Canadian Health Care System

[MedCorps]

I will second Dr. Grazer's books.  Good read and really get you thinking.  Also a nice guy in person and worth going out to hear speak if you get the chance.

MC

 

[Edward Campbell]

The self described "non-partisan" but generally touted as "right wing" Fraser Institute has published a new report a health care, a synopsis, with a link to the main report, is reproduced below under the Fair Dealing provisions of the Copyright Act from the Fraser Institute's web site:

http://www.fraserinstitute.org/research-news/news/display.aspx?id=19381

Australian health care system an example for Canada in reducing costs and waits for treatment

Media Contacts: Nadeem Esmail

Release Date: February 25, 2013

CALGARY, AB—Australia’s universal-access health care system, which outperforms Canada across many measures of access and outcomes, offers important lessons for Canada on health policy reform, argues a new report from the Fraser Institute, an independent, non-partisan Canadian think-tank.

“Canada is at a crossroads: government health spending is among the highest in the developed world, yet Canadians endure some of the longest waits for medical treatment,” said Nadeem Esmail, Fraser Institute director of health policy studies and author of Health Care Lessons from Australia.

“It’s time for Canadian governments to stop throwing money at our fundamentally broken system. Australia is a fine example of a universal health care system that puts patients first. Canada would be wise to follow its lead on cost-sharing, activity-based funding, and private-sector involvement.”

Health Care Lessons from Australia is part of a Fraser Institute series examining the way health services are funded and delivered in other developed countries with universal-access health care systems. The nations profiled all aim to achieve the noble goal of Canada’s health care system: access to high-quality care regardless of ability to pay.

The report includes an introduction from Hon. Janice MacKinnon, finance minister in Saskatchewan’s former NDP government, highlighting Canada’s urgent need for health policy reform.

She writes that while the need for change is widely recognized, it’s difficult to achieve when the debate is too often marked by ideology. As an example, she cites what she calls “myopic and predictable” arguments from public sector unions and other defenders of the status quo that any involvement by the private sector will usher in American-style two-tier health care.

“The debate needs to be moved beyond the stark choices in North America to consider other OECD countries whose systems are less expensive and feature shorter waiting lists and better outcomes,” MacKinnon writes.

In comparing Canadian and Australian health care, the report notes that Canadian government health expenditures (age-adjusted) were 26 per cent higher than Australia’s in 2009. In fact, Canada’s health spending as a share of GDP was the highest among all developed nations with universal-access health care. At the same time, Canadians are forced to endure poor access to medical professionals and medical technologies as well as some of the longest waits for treatment in the developed world.

Australia’s health policy framework differs from Canada’s in the following important ways:

    Cost-sharing for outpatient medical services
    Some private provision of hospital and surgical services
    Activity-based funding for hospital care
    Broad private/parallel health care sector with taxpayer support and dual practice

“Emulating the Australian health care system would not require a marked departure from the current tax-funded, provincially managed, federally supported health care system in Canada,” Esmail said.

“An Australian approach to health care in Canada would primarily require important changes to financial flows within provincial tax-funded systems, a greater reliance on competition and private ownership, and public support for private insurance and care.”

The report suggests that the Canadian health care system would be greatly improved if provinces adopted reforms based on Australia’s proven framework for providing high-quality universal-access health care at reasonable cost:

1)    Consider adopting activity-based funding for health services and allowing private provision of hospital and surgical services.

Global budgets (the dominant form of hospital funding in Canada) disconnect funding from service provision. Conversely, activity-based funding, where funding follows the patient, creates incentives for hospitals to treat more patients and to provide the types of services that patients desire. The result is a greater volume of services from the existing infrastructure, reductions in waiting time, and improved quality and efficiency.

Introducing private provision inside a competitive framework also results in better system performance while ensuring access to quality health care. Importantly, private providers create greater competition, putting pressure on all providers (whether public or private) to operate more efficiently.

“Canada and Australia share the same goals for a health care system that provides patients with timely access to high-quality care, regardless of their ability to pay,” Esmail said.

“Canada would take important steps towards fixing its ailing health care system if we adopted some of the policies that work for Australia”

2)    Consider allowing private health care and insurance, implementing financial incentives for the purchase of insurance, and paying some portion of costs for private care. Canada’s provinces should also consider allowing dual practice for physicians to maximize the volume of services provided to patients in both public and private settings.

Australia’s superior health care performance is in part the result of a vibrant private parallel health care sector. The private sector in Australia plays a large role in both financing and delivering health care, most specifically elective surgery.

“When patients use the private parallel health care sector they free up resources in the universal system for patients who have opted not to seek private care. In Australia, supporting the private parallel sector may have helped reduce wait times and has helped contain health care cost increases,” Esmail said.

