Monday, March 29, 2010

Markets in Everything: Market-Based Health Care in Canada

"The distinguishing feature of Canadian public healthcare is the nearly universal waitlists for virtually all diagnostic procedures and for surgeries (see chart above). The public health care system in Canada has a waitlist in every province and surgery dates are often cancelled or bumped due to a more urgent case arising or a shortage of beds being available.

Timely Medical Alternatives was founded in 2003 as Canada’s first facilitator of private pay medical services and diagnostic imaging. Since then, we have expedited private medical services for thousands of clients and in the process, have saved the lives of 6 of our fellow Canadians.

We are able to facilitate private medical services and diagnostics within 2 – 3 days and surgeries as quickly as 48 hours, in urgent cases. Many of our referrals are to facilities within Canada, and some are available in the U.S., where we have a network of hospitals and private medical services clinics with which we work."


At 3/29/2010 7:44 AM, Anonymous Pietro_F said...

I wonder how long they mean by "Up to" X years. My guess is you got this chart from TMA, so it's no surprise they're going to use this measure as opposed to the average wait time.

It's entirely possible the wait doesn't even come close to this length, so we should find out what the average wait times are as opposed to depending on the chief beneficiary of Canadians' decisions not to wait.

At 3/29/2010 7:57 AM, Blogger juandos said...

Well maybe Canada is being spurred onto doing something about with someone else's money...

The 10 Year Plan outlines strategic investments directed toward reducing waiting times for access to care, especially for cancer, heart, diagnostic imaging, joint replacement and sight restoration services. To support the reduction of wait times, the Federal Government committed to investing $4.5 billion over the next six years, beginning in 2004-05, in the Wait Times Reduction Fund...

At 3/29/2010 8:51 AM, Anonymous morganovich said...

what i find really interesting here is how low many of the prices are in a cash pay system.

now, i grant that "prices as low as" may be misleading, but $750 for an MRI?

when i had a bad bike crash mine was $5k list price.

that's a pretty serious gap.

this seems to bolster the "if we all paid cash prices would be much lower" thesis.

the problem with any third party payor system is it eliminates incentives to manage costs and maximizes incentives to over-consume. this can only result in massive price spikes and or rationing.

At 3/29/2010 9:55 AM, Anonymous Anonymous said...

The problem with this comparison is that at the top of the list is "Knee replacement," which of course is primarily done on seniors and thus paid for by Medicare, our single payer system for seniors.

At 3/29/2010 10:01 AM, Anonymous Pietro_F said...

Found some median statistics for wait times in Canada that paint a less dire picture of centralized health care at this link:

Here are some of them:

The median wait time in Canada to see a special physician is a little over four weeks with 89.5% waiting less than 3 months.

The median wait time for diagnostic services such as MRI and CAT scans is two weeks with 86.4% waiting less than 3 months.

The median wait time for surgery is four weeks with 82.2% waiting less than 3 months.

At 3/29/2010 10:03 AM, Blogger Marko said...

If you pay less than market rates, there will be a shortage. Remember price controls in the 70s? Why does anyone think this crap is a good idea?

At 3/29/2010 10:04 AM, Anonymous Anonymous said...

I wonder how long they mean by "Up to" X years. My guess is you got this chart from TMA, so it's no surprise they're going to use this measure as opposed to the average wait time.

This woman was young and not a "chief beneficiary of Canadians' decisions not to wait."

A real story about Canadian health care.

"Knee replacement," which of course is primarily done on seniors and thus paid for by Medicare, our single payer system for seniors.

Medicare patients are not forced to wait for surgeries in this country beacuse health care is delivered primarily through the private sector. But give the left time, they'll figure out a way to make Grandma suffer.

At 3/29/2010 10:11 AM, Anonymous Anonymous said...

Although the costs listed are a fair amount of change, in reality, they're not nearly as steep as one would suspect - particularly with the wait times one gets. Although I'm sure the costs are high enough to leave some people out, this is intriguing. It's still a lot cheaper - and a lot more convenient - than crossing the US border to get health care.

At 3/29/2010 10:15 AM, Anonymous Anonymous said...

The Fraser Institute’s nineteenth annual waiting list survey found that Canada-wide waiting times for surgical and other therapeutic treatments decreased in 2009. Total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, fell from 17.3 weeks in 2008 to 16.1 weeks in 2009. This nation wide improvement in access reflects waiting-time decreases in 5 provinces, while concealing increases in waiting times in Alberta, New Brunswick, Prince Edward Island, and Newfoundland & Labrador. The total waiting time in British Columbia was unchanged.

The Fraser Institute

Of course, not all wait times are the same:

Alberta left him hanging in bureaucratic limbo for 16 crucial days, his tumour meanwhile migrating to an unreachable part of the brain, while it dithered over his case file, ultimately deciding he was not surgery worthy.

Now, with the Mayo Clinic having done what the Alberta Cancer Board wouldn’t authorize or even explain, but with the tumour unable to be totally removed, the province will now not fund the expensive drug, Avastin, that the Mayo prescribed to keep him alive and keep the remaining tumour from increasing in size — despite the costs of the drug being totally funded by the province for other forms of cancer.


At 3/29/2010 10:39 AM, Anonymous Anonymous said...

