Monday, June 22, 2009

Canada's Health Care System: Poor Value

The beginning of May marks the end of income tax season in Canada. Over one-half of the personal income taxes Canadians just paid in aggregate are required to cover the cost of our taxpayerfunded health care program. Given this level of expenditure, you might expect that Canadians receive world-class access to health care. But the evidence demonstrates that this is not so.

Consider Canada’s waiting lists, which are among the longest in the developed world.

■ In 2007, waiting lists for access to health care in Canada reached a new all-time high of 18.3 weeks from general practitioner referral to treatment by a specialist. Despite substantial increases in both health spending and federal cash transfers to the provinces for health care over the last decade or so, this wait time is 54% longer than the overall median wait time of 11.9 weeks back in 1997.

■ Canadians were more likely to experience waiting times of more than six months for elective surgery than Australians, Germans, the Dutch, and New Zealanders, but slightly less likely than patients in the United Kingdom;

■ Canadians were least likely among the six nations to wait less than one month for elective surgery;

■ Canadians were most likely to wait six days or longer to see a doctor when ill, and were least likely among the six universal access nations surveyed to receive an appointment the same
day or the next day; and,


■ Canadians were least likely to wait less than one hour and most likely to wait two hours or more for access to an emergency room among the six universal access nations surveyed

That is hardly the sort of access you might expect from the developed world’s third most expensive universal access health insurance system.

~Nadeem Esmail of the Fraser Institute

HT: NCPA

29 Comments:

At 6/22/2009 10:02 AM, Blogger Luke TAMU said...

But once I saw this incredible documentary by Michael Moore that said all those countries' health care systems were better than ours!

 
At 6/22/2009 10:09 AM, Blogger jamused said...

Actually, it's exactly the sort of access I'd expect from the developed world's third most expensive universal access health insurance system.

 
At 6/22/2009 11:10 AM, Blogger Robert Miller said...

This comment has been removed by the author.

 
At 6/22/2009 1:24 PM, Blogger QT said...

Canadians were least likely to wait less than one hour and most likely to wait two hours or more for access to an emergency room among the six universal access nations surveyed

...a lot more. Wait times at Emergency are usually about 5-8 hrs. in Toronto & the surrounding area.

Although health expenditures have steadily increased, one needs to also consider how those funds are allocated. Spending on hospitals has declined as a percentage of total healthcare spending from 44% in 1975 to 28% in 2008; more is being spent on drugs. More money is being allocated to the treatment of infants ($7,891 per person) and seniors ($9,967 per person) vs. persons between age 1 and 64 ($1,832 per person).

Although we are spending 10% of GDP on healthcare, there are a huge problems involving access to care. The most problematic involve patients with conditions where timeliness of treatment or ongoing monitoring are critical, for example, radiation therapy for cancer or ongoing monitoring of diabetes which is critical to prevent loss of kidney function, diabetic retinopathy, etc.

 
At 6/22/2009 1:24 PM, Blogger rufus said...

At least they Have Access to Health Care.

Millions of our Citizens Don't.

 
At 6/22/2009 1:43 PM, Anonymous Mugsy said...

Silly rufus, every American has at least access to health care, as emergency rooms are required to treat all.

Is it a perfect system? No. But don't pretend that folks are denied health care outright. Plus, many of the "uninsured" are so by choice - the young and the healthy (I was once so uninsured, and it made sense then). And even then I had access to health care that I paid for out of my own pocket.

 
At 6/22/2009 1:56 PM, Blogger 1 said...

Hey Robert Miller and others, you might find Roger Kimball's Lies, Damned Lies, and Statistics, Division of Health Care Legerdemain over at PajamasMedia an interesting read...

Hey QT again some good links...

Here's one from Investors Business Daily that seems to bolster what you've commented on: Dead Wait

'In Great Britain, where the government's in charge of health care, as many as 1 million people are waiting to get into hospitals at any given time, says the National Center for Policy Analysis.

In Canada, another country where the government metes out care, roughly 900,000 are waiting for hospital beds, the Fraser Institute reports. The New Zealand government says that 90,000 are on hospital waiting lists there
'...

 
At 6/22/2009 1:58 PM, Blogger rufus said...

I may be silly, but I don't babble, authoritatively, about things of which I know Nothing.

ER is Not Healthcare. Emergency Rooms patch you up, determine you're not going to die, prescibe a couple of days pain meds, and send you home to wait for an enormous bill.

