- 90% of the variation in health care spending among developed countries is based on income alone (Newhouse, 'Medical Care Expenditure: A Cross-National Survey' Journal of Human Resources, December 1977)
- For hospital care, the individual pays 2 cents on the dollar, for physician care, 12 cents, for health care as whole, 18 cents (US Department of Health and Human Services, 'Distribution of Health Care Expenses, 1996)
- US spends 15.2% of GDP (1.6 trillion) on health care (Heffler et al, 'Health Spending Projections for 2002-2012')
- Administrative costs as a percentage of medical expenditures in the US: Medicare and Medicaid (27%), Private insurance (16%), (Litow and the Technical Committee of the Council for Affordable
Health Insurance, 'Rhetoric vs Reality: Comparing Public and Private Health Care Administrative Costs', Council for Affordable Health Insurance, March 1994) (inclusive of taxes, etc)
- Under US tax system, employees can spend (through their employers) unlimited amounts on third-party health insurance, all tax free. Funds of middle income employees set aside for
self-insurance would face 25% income tax, 15.3% payroll (FICA), and local/state taxes, encouraging over-insuring
- Inflation adjusted price of cosmetic surgery fell from 1992 to 2002 (CPI and data from the American Society of Plastic Surgeons). Despite quadrupling of demand, fees remained stable...also price
competition, easy entry, innovation
Benefit Mandates
- From 1990-1996, 16 states passed regulations to increase access to health insurance for people with health problems. The uninsured population in these states grew eight times as much as in the states that did not do this (Schriver and Arnett, 'What Staes Can Teach Congress About Health Care Regulation' Heritage Foundation, Backgrounder no 2107, July 1998)
- A Duke University study found that the probability an individual will become uninsured increases with each new mandate imposed by the government (Sloan and Conover, 'Effects of State Reforms on Health Insurance Coverage of Adults', Inquiry 3 (1998( 280-93)
- A study for Health Insurance Association of America (HIAA) found that 20-25% of uninsured Americans lack insurance due to benefit mandates (Jensen and Morrisey, 'Mandated Benefit Laws and Employer-sponsored Health Insurance' HIAA, January 1999)
Privatization attempts
- 7 mil Britons have private health insurance - since Labour assumed power, patients paying out of pocket for medical treatment has gone up 40% ('Thousands Shun the NHS, BBC Health, March 2000)
- NHS announced it would treat some patients in private hospitals, contracted with HCA international to treat 10K cancer patients in Britain (UK to Strike New Deal with Private Health Sector', Reuters Health, Dec 2001)
- Canada provincial government spends $1 bil/yr on US medical care (Dirnfield, 'The Benefits of Privatization', Canadian Medical Assoaication Journal 155, no 4)
- In Norway, the government sends patients waiting for extended periods to private treatment in other countries (Jan Ove Ness, "Norwegian Patients in EU Hospitals: The Medical Treatment Abroad Project", Norwegian Insurance Administration)
- Stockholm's health services council began privatizing all primary care in 1998 and sold St Gor(a)n's, one of the largest hospitals, to a private company in 1999. Funding comes from the government. Cost per consultation in private practices compared to public hospital outpatient clinics ranges from 13% lower in general surgery, internal medicine and dermatology to 17% lower among ear, nose and throat specialists and 28% lower in ophthalmology....costs for lab and x-ray services fell by 50% and overall costs by 30%, private nursing home costs were 30% lower, st goran's now treats 100k more patients a year (A. Wess Mitchell 'Sweden Edges Toward Free-Market Medicine' National Center for Policy analysis, Brief Analysis 369, Aug 2001)
Waiting times
- In England, populations 60 mil, 1 million are waiting to be admitted to hospitals at any one time (Waiting List Figures, Nov 2001' UK Department of Health, Press Release 2001)
- In Canada, population 31 mil, 876,584 are waiting for all types of treatment (Esmail an Walker, "Waiting Your Turn: Hospital Waiting Lists in Canada, 13th edition" Oct 2003, Fraser Institute)
- In Norway, population 4.5 mil, 270,000 are waiting in queues on any given day (Hoel and Saether, "Private Health Care as a Supplement to a Public Health System with Waiting Time for Treatment" Frisch Center for Economic research, Oslo, 2000)
- In New Zealand, population 3.6 mil, waiting lists for surgery and other treatments are 90,000 strong (purchasing for yor health)
- Only 16% of a population of developed countries enters hospital at all (Anderson and Pullier, "Health Spending, Access and Outcomes: Trends in Industrialized Countries" Health Affairs 18, no 3, 1999)
- Canada, 2003, 8.3 weeks from referral to specialist to consultation, 9.5 weeks another before treatment, including surgery (Esmail an Walker, "Waiting Your Turn: Hospital Waiting Lists in Canada, 13th edition" Oct 2003, Fraser Institute)
- In New Zealand, of 90,000 people waiting in 1997, 20,000 waited for more than two years ("Purchasing for your Health 1996/97" NZ Ministry of Health. March 98)
