Cette semaine se tient au Manoir St-Sauver la rencontre du World Health Executive Forum, rencontre abondamment dénoncée par la gauche québécoise car durant cet événement on risque de parler du gros méchant secteur privé…

À chaque fois qu'il est question du privé en santé, on se fait invariablement dire: "aux États-Unis c'est privé, leur système coûte cher et ne vaut rien". Il est plus que temps de nuancer cette affirmation.

Premièrement l'espérance de vie. Quand on regarde l'espérance de vie globale, il est vrai que les États-Unis se classent en queue de peloton. Mais l'espérance de vie "globale" n'est pas un indicateur de la qualité des soins de santé. Si on calcule l'espérance de vie en retirant les morts accidentelles (meurtres, suicides, accidents de la route…), qui ne révèlent rien sur la nature des soins reçus et qu'on se concentre sur la mortalité découlant de maladies, voici ce qu'on obtient:

Le supposément médiocre système américain est associé à la plus haute espérance de vie dans les pays de l'OCDE !

Ce n'est pas tout, voici le taux de survie des gens ayant souffert d'un cancer:

Notez que ces résultats englobent tous les américains, pas seulement ceux avec une assurance. Encore une fois, les États-Unis se retrouvent au premier rang. Le taux de guérison aux États-Unis est aussi supérieur à celui du Canada.

Un préjugé assez répandu veut qu'il n'existe aucun système de santé public aux États-Unis. C'est faux, le réseau public américain est subventionné à hauteur de 6.9% de leur PIB, un taux identique à celui du Canada. La moyenne pour les pays de l'OCDE est de 6.4%.

Mais contrairement aux canadiens, les américains peuvent aussi contribuer au réseau privé, ce qu'ils font à hauteur de 8.5% de leur PIB. Le surplus déboursé par les américains leur permet d’avoir des extras qui ne sont pas disponibles au Canada. Si les américains déboursent autant de leur poche pour des soins privés c’est simple: c’est parce qu’ils sont riches et qu’ils peuvent se le permettre !

Voici des graphiques que j'avais déjà publiés dans un billet précédant:

Santé Public Privé

Santé Public Privé Santé Public Privé

Santé Public Privé Santé Public Privé
Source: The Commonwealth Fund

Je vous rappelle que dans cette série de graphiques, le Canada est le seul pays qui n'utilise pas le privé dans son réseau de soins de santé…

Je vous laisse avec une étude comparative du système de santé canadien publiée par The Fraser Institute:

Fraser Institute
High-priced Canadian health care system provides poor access to care compared to other nations
Release Date: November 05, 2007

Canada spends more on health care than any industrialized nation except Iceland and Switzerland yet we rank near the bottom in terms of access to physicians and new medical technology, according to a new study released today by independent research organization The Fraser Institute.

“Canada’s health care system, in its current format, does not meet the standards set by other industrialized countries, despite being one of the most expensive systems in the world,” said Nadeem Esmail, Director of Health System Performance Studies at The Fraser Institute and co-author of the How Good is Canadian Health Care? 2007 Report.

“When you look at the results achieved by countries such as Japan or Sweden, both of whom have better results at lower costs, it becomes clear that simply pouring more money into the Canadian system is not the answer.”

The peer-reviewed study, How Good is Canadian Health Care? compares Canada to other OECD (Organization for Economic Co-operation and Development) countries that guarantee access to health care regardless of ability to pay. Twelve indicators of access to health care and outcomes from the health care process are examined including access to physicians, access to high-tech medical equipment, and key health outcomes. The United States and Mexico are not included in the study because they do not have universal-access systems

The study focuses on how Canada needs to organize its health care program to provide universal access to high quality care in a timely fashion. To answer this question, which is also the focus of the current debate about health care reform in Canada, the study examines whether other industrialized countries with universal-access health care have implemented the type of policies that are hotly contested and opposed in Canada, but have been shown to produce superior access to health care and better outcomes at a lower cost.

User Fees and Private Providers

The study found that health care costs can be significantly reduced if consumers of care have to participate in paying for the care they demand through some form of user fees. More than three quarters of the universal-access countries in the OECD charge user fees for access to hospitals, general practitioners, or specialists—in many cases, to all three. Low income citizens are often exempted from these fees.

“When it comes to banning user fees, Canada is in the minority,” Esmail said.

Even more surprising, Canada is the only country in the OECD that outlaws privately funded purchases of core services. Every other OECD country has some form of user-pay, private provision of health care. While many OECD countries also rely almost exclusively on public hospitals to provide publicly insured services, more than half of the countries permit private providers to deliver publicly funded care.

“Those who support the status quo and oppose reform here in Canada are behind the times. They don’t seem to realize that throughout Europe, Asia and elsewhere in the developed world, nations have built efficient, highly-functioning health care systems by blending public and private health care,” Esmail said.

Comparing Health Outcomes

The study finds that Canada, while spending more on health care than any other industrialized country in the OECD except Iceland and Switzerland, ranks 17th in the percentage of total life expectancy that will be lived in full health; ranks 22nd in infant mortality, 15th in perinatal mortality, fourth in mortality amenable to health care, ninth in potential years of life lost to disease, 10th in the incidence of breast cancer mortality, and second in the incidence of mortality from colorectal cancer.

The Number of Doctors

On an age-adjusted, comparative basis, Canada, relative to comparable countries of the OECD, has a small number of physicians, ranking 24th out of 28 countries with 2.3 doctors per 1,000 people for a total of 68,171 doctors. To rank as highly as first-ranked Greece, Canada needed 61,679 more doctors than we actually had in 2004. Notably, Canada had the second-highest ratio among 20 OECD countries for which data were available in 1970. Since 1970, however, all but one of these countries have surpassed Canada’s growth in doctors per capita. While the age-adjusted proportion of doctors in Canada grew by 24 per cent, the average increase in the proportion of doctors in the other 19 countries was 149 per cent.

It’s impossible to determine if Canada has too many or too few doctors in an absolute sense, but we have fewer doctors per capita on an age-adjusted basis than most other countries in the OECD and report longer waits for access to treatment.

Access to Technology

With regard to age-adjusted access to high-tech machinery, Canada performs dismally by comparison with other OECD countries. While ranking number three as a health care spender, Canada ranks 13th of 24 in access to MRIs, 18th of 24 in access to CT scanners, seventh of 17 in access to mammographs, and ties with two other nations at 17th of 20 in access to lithotriptors. Lack of access to machines also means longer waiting times for diagnostic assessment, and mirrors the longer waiting times for access to specialists and to treatment found in the comparative studies examined for this study.

“The evidence is overwhelming; the Canadian health care model is inferior to those used in other OECD countries. The models that work best have user fees; alternative, comprehensive, privately funded care; and private hospitals that compete for patient demand,” Esmail said.

“None of these reforms mean the Americanization of Canadian health care. The choice is between what we have now and finding a better way to deliver universal access to health care. It’s about emulating the successful models in European and Asian countries that do a better job than Canada’s at delivering on the promise of universal access to high quality care in a timely fashion regardless of ability to pay.”