A Canadian's Perspective on Health Care
A Canadian's Perspective on Health Care
Canadian medicare is administered by the provinces. The national program is a set of standards and some funding. Each province has some wiggle room. Ontario completes its funding through a payroll tax whereas BC charges $54/mo per individual ($99/mo for a family). Poor people have the payment waived. Employed people have it paid by their company. There is a 3-month wait time to qualify to avoid drop-in health care. Hospitals also do private fund-raising for improvements to their facilities.
National medicare insurance grew out of an implementation in one province (Saskatchewan). After five years it had proved to be cost effective in improving medical services and saving money. It was promoted to national status. It has proven to be cost-effective. Some side effects include less income for our doctors, but recently also substantially less liability insurance to balance off their lower income.
There are some abuses from people going to the doctor for every ache or pain or even for colds and the flu. But on average it privides good medical repair services for the money.
Here is the latest data on wait times for major surgery in BC. Average wait time for the province is under 4 months. My hospital, Vancouver General, is about half that.
The wait list data can be troublesome. But the statistic about operations performed during the quarter in the specific hospital are the most accurate, because they have to report this accurately to get paid.
People that don't know the system try to infer that wait times are bad. The government does not determine the supply. That is done by the free market. Because access to specialists is "free", there are no artificial constraints on demand. And, yes, urgent cases are handled on a priority basis. First time referrals usually take the longest unless they are urgent.
(DW and I are both going in for colonoscopies from the same GP. It is her second time and she gets it in 2 months, I wait 6 months because it is my first time. Both are routine screening so not urgent.)
There are some user-pay choices. I can get a virtual colonoscopy tomorrow if I want peace of mind and am willing to open my wallet. Lens implants come in two versions. The new improved foldable ones have a user-pay premium of $300 whereas the standard lens is free.
There are many walk-in clinics for routine items like kids' earaches to avoid overloading either the GP or hospital emergency. More serious emergencies such a broken bones require emergency ward treatment and these tend to be overloaded at certain times resulting in extended wait times. All the life-threatening cases get handled first, e.g. bleeding, concussions.
The Canadian walk-in clinics offer the convenience of being in your neighbourhood and are usually faster - 15 minutes instead of 30 minutes waiting in the emergency ward. And parking is often free as well.
There are two tiers for many things already. Blue Cross insurance provides many enhancements such as semi-private hospital rooms, wheel chairs, nursing in the home...
Private company insurance covers dental, drugs, eye care coverage (glasses, lens). And even in the core services such as opthamology, cataract surgery is covered but the new foldable lens are a $300 option. Laser surgery corrective procedures are not covered by anyone.
Also, there have been many improvements in the last 5 years to the basic services through infusion of new cash. The feds went through a period of cutbacks to balance their budget. But they have been running increasing budget surpluses for over 5 years and this enabled them to open the purse a bit further. Most of the press has been aimed at increasing pressure on the federal government and it is working. National funding for the health care system comes from general revenues and from sin taxes on alcohol, tobacco and gasoline.
But the low penetration of MRI, PET, and CT machines does not seem to causing a problem. In fact one of the problems is the CIHI's inability to tie a high penetration number to improved survival rates. IOW a business case. BTW much of the data available is pretty old and no longer representative.
January 13, 2005—A new report released today by the Canadian Institute for Health Information (CIHI) shows Canada had 151 MRI scanners at the beginning of 2004, more than four times the number it had a decade ago (40), and up from 144 the previous year. The report, Medical Imaging in Canada, 2004 also notes a 44% increase in the number of CT scanners during the last decade, from 234 to 338. Since 1997, more MRI scanners than CT scanners were installed.
I guess if I was diagnosed with a brain tumor, I would pay to go to The Mayo Clinic for my MRI and treatment. There are certain things where money is no object. But I would not want anyone claiming it is because I could not get it in Canada.
We had quite an exodus to the US of experienced doctors about ten years ago. This made it hard to get into see a doctor when you moved. You always could if your knew how to work the system. This gave impetus for high growth of the walk-in clinics. New doctors saw it is a fast way to establish a practice and share costs.
Last year there was a net influx of doctors from the US because, after paying for the escalating malpractice insurance, they were netting less for the first time in decades. There are still areas underserviced. When my son moved his family to Belleville east of Toronto, it took a year to get a new family doctor there. This was four years ago. They used walk-in clinics but everyone likes to have a family doctor.
Canadians Healthier Than Americans, Survey Says - Forbes.com
Canadians are healthier than Americans, have better access to health care and have fewer unmet health needs, a new study of both countries reveals.
...
While Americans were more likely to identify cost as the impediment to care, Canadians were more likely to cite waiting times as their main obstacle to good care. However, just 3.5 percent of Canadians were impacted by treatment delays, the survey found.
Beware much of what you hear. There are strong lobbies with deep pockets aligned against any national health initiatives. Here is an example of what 60 Minutes reported on one such lobbyist (albeit not for the HMOs yet):
Rick Berman is an expert on PR campaigns.
"If the government is truly interested in my health and welfare, I'm appreciative of it. But, I think I can take care of myself," Berman tells Safer.
He seems to be effective at helping the fight against The Nanny State on behalf of big corporations.
Epilog:
You should not expect more taxes. It should be a shift of premiums from many dozen insurance companies to a few. Taxpayers should demand a reduction in the administrative costs. All the staff needed to deny claims and also deny new applicants will vanish, estimated to be over 30% of the cost of care. Just 16% of that cost would cover the uninsured.
Shortages may be driven by higher demand when 47 million new claimants start using the systems. This is the trickiest transition. New capacity must be added as new claimants are added. This will create a demand for capital that must be satisfied efficiently. Introduction of more walk-in clinics might help the transition.
I went back and ressurected a piece I put together a couple of years ago. I was considering retirement to the sunbelt areas of San Diego (La Jolla, Del Mar, Coronodo Island), Palm Springs or Scottsdale:
US Health Care Issues
It seems to be as relevant today as it was then. The US has big growing problems with health care:
1) Rapidly escalating costs
2) Increasing profit margins for HMOs
3) Companies reducing coverage, introducing copays, and downsizing older workers.
The US system spends 17% of GDP on health care yet sees 50% of personal bankruptcies directly attributable to medical bills, and 47 million have no access at all. Canada spends 9% of GDP on health care and everybody has access to it.
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