- Adam Smith Institute says current NHS waiting lists will wait 1 million years longer than doctors deem acceptable (Young, Butler, "The Million Year Wait")
- Britain's National Audit Office reported that "inappropriate adjustments" have been made to make them seem smaller (Sir John Bourn, Comptroller and Auditor General, "Inappropriate Adjustments to NHS Waiting Lists", Dec 2001)
- Patients having to wait more than four months for surgery, by country - US 5%, Aus 23%, NZ 26%, Can 27%, Britain 36% (Schoen, Blendon, DesRoches, Osborn "Comparison and HEalth Care Systtem Views and Experiences in Five Nations, 2001" Commonwealth Fund, May 2002/ Harvard School of Public Health) Public Health)
America's uninsured
- 43.6 million Americans, 15.2%, lack insurance, but about 1/3 qualify for gov't coverage through low-income children or medicaid, 1/3 in households with more than $50/k yr
- Of those who become uninsured, 74.7% obtain insurance within the year, 2.5% remain insured for more than 3 yrs (Devon Herrick, 'Uninsured by Choice: Update' Brief Analysis no 460, National Center for Policy Analysis, Oct 2003)
- About one in six uninsured persons lives in a family with an income between $50,000 and $75,000, almost one in six earns $75,000. Between 1993 and 1999, the number of uninsured increased by 57% in household earning between $50,000 to $75,000 and by 114% among households earning $75,000+, while households earning less than $50,000 number of uninsured dropped 2%. Less than 25K, 24%, 25-50K, 34%, 50-75K, 16%, 75K+, 16% (Robert J Mills, 'Current Population Reports, Health Insurance Coverage: 1999' 60-211, US Census Bureau, Sep 2000
Equality
- The Black report found little evidence that British health care was any more equal than when NHS started ('Inequalities in Health, UK Department of Health and Social Security), and Acheson report found access had become less equal (Independent Inquiry into Inequalities in Health' Stationery Office)
- Low income people in the US without job-related insurance spend only about $50 more out of pocket for health than those with, 2.4 visits to doctor each year (3.4 without). When they are seriously ill, they receive same level of treatment (Johnson and Crystal, "Uninsured Status and Out of Pocket Costs at Midlife', Health Services Research 35, no 5, Dec 2000)
Life expectancy
- "To analyze the question of life expectancy, I examined the relationship between average life expectancy and income distribution in 1995, using a statistical technique called regression analysis. I also examined the relationship between average life expectancy and per capita GDP. To focus on the distribution of income without the confounding effect of living in an impoverished society, I limited my data collection to 24 advanced countries having a per capita GDP of $7,500 or more. Among the results:
"There is a positive relationship between life expectancy and a more equal income distribution that is statistically significant but not particularly strong, leading to a predicted 7.1-year difference in life expectancy between the most-and least-egalitarian countries in the sample, based on inequality alone.
· "However, there is also a positive, statistically significant relationship between life expectancy and per capita income, leading to a predicted 6.3-year difference between the highest and lowest per capita GDP countries in the sample, based on income alone. statistical analysis involving average life expectancy and its relationship to a combination of factors
- "Per capita GDP, an index of government transfers and subsidies as a share of GDP and an index of total government expenditures as a share of GDP, reveals that the fiscal activity of government does not add a day to the length of our lives." Gerald Scully, Brief Analysis No. 328 Tuesday, July 18, 2000
- Japanese-americans and Japanese have similar LE ("How Not to Judge our Health Care System" National Center for Policy Analysis, Brief Analysis 141, 1994)
- As do whites and europeans (eberstadt, 'the tyranny of numbers: mismeasurement and misrule' AEI, 1995 - US LE men: black 68, indian 73, white 75, hispanic 77, asian 81, women black 75, white 80, indian 82, hispanic 84, asian 87 (National Projections Program, Population Division, US Census Bureau, Jan 2000)
- Infant mortality rates: Blacks, 13.7, Puerto Ricans, 7, Whites, 6, Asians, 5 (Infant Mortality Statistics from the 1997 period: Linked Birth/Infant Death Data Set" National Vital Statistics reports 47, no 23 july 1999)
Advanced technology
- In availability of advanced medical technology, Canada ranks last out of the 29 OECD countries ('It's the Prices, Stupid: Why the United States is so Different from Other Countries' Anderson, Reinhardt, Hussey and Petrosyan, Health Affairs, vol 22, no 3, May 2003)
- MRI units per capita: 2.5 canada, 3.9 UK, 8.1 US; CT scanners, 13.6 US, 8.2 Can, 6.5 UK, Lithotripsy units 1.5 US, .4 can, .2 UK (ibid)
- Coronary bypass (per 100,000 people per yr), 203 US, 65 Can, 41 UK, coronary angioplasty 388.1 US, 80.8 Can, 51 UK, renal dialysis US 86.5, Can 45.7, UK 27
- Yearly mammograms, cost per year of life saved: age 55-64 $110,000, 40s $190,000...cervical cancer tests: cost per year of life saved, every 4 yrs vs. never $12,000, every 3 vs 4 $220,000, 2 vs. 3 $310,000, 1 vs 2 $1,500,000 vs 2 $1,500,000 (Tengs et al, 'Five Hundred Lifesaving Interventions and their Cost-Effectiveness')
