1 Copyright (c) The Fraser Institute 2004 How Good Is Canadian Health Care? n Presentation to the Nassau Institute and the Atlas FOundation n Michael Walker,

1

Copyright (c) The Fraser Institute 2004

How Good Is Canadian Health How Good Is Canadian Health Care?Care?

Presentation to the Presentation to the Nassau Institute and the Nassau Institute and the Atlas FOundationAtlas FOundation

Michael Walker, Michael Walker, Executive DirectorExecutive Director

The Fraser InstituteThe Fraser Institute 23 April, 200423 April, 2004

Copyright © The Fraser Copyright © The Fraser Institute, 2004Institute, 2004

2


Why we did this studyWhy we did this study

1.1. Lengthening wait lists for health accessLengthening wait lists for health access

Our research over the past decade has been showing:Our research over the past decade has been showing:

3


GP Referral to Treatment 1993/2003

17.6

18.5

29.9

15.1

14.3

20.1

21.1

19.4

19.9

21.8

17.7

10.4

10.5

9.8

10.5

9.2

7.3

12.3

11.5

17.1

10.6

9.3

0 5 10 15 20 25 30 35

BC

AB

SK

MB

ON

QC

NB

NS

PE

NF

CN

Pro

vin

ce

Median Wait (Weeks)

19932003

4


GP Referral to Treatment: 1993/2001-02

17.7

6.1

8.1

11.1

13.0

14.1

32.2

20.1

10.3

16.4

30.0

15.3

28.6

9.3

2.5

5.3

4.4

9.0

13.2

19.5

12.9

5.8

10.2

14.6

8.8

14.3

0 5 10 15 20 25 30 35

Weighted Median

Medical Oncology

Radiation Oncology

Internal Medicine

Urology

Cardiovascular Surgery (Elective)

Orthopaedic Surgery

Neurosurgery

General Surgery

Otolaryngology

Ophthalmology

Gynaecology

Plastic Surgery

Median Wait (Weeks)

19932003

5


A Typical Attitude………..?A Typical Attitude………..?

““Administrators maintain waiting lists on Administrators maintain waiting lists on purpose the way airlines overbook. As for purpose the way airlines overbook. As for urgent patients on the list who are in pain, the urgent patients on the list who are in pain, the public system will decide when their pain public system will decide when their pain requires care.These are societal decisions. requires care.These are societal decisions. The individual is unable to decide rationally.”The individual is unable to decide rationally.”

Charles Wright, then Vice-president Vancouver Charles Wright, then Vice-president Vancouver Hospital Hospital (Source: Readers Digest Interview 1992)(Source: Readers Digest Interview 1992)

6


Very or extremely difficult to see a Very or extremely difficult to see a specialist. By income strata, 2001specialist. By income strata, 2001

Source:CommonwealthFundSurvey, 2002

0

5

10

15

20

25

30

35

Australia Canada NewZealand

UnitedKingdom

UnitedStates

Below-Avg Income

Above-Avg Income

7


Better Access To Care?Better Access To Care?

Source: Blendon et al. (2002)Source: Blendon et al. (2002)

0%

10%

20%

30%

40%

50%

60%

70%

Perc

en

t o

f R

esp

on

den

ts

Difficult to see aspecialist

Waited More than OneMonth for Non-

Emergency Surgery

Australia

Canada

New Zealand

United Kingdom

8


Access is Better than 2 Years AgoAccess is Better than 2 Years Ago

Source: Commonwealth Fund Survey, 2002

0

5

10

15

20

Australia Canada New Zealand UnitedKingdom

United States

9


Rated overall medical care as: excellentRated overall medical care as: excellent


0

5

10

15

20

25

30


United States

10


Rated overall medical care as: Fair or Rated overall medical care as: Fair or PoorPoor


0

2

4

6

8

10

12

14

16


United States

11


Change in Citizens’ Approval of Change in Citizens’ Approval of Health Care System 2001-1990Health Care System 2001-1990

-35-30-25-20-15-10

-505

10

Australia Canada UnitedKingdom

UnitedStates

Australia

Canada

United Kingdom

United States

SourceSourceCommonwealth FundCommonwealth FundSurvey 2002Survey 2002

12


Change in Citizens’ Demand for Change in Citizens’ Demand for Fundamental Reform 2001-1990Fundamental Reform 2001-1990

