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Subject:  Healthcare in Canada Date:  6/26/2004  9:06 PM
Author:  coldcanuck Number:  9088 of 23810

In following up with JohnGaltII's "Economics in Health Care" dissertation, I'd like to inform the readers of a few facts of the Canadian healthcare system. I will attempt to discern my opinion from fact.

First of all, it is considered a "universal" healthcare system in that the same level of healthcare is available to everyone. In my opinion, this does not imply "excellent" or "very good" healthcare, but rather "minimally compliant" healthcare. If you're a member of the lower income group, it is great because you get the same services as provided to the wealthy. On the other hand, you have to consider the level of care.

Generally, the services of care are significantly lower. Any Canadian mother who has watch "Maternity Ward" on TLC will atest to that. One can view birthing mothers in US hospitals being applied oxygen during birth, while that only happens in extreme occasions in Canada (my wife, in the birth of our second child, was given laughing gas by a nurse, however the bottle was empty and ended up giving birth without and pain medication, so figure out her opinion of the healthcare system).

Further, there is only one queue for both the rich and the poor. Whether you are a deadbeat welfare ricipient of a highly productive CEO of a $2B corporation, you are in the same queue for services. Currently in my region (Ottawa, the capital of Canada) the wait for an non-emergency MRI is 9 months.) A colleague of mine at work had a significant problem with her back and was receiving rehab for it, and was working only in the morning and taking the afternoon off due to back pains. Her specialist wanted an MRI to judge whether to continue rehab or pursue surgery, and the wait was 8-9 months. She ended up going over to the province of Quebec to get an MRI at a private clinic (more on Quebec later). So here it was, my company (and Canada) was losing a 50% of a full-time employee due to a lack of immediate service while there was undoubtedly a less productive citizen (retired senior or welfare ricipient) on the waiting list above her. This is a net loss to Canadian society.

Further, the Canadian system is, although noone wants to admit, a partial two-tiered system. Third-party payers, such as insurance companies and the provincial Workers Compensation Boards, and sports teams, can "jump the queue" by paying the complete cost of service (restrictions differ province to province I'm sure, but clinics here in Ontario must provide 8 hours of public service per day before accepting private clients.) However, not service can charge a user fee if it is to be paid for by the public system. Hence this creates a problem alluded to by John - there is no incentive for Canadians to avoid going to the doctor for every runny nose - the third party payor (the govt) picks up 100% of the cost. To make things worse, a friend of mine, a general practitioner, claims he frequently gets medical visits from seniors who have no problems simply because they want someone to talk to (no kidding).

Quebec is a different noodle in Canada. (Opinion kicks in here). Although technically part of Canada, it believes it is ncessary to run many of its gov't systems separate from Canada (pension plan, healthcare) and preserve its constitutional right to speak French and force the French language on anyone residing in the province and in the federal gov't (don't get me started on this). Quebec seems to be able to run private clinics despite our federal laws strictly prohibiting such, as exemplified by by my colleague going across the border for an MRI and news broadcasts of federal politicians getting healthcare from private clinics.

It is true that many Canadians receive healthcare from US facilities. Anyone with a serious illness and cash (or a third party payor) would simply be idiotic to stay in Canada and put up with the waits. However, we also receive many Americans up in Canada to receive medication (due to Canada's patented medicine pricing policies) and to attend specialized services, such as the Shouldice Clinic (a popular hernia clinic which operates outside Canada's public healthcare system because it was grandfathered when private clinics we outlwed, as I understand it.)

So yes, the statistics indicate that the per capita healthcare spending is less than the US. However, you have to take into account that drug expenses in Canada are considerably lower due to gov't price caps, as well as the relatively mediocre services provided. Further, professionals in the Canadian medical profession are renumerated dramatically less than US counterparts, and this is exacerbated in Quebec, where my brother-in-law indicates Quebec doctors are compensated considerably less than Ontario doctors for similar procedures (he's worked in both provinces). It is a huge problem here that Canadian medical graduates are graduating with huge debts (since medical tuition has increased dramatically in recent years) that they accept employment in the US purely based on compensation alone.

In my opinion, the Canadian system is going to get worse before it gets better. Canada's "family reunification" immigration policy (where family members of immigrants are given immigration preference over others) ends up resulting in a significant number of Chinese and Eastern European seniors coming into the country. Further, Canada's gernerous refugee policies result in many refugees being admitted. The net result is that these people become a huge burden on the already overburdened Canadian healthcare system without making any economic contribution to the country (as an aside, there was a recent story in the media where Canada was accepting refugees from Africa with advanced symptoms of AIDS at an annual cost of approximately $3500 to the sytstem, despite Canadian policy stipulating that these cases should be rejected.)

Bottom line is that, in my opinion and others as well, the Canadian healthcare system is deteriorating and is unsustainable in its current form. Costs are increasing at a rate of 15% per annum, and is costing between 35% and 40% of Canadian GDP. On one hand it is nice to see that every has access to healthcare (the courts have decided that the Canadian healthcare system is required to pay for incarcerated criminals to have sex changes (no kidding!!!)), however the system is become a significant financial burden on the working population. Something has to give.

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