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Health Care Systems:An International Comparison

Strategic Policy and ResearchIntergovernmental Affairs

May 2001


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Taxes Social Security Funds Private Insurance

Australia (1992) 4

Canada (1990) 4

Denmark (1993) 4

France (1990) 4

Germany (1989) 4

Italy (1988) 4

Japan (1991) 4

Netherlands (1983) 4

Norway 4

Sweden 4

Switzerland (1991) 4

United Kingdom (1994) 4

United States (1990) 4

Health systems main source of financing

Most industrialized countries have established hybrid systems in which

the public sector, which has the greater share of responsibility, works

alongside the private sector, both in the funding of health care

Source: Blanchette, Claude, Public and Private Sector Involvement in Health Care Systems: An International Comparison , Bulletin 438E,

Library of Parliament, 1997


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Australia (1992) 75 --- 25

Canada (1990) 98 --- 2

Denmark (1993) Most --- ---France (1990) 65 16 19

Germany (1989) 51 35 14

Italy (1988) 80 20 0

Japan (1991)* 19 --- 81

Netherlands (1983) 15 85 0

Norway Most --- ---Sweden Most --- ---

Switzerland (1991)* 46 32 22

United Kingdom (1994)* 5 90 5

United States (1990)** 27 59 14

Main Delivery Entity of Hospital Health Care

(as percentage of hospital beds)

and in the delivery of hospital care

* As percentage of hospitals ** As percentage of acute-care hospital bedsSource: Blanchette, Claude, Public and Private Sector Involvement in Health Care Systems: An

International Comparison, Bulletin 438E, Library of Parliament, 1997

Public Non-Profit Private


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With the exception of Germany and the United States, most of the

industrialized countries have universal publicly funded health care

systems

Percentage of Total Population with Public Insurance (1997)

100.0 100.0 100.0 100.0 100.0 100.0 100.0 99.592.2

45.0

0

1020

30

40

50

60

7080

90

100

Australia Canada Denmark Italy Japan Sweden United

Kingdom

France Germany United

States

%

Source: 2000 OECD Health Data


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The payment of user fees is a common practice in most OECD

countries, but this practice is less widespread in Canada

D: Deductible, C: Co-insurance *Depending on provinces

Source: Blanchette, Claude, Public and Private Sector Involvement in Health Care Systems: An International Comparison, Bulletin 438E, Library of

Parliament, 1997

PublicPublic HealthHealth Care UserCare User FeesFees1993 ($CDN)1993 ($CDN)

Australia $5-$8 $11 --- ---

Canada --- D/C* --- ---

Denmark --- 0%-50% --- ---

France 25% 30%-100% 20%


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Public coverage of complementary care

Countries coveringalmost all care

Countries not covering the following care

Drugs Glasses Dental care Prostheses Other

Canada1

United StatesAustralia

United

Kingdom2

Portugal3

Sweden2

Canada


United

Kingdom

France

Japan

Austria

Canada


France

Austria

Canada

United StatesFrance

Portugal

Canada4

United StatesJapan5

New

Zealand6

1. The Canadian system covers only drugs received in hospitals. Drugs prescribed outside hospitals are paidin part or entirely by consumers, by private insurance or by public provincial insurance.

2. Affordable Drugs 3. Some pharmaceutical products 4. Private hospital care and sanatoria5. Medical check-up, private room and injection 6. Outpatient care

Germany

Italy

Belgium

Denmark

Finland

Greece

Iceland

Luxembourg

Norway

Spain

Not counting the United States, Canada has among the most limited

publicly funded extended care coverage in the OECD countries

Source: Blanchette, Claude, Public and Private Sector Involvement in Health Care Systems: An International Comparison,

Bulletin 438E, Library of Parliament, 1997


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Canada spends about the same percentage of GDP on health care as the

G7 average, while the US spends substantially more

Health Spending as a percentage of GDP (1997)

6.58.3

7.1 6.47.2

5.66.7

5.3 5.7 5.8

7.42.4

2.5 2.9 2.8 1.42.8

1.3

2.3 1.5 1.0

6.4

0

2

4

6

8

10

12

14

US Germany France G7Average

Canada Sweden Australia Denmark Italy Japan UK

%

Public Spending Private Spending



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The United States spends a larger percentage of its GDP on health care

mainly because of higher labour, administrative and malpractice

insurance costs

Administrative Costs as a Percentage of Health Spending

7.5

3.13.6

0.80.2

6.9

8.3

3.7

5.9

7.8

0

2

4

6

8

10

Germany United States Australia Canada France

%


* 1994 for Australia, Canada, Switzerland, 1995 for Germany and 1996 for France and United States.



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Canadas public spending as a percentage of overall health care spending is

lower than in many industrialized countries but higher than in the US

Public Health Spending as a Percentage of Total Health Spending

84 8478 78 76 75 75

67

56

41

83 85 84

70

8077

7074

6759

46

90

0

1020

30

40

50

60

70

80

90

100

Sweden UK Denmark Italy Japan Germany Canada France Australia G7

Average

US

1990 1997


%


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Per-capita health care spending in Canada is lower than the G7

average, while it is subtantially higher in the United States

Per-Capita Health Spending

1997

1,9011,621 1,517 1,520 1,712

1,2741,469 1,406

1,128 1,177

2,194

1,126 542658 527

330

635293 354

485 214

1,822

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

US G7Average

Germany Canada France Denmark Australia Sweden Japan Italy UK

$US



* Data in US dollars converted with purchasing power parity.