-10

-5

0

5

10

15

20

25

Australia Canada UnitedKingdom

UnitedStates

Australia

Canada

United Kingdom

United States

SourceSourceCommonwealth FundCommonwealth FundSurvey 2002Survey 2002

13


Angus Reid Polls Angus Reid Polls

0

10

20

30

40

50

60

70

1991 1993 1995 1996 1998 1999 2000

Excellent/Very Good

Fair/Poor/Very Poor

Medicare in Canada works just fine the wayit is now……….37 per cent Agree

14


Percentage Needing Care Not Received - By Income Group

0

1

2

3

4

5

6

7

8

Lowest Lower Middle Middle Upper middle Highest

Income Group

Pe

rce

nta

ge Canadian Average

Source:Statistics Canada Population Survey

15


Mortality and IncomeMortality and Income

““Heart attack patients who live in poorer Heart attack patients who live in poorer neighborhoods are dying at a higher rate and neighborhoods are dying at a higher rate and experience greater barriers to specialist experience greater barriers to specialist services than more wealthy Ontarians”services than more wealthy Ontarians”

““For every $10,000. Increase in average For every $10,000. Increase in average neighborhood income there was an associated neighborhood income there was an associated 10% reduction in risk of death”10% reduction in risk of death”

Source: New England Journal of Medicine, October, 1999Source: New England Journal of Medicine, October, 1999

16


Does Canada have one tiered Does Canada have one tiered medicine?medicine?

Peter Coyte and University of Toronto Researchers, Peter Coyte and University of Toronto Researchers, April 25, 2000April 25, 2000

““Wealthier and more highly educated Canadians are Wealthier and more highly educated Canadians are almost 30 percent more likely to see a specialist…almost 30 percent more likely to see a specialist…

““Removing financial barriers doesn’t necessarily mean Removing financial barriers doesn’t necessarily mean that everybody has equal access to health care...that everybody has equal access to health care...

““It appears that a multi-tier health care system exists in It appears that a multi-tier health care system exists in Canada even for those services covered under the Canada even for those services covered under the principle of universal access in the Canada Health Actprinciple of universal access in the Canada Health Act

17


WhyWhy we did this studywe did this study


2.2. Widening gaps between actual and clinically Widening gaps between actual and clinically reasonable waiting times for proceduresreasonable waiting times for procedures

Our research over the past decade has been Our research over the past decade has been showing:showing:::

18


Actual and Reasonable Wait for Treatment 2003

4.8

2.1

3.6

2.6

3.0

6.1

0.9

7.3

4.2

4.0

5.3

7.1

5.4

8.2

9.5

2.6

6.1

5.7

5.7

10.7

2.1

18.9

7.7

5.9

10.0

16.0

7.3

17.0

0 2 4 6 8 10 12 14 16 18 20

Weighted Median

Medical Oncology

Radiation Oncology

Internal Medicine

Urology

Cardiovascular Surgery (Elective)

Cardiovascular Surgery (Urgent)

Orthopaedic Surgery

Neurosurgery

General Surgery

Otolaryngology

Ophthalmology

Gynaecology

Plastic Surgery

Median Wait (Weeks)

Actual

Reasonable

19





3.3. Declining relative access to advanced Declining relative access to advanced technologytechnology

Our research over the past decade has been Our research over the past decade has been showingshowing::

20


What is the state of medical What is the state of medical technology in Canada?technology in Canada?

A compilation of OECD data A compilation of OECD data Fraser Institute Survey of Medical TechnologyFraser Institute Survey of Medical Technology A Canada-U.S. comparison based on direct A Canada-U.S. comparison based on direct

hospital comparisonhospital comparison

21


Direct Hospital ComparisonDirect Hospital Comparison

Hospitals in Oregon, Washington and British Hospitals in Oregon, Washington and British ColumbiaColumbia

Teaching hospitals - availability of technology Teaching hospitals - availability of technology and proceduresand procedures

Regional hospitals of comparable sizeRegional hospitals of comparable size

22


Some procedures and machines Some procedures and machines not available at all in not available at all in B.C….Canada?B.C….Canada?

Based on data developed from comparative Based on data developed from comparative surveys made by the Fraser Institute of surveys made by the Fraser Institute of teaching hospitals and non-teaching hospitals teaching hospitals and non-teaching hospitals in Oregon, Washington and British in Oregon, Washington and British

Columbia Columbia

23


Therapies and procedures not Therapies and procedures not available end of 1998 in available end of 1998 in B.C…..Canada?B.C…..Canada?

