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Alan Stolier, MD/

HEALTHCARE AROUND THE WORLD: PART 8 CANADA

HEALTHCARE AROUND THE WORLD  PART  7: CANADA 

In 1910, Tommy Douglas insured his knee while living in Scotland. Still limping and using crutches intermittently, his family emigrated to Canada. The family could not afford corrective surgery. Fortunately, an orthopedic professor in Winnipeg chose Tommy for surgical technique demonstration. Tommy was evidently bothered by the unfairness of the system. Because, when he became premier (governor) of Saskatchewan in 1944, he established a single-payer healthcare system for the entire Province. The program was so successful that by 1961, a taxpayer-funded hospital insurance program covered all Canadian residents. When the U.S. adopted a national health insurance model for citizens 65 and older, they gave it the same name that Tommy Douglas gave it, Medicare. In fact, in 2004 there was a national poll to determine the greatest Canadian of all time. No, it wasn’t Alexander Graham Bell or Wayne Gretzky, it was Tommy Douglas!

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Canadians currently have a longer lifespan and lower rates of infant mortality. The cost is also much less that of the U.S. It’s thought that lower costs are due to a more efficient payment system “and the sheer clout that a universal system has in price negotiations.” Canada spends a bit over 10% of GDP on healthcare. Unfortunately, it does not seem to be enough as Canada can’t seem to stay up with medicine’s rising cost. Because the system is incessantly scrimping, fewer students are studying to be doctors and nurses. In 1991 an official commission recommended that Canada decreases the number of medical students. Since then the ratio of doctors to patients has fallen in what some Canadians call “underdoctored”.

 For acute illnesses and accidents, the Canadian system does guarantee care to all, usually at no cost. Yet if your illness is not serious, you enter the twilight zone of the waiting list. Many leave the free care of Canada, to pay for care in the United States merely to avoid the queue. The Frasier Institute, a Canadian thinktank suggests that about 63,000 citizens seek health care south of the border. It has been reported that number may be in the millions. But more academic studies suggest that the medical tourism number is quite small. Uwe Reinhardt, a Princeton economist who grew up in Canada, noted that “Canadians don’t mind the waiting list so much so long as the rich Canadian and the poor Canadian have to wait about the same amount of time.”

 Each province and territory run its own Medicare plan. Yet all are tightly coordinated in a structure that works like a single-payer system. The federal government provides most of the funding and sets most of the rules, giving Medicare significant clout when negotiating fees, equipment, and drugs. A 50-75% reduction in drug prices drives a huge cross-border pharmaceutical trade. Normal dental care is not covered but dental surgery performed in the hospital is covered and free. Most Canadians must pay for their drugs, though Medicare covers the cost for the poor, elderly and those with chronic illnesses.

 To be concise, the Canadian Government pays for most medical costs.  “And yet most Canadians-roughly two out of three working people also have private health insurance to pay the tab for things that aren’t covered by the system. This includes things such as dental care, private hospital rooms, prescriptions, etc.…” Because drugs are cheaper, as are hospital rooms, private insurance is cheap. In fact, many employers provide it as a fringe benefit.

 It is interesting to note that all provinces make it illegal for patients or plans to pay privately for any medical service that is covered by Medicare. To put a fine point on it, a doctor or hospital that bills Medicare is not allowed to charge patients for any procedure covered by Medicare. As a consequence, though there are differences between provinces. there is little private practice in Canada. 

 Doctors in Canada complain that they’re underpaid. Nonetheless, there are at least a few advantages. The provinces pay for malpractice insurance. All medical records are digital and shareable throughout the country. In the U.S.,  medical records are rarely shareable, even when hospitals are located across the street from one another, and using the same digital service. Medical school tuition is also much less than found in an American public university. As a result, there is far less debt.

 Ultimately, Canada shows us that a coordinated payment system has enough negotiating clout with providers and pharmaceutical companies to take control over costs. Yet, with rising healthcare costs worldwide, skimping on expenditures will result in the “kind of frustrating waiting lists that continue to plague Canadian medicine.

Next Part: Switzerland

Link to part 1 HEALTHCARE AROUND THE WORLD

Link to part 2 HEALTHCARE AROUND THE WORLD: PART 2 HEALTHCARE MODELS

Link to part 3 HEALTHCARE AROUND THE WORLD: PART 3 FRANCE

Link to part 4 HEALTHCARE AROUND THE WORLD: PART 4 GERMANY

Link to part 5 HEALTHCARE AROUND THE WORLD: PART 5 JAPAN

Link to part 6 HEALTHCARE AROUND THE WORLD: PART 6 UNITED KINGDOM

Link to part 7 HEALTHCARE AROUND THE WORLD PART 7: TAIWAN

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