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Assembling Canada’s Health System Profile for the European Observatory
Monitoring Health Systems Change/ReformsPAHO/WHO Seminar, Belize, 30 May 2006
Gregory P. Marchildon, Ph.D.Canada Research Chair in Public Policy and Economic History
Graduate School of Public Policy, University of Regina
G.P. MarchildonGraduate School of Public Policy
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G.P. MarchildonGraduate School of Public Policy
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Comparative Template
• European Observatory on Health Systems and Policies (WHO Regional Office for Europe)
• Health Care Systems in Transition (HiT) profiles: focus on Europe but a few exceptions …
• Australia, New Zealand, and now …• Canada• Common questions• Compulsory tables, figures, and diagrams
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Comparator Countries
• Canada not part of WHO’s European database• Rely on OECD health database (2004)• 5 countries selected on basis of history, size,
wealth and political or policy considerations– Australia– France– Sweden– United Kingdom – United States
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Systematic Comparisons: Quantitative and Qualitative
1. Health status2. Organizational structure: governance and
management3. Financial resources: revenues and
expenditures4. Regulation and planning5. Physical and human resources6. Provision of services7. Health care reforms8. Assessment: public, mixed and private
Total Health care expenditures as a share of GDP in Canada and selected countries, 1960 to 2002
0
2
4
6
8
10
12
14
161
96
0
19
70
19
80
19
85
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
% o
f G
DP
AUST CAN FR SWE UK US
Public Health Care Expenditures as a share of GDP in Canada and selected countries, 1960 to 2002
0
1
2
3
4
5
6
7
8
91
96
0
19
70
19
80
19
85
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
% o
f G
DP
AUST CAN FR SWE UK US
Comparatives Trends in real PUHE, PRHE, and THE, cumulative % change, 1990-2001
Comparative Health Status Indicator Rankings (OECD rankings in brackets)
Life Expectancy at
Birth(1999)
Potential Years of LL per 100,000
(1997)
Perinatal Mortality per
100,000 (1999)
DPT Immunization% of Children
(1997)
Measles Immunization% of Children
(1998)
SWEDEN 1 (4) 1 (1) 2 (7) 1 (2) 1 (6)
CANADA 2 (5) 2 (8) 3 (13) 4 (22) 2 (7)
AUSTRALIA 3 (7) 3 (9) 1 (3) 6 (25) 5 (18)
FRANCE 4 (8) 5 (15) 4 (17) 2 (8) 6 (19)
UK 5 (18) 4 (10) 5 (18) 3 (18) 4 (15)
USA 6 (20) 6 (22) 6 (20) 5 (23) 3 (13)
Malignant Neoplasms
(2000)
Cerebro-vascular Diseases
(2000)
Respiratory
System Diseases
(2000)
Ischaemic Heart
Diseases (2000)
SWEDEN 1 (2) 5 (11) 1 (4) 4 (16)
CANADA 4 (15) 1 (2) 3 (10) 3 (12)
AUSTRALIA 2 (8) 4 (5) 4 (12) 2 (11)
FRANCE 5 (18) 2 (3) 2 (8) 1 (3)
UK 6 (20) 6 (18) 6 (25) 6 (22)
USA 3 (14) 3 (4) 5 (22) 5 (21)
Comparative Disease Indicator Rankings (OECD rankings in brackets), 2000
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Observations and Conclusions
• Importance of comparative perspective• Allows you to ask better questions• But rarely provides direct or conclusive
answers• Health system performance?
– Health status– Health care (amenable mortality)– Fiscal performance– Patient/user/citizen satisfaction
