity, the U.S. ranks last. Among adults with chronic conditions almost half (45%) with below average incomes in the U.S. reported they went without needed care in the past year because of costs, compared with just 4 percent in the Netherlands. Lower-income U.S. adults with chronic conditions were significantly more likely than those in the six other countries surveyed to report not going to the doctor when they're sick, not filling a prescription, or not getting recommended follow-up care because of costs.

http://www.commonwea...-Countries.aspx

But we can't crow, we came in at number 6.

Edited by Canuckistani
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Dr. David Gratzer exposed Canada's health care system for what it really has become...years ago in Code Blue:

Mountain-bike enthusiast Suzanne Aucoin had to fight more than her Stage IV colon cancer. Her doctor suggested Erbitux—a proven cancer drug that targets cancer cells exclusively, unlike conventional chemotherapies that more crudely kill all fast-growing cells in the body—and Aucoin went to a clinic to begin treatment. But if Erbitux offered hope, Aucoin’s insurance didn’t: she received one inscrutable form letter after another, rejecting her claim for reimbursement. Yet another example of the callous hand of managed care, depriving someone of needed medical help, right? Guess again. Erbitux is standard treatment, covered by insurance companies—in the United States. Aucoin lives in Ontario, Canada.

When Aucoin appealed to an official ombudsman, the Ontario government claimed that her treatment was unproven and that she had gone to an unaccredited clinic. But the FDA in the U.S. had approved Erbitux, and her clinic was a cancer center affiliated with a prominent Catholic hospital in Buffalo. This January, the ombudsman ruled in Aucoin’s favor, awarding her the cost of treatment. She represents a dramatic new trend in Canadian health-care advocacy: finding the treatment you need in another country, and then fighting Canadian bureaucrats (and often suing) to get them to pick up the tab

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Oh my....denied coverage. Sucks, glad she didnt die.

Here is Dr Pino who admits to Congress she denied coverage to numerous people, some of which died.

http://www.examiner....patient-s-death

Shall we now say this exposes what the US healthcare system really is all about? Oh yeah, she was promoted for saving the co millions.

Probably not fair though....

But there are those for profit health insurance companies....oh wait...

http://www.propublic...existing-condit

Its a dumb mans game, on both sides.

Edited by guyser
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Its a dumb mans game, on both sides.

It may be a "dumb mans game", but unlike in Canada, the US "system" makes no pretense about healthcare guarantees or single payer access gatekeeping or monopoly on approved procedures. Health care is not a right in either country, but some Canadians think it is.

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It may be a "dumb mans game", but unlike in Canada, the US "system" makes no pretense about healthcare guarantees or single payer access gatekeeping or monopoly on approved procedures. Health care is not a right in either country, but some Canadians think it is.

pretense? Do tell...

every Canadian has an access right to basic health care. As for your wanton lessening of your own right, perhaps you could offer comment on the Preamble within your U.S. Constitution, particularly in regards to the (my) highlighted reference to 'well being':

We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.
..... why... I understand your Supreme Court recently upheld a general welfare promotion initiative (something called the Affordable Care Act) biggrin.png
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every Canadian has an access right to basic health care. As for your wanton lessening of your own right, perhaps you could offer comment on the Preamble within your U.S. Constitution, particularly in regards to the (my) highlighted reference to 'well being':

Health care, no matter how basic (or any other attempt by you to minimize the level of care), is not a right of citizenship in either country.

..... why... I understand your Supreme Court recently upheld a general welfare promotion initiative (something called the Affordable Care Act) biggrin.png

Legislation does not constitute rights of citizenship. Such legislation, be it the CHA or ACA, can just as easily be extinguished...hence they do not create "rights". Guns on the other hand.......

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It may be a "dumb mans game", but unlike in Canada, the US "system" makes no pretense about healthcare guarantees or single payer access gatekeeping or monopoly on approved procedures. Health care is not a right in either country, but some Canadians think it is.

True that.

However, we dont take money and then deny 1 in 7 people from a procedure.

It is true we do not approve all either, if it has not been feted by Health Canada then the client cannot have HC pay for it.

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...However, we dont take money and then deny 1 in 7 people from a procedure.

It is true we do not approve all either, if it has not been feted by Health Canada then the client cannot have HC pay for it.