This nation has millions of young females suffering from diseases such as endometriosis, krohns, etc. When the pain gets "too bad" they go to the emergency room. The ER runs an MRI. Maybe some other tests. Keeps them for "observation" for a couple of hours, writes them some pain meds, and sends them home.

Two, or three weeks later: Rinse, repeat. You could easily be looking at $50,000.00/yr. Guess who pays? One way or the other, You do.

The "Specialists" visit that's required to cure her is unobtainable. She's unable to hold a job, and the odds are the job that she can find will have an insurance with a $3,000.00 limit. Yep, $3,000.00 (I retired out of the insurance business.) You can't get one advanced test, much less treatment done for $3.000.00.

So, every couple of weeks You pay for another ER visit, some more MRIs, and some more "observation." You're being Had. I hope you're enjoying it.

 
At 6/22/2009 2:21 PM, Blogger 1 said...

"I may be silly, but I don't babble, authoritatively, about things of which I know Nothing"...

Oh yes you do... The entertainment value though is occassionally worth the price of admission...

"This nation has millions of young females suffering from diseases such as endometriosis, krohns, etc. When the pain gets "too bad" they go to the emergency room...."...

Well rufus again here's YOUR chance to man up with YOUR WALLET and help bail those poor lassies out...

Jay Goltz writing in the New York Times blog, 'You're the Boss' has this: How the Stimulus Package Discourages Hiring

Consider these three paragraphs from Goltz's posting: So here’s my question: Why do we automatically assume that these companies are in a position to be fronting money for anyone. Why are they automatically in a better position than the insurance company, the employee, or the employee’s relatives?

It gets even worse when the employee files for unemployment. A lot of people — including a lot of business owners — don’t understand how this works. Because the government cuts the unemployment check, it is widely assumed that it’s the government that pays the unemployment benefits. In reality, those benefits are funded by employer taxes. And here’s the killer: The more unemployment benefits your former employees collect, the higher your taxes go.

It works like insurance. If the government pays a claim, your rates go up. In fact, if your former employee collects $10,000 in unemployment payments, you can expect to pay close to twice that in increased premiums. At least that’s how it works in my state, Illinois.
...

Are we sure we want Uncle Sam involved in the health business?

At Rasmussen Reports you can see the following dated June 15: 41% Favor Public Sector Health Care Option, 41% Disagree

 
At 6/22/2009 3:28 PM, Blogger rufus said...

You don't get it, 1,

I'm Already Doint That. And, So Are YOU. Those people can't pay those bills. That means, You are paying them. You just don't realize it. But, you're paying them everytime your employer holds down your raise due to higher health insurance premiums. Did you really think it was the Business Owner that paid those health insurance premiums?

Or, in some cases, you're paying through higher taxes; but, you ARE paying.

I'm just trying to tell you there's a "Cheaper" way to go.

 
At 6/22/2009 4:13 PM, Anonymous Mario Balistreri said...

A major issue for insurance providers and the uninsured is the amount of extra sometimes unnecessary tests that are run on a patient. These extra tests are being done as a precautionary measure by doctors, nurses, and other medical practitioners, to minimize malpractice lawsuits.

The Journal of the American Medical Association (JAMA) produced an article highlighting these medical malpractice lawsuit statistics, with regard to patient death, “up to 225,000 deaths each year, are caused by medical negligence of some nature. And that number is ever growing”. We can assume that in most cases this negligence is unintentional; doctors need to protect themselves as many of these lawsuits exceed the million dollar range.

 
At 6/22/2009 4:16 PM, Anonymous Mario Balistreri said...

A major issue for insurance providers and the uninsured is the amount of extra sometimes unnecessary tests that are run on a patient. These extra tests are being done as a precautionary measure by doctors, nurses, and other medical practitioners, to minimize malpractice lawsuits.

The Journal of the American Medical Association (JAMA) produced an article highlighting these medical malpractice lawsuit statistics, with regard to patient death, “up to 225,000 deaths each year, are caused by medical negligence of some nature. And that number is ever growing”. We can assume that in most cases this negligence is unintentional; doctors need to protect themselves as many of these lawsuits exceed the million dollar range.

 
At 6/22/2009 4:20 PM, Blogger mario17b said...

This comment has been removed by the author.

 
At 6/22/2009 4:20 PM, Blogger mario17b said...

This comment has been removed by the author.

 
At 6/22/2009 6:25 PM, Anonymous Anonymous said...

I'm just trying to tell you there's a "Cheaper" way to go.

Name a single program or industry where government involvement has resulted in cheaper anything.

 
At 6/22/2009 6:27 PM, Anonymous Anonymous said...