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Growth of per-capita public spending during the 1990s was substantially

below the G7 average in Canada, while it was above the G7 average in the

United States

Average Annual Growth of Per-Capita Health Spending

1990-1997

9.27.7

7.1

5.4 5.3 5.1 4.9

1.91.1 1.0

0.3

8.2

4.0

6.8

5.0

2.1

4.83.9

6.07.5

9.7

19.1

0

2

4

6

8

1012

14

16

18

20

Germany US Japan G7Average France UK Australia Canada Italy Sweden Denmark

%




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Public Health Spending as a Share

of Total Government Spending

1414

1415 15 14

1213

1211

13

20

17 17 16 1615

1513 13

1112

0

5

10

15

20

25

US Germany G7

Average

Japan Australia Canada UK France Denmark Italy Sweden

%

1990 1997

While the share of public spending allocated to health care is lower than

the G7 average in Canada, it is higher in the United States



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Number of Physicians* and Nurses**

per 1,000 persons, 1997

5.8

3.4 3.1 3.0 2.9 2.7 2.7 2.5 2.1 1.8 1.7

4.9

9.510.2

5.9

77.4

8.3

9.5

7.6 7.4

4.5

0

2

4

6

8

10

12

Italy Germany Sweden France Denmark G7

Average

US Australia Canada Japan UK

Physicians Nurses

* 1996 for Japan, United Kingdom, Denmark, Sweden and the G7 average.

**1996 for Italy, Japan, United Kingdom, Australia, Denmark, Sweden and the G7 average.


Health care delivery in Canada is dependent on a smaller number of

physicians than the average for the G7 countries


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* Data in US dollars converted with purchasing power parity.** 1991 for UK, 1992 for Canada and Germany, 1995 for Sweden and 1997 for France and Japan.


Physicians incomes are substantially higher in the United States than

in other industrialized countries

Annual Average Income of Physicians

1996**

199,000

104,700 100,781

62,273 62,007 58,416 55,944 52,54740,774

0

40,000

80,000

120,000

160,000

200,000

240,000

US Germany C anada Japan France Denmark Australia UK Sweden

$US*


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Canada has far fewer scanners and magnetic resonance imaging

machines per capita than the United States and the G7 average

Units of Scanners and MRIs per one million persons*69.7

28.1 26.9

20.817.1

14.6 13.7

9.7 8.16.3 5.8

11.3

16.0

2.96.2

4.16.8

2.5 1.73.4 2.5

18.8

0

10

20

30

40

50

60

70

80

Japan

(1996)

G7

Average

US

(1993)(1995)

Australia

(1995)

Germany

(1997)

Italy

(1997)

Sweden

(1993)(1995)

France

(1997)

Canada

(1997)

UK

(1993)(1995)

Denmark

(1990)

Scanners Magnetic Resonance Imaging



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Life expectancy in Canada compares favourably with the other G7

countries, while the United States compares less favourably

Life Expentancy

1997

80.079.0 78.5 78.2 78.1

77.2 77.2

75.7

78.1

76.7

71

74

77

80

Japan Canada Sweden Italy France G7

Average

UK Germany US Denmark

Source: World Health Report 1999

Number

of years


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Canada and the United States rank poorly on some health status

indicators, although Canada outperforms the United States

* 1995 for Italy, 1996 for Canada, Denmark, United States and Sweden** 1993 for Denmark and Italy, 1996 for United States and Sweden, 1997 for Germany and United Kingdom

*** 1993 for Denmark and Italy, 1994 for Japan, 1996 for United States and Sweden and 1997 for Germany andUnited Kingdom1 Includes ischaemic heart diseases, acute myocardial infarction, cerebrovascular diseases and others.


Health IndicatorsRank Infant Mortality Rate Cancer Mortality Rate Heart Disease mortality 1

per 1,000 births per 100,000 persons per 100,000 persons

(1997*) (1995**) (1995***)

1 Japan (3.7) Japan (156) France (173)

2 Sweden (4.0) Sweden (158) Japan (178)

3 Germany (4.8) Australia (177) Canada (227)4 France (4.8) United States (183) Australia (255)

5 Australia (5.3) Canada (184) Italy (271)

6 Denmark (5.6) Germany (184) Sweden (273)

7 United Kingdom (5.9) France (186) United States (280)

8 Canada (6.0) Italy (195) United Kingdom (282)

9 Italy (6.2) United Kingdom (192) Germany (308)10 United States(7.8) Denmark (227) Denmark (328)


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Only 23 percent of Canadians, compared with over one third of Americans,

feel that their health care system needs to be completely rebuilt

system works pretty well, only minor changes needed

they did not get needed care in past year

it is very difficult for themselves or family

members to see a specialist or consultant

they had problems paying medical bills in the past12 months

amount spent in the past year on medical bills not

covered by insurance was more than US $750

the medical care they and their family received in the

past 12 months has been excellent or very good

completely rebuild the health care system

recent system changes will harm quality of care

30%

19%

28%

8%

35%

10%

19%

54%

23%

20%

45%

10%

47%

5%

9%

54%

32%

9%

38%

12%

34%

15%

10%

54%

14%

25%

12%

10%

29%

3%

1%

50%

33%

17%

18%

14%

40%

18%

29%

49%

Source: The Commonwealth Fund 1998 International Health Policy Survey

Australia Canada New Zealand UK US% of public saying:

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