Timely Medical has chosen to promote itself to Canadians using the references to approx. wait times for the government system. If their claims about government wait times were bullshit, their prospective clients would know that.

At 3/29/2010 1:46 PM, Blogger Bill_C said...

This is very similar to the situation in the UK. When I lived there a number of my British friends had private health insurance so they could avoid wait times. My neighbor was a pediatric oncologist who worked 3 days a week as a NHS provider and 2 days a week for a private practice. Which do you think paid her more? We could go to a single payer system and there will still be private insurance for those that want shorter wait times or what they view as preferred care.

At 3/29/2010 2:35 PM, Blogger Methinks said...


My relative in Toronto was told she would have to wait 3 months for an MRI. Then, there was another wait for the MRI to be read. After days of calling around, the family found a location two hours away from Toronto with only a two week wait.

This relative's spouse has been crippled by a pinched nerve. It's year four and he's still waiting to see a specialist.

At 3/29/2010 2:37 PM, Anonymous Terrence said...

Pietro_F - the only thing sillier than shooting the messenger (Timely Medical), is to quote Wikipedia!

As was pointed out, if Timely Medical was making false or inflated claims, it would NOT be attracting clients. Wikipedia is NOT worth commenting on, other than to laugh at it.

You are obviously NOT a Canadian, or you would NOT be making such silly, uninformed comments about the Canadian Heath Care System.

Within Canada, the Health Care System is often called the "National Wait System", or variations on that.

I doubt that a single Canadian does not have a relative or friend who had to wait ridiculously long times to see a specialist, let alone get needed surgery.

At 3/29/2010 3:55 PM, Anonymous Anonymous said...

>The median wait time in Canada to see a special physician is a little over four weeks with 89.5% waiting less than 3 months.<

I can get an appointment with a American specialist in four days if I can get there that fast. I've never waited longer than a week. The above is not indicative of an efficient system. But Canada is short so many doctors because of the health care system that long waits are inevitable.

At 3/29/2010 4:52 PM, Blogger Craig Howard said...

If you pay less than market rates, there will be a shortage.

I'm really not too sure what you're talking about. I suppose you could say that Canadians -- through their nationalized system -- do pay less than market rates as they pay nothing when they go for care. And yes, there is a shortage of health care in Canada.

Surely, you're not referring to the private company in the article. You see, there is no health care market in Canada -- TMA is attempting to create one.

At 3/29/2010 5:26 PM, Anonymous Anonymous said...

The Australian system seems much like the Canadian one. I had to have my gall bladder removed and it took 3 months to see a specialist and a further 6 to have the operation. It was delayed for a month and in the meantime I started getting quite sick and ended up in emergency at 4 am with the worst pain imaginable. They then had to wait another 3 days for the op. The whole saga would have ended up costing a lot more because of the delays and me getting so sick.
I was never even told I could have had it done privately and almost surely would have paid the 6K so so it would have cost.

At 4/03/2010 11:55 PM, Anonymous Anonymous said...

very flawed argument: as noted if a serious case comes up you get bumped. of course you do if you need the service you get it right away. if you are complacent you will get pushed back -the squeeky wheel gets the grease. priorities rule. comparing canadian and american health care systems is ludicrous, the foundations are like comparing social democracy with capitalism. if you want better service you go global and join the medical vacation system.

At 4/07/2010 1:03 AM, Anonymous Monado said...

Here is what I have seen in Canada:

Minor surgery: wait, a few hours to a few days to a few weeks; cost, free.
Arthroscopic knee surgery: wait, 2 weeks - 5 months; cost, free.
Hip replacement: wait, 4 - 6 months; cost, free.
MRI and CAT scans: wait, a few hours - 1 day; cost, free.
Burn treatment: immediate; cost, free.
Double lung transplant: wait, 7 months; cost, free.
Colestomy : wait, 2 - 3 days; cost, free.
Emergency room treatment, triaged by urgency; cost, free.
Medical lab tests and X-rays or ultrasounds, ECGs EKGs, etc: if done in hospital, a few hours, cost, free; if your doctor prescribes them, drop into the laboratory of your choice and be served in turn: a few minutes - a couple of hours; cost, free.
Annual physical exam, make your appointment and keep it; cost, free. Lab tests to go with it (mammogram, prostate screening, occult blood for colon cancer--the doctor gives you a prescription: drop into a lab, as above; cost, free).
Colonoscopies to check for pre-cancerous polyps: doctor gives you a prescription if age or family history warrant it; you call hospital lab and make appointment; keep appointment, get scoped, have someone take you home. Cost, free.
Blood in the urine: treatment, immediate; cost, free.
Spending a year in hospital dying of cancer - waiting time, none; cost, free. Planning visits from a case coordinator about long-term accommodation (that's what the republicants are calling a death committee).
Stroke or heart attack - emergency treatment immediate, surgery scheduled as urgent elective and done within a day or two, physical and occupational therapy in hospital and live-in rehabilitation centres, living skills, more case coordinators, and follow-up visits at home, on schedule. Cost, free.
Infected wound: treatment immediate, hospitalization when symptoms warrant, daily nurse visits to refill antibiotic pump, months of physical therapy almost daily, drop-in. No waiting. Cost, free.
Pregnancy & childbirth with all pre-natal and postnatal examinations: Waiting time, none: just make the appointments and show up. Cost, free.

Get the picture?


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