Thoughts on Canadian Health Care

Warning… this is a bit of a rant 🙂  As Canadians, we tend to be pretty accepting of most things:

  • Poor customer service? “Oh, he’s probably just having a bad day, we all do from time to time…I’m only giving him a 10% tip”
  • Government hikes to sales/income tax? “Well, what can you do?  Besides, we need to fund our great social programs somehow”
  • 8-hour wait time at the hospital when suffering from a serious sinus infection? “I don’t have a family doctor, so what choice do I have?  At least it’s free”

We can be pretty passive.  The process of looking internationally for medical school opportunities has led me to all kinds of interesting places, which in turn has opened my eyes to the possibility that Canada may not, in fact, be the greatest place to live.  Don’t get me wrong, I am very grateful for many privileges and blessings I have as a Canadian, including but not limited to: nearly universal access to basic education right up to high school, publicly funded (not free) healthcare, a generally kind population, freedom of speech/religion/expression, and poutine.  However, there are still things we lack, some of which actually exist in other parts of the world, including quick and efficient access to doctors and medical services.  Even though sometimes this comes at a cost – up front – to the consumer.

Yeah, I’m going there.  You see, the more I think about (and research) the medical profession and all that’s involved, the more I come to realize that nothing in this world is free (theological implications aside).  I think as Canadians it would actually do us a whole lot of good to scrap the perception that we live in a country with “free” health care.  The fact is, most of us pay 1/4 of our income or more to benefit from our medical system, among other things, and that’s a lot of money when you add it up.  Let’s say you make a mere $12 an hour and pay 15% income tax.  Even that adds up to almost $2 per HOUR that goes to the government.  Over the course of a year, working full-time, that’s over $3700.00 (I know this is a horrible example, since I haven’t accounted for the basic amounts you can claim, etc., etc.).  Most of us probably pay $1000, give or take a few hundred, for auto and home insurance each year; why not open the market to private health insurance providers and pay a similar premium for that coverage, leaving us with more money in our pockets?

The thing we need to realize is that Medicare IS an insurance provider – that’s exactly what they are, and there’s NO competition (by law) in the market, so the service can be as poor, sloppy, and inefficient as all get-out, but nobody’s there to oust them.  Studies and reports have shown that Canada performs among the worst (some years the very worst) of developed nations in terms of customer experience and value for money when it comes to health care, and that a socialist (i.e. non-competitive) model for health care is likely a root cause.  Instead of getting all fired up about a two-tiered medical system and losing our “free” medical care, we need to acknowledge the real cost of our system and work towards changing it.  Check out these stats, from a 2010 publication by the Canadian Medical Association:

  • Canada ranks 26 of 30 industrialized countries based on our ratio of physicians to population.
  • An OECD study of countries with wait times shows that the availability of physicians has the strongest association with lower wait times.
  • The average age of a Canadian physician is 51 years old; 38% of physicians are over the age of 55, representing more than 26,000 physicians.
  •  The Canadian Nurses Association is projecting a shortage of 60,000 full‐time equivalent nurses in Canada by 2022 if no new policies are adopted.

I found the average age of physicians especially striking – think about it, that means HALF of the physicians practicing in this country are over the age of 51, and will likely be retiring within 10 years or less, give or take a few years, depending on their personal circumstances.  Even if they want to retire later, CBC’s White Coat Black Art recently had an interesting piece (link to podcast, mp3) about how some doctors are being forced into retirement due to clinical concerns that arise with old age…

Anyway, I got side-tracked for a while and I’m just getting back to this, but one last point I want to bring up is this: considering the poor ratings we’ve had internationally in terms of value and quality of health care, combined with the relative lack of young physicians, why doesn’t Canada make it easier for aspiring young’uns like me to get into the field?  According to CaRMS, the agency that hooks up new MD grads with residencies, only about 1 in 4 QUALIFIED applicants is accepted to a Canadian medical school each year, and it takes an average of over 2 years (2.59 application cycles) for the ones who do get in (more details here – PDF).  I believe these are just a couple of symptoms of a weak and crippled health care philosophy, which is somehow contemporaneously well-funded but delivers lower than average results.  If the market was open for competition, and we had a choice of where we wanted to invest our dollars and receive care, perhaps Canadians would feel more accountable for their own health care (and health), and hospitals (which are businesses, after all) would do more to make themselves attractive to patients (i.e. improve service).  Of course, a safety net would still be required for those who have potential to fall through the cracks, so a complete withdrawal of public funding would not be realistic.

