Dec. 16, 2004

CANADIAN HEALTH CARE

1. Who: 100 percent of the people. By 1971, the private insurance companies had been purchased by the provincial governments (though often run the same as before) and the Canadian health care system could be “characterized as a single-payer government health insurance run by the provinces with general federal rules and financial contributions” (Chernomas and Sepehri, 1995, p. 183.)

2. Cost: The cost to a person going in for treatment is nothing. Each province gets money and they decide how to spend it. The cost of the system is paid for out of federal and provincial taxes on individuals and corporations.

The federal government pays provinces on a per capita rate tied to changes in the GDP. Although Canada spends relatively less than the United States (as measured by health expenditures as a percent of GDP), the health care system has faced the need to control costs. An important way that Canada controls cost is through controlling the spread of technology, an important factor in health care cost increases. Purchase of new equipment, especially the more expensive and larger items, requires provincial consent. High-technology medical equipment, such as magnetic resonance imaging machines, is located largely in the academic medical centers. This means the equipment is used more efficiently than in the United States (White, 1995). White writes, “Less capacity for more expensive treatments means that those treatments are not as likely to be overused and that each use costs less.”

The covered services vary somewhat from province to province. In general, all medically necessary hospital and physician services are covered. You get treatment within your province; however, you do not get to choose where you get treatment in the province. Canada limits number of doctors and specialists. Canada also does not accept American credentials. Canada also limits the amount of money doctors can make, so if you reach that amount, there is no financial incentive to take on more patients.

3. How and how much: In Canada, you will not receive a bill for services. Each provincial resident receives an insurance card entitling him or her to services, not only in the home province but anywhere in Canada . All provincial plans must meet five criteria set forth in the 1984 Canada health Act. The first criterion is that the plans must be publicly administered, that is, by a public body on a nonprofit basis. Second, the plans must be comprehensive. Third, the plans must be universal, covering all residents. Fourth, the plans must be portable, so that residents can obtain needed services in all territories and provinces. The act contains provisions for paying for out-of-province services (including out-of-country services). Finally, the plan must be accessible. This means that services are to be available to all and not impeded by charges (though some provinces do impose charges on recipients); that there be reasonable compensation for providers; and that hospitals be paid based on their costs (Health Canada, 1998)

Physicians are generally paid on a fee-for-service basis, with payments based on fee schedules negotiated between each provincial government and provincial medical associations. To prevent physicians from increasing the number of services they offer to increase their income, the provinces have established caps on physician expenditures. In some cases, provinces have put limits on physicians' income. (Graig, 1999)

The Canadian system faces a number of problems. These include budget restraints on fund transfers from the national government to the provinces; dissatisfaction among providers, especially physicians; continued long waiting times for elective procedures; concerns about the efficiency of the system; and some growing dissatisfaction with the system among the public. One of the major pressures, facing Canadian citizens if not the system, is the increasing cost of pharmaceuticals.

Despite the fact that Canadians spend considerably less on health care than Americans, as measured by percent of gross domestic product, it remains the case that the Canadian system is the second-most expensive system in the world (using the same measure.)

4. What is or is not covered: Everything is covered for a major medical event such as a heart attack or cancer. There are many different parts of this, however. Eye exams are covered but not glasses. Dental is not covered. Medications are covered if you are in the hospital but not if you are not hospitalized, unless you are age 65 or over. Diabetics' supplies are not covered; however, there are resources to help cover those costs.

5. Settle disputes: Canada does not have malpractice insurance. If there is a dispute, which happens rarely, the Medical Board settles it. If there is an incident in the hospital, then the Hospital Board will decide.

6. Rankings: Canada ranks second in the world in life expectancy at birth; third in child mortality; second in adult mortality; and second in healthy life expectancy. (WHO)

7. Waiting lines: If you are suffering a major medical crisis, then there is treatment; however, if it is not an emergency, then you can either go with no treatment or you may wait months to receive treatment. You may also have to travel many miles within the province to receive the desired specialized treatment.

If Canada feels that a hospital is not serving a need, the government will close it. One of the consequences of budget cuts, hospital closings and other cost containment measures, is huge backups in emergency rooms, and the fact that patients often have to wait a long time for certain surgeries. Anxious patients often wait for months for surgery, often unaware of their choices and their chances. However, every diagnosis should have a sound medical opinion behind it, so that people with non-emergency medical needs who have to wait may want quick service but have no medical need for it. The fact that they can’t get what they want when they want it doesn’t necessarily show a problem or that the system is bad. It may also show unreasonable demands or expectations by patients.

Sources
Chernomas, R., Sepehri A. The Canadian health care system as a managed care model for the United States, Health Care Management 2 (1);183-190,1995

Graig, L.A. Health of Nations: An International Perspective on U. S. Health Care Reform, 3rd ed. , Washington , DC : CQ Press, 1999

Health Canada Canada Health Act Annual Report 1997-1998 , Ottawa , Ontario : Minister of Public Works and Government, 1998.

Patel, K., Rushefsky , M.E. Health Care Politics and Policy in America , 2nd ed. , Armonk , NY : ME Sharpe, 1999

Posner, M., Nemeth, M. Condition critical, Maclean’s 108(46): 46-50, Nov 13, 1995 .

White, J. Competing Solutions: American Health Care Proposals and International Experience, Washington , DC : The Brookings Institution, 1995.

World Health Organization (WHO), www.who.int