At least they Have Access to Health Care.

Millions of our Citizens Don't.

Dufus,

Same ole schtick. You just jump from post to post getting shot down everytime. Go back and read the previous responses.

 
At 6/22/2009 6:57 PM, Anonymous Anonymous said...

This story Oregon Travail ties into a couple of themes Dr. Perry likes.

Oregon is driving businesses out with tax hikes, including a tax on health benefits. This will, of course, lead to more people losing their health care. Pathetic.

 
At 6/22/2009 7:18 PM, Anonymous Anonymous said...

Of course, there is one group of people that "health care reform" will not impact. Any guesses?:

Last September Sen. Barack Obama promised that under his health-care proposal "you'll be able to get the same kind of coverage that members of Congress give themselves." On Monday, President Obama repeated that promise in a speech to the American Medical Association. It's not true.

The president is barnstorming the nation, urging swift approval of legislation that is taking shape in Congress. This legislation -- the Affordable Health Choices Act that's being drafted by Sen. Edward Kennedy's staff and the Health, Education, Labor and Pensions Committee -- will push Americans into stingy insurance plans with tight, HMO-style controls. It specifically exempts members of Congress (along with federal employees; the exemptions are in section 3116).

WSJ

 
At 6/22/2009 7:35 PM, Blogger OA said...

"At least they Have Access to Health Care.

Millions of our Citizens Don't."

Being on a long waiting list is "access" only in the technical sense. There are many stories of people being on a waiting list so long that a temporary problem turns into a permanent disability.

Yes, people fall through the cracks in the US, but a government program to cover everyone is huge overkill. The government can't stop the $60 billion in Medicare fraud every year and SS is going bankrupt. Giving them another program is the stupidest idea in decades.

 
At 6/22/2009 7:44 PM, Anonymous Anonymous said...

2009 study - Canadian wait times little improved:

"The study showed that for many of the medical specialities in Canada examined, we don't even come close to meeting that target," said Bellan. "There remains a great deal of unfinished business when it comes to addressing wait times in Canada."

For cancer patients, the study found that the median wait time for radiation therapy was almost seven weeks, exceeding the benchmark of four weeks.

"If I have cancer, I don't want to wait at all. I want to be a priority and not because I have money or influence, but because I need care," Canadian Medical Association president Dr. Robert Ouellet said in a speech Thursday to the Montreal Economic Institute.

Patients are also facing long delays when they go the emergency department, the WTA said, waiting an average of nine hours to be seen and treated and for patients who needed to be admitted, the average wait time was nearly 24 hours.

"The longer wait for patients to be admitted is often due to the inability to find an available hospital inpatient bed," the WTA said.

Canada.com

 
At 6/22/2009 10:36 PM, Blogger QT said...

Anon. 7:44,

Spot on. I know a gentleman who was in a motorcyle accident..busted knee, broken cheek bone. He could only get a bed in a corridor and waited 48 hrs in agony to get surgery. His father had to bring him a blanket from home because there "weren't any" according to staff.

I know another patient who spent 2 years trying to get a diagnosis for West Nile and has ended up with permanent neurological damage.

My husband has a permanent disability because his torn rotator cuff went inoperable due to the length of time he had to wait for an MRI on his shoulder (8 months).

I realize these are just individual stories but personally, I have very little confidence in the Canadian health care system. The patient must fight for even the most basic level of care which seems fundamentally wrong.

Thank God for the U.S. It is at least reassuring to have an alternative to inaccessible or in adequate care.

 
At 6/23/2009 3:46 AM, Anonymous richard said...

Mark,

> Canadians were more likely to experience waiting times of more than six months for elective surgery than [...] the Dutch

That's not much of an argument against nationalized health care.

In the Netherlands, we also have a 'single payer' system. You pay app 1050 euro's ($1400) per adult per year for some sort of standard package. It is defined what is in there and what not. For instance: for my kid I get one set of eyeglasses every 3 years. And up to 250 euro. (They cost e500, but I could have shopped around, or choose a more cheaper one)

The government will make you do it if you are a salaryman. If you don't make enough money, the government will give you the money.

This goes to a commerial insurance company who takes care of the rest. Children are free. The insurance company cannot refuse you on medical grounds. Only if you don't pay they can refuse you.

 
At 6/23/2009 10:27 AM, Anonymous Anonymous said...

"Name a single program or industry where government involvement has resulted in cheaper anything."

Government "involvement" has sure made my house cheaper. Unfortunately, it did so after I bought it.

