Are we getting value for money with Canadian health care? And, if not, what do we do about it?
A paper mulling the federal financing of provincial programs doesn't seem particularly interesting. But Jason Clemens is no ordinary author -- he's bright and his thinking is clear. Clemens worked at the Fraser Institute, served as vice president of an American think tank, and now works at the Macdonald Laurier Institute. Though only back in Canada for a few months, he's already penned a handful of papers. His latest, which considers the two questions above, is important. (The full text can be found here.)
Federal politicians promise more funding for the Canadian health-care system. After years of cuts, it was a Liberal government that pledged robust increases in health spending; Prime Minister Harper, campaigning for re-election this year, promised to continue the increases.
The result? The Canadian Health Transfer -- the primary federal funding mechanism for health care -- is expected to increase from just over $20 billion in 2006-07 to slightly more than $32 billion by 2014-15 - about a 60 per cent increase in under a decade.
But are we getting value for money?
Clemens looks at a variety of measures. He compares Canada to the other OECD nations. The results are startling.
Start with spending.
Canada is on the top end. But as Clemens points out, our sixth place ranking (tied with Switzerland) is a bit deceiving. Adjust for age and exclude the non-universal health-care system, and we spend the most of any country with a universal system.
How do we fare?
Consider the supply of physicians.
Ouch.
Clemens summarizes other data:
• Canada ranks 16th in access to nurses.
• Adjusted for population, Canada ranks 24th in hospital beds.• Canada's wait times are also long compared to other industrialized countries. A study by the Commonwealth Fund indicated Canada performed the worst among the seven countries analysed. Of the seven questions aimed at wait times, Canada had the worst response in five and the second worst in the remaining two.
• Canada has comparatively middling performance in access to medical technologies. Canada ranked 16th out of 27 participating OECD countries for both access to MRIs and CT scanners.
• Canada ranks marginally better for access to mammograms: 11th of 25 countries.
Of course, there is more to comparisons than simply looking at, say, high-tech gadgets like MRIs. After all, when it comes to health care, more isn't necessarily better.
Still, even with this type of a crude comparison, Canadians clearly aren't getting value for money. And there's limited evidence that the sort of massive infusions of cash seen in recent years are making a material difference -- except that providers make better coin.
Clemens suggests a remedy. Using welfare reform as a model, he proposes that the federal government block grant health funding, turning the money over to the provinces, and allowing them to innovate.
It's a novel idea -- though I'm not quite as optimistic as he is. The reason that Ontario rejects user fees and Manitoba dismisses more private provision of health services has little to do with the federal government and much to do with the ambivalence of the Canadian people. Afraid of an Americanization of the system, Canadians fear change.
But looking at the OECD data, we see that Canadians could get more technology, shorter wait times, and still maintain a universal system. Where to look for ideas? Try Sweden or Denmark.
And, at the end of the day, is anyone really afraid of a Swedenization of the Canadian health-care system?
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Fewer people suffer and die in those systems.
How many more people have to die needlessly in our antiquated and dogmatic system until we can look at how they do things?
What is the number?
10,000?
Should we allow another 10,000 people die before we look and learn from the countries that have better health care systems than us?
Or is that number too low?
You want to wait longer?
What is the number?
How many more people are we going to sacrifice on the altar of poltical ideoology?
I also compared life expectancy, infant mortality and cancer survival rates with the French system, you favourite. Between 2005 and 2010 life expectancies in Canada and France were the same at 80.7 years. France betters Canada in infant mortality at 3.29 to 4.92. As for five year cancer survival rates, as of 2009 the best results are U.S., Australia, Canada, France and Japan.
Also, France spends more money on health care than Canada does.
It turns out Canada's health care is not as bad as you claim.
We made progress!
Someone actually looked at the alternatives instead of simply braying the glories of our system!
so much for that 'sacred oath' he took when he became a doctor
increase corporate taxes and increase the corporate tax for healthcare
healthy workers are productive workers
canadians aren't afraid of change doctor, canadians are afraid of losing their homes due to health problems
#1 cause for bankruptcies in America is to pay for medical bills
this article is obviously a trial balloon sent up by the harpo hunta to see how and when they can start to dismantle universal healthcare
i watched a lecture last night given by noam chomsky back in april 2011 at hart house at u of t and he stated that it is a very typical tactics by the corporate - gov't ruling class to "defund a program, wait until people complain about how bad it is, then have the corporate sector take over and when they screw it up, have the gov't bail them out"
we know what you're trying to do doctor, you're doing the PMOs bidding, we see thru your thinly veiled ruse to convince canadians that changes to our UNIVERSAL healthcare is needed
shame on you doctor, shame shame shame
the CMA should pull your licence
Anyone who declares bankruptcy and has over $1000.00 in unpaid medical bills is included in that.
You can owe a million to your booky, but if you owe your doc $1001.00 it is classified as a medical bankruptcy.
Obviously it is garbage.
But why talk about the US system?29 countries have better health care than us, why wouldn't we try to learn from them?
Or should we keep derailing any sensible and adult conversation about health care reform by making up stories about the US system?
One way reduces suffering and deaths, the other way makes you feel good about your political ideology.
I guess the question is which is more important to you, political dogma backed by lies, or reducing pain and suffering.