Australia also allows physicians to work in both the public and private health care sectors rather than requiring them to opt out of the universal system. This has the benefit of making more efficient use of highly skilled medical resources.

3)    Provinces should consider implementing cost-sharing regimes for universal health care with reasonable annual limits and automated exemptions.

A lack of cost-sharing (i.e. when patients are required to pay for a portion of their insured medical services) has resulted in excessive demand and wasted resources in Canada’s health care system. Cost-sharing encourages patients to make more informed decisions about when and where it is best to access the health care system, thus increasing the cost efficiency of health care (ultimately reducing total spending) and improving access to treatment for those in need. Cost-sharing policies have been shown not to have an adverse effect on health outcomes as long as low-income populations are exempt.

I have often noted that within the OECD, the "club of rich, advanced nations," two countries stand out has having poor health care systems (being both expensive to operate and providing poor health results): Canada and the USA. Almost every advanced, Western state, and several Asian ones, too, have health care systems that produce better results for more people than does Canada and they do so at lower costs. Even France, a country for which I have little regard, a place that I regard as the archetypical "shitty little country," has a better health care system than does Canada.

It is time for some big, Big BIG changes which the provinces must lead: ignoring the bureaucrats in Ottawa and, eventually forcing Ottawa to jettison the ill conceived, deeply flawed Canada Health Act.

 

[OceanBonfire]

Meanwhile in the US:

A CBS News investigation found American health care institutions are being taken apart and shut down by investors looking for profits.

https://twitter.com/x/status/1600127420337635329

"What they've done is extremely evil": Pennsylvania hospital shutdown spurs questions about private equity in health care

A for-profit California company saw windfall dividend — and patients scrambled for care, a CBS News investigation found.

www.cbsnews.com

Hospital closure leaves patients scrambling, owners collect millions

Private equity is piling into healthcare, snapping up everything from local doctors' offices, to specialty clinics, even hospices. A CBS News investigation looked at these deals and found the owners of one for-profit company made millions, before some of their community hospitals shut down...

www.cbsnews.com

 

[Bruce Monkhouse]

Meanwhile in the US:

https://twitter.com/x/status/1600127420337635329

"What they've done is extremely evil": Pennsylvania hospital shutdown spurs questions about private equity in health care

A for-profit California company saw windfall dividend — and patients scrambled for care, a CBS News investigation found.

www.cbsnews.com

Hospital closure leaves patients scrambling, owners collect millions

Private equity is piling into healthcare, snapping up everything from local doctors' offices, to specialty clinics, even hospices. A CBS News investigation looked at these deals and found the owners of one for-profit company made millions, before some of their community hospitals shut down...

www.cbsnews.com

Guess you haven't gone to a Canadian hospital lately then?? Nice big one 10 minutes from me, that has had tons of renovations over the last few years, but right now I'd be driving 40 minutes to a tiny little village north of here and hoping I'm only sitting for a day or so before I get seen.....

 

[lenaitch]

What "tiny little village" in Ontario has a hospital?

We must be an outlier. I've taken my wife to our local hospital emerg a number of times. I will stay with her until she is 'taken in' to emerg then go home a wait for a phone call. The hospital has a half-hour free parking grace period. The last two times, I was under the half hour. The last time, was for a hard fall. In and out, examined, diagnosed, imaging, etc. in three hours. I realize timing makes a difference. Early morning seems golden. Later on, the people with the sniffles, no family doctor, etc. start wandering in.

 

[mariomike]

Dropped off a bottle of scotch for the family doctor, and a box of chocolates for the receptionist, today.

 

[Bruce Monkhouse]

What "tiny little village" in Ontario has a hospital?

Fergus - Mount Forest - Meaford keep going??

 

[Brad Sallows]

Meanwhile in the US, if you have health insurance you probably have a GP and can get almost any kind of imaging within a couple of days and a specialist's opinion shortly thereafter. Here, I pay my taxes and wait 3 months for imaging and another 3 months for a specialist to go over the images.

Our system is for sh!t right now and Squirrels! south of the border do nothing to improve it.

 

[mariomike]

Here, I pay my taxes and wait 3 months for imaging and another 3 months for a specialist to go over the images.

Post-retirement HCSA cover private MRI.

Diagnostic tests – the cost of medical tests such as cardiographs, electrocardiograms, x-rays, ultrasounds, MRI, and CT scans (including the cost of any related interpretation or diagnosis). Deluxe or elective tests are eligible.

 

[mariomike]

Fergus - Mount Forest - Meaford keep going??

Smaller places ship a lot of their more serious / complicated cases to larger hospitals.

 

[Good2Golf]

Smaller places ship a lot of their more serious / complicated cases to larger hospitals.