Quality
- % of individuals 65+ reporting health as 'good', Aus 70.8, Can 70.2, Denmark 59.7, Ger 47.4, Neth 56.8, Nor 62.3, Swe 55.5, UK 56.5, US 72.6 (OECD Health Data, 2002)
- Ages 45-64: Aus 81.8, Can 84.9, Den 74.2, Ger 58.2, Neth 71.7, Nor 75.6, Swe 71.1, UK 71, USA 85.4
- In Britain, 20% of colon cancer considered curable at diagnosis are incurable by time of treatment (The Observer, "Cash-strapped NHS Hospitals Chase Private Patient Bonanza" Anthony Browne Dec 2001)
- Survey: Long wait to see doctor problem? 14/21/24, (US, UK, Canada) Difficulty seeing specialist due to long wait? 40/75/86, Long wait for nonemergency surgery? 5/38/27, Surgery delayed due to cancellation? 5/10/16 (Blendon, et al 'Inequities in Health Care: A Five-Country Survey' Health Affairs, vol 21, no 3, May/June 2002)
- Breast cancer mortality ratio (% of those who have it that die from it) NZ 46 UK 46 Germ 31 Can 28 US 25 France 35 Aus 28 (ibid)
- Prostate cancer mortality ratio - NZ 30 UK 57 Ger 44 Can 25 US 19 France 49 Aus 35 (bid)
- Britons are more likely to be killed by an infection caught in a hospital than by a car accident ('Watchdog Healthcheck' BBC online news Jan 2001)
- 5000/yr die ('NHS bugs kill 5000 a year' BBC Online News, Feb 2000)
Prescription drugs
- Only one in five drugs tested ever makes the market, averaging $900 million in costs for each new drug (Press release, "Total Cost to Develop a New Prescription Drug, Including Cost of Post-approval Research, is $897 Million" May 13, 2003, Tufts Center for the Study of Drug Development)
- Economist Patricia Danzon discovered, excluding generic drugs (42% of US purchases), ignoring different consumption patterns, and ignoring rebates as a result of controlled study, comparing between 187 to 484 products, average prices in Canada, Germany, Sweden and Switzerland higher than us, but France, Italy, Japan, and the UK arelower. But when variations of income are accounted for, USA is lower than all except France (Danzon, 'The Uses and Abuses of International Price Comparisons' in 'Competitive Strategies in the Pharmaceutical Industry, R. B. Hems (AEI press 1996), also 'Pharmaceutical Price Regulation: National Policies Versus Global Interests (AEI 1997)
- Columbia University professor Frank Lichtenberg found that each dollar spent on drugs is associated with a four dollar decline in hospital spending (22) and reduction in the age of drugs reduces spending on hospitalization and doctor visits by 7.2 times as much as it increases drug expenditure. The number of hospital stays, bed days and surgical procedures declines most rapidly for those diagnoses with the greatest increase in the total number of drugs prescribed and the greatest use of new drugs (Frank Lichtenberg, 'Benefits and Costs of Newer Drugs: An Update' National Bureau of Economic Research, NBER working paper w6569, May 1998)
- By shopping around, best price shopping versus Canadian drugs, for seven of ten drugs, US buyers can lower their costs an average of 38% below Canadian price, and all ten drugs produces average cost of 10% below buying in Canada (Survey of pharmaceutical websites by 'Lives at Risk: Single Payer Health Insurance Around the World')
- In Europe, the European Agency for the Evaluation of Medicines must approve the drug, drug makers must negotiate selling price with each national government, and must separately negotiate the reimbursement rate (subsidy) paid by the EU. As a result, a major new medication treating the nervous system was not accessible to patients for three additional years in France and six in Portugal after US introduction...anti-infection therapy already available in other EU countries was not accessible to patients for three years in Belgium and France and more than four years in Portugal and Greece...new cardiovascular drug available in other EU countries was withheld for almost three years from patients in Portugal, Spain and Greece ('Patient Access to Major Pharmaceutical Products in EU Member States' Europe Economics, 1998)
- In Britain, the lack of access to the best cancer drugs costs lives of 25,000 Britons (Karol Sikora, 'Cancer Survival in Britain' British Medical Journal 319, no 7208 (Aug 1999) 461-62)
- In Canada, the Patented Medicines Price Review Board decides if drugs are a substantial improvement over existing drugs and allows higher prices. Between 1994 and 1998, only 24 of the 400 drugs were approved (William McArthur, 'Prescription Drug Sosts: Has Canada Found the Answer?' NCPA, NCPA brief analysis no 323 May 2003)
Also, each province has a review committee. Of 23 cardiovascular drugs approved between 1991 and 1998, one province covered only ten, while another covered twenty-three (Devidas Menon, 'Pharmaceutical Cost Control in Canada: Does it Work?' Health Affairs no 20, no 3, May/June 2001) 99)
- University of Toronto study concluded that the main effect of price controls has been to limit patients' choice and cause them to rely more on hospitals and surgery (William McArthur, 'Prescription Drug Sosts: Has Canada Found the Answer?' NCPA, NCPA brief analysis no 323 May 2003)