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Medical bills prompt more than 60 percent of U.S. bankruptcies
Bankruptcies due to medical bills increased by nearly 50 percent in a six-year period, from 46 percent in 2001 to 62 percent in 2007, and most of those who filed for bankruptcy were middle-class, well-educated homeowners, according to a report that will be published in the August issue of The American Journal of Medicine.
It disgusts me to have you say people in Canada "suffer" and die" because of our healthcare system. That is disingenuous and childish in its bold falsehood.
I have no idea where you're coming from because unless you are a very rich single man who has no children and has no plans to have any children or grandchildren and who does not have parents or other senior friends or relatives you care about in any way then I guess you can feel this way. Alternatively you're just a loud-mouthed trouble-maker who is either just yanking our chains or has serious psychological problems.
In other words - go away !!
What does that mean? Adjust for whose age?
And he's comparing us to OECD countries with bigger non-universal health care systems, but then excluding that (relatively larger) privately funded segment of their health systems. That skews the numbers right there.
They have better health care than us.
As do 27 other countries.
Why don't we learn from them?
Let''s say we place a Registered Nurse in every SCHOOL in the Nation.
Let's say we place a Dietician in every SCHOOL in the Nation.
Let's say we have a Dentist visit the CLASSROOM's in the Nation.
Let's say we have a Doctor visit the CLASSROOM's in the Nation.
Let's say we start PREVENTION programs early and often and teach the Nation's students how to manage their health and diet.
Let's say we post a INVESTIGATIVE TEAM in every Hospital in the Nation.
Let's say we recover all medical treatment costs of injuries caused by impaired driving, driving infractions, drug inducement, sports injuries, assaults and workplace accidents.
Let's say we recover all medical treatment costs from The Corporate State over addictions caused by government regulated tobacco, alcohol, gambling and prescription drugs.
Let's say we deploy a complete array of OXYGEN based prevention of the spread of anaerobic bacteria and virus molecules at all places of human activity.
Let's say we adopt the Oil Protein Diet protocol established by a 6 time Nobel nominee, Dr. Johanna Budwig, to prevent cancer and arthritis.
If you think of transferring health care dollars to a 13 year Provincial Premier named Ralph Klein who abused himself with tobacco and alcohol, and who is now costing PUBLIC health care big time with lung disease and dementia issues, will do anything efficiently for health care administration, then you just fell out of a tree!
But there's no reason why that has to be matched with socialized health delivery. Let's get more free enterprize into our health care system. Government delivery will never match the efficiencies of private enterprize.
here's a small example: nurses often work 12-hour shifts. this is absurd, since we've known for >50 years that no one can perform well after 8-ish hours. the effect of 12-hour shifts is lower productivity, higher cost and probably somewhat lower healthcare quality (and I'm NOT blaming the nurses!). and this is not a "labor" issue - it's a matter of determining policy with the goal of optimizing performance and efficiency.
You lost me with first mention of the Fraser Institute. Rather than actually trying to solve problems, their purpose is to invent so called solutions that conform to their extreme right-wing principles. They have an agenda. Their mission is to brainwash the public into accepting the views of the corporate overlords that founded them.
Health care in Canada is not broken. It should be seen as an essential service that should not be commoditized. Yes it can be made better and more efficient. But it will not be improved by introducing a private, for-profit economic model. Unregulated free markets have created havoc on the world. We don't need that same type of garbage to seep into our healthcare.
Why not look at the countries that have better health care than us and learn from them regardless of their political ideology?
Or is political dogma more important than stopping uneccessary suffering and death?
It reminds me of a guy I was golfing with in West Virginia a year or so ago who said to me "If your healthcare system is so good why do Canadians hate it so much?" Another "Huh?". The lies from the Right and the vested interests in Private Healthcare are just overwhelming. Too bad Progressives and liberals tend to be too nice and let them get away with it.
Time for a little "Agressive Progressivism" IMO ...
We don't need oversimplifications from the extremist right-wing crazies at the Fraser Institute, who buy into a theory of social interaction (game theory) developed by a paranoid schizophrenic (John Nash).
And after having a friend of mine go to a VET to his broken leg X-rays read, and found out that it was set very poorly, I think we have lots of room for improvement.
The analogy I use is that of a door with a latch. That's we have now thanks to the CHA - no matter how much they push on the door they can't open it and it is self-securing. Opening things up as you suggest is like undoing that latch. You can't just unlatch the door a little bit, unlatched is unlatched. Then from that point on we will need governments inside Canada pushing back on the door to offset the push we will see from the outside. And it then is only a short time before we get a government in Canada that doesn't hold that door ... that let's the door swing wide open. HMO's here we come !!! The toothpaste is out of the tube and it ain't going back in -
Goodbye Universal Healthcare, Hello Americanized Healthcare (if you can call it that). And I'm going to blame people like you for it.
How do you have that control of MY health and MY body?
The vast majority of Canadians believe that all Canadians' medical care should not be based on how much money you have. And for that to work everyone has to be in the pool - allowing people to buy "special" care just because they have money threatens the ability to provide for everyone.
I'd really like to know whether you have any particular beefs with the medical system here in Canada (assuming you actually live here). I personally have never had anything but the best of care for all the generations of my extended family so I don;t see how having the ability to pay more for the same care makes any sense anyway. You obviously are talking about the old libertarian "I don't want any of my money to go to help other people !" school of thought. Why don't you move to Texas and spend all the money you want.