08 - International comparisons

Why do we look at how other countries organize and deliver health care?

• Opportunity to learn about alternative approaches

• Different approaches can impact health outcomes

No two countries are alike – how to reasonably compare?

• Generally regarded as ‘developed countries

• High-income countries

  • World Bank: Gross National Income

  • High Human Development Index

A country is considered high income if its

GNI (Gross National Income) per capita is more than $13,845 USD per year.

GNI per capita means

the average income per person in that country.

what do notice from this photo

• North America, Western Europe, Australia, Japan, and some Middle Eastern countries are mostly high income.

• Many countries in Africa, South Asia, and parts of Latin America are not high income.

• Russia and some Eastern European countries are in the “former high-income” category.

High human development index

Quantifies a country's "average achievement in three basic dimensions of human development: a long and healthy life, knowledge, and a decent standard of living“ (UN)

Health outcomes

• Influenced by a variety of social and economic factors

  • Many of these factors are outside the control of health care systems

    • Policies and public investments in education, employment, nutrition, housing, transportation, and environmental safety

• Broad and population-based

Health care outcomes

• Outcomes that can be improved by the delivery of health care services

• ‘silos’!

  • Primary care

  • Specialized care (hospitals)

  • Long-term care

  • Rehabilitation, pharmaceuticals, diagnostics, dental care, mental health care, traditional/ complementary/ alternative medicines, vision care…

• Specific to services/interventions

Health outcomes vs health care outcomes: focus

• Health outcomes are broader and focus on the general health status of individuals or populations.

• Healthcare outcomes are specific to the results from healthcare services or medical interventions.

Health outcomes vs health care outcomes: Factors

• Health outcomes are determined by a wide range of factors, including non-healthcare determinants like social and environmental conditions.

• Healthcare outcomes are primarily influenced by the quality of healthcare delivery, which includes access, provider competence, and the effectiveness of treatment protocols.

Health outcomes vs health care outcomes: Perspective

• Health outcomes are often used in public health contexts to assess population well-being, government policies, or lifestyle changes.

• Healthcare outcomes are used to assess the performance of healthcare providers, hospitals, or specific interventions in a medical or clinical setting.

Health outcomes vs health care outcomes: example cancer

Health outcomes: The presence of cancer (e.g., cancer incidence or survival rate)

→ This describes the population’s health status.

Health care outcomes: Cancer treatment options like: Surgery, Chemotherapy, Immunotherapy, Radiation, Hormone therapy
→ How effective these treatments are would be a healthcare outcome.

Health outcomes vs health care outcomes: example cancer

Health outcomes: Having diabetes or measuring diabetes rates
→ Reflects the population’s overall health

Health care outcomes: Diabetes treatment options like: Insulin, Medications, Gene therapy (future), Artificial intelligence tools, Stem cell therapy

How does Canada compare to other healthcare to other high income countries

Goal: To compare health care system performance of 11 high-income countries

Methods: Analysis of performance measures drawn from Commonwealth Fund, OECD, and WHO data

Findings: Norway, Netherlands, and Australia are top performers; US ranks last overall, despite spending the most

Health care system performance domains - Access to care

Affordability and timeliness

Health care system performance domains - Care process

Preventive care, safe care, coordinated care, engagement and patient preferences

Health care system performance domains - Administrative efficiency

How well health systems reduce documentation and other bureaucratic tasks

Health care system performance domains - Equity

Income-related disparities in access to care, care process, and administrative efficiency

Health care system performance domains - Health care outcomes

Outcomes most responsive to health care: infant mortality rate, life expectancy, maternal mortality, avoidable mortality

Health Care System Performance Rankings

1st - nor

2nd - neth

3rd - aus

10th - can

11th - us

Health Care Spending as a Percentage of GDP, 1980–2019

Factors Influencing Healthcare Spending

1. Healthcare model/market driven systems

2. Population demographics

3. Efficiency and cost containment

4. Health system coverages and accessibility

5. Technological innovation and resource intensity

Interpretation and Balance from the photo

• Higher % of GDP not necessarily correlated with health outcomes

• Low % of GDP potentially underinvestment

• Balance = strong outcomes without breaking the bank

Key Points

Context Matters:

• higher spending may indicate greater investment or inefficiencies, while lower spending could indicate underinvestment.

Not Just Spending, but Value:

• Evaluating healthcare requires looking beyond spending to the value provided, which includes outcomes like life expectancy, health equity, and overall population health.

Different Countries, Different Strategies:

• Comparing shows that the effectiveness of spending depends on the healthcare model, efficiency, and equity policies.

Health Care System Performance Scores: Affordability

Health Care System Performance Scores: Equity

Cost-Related Access Problems Affect

Low Income Populations, Especially in the U.S.

4 Lessons learned from top performing countries

Provide universal coverage and remove cost barriers so people can get the car they need in a way that works for them

Invest in primary care systems to ensure highvalue services are available equitably, reducing risk of discrimination and unequal treatment

Reduce administrative burdens that cost patients and clinicians time and effort and can discourage access to care, especially for marginalized groups

Invest in social services that increase equitable access to nutrition, education, childcare, community safety, housing, transportation, and worker benefits, leading to healthier population and less demands on health system

organization of the healthcare system in canada

organization of the healthcare system in the us

US health care stats

• us public spending is similar to other countries; out-of-pocket and private spendinng are higher than most

• the us has the lowest life expectancy

• suicide rate are the highest in the us

• adults have the highest chronic disease burden

• highest rate of obesity

• high rate mri scans

• among the highest rate of hospitilizations from preventable causes like diabetes and hypertension

• highest rate of avoidable deaths

Why does the US spend so much more, and apparently get so much less?

Administrative costs

• Physician & hospital administrative activities

• Insurance administrative costs

Norway healthcare system

• Universal healthcare

• Primary care is the backbone

• High levels of health equity

• Centralized Management

• Quality of Care

• Public health and prevention

• Government investment and public trust

• Universal healthcare

• Publicly funded through taxation

• Minimal out-of-public

• Primary care is the backbone

• Gatekeepers

• Strong focus on prevention

• High levels of health equity

• Available to everyone, even in remote/rural areas (has incentive policies)

• Mitigates socioeconomic status impact on health outcome

• Centralized Management

• National coordination reducing duplication and promoting standardization

• Digitalization of healthcare – very efficient

• Quality of Care

• Integrated and coordinated services, seamless patient journey

• Strong standards for safety and training (low rates of medical errors)

• Public health and prevention

• High emphasis on population health

• Addresses SDOH (e.g., housing, income inequality, welfare model)

• Government investment and public trust

• High spending – staff, resources, spaces

• Strong public and political support for the welfare state

What are some takeaways when we explore international perspectives?

• Performance domains provide a lends for evaluation

• Comparative analysis reveals strengths and weaknesses

• Spending is not always correlated with outcomes

• Resources allocation is an important strategy

• Balancing cost and value

• QALYs, patient satisfaction, equity

• Equity and access are crucial indicators of system effectiveness

• Efficiency drives sustainability

• Holistic health systems thrive – prevention, physical and mental