Posted on 08/27/2002 9:31:53 PM PDT by joyce11111
from the August 28, 2002 edition - http://www.csmonitor.com/2002/0828/p01s04-wogi.html
Canadian model of healthcare ails
Report ranks Canada's state-funded system near the bottom among industrial nations.
By Eric Beaudan |
Special to The Christian Science Monitor
TORONTO - When Bill Clinton attempted to reform US healthcare in 1994, his administration often touted Canada's publicly funded, universal access system as a model to be emulated. As it turns out, the Canadian system may be crumbling under its own weight.
Despite spending nearly C$100 billion (US$64 billion) per year on healthcare – the most per capita among countries that run a similar system – a study released last week by the Fraser Institute, a public-policy think tank in Vancouver, shows that Canada ranks only slightly higher than Hungary, Poland, and Turkey in the quality of service its citizens receive.
Canada is the last industrialized nation to rely solely on government funds for its core healthcare system. There's an emerging view that it, too, may abandon a system that has long been a symbol of its national identity.
"We are no longer the model," says Michael Walker, executive director of the Fraser Institute. "When you consider that equal access in a country as spread out as Canada would require a greater number of physicians and diagnostic equipment, we're clearly headed in the wrong direction."
Two issues in particular plague the Canadian system, which forbids any form of user payment or private care for core services: the number of doctors and access to high technology.
Canada fields 1.8 doctors per 1,000 inhabitants, which places it 17th on a list of 20 countries with universal access (the list does not include the US). To leap into first place, Canada would need to add 48,000 doctors to its current roster of 57,000.
Canada lags even further behind in access to high-tech equipment, including machines used for magnetic resonance imaging (MRI) and computed axial tomography (CAT) scans. This shortage affects wait time for diagnostic assessments, which in provinces such as Saskatchewan can run well over three months.
According to Dr. Walker, hospitals absorb 55 percent of the total annual healthcare budget. The Fraser study found that nonmedical staff – including painters, electricians, and cooks – tend to be paid 50 percent higher than their counterparts in nonmedical industries. "We are not controlling our costs," he says.
Exacerbating Canada's poor performance among industrialized countries is its proximity to the US, notes Princeton University health economist Uwe Reinhardt. "Since Canada is part of the American job market, Canadian nurses and doctors must be compensated at levels that compete against US jobs," he says. "That means that even with the same level of care, Canadians will pay more than Europeans for core services."
Another survey, released last week by the Canadian Medical Association (CMA), shows growing dissatisfaction with the current system. The findings reveal that six in 10 Canadians expect the quality of healthcare to worsen over the next five years. And with 58 percent of respondents acknowledging that their confidence in the system is falling, versus 51 percent in 2000, Canadians are seriously contemplating a user-pay system. While 56 percent of survey respondents say they would pay more in taxes to maintain current service levels, 49 percent say they would welcome an approach that blends public and private care.
Canada's provincial leaders pledged C$1 billion (US$640 million) to purchase high-tech equipment starting this year. But any shortening of the typical two-month wait for patients to receive MRI tests and CAT scans isn't likely soon.
"It will take a decade to get speed of access and modern healthcare back in Canada," says Michael Decter, chair of the national board of the Canadian Institute for Health Information, and former deputy minister of health in Ontario.
Although Mr. Decter agrees that the system is shaken, he still says that modernized public healthcare is the solution.
"We do well on life expectancy and immunization of children compared to the US," he says, noting that the US spends about 40 percent more on healthcare in total than Canada. "But we see the drug ads on US television and worry that we're not as shiny and new as the Americans."
Fixing the deficiencies of the healthcare system is now the mandate of a royal commission, headed by former Saskatchewan premier Roy Romanow. Over the next few months, Mr. Romanow will head to London, Paris, and Washington to gather insights that could help remedy Canada's ailing system.
Solutions would likely include greater home care, user fees for patients who can afford them, and private or semiprivate hospitals, all of which top-ranked countries such as France, Sweden, and Australia feature.
The strains on the system are already forcing local shifts to alternative models. Some communities are allowing nurses to treat minor cases without referring patients to a doctor. Seventy-seven percent of nurses and 60 percent of doctors support this approach.
One of the CMA's recommendations is setting national standards for wait times.
"Canadians are divided over the establishment of user fees," says CMA president Dana Hanson. Although Dr. Hanson believes in a publicly funded system, he doesn't discount private-public partnerships. Some provinces already hire private labs, he points out.
Should Romanow's commission fail to deliver a workable solution, Canada's 10 provinces might be forced to take matters into their own hands.
"Some provinces could independently impose user fees or copayments," suggests Walker. Ontario and Alberta are the two provinces who, he says, might be able to give up federal Medicare aid in favor of a provincially run system. Both provinces are wealthier and less dependent on federal outlays to balance their medical costs.
But Mr. Reinhardt says introducing some features of the US healthcare system might be fraught with difficulties. "[The US] system has left 40 million people uninsured," he says, "and medical bills have become the second leading cause of personal bankruptcy in the US."
--------------------------------------------------------------------------------
Though lower taxes would allow greater insurance purchasing power, which in turn should lower premiums, no?
Might someone more learned clue me otherwise?
This is not true-anyone can walk in to any emergency room and get treatment. Give a john Doe name and address and you will never get a bill. Illegals do if millions of time every day in the USA !
Uncle Sam pays the bill so we "do" have universal health care !
This has already happened.
A year of two ago Quebec had to send it's cardiac patents to the states for treatment.
I've seen hospitals in Quebec that were almost third world.
Hospitals in Ontario seem to be a little better.
Strikes seem to plague the canuckistan health system too.
Of course everyone is unionized in the socialist monarchy of canuckistan.
From junkies in vancouver to nurses in quebec.
Canuckistan! Socialism from sea to whining sea!
Well, they could also abort more fetuses and euthanise useless old people (say those over 50) so they have less people that can get sick. That would be fair!!!
A year of two ago Quebec had to send it's cardiac patents to the states for treatment.About ten years ago Quebec sent its premier to the US for cancer treatment. World leaders in general are more likely to be found in places like Bethesda, Rochester, MN, and Cleveland getting medical treatment than in Toronto, Montreal, or London. The simple reason: Socialism Sucks.
-Eric
This is true. I work in this field, collecting information about health care costs and payments. I see thousands of cases a year. Poor people walk into hospital ERs (either for emergency or basic medical care), get top-class diagnostic procedures, facilities, and treatments just as middle-class people do, run up a multi-thousand dollar tab, and the government--that's us, boys and girls!--pays for a good part of it; the hospital eats the rest of the costs. It's amazing. So far I have not encountered a case in which a hospital turned an indigent person away because he didn't have health insurance. I'm beginning to wonder why I bother with health insurance when apparently no one else in this country needs to do so.
And by the way, so far I have also not found any cases in which a private health insurer paid for everything it was supposed to. The hospitals are struggling with these expenses, which is part of the reason they have to charge youso much in order to pay for their new CAT scan machinery. You would also be surprised to learn how little the doctors are really getting.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.