 
At 6/23/2009 11:25 AM, Blogger 1 said...

"That's not much of an argument against nationalized health care'...

That's all the argument one needs...

BTW Richard how many people are in the Netherlands and compare it to how many people are in the US...

Larger numbers have a magic and properties all their own...

 
At 6/23/2009 5:03 PM, Anonymous Anonymous said...

This reminds me of...
Oh yeah! Public education. Increased cost, reduced output/quality.

 
At 6/23/2009 5:16 PM, Anonymous Anonymous said...

"At least they Have Access to Health Care.
Millions of our Citizens Don't."

Everyone can drop by the MinuteClinic, open 24/7, no appointments needed. Common problems are sovled for <$100.

 
At 7/03/2009 11:25 PM, Anonymous Anonymous said...

I used to think the Canadian system was much better but the recent debate in the US has made me rethink my opinion. Now I believe there needs to be a balance. It seems obvious to me that the government needs to provide basic health care to everyone while those who can afford it should be free to access private care.

I know a guy who is an expert in health care systems. He travels all over the world helping to set them up. He says that if his mother gets cancer he will immediately take her to the Mayo Clinic. But at the same time, he says that the Canadian system is best for the great majority of people. What's wrong with mortgaging the house to get special care for mom if that's what matters most to you? But you shouldn't HAVE TO put your family in poverty to help out mom. Like another poster said, all scarce resources have to be rationed one way or another. With the boomers getting older and sicker by the minute, the situation can only get worse. In the US health care costs way too much money while here you wait a bit, sometimes longer than you really should but USUALLY it works out well. So, take your pick.

Let's try to find a compromise that includes the best of both systems.

 
At 7/22/2009 8:54 PM, Anonymous Anonymous said...

Bill Moyers Journal (10 July 2009)

http://www.pbs.org/moyers/journal/07102009/profile.html

Here are the "inside" truths.....
Educate yourselves and learn the real facts.

WENDELL POTTER
With almost 20 years inside the health insurance industry, Wendell Potter saw for-profit insurers hijack our health care system and put profits before patients. Now, he speaks with Bill Moyers about how those companies are standing in the way of health care reform.

Looking back over his long career, Potter sees an industry corrupted by Wall Street expectations and greed. According to Potter, insurers have every incentive to deny coverage — every dollar they don't pay out to a claim is a dollar they can add to their profits, and Wall Street investors demand they pay out less every year. Under these conditions, Potter says, "You don't think about individual people. You think about the numbers, and whether or not you're going to meet Wall Street's expectations."

 
At 7/25/2009 8:34 PM, Anonymous Anonymous said...

As a Canadian now living in the US, I take exception to this article.

First, the Fraser Institute is a well known right-wing think tank famous for skewing data to support its causes. Not to be trusted.

For example, official wait times in emergency rooms in Canada (in Ontario, at least, my home province) are measured from the time you check in until the time you leave (not what you generally think of as wait times) and include time waiting for tests, etc.

Second, some problems in Ontario are still left overs from the previous Conservative government which closed hospitals, amalgamated others, fired nurses, limited purchases of equipment, etc, etc in order to create a crisis to bring in American style health insurance which they believed in ideologically. A bit of background some would find relevant.

Third, we have many Americans using our system with fraudulent health cards bought in the US. Ontario has about 13 million residents and 15 million health cards. We now have three versions of the health card, each time trying to stay ahead of the forgers. Likely more Americans come to Canada fraudulently for health care than Canadians come to the US (where, it might be pointed out, the provincial health system still picks up a huge amount of the cost, which is the only reason they can afford to go).

I really dislike the US system and I would gladly choose Canadian care given my experience of both. I would rather have a doctor working for the government choose the most cost effective treatment for all sufferers than a statistician working for an insurance company choose the least cost alternative after trying to disqualify me from care in the first place.

One should also note that Tommy Douglas, the initiator of the Canadian system when premier of Saskatchewan (and Kiefer Sutherland's grandfather!), was recently voted as the greatest Canadian ever in a CBC (Canadian Broadcasting Corporation) poll. So many Canadians think the system is one of our greatest successes.

Can you find horror stories? In every system, yes. Can you cherry pick bad data? Yes. Can the Canadian system be improved? Yes - at the same tax rate as three years ago with the then budget surplus the current Conservative government frittered away in mindless tax cuts.

Kenneth Arrow's now ancient paper on the failures of the free market in health care should be required reading before anyone can suggest that the market has all the answers (if it does, why is no one else moving towards or even seriously discussing moving to an American system?)

 

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