Intraoperative Transesophageal Intraoperative Transesophageal ecocardiography for anesthesia ecocardiography for anesthesia

Echocardiography with harmonic imagingEchocardiography with harmonic imaging Radioactive balloon AngioplastyRadioactive balloon Angioplasty Emergency Room dedicated ultrasoundEmergency Room dedicated ultrasound GI endoscopic UltrasoundGI endoscopic Ultrasound GI Endoscopic laserGI Endoscopic laser Minilaproscopy (3mm)Minilaproscopy (3mm) Frameless StereotaxyFrameless Stereotaxy

24


More procedures not availableMore procedures not available

Laparoscopic laser ablation of the Laparoscopic laser ablation of the EndometriumEndometrium

3D guided sinus surgery3D guided sinus surgery Intraoperative CT scansIntraoperative CT scans Open type MRIOpen type MRI MRI breast coilMRI breast coil Pet scan for clinical usePet scan for clinical use Laser angioplastyLaser angioplasty BrachytherapyBrachytherapy Laser prostatectomyLaser prostatectomy

25


Comparing non-teaching hospitals Comparing non-teaching hospitals of comparable size in Canada and of comparable size in Canada and the U.S.the U.S.

26


Intensive Care Facilities

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Intensive CareUnit

Cardiac ICU Pediatric ICU Neonatal ICU

Washington

Oregon

British Columbia

27


Availability of Diagnostic ImagingTechnology

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ultrasound CT Scanner Nuclear Medicine MRI

Washington

Oregon

British Columbia

28


Cardiac Procedures Technology

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Angioplasty CardiacCatheterization

Lab

Coronary ArteryBypass Graft

Transplant

Washington

Oregon

British Columbia

29






4.4. Long waits for treatment and diagnostic Long waits for treatment and diagnostic machinesmachines

Our research over the past decade has been Our research over the past decade has been showingshowing::

30


CT Scans

6.0

6.0

8.0

6.0

5.0

4.5

4.0

4.0

6.0

8.0

5.2

6.0

6.0

6.8

7.0

5.0

6.0

4.0

4.0

8.0

4.0

5.5

0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0

BC

AB

SK

MB

ON

QC

NB

NS

PE

NF

CN

Pro

vin

ce

Median Wait (Weeks)

2003

2001-02

31


MRI Scans

18.0

8.0

14.0

9.0

11.0

13.5

5.0

16.0

12.0

20.0

12.4

12.0

12.0

20.0

10.0

10.0

15.0

8.0

24.0

12.0

24.0

12.7

0.0 5.0 10.0 15.0 20.0 25.0 30.0

BC

AB

SK

MB

ON

QC

NB

NS

PE

NF

CN

Pro

vin

ce

Median Wait (Weeks)

2003

2001-02

32


Ultrasound

2.5

3.0

2.0

10.0

2.0

4.0

4.0

4.0

9.0

7.5

3.2

2.5

2.8

2.0

8.0

2.0

6.0

4.0

3.0

6.0

6.0

3.6

0.0 2.0 4.0 6.0 8.0 10.0 12.0

BC

AB

SK

MB

ON

QC

NB

NS

PE

NF

CN

Pro

vin

ce

Median Wait (Weeks)

2003

2001-02

33


Waiting for Radiotherapy - Cancer

0 10 20 30 40 50

T2NoMo Larynx

Stage IIIb NSCLC

Stage B2 Prostate

T2NoMo Breast

Bone Metastases

Spinal CordCompress

Days

Actual Wait U.S.

Medically Acceptable Wait U.S.