Understood, as Canada's "system" is more about who pays than how it is provided. But therein lies the gatekeeper problem that people of means will simply bypass when they choose to do so. The vast majority of U.S. health insurance company claims are processed and settled without issue per the group contracts negotiated by employers or private policy holders. Though regulated, there is no government monopoly on the insurance market.

Edited by bush_cheney2004
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Understood, as Canada's "system" is more about who pays than how it is provided.

Dont think I can agree with that.

I know who pays, it never is a question. How coverage is proceeding, timeliness ,efficiency and so on are a minor concern. Who pays...never

But therein lies the gatekeeper problem that people of means will simply bypass when they choose to do so.

That small number (as has been shown here) means nada to most people. Some people buy Ferrari's....nice. But why would I care they do?

The vast majority of U.S. health insurance company claims are processed and settled without issue per the group contracts negotiated by employers or private policy holders. Though regulated, there is no government monopoly on the insurance market.

And true also.

However calling in to an HMO to find out 1- who to see 2-getting approval for by some cubicle junkie 3-submitting the results hoping for payment 4-paying the deductible is not nor ever will be something I would want.

Edited by guyser
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Health care, no matter how basic (or any other attempt by you to minimize the level of care), is not a right of citizenship in either country.

no - the/my reference to 'basic' was an acknowledgement to qualifiers wholly consistent with the principles of the Canada Health Act; principles that speak to universality, to accessibility, etc. The/my reference to 'basic' aligns with the fundamental tenet of Canada's healthcare 'system': "the universal coverage for medically necessary health care services provided on the basis of need, rather than the ability to pay".

Legislation does not constitute rights of citizenship. Such legislation, be it the CHA or ACA, can just as easily be extinguished...hence they do not create "rights". Guns on the other hand.......

ya, ya... I appreciate you would make the association between guns and your Constitution promoting, 'the general welfare/well being'!!!

We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.
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Dont think I can agree with that.

I know who pays, it never is a question. How coverage is proceeding, timeliness ,efficiency and so on are a minor concern. Who pays...never

Unless you have Stage IV colon cancer and need an experimental drug therapy available in another country. Then "who pays" is unclear.

That small number (as has been shown here) means nada to most people. Some people buy Ferrari's....nice. But why would I care they do?

Not you personally, but the "optics" of high profile Canadian PMs/MPs buying Ferraris is not good.

However calling in to an HMO to find out 1- who to see 2-getting approval for by some cubicle junkie 3-submitting the results hoping for payment 4-paying the deductible is not nor ever will be something I would want.

Paying the deductible is part of the contract....not any kind of surprise unless one can't read. Eligibility and coverage for procedures are also well defined in the group contract. There is a code for each one, right down to disposable finger cots. Approval for the cost is a completely different matter than waiting many months for a simple procedure if the facilities and staff are even available.

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no - the/my reference to 'basic' was an acknowledgement to qualifiers wholly consistent with the principles of the Canada Health Act; principles that speak to universality, to accessibility, etc. The/my reference to 'basic' aligns with the fundamental tenet of Canada's healthcare 'system': "the universal coverage for medically necessary health care services provided on the basis of need, rather than the ability to pay".

This is just universal political rhetoric befitting of any collectivist, replete with many "qualifiers". No such right is established.

ya, ya... I appreciate you would make the association between guns and your Constitution promoting, 'the general welfare/well being'!!!

[/size]

Enumerataed rights carry much more weight than a provincial health insurance card....just sayin'.

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no - the/my reference to 'basic' was an acknowledgement to qualifiers wholly consistent with the principles of the Canada Health Act; principles that speak to universality, to accessibility, etc. The/my reference to 'basic' aligns with the fundamental tenet of Canada's healthcare 'system': "the universal coverage for medically necessary health care services provided on the basis of need, rather than the ability to pay".
This is just universal political rhetoric befitting of any collectivist, replete with many "qualifiers".

Enumerated rights carry much more weight than a provincial health insurance card.... just sayin'.

just what did your so-called Constitution "framers" mean when they enumerated the promotion of, 'the general welfare (well being)'? I await your qualified, collectivist rhetoric...
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[/size]just what did your so-called Constitution "framers" mean when they enumerated the promotion of, 'the general welfare (well being)'? I await your qualified, collectivist rhetoric...

