What Bahamas Can Learn from Global Experience with Health Policy?

1. What Bahamas Can Learn from Global Experience with Health Policy? • Nassau • June 21, 2007 • Michael Walker • Senior Fellow • The Fraser Institute

2. Plan of Discussion • Why should you listen to what I have to say? • Health Care Policy in Context • Myth Versus Reality about the Canadian Model and its comparative performance • Alternative futures for Bahamian Policy

3. Why Should You listen to me? • Bahamians -- like many Americans-- are apparently attracted by the Canadian health care model • I have been researching the Canadian model since 1978 and public policy for nearly 40 years • For 17 years my colleagues and I have been measuring the extent of rationing in the Canadian system and its comparative performance • Recently, the Canadian Supreme Court agreed with our research in finding that the combination of the actual performance of the Canadian health care system and the prohibition of private care in Canada violated the constitutional rights of Canadian citizens.

4. Background to the Health Care Debate - General Issues? • Wealthy people and nations tend to be Healthy • Policy can increase the health care access of the less wealthy by taxing the income of the wealthy • Human and financial capital try to avoid taxes and the competition for both kinds of capital is global • Nations which attempt to solve the health problem of the less wealthy by taxing human and financial capital will attract less of both • Therefore, policy which pursues gains in population health without careful attention to the growth and per capita income effects of the methods chosen may produce short term gains at the expense of larger long term loses

5. Background to the Health Care Debate – Specific Issues II? • Health care will become the largest non-traded sector of the Bahamian Economy • It will be the source of the most interesting jobs and the highest tech employment in the economy. • The policies you set there will have a huge impact on the Economic Policy setting overall and your economic success as: • -Tax Policy is affected by the health tax • -Labour policy is affected by GBE growth • -The structure of your politics is affected by PS unions • -The technological sophistication of you country is affected by politicization of capital allocation

6. How has Overall Bahamian Policy Been Doing? • Fraser Institute in conjunction with Institutes in 70 countries has been measuring policy in 130 countries since the 1970s • The measures score 38 policies 1 to 10 and rank the countries • The following slides show how Bahamas performance has changed over time

7. Bahamas Versus the Top Ten Source: The Fraser Institute.

8. Bahamas Competitive Policy Rank Source: The Fraser Institute.

9. The Quality of Policy Really Matters

10. Per Capita Income and Economic Policy Quality Quartile Worst Policy…………… Best Policy Sources: The Fraser Institute; The World Bank, World Development Indicators CD-ROM, 2005.

11. Growth in Real GDP Per Capita and Policy Quality Quartile Worst Policy …………….Best Policy Sources: The Fraser Institute; The World Bank, World Development Indicators CD-ROM, 2005.

12. Human Poverty Index and Policy Quality Quartile Worst Policy …………..Best Policy Sources: The Fraser Institute; United Nations Development Programmme, Human Development Indicators 2005, available at http://hdr.undp.org/statistics/data/index_indicators.cfm.

13. Human Development Index and Policy Quality Quartiles Worst Policy …………Best Policy Sources: The Fraser Institute; United Nations Development Programmme, Human Development Indicators 2005, available at http://hdr.undp.org/.

14. Life Expectancy at Birth and Policy Quality Quartiles Worst Policy ………… Best Policy Sources: The Fraser Institute; The World Bank, World Development Indicators CD- ROM, 2005.

15. Infant Mortality and Policy Quartile Worst Policy………..….Best Policy Sources: The Fraser Institute; The World Bank, World Development Indicators CD-ROM, 2005.

16. % of Population Using Improved Water Sources and Policy Quartile Worst Policy ……………Best Policy Sources: The Fraser Institute; The World Bank, World Development Indicators CD-ROM, 2005.

17. As is clear from this global scan…The Quality of Policy Really Matters For BahamiansAndWe can se the effects of Bahamas’ policy decline

18. Bahamian Per Capita Income Rank declining compared to the World Source: The Fraser Institute.

19. 1970-85 Average Per Capita Growth 1.27% 1985-2000 Average Per Capita Growth 0.06%

20. So, The decline in Policy Quality is showing up in lower average incomes and lower growth rates. Apart from any other development, this is going to reduce the comparative health status of Bahamians

21. The Canadian Case • The only country in the OECD that has an exclusively public sector single payer for heath care is Canada • The Canadian system should be carefully studied before launching a National Health Insurance plan in The Bahamas • The following is a careful set of measurements of the Canadian system. • These measurements caused the Canadian Supreme Court to rule that the provisions of the sort of System we have were injurious to the health of Canadians and violated their Constitutional Rights.

22. Age-adjusted Health Spending in the NHI OECD Nations 2003 Source: OECD (2006) Calculations by Authors

23. Inflation Adjusted Provincial/Territorial Spending Per Person Source: CIHI (2006)

24. Health Results:Getting What We Pay For?

25. Health Results:Waiting Times

26. Median Wait by Province, 2006

27. Median Wait by Specialty, 2006

28. Waiting For Care – 2006 v. 1993

29. Actual Wait Time v. Reasonable

30. Wait Times for Diagnostic Technology

31. Diagnostic Wait Times in 2006

32. Canadians Wait Longer Than Others Source: Schoen et al. (2005 )

33. Canadians Wait Longer Than Others Source: Schoen et al. (2005)

34. Canadians Wait Longer Than Others Source: Schoen et al. (2005)

35. Health Results:Access to Doctors & Technology

36. Doctors in the OECD 24th Source: OECD (2006) Calculations by Authors

37. MRI Machines in the OECD Japan (2002): 29.9 13th Source: OECD (2006) Calculations by Authors

38. CT Scanners in the OECD Japan (2002): 78.4 Korea: 49.4 17th Source: OECD (2006) Calculations by Authors

39. Mammographs in the OECD 7th Source: OECD (2006) Calculations by Authors

40. Lithotriptors in the OECD 18th Source: OECD (2006) Calculations by Authors

41. Comparisons of Age Adjusted Access • 24th of 28 countries for access to physicians • 13th of 24 countries for access to MRI machines • 17th of 23 countries for access to CT scanners • 7th of 17 countries for access to Mammographs • 18th of 20 countries for access to Lithotriptors

42. Health Results:Health Outcomes

43. Life Expectancy in Full Health in the OECD 16th Source: OECD (2006); WHO (2006)

44. Infant Mortality in the OECD Turkey not shown 21st Source: OECD (2006)

45. Perinatal Mortality in the OECD Turkey not shown 14th Source: OECD (2006)

46. Mortality from Disease in the OECD 8th Source: OECD (2006) Calculations by Authors

47. Potential Years of Life Lostin the OECD Portugal, Czech Republic, Poland, Slovak Republic, and Hungary not shown 9th Source: OECD (2006) Calculations by Authors

48. Medically Avoidable Mortality (MAHC) Slovak Republic, and Hungary not shown 4th Source: WHO (2006) Calculations by Authors

49. Breast Cancer Mortalityin the OECD 10th Source: Ferlay et al. (2004) Calculations by Authors

50. Colon/Rectum Cancer Mortalityin the OECD 2nd Source: Ferlay et al. (2004) Calculations by Authors