Medically Acceptable Wait Canada

Actual Wait Canada

Source: Dr. William McKillopChief of OncologyOntario Regional Cancer CentreKingston, Ont.1996

34






4.4. Comparative shortages of treatment and Comparative shortages of treatment and diagnostic machinesdiagnostic machines

5.5. Disconnection between health spending and Disconnection between health spending and access across the provincesaccess across the provinces

Our research over the past decade has been Our research over the past decade has been showing:showing:

35


Spending and waiting, 1993-2003

0

5

10

15

20

25

30

35

40

1500 1700 1900 2100 2300 2500 2700 2900

Real Per Capita Spending (2001 dollars)

Wai

ting

Tim

e (w

eeks

)

36


Monopoly hospitals pay too much Monopoly hospitals pay too much for their labourfor their labour

$10

$12

$14

$16

$18

$20

$22

$24

Hospital Wage

Hotel Wage

37


Monopoly hospitals pay too much Monopoly hospitals pay too much for their labourfor their labour

0%

5%

10%

15%

20%

25%

30%

35%

40%

% D

iffe

ren

ce

38


So, That’s why we did the study So, That’s why we did the study How Good Is Canadian Health Care?How Good Is Canadian Health Care?

How much does Canada spend?How much does Canada spend? How does our access to doctors and technology How does our access to doctors and technology

compare with other equal access OECD countries?compare with other equal access OECD countries? Does the Canadian health care system produce Does the Canadian health care system produce

better outcomes than others equal access better outcomes than others equal access countries in the OECD?countries in the OECD?

How does Canadian health policy compare with How does Canadian health policy compare with that in other equal access, publicly funded health that in other equal access, publicly funded health care systems?care systems?

This comparative study does not include the U.S. This comparative study does not include the U.S. since it is not a universal access systemsince it is not a universal access system

39


How Much Do We Pay for Health How Much Do We Pay for Health Care Compared to Other Countries?Care Compared to Other Countries?

Spending as a share of GDP in 1999Spending as a share of GDP in 1999

40


Age Matters for Health Care CostsAge Matters for Health Care Costs

Seniors (over 65) accounted for 12.5% of the Seniors (over 65) accounted for 12.5% of the population in 2000-01 population in 2000-01

Consumed 42.7 percent of total health Consumed 42.7 percent of total health expenditures that yearexpenditures that year

Canada has the 7Canada has the 7thth lowest proportion of lowest proportion of population over age-65population over age-65

41


Age-adjusted Health Spending in Age-adjusted Health Spending in the OECD 2001the OECD 2001

0

2

4

6

8

10

12

% G

DP

Source: OECSource: OEC

42


Do We Get Our Money’s Worth (in Do We Get Our Money’s Worth (in an age adjusted way) ?an age adjusted way) ?

Doctors?Doctors?

High-tech machines?High-tech machines?

Access to care?Access to care?

Is our health care system performing Is our health care system performing better than the rest?better than the rest?

43


Doctors in the OECDDoctors in the OECD

0 0.5 1 1.5 2 2.5 3 3.5

Doctors per 1000 population (Age Adjusted, 2001)

TurkeyNetherlandsSpain (1998)

New Zealand (2000)United Kingdom

PolandSlovak Republic

CanadaSwitzerland

Sweden (2000)OECD Avg.

GreecePortugal

LuxembourgAustralia

Belgium (1998)Hungary

DenmarkNorway

GermanyFinlandFrance

Czech Republic (2000)Austria

Source: OECD (2003)Source: OECD (2003)

16th16th

44


MRI Machines in the OECDMRI Machines in the OECD

0

5

10

15

20

MR

I M

ach

ines

Per

Mil

lio

n P

op

ula

tio

n (

Ag

e A

dju

sted

, 20

01)

Japa

n

Icel

and

Switzerla

nd

Korea

Austria

Finlan

dIta

ly

Sweden

Denmar

k

OECD Avg

.

Germ

any

Australia

Spain

Luxem

bourg

United

Kingdom

Canada

New Zeala

nd

Belgiu

m

Portugal

France

Czech

Repub

lic

Greece

Slovak

Rep

ublic

Hungary

Poland


15th15th

45


CT Scanners in the OECDCT Scanners in the OECD

0

5

10

15

20

25

30

CT

Scan

ners

Per

Mil

lio

n P

op

ula

tio

n

(Ag

e A

dju

ste

d,

2001)

17th17th

Japan: 73.7Japan: 73.7

Korea: 44.8Korea: 44.8


46


Radiation Therapy Machines in Radiation Therapy Machines in the OECDthe OECD

0

2

4

6

8

10

12

14

16

18

Rad

iati

on

Th

era

py M

ach

ines P

er

Mil

lio

n

Po

pu

lati

on

(A

ge A

dju

ste

d,

2001)


8th8th

47


Lithotripters in the OECDLithotripters in the OECD

0

1

2

3

4

5

Lit

ho

trip

ters

Per

Mil

lio

n P

op

ula

tio

n

(Ag

e A

dju

ste

d,

2001)