The general welfare clause is more directed at the states, not individuals. It would be inconsistent to take the liberty of some citizens to provide for the "welfare" of others at the time of the framer's writing. In general, and unless specifically enumerated, one's rights do not exist if they must be derived from the liberty of another.

Government can and has legislated wealth redistribution schemes to provide for such individual 'welfare', but it has no foundation as an enumerated right, and is subject to change via administrative procedures and means testing.

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Unless you have Stage IV colon cancer and need an experimental drug therapy available in another country. Then "who pays" is unclear.

Of course there is no difference if it is an American seeking that treatment. However the Canadian experience could well be they pick up the cost, not about to happen with an HMO.

Not you personally, but the "optics" of high profile Canadian PMs/MPs buying Ferraris is not good.

Optics may not be, but very few people buy Ferraris to make the point pretty much moot.

Paying the deductible is part of the contract....not any kind of surprise unless one can't read. Eligibility and coverage for procedures are also well defined in the group contract. There is a code for each one, right down to disposable finger cots. Approval for the cost is a completely different matter than waiting many months for a simple procedure if the facilities and staff are even available.

Eligibility and coverage are written,but not well defined judging by the number of denials. Not to mention the harder the use of said policy the closer to the door that coverage will cease.....and then the group contract must be re-written with higher costs for all.

Approval for cost, approval for seeking treatment and who to go to is IME the most reprehensible part. If it is denied , any waiting for a Canuck (for which we both know is not as portrayed) seems like a minor inconvenience compared to and American being told no coverage at all.

Edited by guyser
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The general welfare clause is more directed at the states, not individuals. It would be inconsistent to take the liberty of some citizens to provide for the "welfare" of others at the time of the framer's writing. In general, and unless specifically enumerated, one's rights do not exist if they must be derived from the liberty of another.

Government can and has legislated wealth redistribution schemes to provide for such individual 'welfare', but it has no foundation as an enumerated right, and is subject to change via administrative procedures and means testing.

rhetoric, indeed! So... an example like your Affordable Care Act impacts the "liberty" of some... of all??? How so?

in any case, this mindless twaddle concerning right vs. privilege means nothing, particularly when you, as you did, qualify legislation as the (overall) determiner. The proverbial 'when pigs fly' applies when you suggest/imply Canadians could lose our 'right' (perceived or real) to healthcare on a government's legislative whim... ain't gonna happen, no way, no how. Just as Americans will never lose Medicare/Medicaid (on a GOP/MadTeaHatter) venture into political suicide... or ObamaCare once it gets fully entrenched.

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Eligibility and coverage are written,but not well defined judging by the number of denials. Not to mention the harder the use of said policy the closer to the door that coverage will cease.....and then the group contract must be re-written with higher costs for all.

Approval for cost, approval for seeking treatment and who to go to is IME the most reprehensible part. If it is denied , any waiting for a Canuck (for which we both know is not as portrayed) seems like a minor inconvenience compared to and American being told no coverage at all.

Don't forget the pre-existing condition crap. "You're sick? How do you expect to get health care coverage if you're sick?"

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rhetoric, indeed! So... an example like your Affordable Care Act impacts the "liberty" of some... of all??? How so?

It's a libertarian concept...one can't take the liberty (labour) of one and give it to another as "welfare". The scheme is to legislate taxes and redistribute wealth / benefits instead.

The proverbial 'when pigs fly' applies when you suggest/imply Canadians could lose our 'right' (perceived or real) to healthcare on a government's legislative whim... ain't gonna happen, no way, no how. Just as Americans will never lose Medicare/Medicaid (on a GOP/MadTeaHatter) venture into political suicide... or ObamaCare once it gets fully entrenched.

I suggested no such thing, and don't care what you do in Canada. I understand that the CHA collectivist mindset insists that "basic healthcare" is a right, but clearly this is not the case. It fails the "rights" smell test at many levels.

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Guest American Woman
I understand that the CHA collectivist mindset insists that "basic healthcare" is a right, but clearly this is not the case. It fails the "rights" smell test at many levels.

I don't understand why dental and eye care aren't also considered a right.

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Guest American Woman

In the vein that the posters are suggesting it is a right, both dental and eye care are lumped in when they are emergencies.

So health care is only a right in Canada when it's an emergency?

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