Can money buy health? (Comments).

All of us welcome the increased spending on health care in the current federal and provincial budgets. Most professionals in the field see this flow of money as a beginning, and argue that much more is and will be needed because of the growing numbers of aged in our population.

Will money necessarily buy health? On page 7 of this issue, we have a report of a u.s. study of Medicare expenditures by regions. (Medicare is the public plan that provides health care services for the aged). The study found broad differences in costs by regions. For instance, nearly twice as much was spent per person in Miami than in Minneapolis. The essential differences emerged in the number of services and treatments rendered to each patient. At the conclusion of the study, the researchers found no differences in the outcomes: people lived just as long and were equally satisfied with their treatments in all parts of the country. The seniors were just as healthy or sick in the low spending areas as in the higher spending ones.

Other comparative studies show more health care spending does not necessarily make a difference. Among the developed countries that make up the Organization of Economic Cooperation and Development (OECD), the United States spends more (including private and public funds) than any other country. Yet, rates of mortality and pathology are better in Canada as well as other lower spending countries.

We have our special experience in Canada. During the dozen years that we have been living with decreased spending on health care, we were uneasy with the delays and uncertainties in getting treatment. Health care personnel coped as best they could. Nevertheless, the health of Canadians did not decline and even improved in some categories. The Canadian experience, as well as other studies, suggests money may buy us more and better health care, but it will not necessarily buy us better health.

We remind ourselves that most of the great advances in general health in most countries came not only from doctors, pills, and scanning machines, but largely from other measures--better housing, better nutrition, income security measures, industrial health and safety, shorter work week, education, safe drinking water, parks and recreation services. Currently, one of the important gaps in our health picture is the homeless who are exposed to conditions that cause or exacerbate physical and mental health.

In the race to increase funding for health care services, we neglect the other areas that contribute to general health. In most provinces, budgets for other social services contributing to general health are declining. Services for seniors that do not include multi-million dollar machines are being cut drastically. Yet, a large number of research efforts all over the world have indicated social and other programs for seniors that keep them actively engaged in life, contribute greatly to their general health and well-being, and cut the costs of health care.

According to Victoria University's Neena Chappell: "The facts now show that, when we look at the big picture, more medical technology is not always the best way to serve seniors or society as a whole." Chappell also states: "The real bargain in seniors' medical care is preventive measures in younger age groups." International comparisons support this contention. Those OECD countries that spend less than Canada or the us on health care spend considerably more on other social programs for all age groups.

These are not dramatic programs. They have none of the glamour of brand new institutions and shiny Mm machines. They involve thousands of smaller, lower cost efforts, and employ non-medical staff and volunteers. These programs do cost, but not nearly as much as the health care system will cost if we continue to finance them in as thoughtless a fashion as we do now.

The next big social and political issue for all Canadians should be general health, not just health care. Social programs that contribute to better living should be seen as contributing to the general health of the population, and not as competitors for funds at the expense of the health care system, or vice versa. Otherwise, it is a bottomless pit there will never be enough money for health care services alone.

Yes, money can us buy us health, but only if we act wisely, and deal with the total picture of health and well-being for all Canadians.--L.K.