Korea: 7.9Korea: 7.9

14th14th

48


Comparisons of Age Adjusted Comparisons of Age Adjusted AccessAccess

1616thth of 23 countries for access to physicians of 23 countries for access to physicians

1515thth of 24 countries for access to MRI machines of 24 countries for access to MRI machines

1717thth of 23 countries for access to CT scanners of 23 countries for access to CT scanners

88thth of 22 countries for access to radiation therapy of 22 countries for access to radiation therapy machinesmachines

Last (tie) of 15 countries for access to LithotriptersLast (tie) of 15 countries for access to Lithotripters


49


Does it really matter that we don’t Does it really matter that we don’t have access to doctors or machines?have access to doctors or machines?

How do the health outcomes in Canada How do the health outcomes in Canada compare to those in other countries?compare to those in other countries?

50


Disability Free Life Expectancy Disability Free Life Expectancy in the OECDin the OECD

82%

84%

86%

88%

90%

92%

94%

Source: OECD (2003); WHO (2000)Source: OECD (2003); WHO (2000)

14th14th

51


Infant Mortality in the OECDInfant Mortality in the OECD

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

Rate

per

1,0

00 L

ive B

irth

s


16th16th

Poland, Hungary, and Turkey not shown

52


Perinatal Mortality in the OECDPerinatal Mortality in the OECD

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

Rate

per

1,0

00 B

irth

s


12th12th

53


Mortality in the OECDMortality in the OECD

0

100

200

300

400

500

600

700

800

900

Rate

per

100,0

00 (

1999)


9th9th

54


Potential Years of Life Lost in the Potential Years of Life Lost in the OECDOECD

1500

1700

1900

2100

2300

2500

2700

2900

3100

Years

(1999)


9th9th

Czech Republic, Portugal, Poland, Slovak Republic, and Hungary not shown

55


Mortality Amenable to Health Care in Select Mortality Amenable to Health Care in Select OECD CountriesOECD Countries

0

20

40

60

80

100

120

140

Mo

rtali

ty p

er

100,0

00 (

1998)

Source: Nolte and McKee (2003)Source: Nolte and McKee (2003)

8th8th

56


Breast Cancer Mortality in the Breast Cancer Mortality in the OECDOECD

0%

10%

20%

30%

40%

50%

60%

Source: Ferlay et al. (2001)Source: Ferlay et al. (2001)

6th6th

57


Colon/Rectum Cancer Mortality in Colon/Rectum Cancer Mortality in the OECDthe OECD

0%

10%

20%

30%

40%

50%

60%

70%

Co

mb

ine

d M

ale

an

d F

em

ale

Mo

rta

lity

Source: Ferlay et al. (2001)Source: Ferlay et al. (2001)

1st!1st!

58


How do Canadian Health Outcomes How do Canadian Health Outcomes Compare to other Equal Access Compare to other Equal Access Countries?Countries?

Disability Adjusted Life Expectancy, Disability Adjusted Life Expectancy, 14th14th Infant and Perinatal Mortality, Infant and Perinatal Mortality, 16th and 12th16th and 12th Mortality from all causes not external or ill Mortality from all causes not external or ill

defined, defined, 9th9th

1.1. Preventable Years of Life Lost Preventable Years of Life Lost 9th9th2.2. Mortality Amenable to Health Care Mortality Amenable to Health Care 8th8th3.3. Surviving Breast Cancer Surviving Breast Cancer 6th6th4.4. Surviving Colon/Rectum Cancer Surviving Colon/Rectum Cancer 1st1st

59


Why Are We first in the Spending Why Are We first in the Spending Column but not in the Column but not in the

Access or Health Care Outcomes Access or Health Care Outcomes Columns?Columns?

There are three reasonsThere are three reasons PolicyPolicy POLICYPOLICY

POLICY!POLICY!

60


What do Sweden, France and What do Sweden, France and Australia have that Canada does Australia have that Canada does

not?not?

1. Lower cost health care1. Lower cost health care

2. User fees at the point of access to healthcare2. User fees at the point of access to healthcare

3. Parallel private medical insurance3. Parallel private medical insurance

4. Parallel private hospitals4. Parallel private hospitals

5. Parallel private for-profit health care delivery5. Parallel private for-profit health care delivery

61


How Does Canada Compare in How Does Canada Compare in Health Care Policies that Health Care Policies that

Affect Health Care System Affect Health Care System Performance?Performance?