Larger hospitals sometimes ship cases to smaller hospitals. Some even have the docs shuttle around the region to practice in surrounding facilities. My family has used ER *services and I’ve had specialist appointments in Kemptville and Winchester from docs based in Ottawa. The facilities are actually not bad at all and less strained than the facilities, especially ER, in larger centres.

 

[Edward Campbell]

Meanwhile in the US, if you have health insurance you probably have a GP and can get almost any kind of imaging within a couple of days and a specialist's opinion shortly thereafter. Here, I pay my taxes and wait 3 months for imaging and another 3 months for a specialist to go over the images.

Our system is for sh!t right now and Squirrels! south of the border do nothing to improve it.

This was, I hasten to point out, several years ago, but when (after I retired) I was undergoing some innovative treatment for a fairly serious problem the specialists and my GP, a firm believer in our national health care system, really wanted to see some images, like once a week or so. My GP finally said, "can you afford to go down to Syracuse, say every ten days or so, and pay a few hundred US dollars for a scan? I know the radiologist there quite well and I will certify it as medically necessary and your insurance might cover at least some of the costs." I could, I did, and yes my insurance covered over half the costs but I was still a few thousand dollars out of pocket for what the physicians felt was necessary but our "system" could not provide.

 

[OldSolduer]

Meanwhile in the US, if you have health insurance you probably have a GP and can get almost any kind of imaging within a couple of days and a specialist's opinion shortly thereafter. Here, I pay my taxes and wait 3 months for imaging and another 3 months for a specialist to go over the images.

Three months?? Luxury!!!

In Manitoba the wait to see a specialist can be 18 months, surgery if required 12-18 months AFTER that.

We are at least 405 doctors short in Manitoba.

 

[lenaitch]

Fergus - Mount Forest - Meaford keep going??

Ok. We have a different definition of 'village'. To me, places like Everett, Maxwell and Goodwood are villages. It's matter of personal perspective since terms like 'city', 'town' and 'village' are undefined in Ontario. Oakville calls itself a town; pop. around 220K. Dryden calls itself a city; pop. around 7400. It makes little sense.

 

[Humphrey Bogart]

Three months?? Luxury!!!

In Manitoba the wait to see a specialist can be 18 months, surgery if required 12-18 months AFTER that.

We are at least 405 doctors short in Manitoba.

I moved to Ontario six months ago. I have been waiting six months for an appointment with a Nurse Practitioner (not even a Doctor). The appointment was to be next week and I had arranged to have the day off with work.

Got a call this morning:

"Sorry appointment cancelled, that NP is no longer with our clinic, we will reschedule you when we get a new one"

Whenever that is

I would much rather pay for insurance and get on-demand treatment than what we currently have. Of course I have the money for it so maybe my opinion would change if that wasn't the case.

 

[Halifax Tar]

I would much rather pay for insurance and get on-demand treatment than what we currently have. Of course I have the money for it so maybe my opinion would change if that wasn't the case.

Maybe a buy in or buy out system. Pay for your own health insurance and get a break on your taxes ?

 

[mariomike]

The facilities are actually not bad at all and less strained than the facilities, especially ER, in larger centres.

I'm sure they are not bad.

But, that is not what I meant. I understand some ERs may have shorter wait times than others.

Rural Ontario communities hit hard by ER closures, hospitals face staff challenges

Doug Walsh remembers being rushed to the emergency department in his rural Ontario community when he had a stroke a decade ago and credits the urgent ...

www.thestar.com

When a patient requires a higher level of care - such as a Level 1 Trauma Centre, for example - when "not bad" isn't good enough, they are transferred to an appropriate facility by land or air paramedics. Often Ornge.

When the patient is well enough, they are returned to their community hospital for recovery.

 

[mariomike]

I realize timing makes a difference. Early morning seems golden.

Our car count did not go into high gear until 11 A.M.

Wasn't enough call volume to justify any earlier than that.

 

[mariomike]

Dryden calls itself a city; pop. around 7400. It makes little sense.

The funny thing is, Dryden is a single-tier city. On the other hand, Mississaga, with a population of 721,000, is two-tier.

Mississauga is still trying to get a divorce from Peel Region. To break free and become independent with all the autonomy and powers that Dryden has.

​

 

[Colin Parkinson]

My wife needed an MRI, 6-8 month wait list, we said we go private, the specialist said "I won't look at it till it's your turn" . We got wife's file from the family doctor, she flew to Malaysia got it done, 12 other tests, consults with doctors, all added to her file, spent time with her family and flew home for the cost of a private MRI here.
I just spent $2,000 on my daughters tooth yesterday (Thank god we have two insurance coverage). Otherwise I be shipping her over there for any major work. I really should get into medical tourism with my brotherinlaw.