62


Cost Sharing – User Fees, Cost Sharing – User Fees, Deductibles and Co-payments - in Deductibles and Co-payments - in

the OECDthe OECD

0%

10%

20%

30%

40%

50%

60%

70%

80%

Overall Hospital GP Specialist

Cost Sharing

No Cost Sharing

63


Providers of Public Health Care in Providers of Public Health Care in the OECD.the OECD.

0%

10%

20%

30%

40%

50%

60%

Public Ownership/Management Mixed Ownership

64


But, don’t forgetBut, don’t forget

Every single one of the OECD countries, except Every single one of the OECD countries, except Canada and the Czech Republic have a Canada and the Czech Republic have a PRIVATE ALTERNATIVE so you don’t have to PRIVATE ALTERNATIVE so you don’t have to wait if you don’t want to.wait if you don’t want to.

65


Private Parallel Health Care in the Private Parallel Health Care in the OECDOECD

0

10

20

30

40

50

60

70

80

90

100

Available Not Available

66


Is Canada Unique?Is Canada Unique?

Only two of the 27 countries surveyed Only two of the 27 countries surveyed have no comprehensive private provision have no comprehensive private provision of care: Canada and the Czech Republic.of care: Canada and the Czech Republic.

Canada is the only country to have full Canada is the only country to have full public management of hospital resources public management of hospital resources and no private parallel insurance system.and no private parallel insurance system.

Canada is the only country to effectively Canada is the only country to effectively outlaw private parallel health care.outlaw private parallel health care.

67


Rank middle of the road in health Rank middle of the road in health care outcomescare outcomes

Rank at the bottom in access to Rank at the bottom in access to care, supply of technologies, supply care, supply of technologies, supply of physiciansof physicians

Rank at the very top in spendingRank at the very top in spending

So…So…How Good How Good IsIs Canadian Health Care? Canadian Health Care?

68


Lessons Learned…Lessons Learned…

The models that produce superior results The models that produce superior results and cost less than Canada’s have:and cost less than Canada’s have:

User feesUser fees

Alternative, comprehensive, private Alternative, comprehensive, private insuranceinsurance

Private for-profit hospitalsPrivate for-profit hospitals

69


The lesson from Canada for The lesson from Canada for Bahamian Health Care ReformersBahamian Health Care Reformers

Canada is only one of many Universal Access Canada is only one of many Universal Access Health Care models in the OECDHealth Care models in the OECD

Canada has been able to provide reasonably Canada has been able to provide reasonably comprehensive insurance – though some comprehensive insurance – though some remain uncoveredremain uncovered

Canada has not solved the health care access Canada has not solved the health care access problem in general or for low income peopleproblem in general or for low income people

Some combination of public and private Some combination of public and private provision system as in Sweden, France or provision system as in Sweden, France or Australia is likely to be the best option for the Australia is likely to be the best option for the BahamasBahamas

70


Health and Economic FreedomHealth and Economic Freedom

Economic Freedom of the World ProjectEconomic Freedom of the World Project Economic Freedom NetworkEconomic Freedom Network The Nassau InstituteThe Nassau Institute

71


0

10

20

30

40

50

60

70

Yea

rs

Bottom20

Next 20 Middle20

Next 20 Top 20

Economic Freedom Quintiles, 2000

Health Adjusted Life Expectancy 2001

72


0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

Pro

ba

bili

ty

Bottom20

Next 20 Middle20

Next 20 Top 20


Probability of Death Ages 15-59, 1999

73


0

0.02

0.04

0.06

0.08

0.1

0.12

Yea

rs

Bottom20

Next 20 Middle 20 Next 20 Top 20


Probability of Death Before Age 5, 1999

74


0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

Eq

ua

lity

Ind

ex

Bottom20

Next 20 Middle20

Next 20 Top 20


Equality of Child Survial, 1997

75


Available at www.fraserinstitute.ca. Available at www.fraserinstitute.ca.

76


The End……phew!The End……phew!

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Documents

1 Copyright (c) The Fraser Institute 2004 How Good Is Canadian Health Care? n Presentation to the Nassau Institute and the Atlas FOundation n Michael Walker,