I leave you with this article, which talks about how Dalhousie University has been basically forced to sell seats to international students just to cope with budgetary constraints.  It’s easy to blame the school for having such a short-sighted vision (since it’s certain that these students will not stay in Canada to practice), but it’s just another reflection of our current state of health care and where priorities lie.  For the full text, see here.  I know as a Canadian student currently on the wait list for Dal, this was painful to read.

I’m interested in hearing your thoughts on health care in Canada.  Also, any opinions out there on which party is presenting the best health care platform for the upcoming election?

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5 thoughts on “Thoughts on Canadian Health Care

  1. I do agree with some of what you say but at the same time the thought of what you suggests does worry me. When I was pregnant with the twins I read up a lot on c-sections since the chance of me having one was great. One fact that I fell upon more then once was that in the states c-sections stats are ridiciously high. After pooring through some material I found that a lot of people expressed concern that Dr’s, mainly the Gynecologists obivously, often present c-section as the best and only option not out of concern for the patient but for their own interests , e.g. fear of law suits, malpractice, more $$ in their pocket for the procedure as iit is faster and more $$. The thought of some, even if not all, dr’s choosing to make my medical decisions for $$ and not out of interests such as yours mixed with the often subcare that insurance providers provide would be something I hope I never experience.
    Don’t get me wrong in some ways we aren’t better since we work under a kind of backwards model. We sometimes don’t get the service or medical treatment we need/desire because it costs “too much” to the government. I just think their has to be a better system to model and both Canada and the States have it wrong.
    ON a more positive note, good luck with the whole Dr thing. I think you would do great in that profession.

  2. I dunno, while you bring up some good points Tim, our healthcare system is felt to be better than many others. I just took a healthcare economics class this semester and really, ours is considered better than the UKs on an international stage, and while the US has much lower wait times many of their citizens simply don’t have access to it.

    Canadians already purchase health insurance for pharma-care, dentistry, elective care, etc. and those premiums are government regulated as well, so having health insurance for basic healthcare would not solve the problem, it would still be government regulated. Privatization also does not mean less government spending. The American government currently spends the highest percentage of GDP on healthcare (13%) and they have the highest GDP. So Privatization does not necessarily mean lower taxes.

    I do agree with the ridiculousness of our medical school system though. So much PSE reform is needed in this country. Our healthcare system is not horrible, but there are many things that could be fixed. Privatization is not the answer. I think a huge problem is that healthcare is managed by each province, but their funding is provided by the federal government, so each system is funded for differently (it should all be federal).

    Anyways, I could go on, but there are some musing. Here’s the healthcare debate http://watch.ctv.ca/news/election-2011/health-care/#clip449378

  3. Excellent blog post.

    I can understand your frustration watching hospitals provide residencies for international graduates at a hefty fee while Canadian students could make use of the residency positions. After all, there are only so many MDs available to teach and only so many facilities to provide the training, once the spot is used up it is not so easy to create more training positions.

    Truth is that the more doctors and nurses and facilities that are created, the more utilization costs will rise, hence the shortage of providers and facilities in the current system.

    Only external sources to the monopoly system can provide the additional services required and the laws (especially Bill 8 in Ontario) must be changed to reflect new realities.

    The ability of the monopoly system to meet the growing demands is clearly inadequate given shrinking tax base and growing dependency ratio despite later retirement and immigration. Tough facts to swallow.

  4. Having experienced the need for many Dr. visits while living in the US for the past 5 years- I can definitely say I prefer this system. I don’t like that I have to pay a $20 co-pay each visit or a high premium, but I honestly can say you get what you pay for. I’ve met some amazing specialists and physicians here who have taken the time and energy to really pursue issues no Doctors did in Canada. The Canadian system to me seems tired- I feel like it’s slowly dying. There are definitely a lot of issues here as well, good care can be hard to find without insurance or money. However, there are a lot of systems in place for low-income families and those without coverage. For about 8 months when we were first married I wasn’t allowed to get insurance due to the immigration process, and Doctors and hospitals always gave us a discount or set us up with a program to help. I think Obama’s idea of universal health care in the US is silly and unrealistic, as the demand will be overwhelming and the care will end up being sub-par. I’m rambling but my point is, having spent 25 years in Canada and never being impressed by the medical care, to coming here and having to pay a lot of money to get amazing care, to now being in a place where we’re provided with amazing insurance- I think paying for it is really worth it. Do I think we should have to pay? No- medical care really should be a human right- however, we live in a society where nothing is really free- so I have to be realistic.

  5. I’ve had to use the health care system of two different countries (Canada and Japan) so far, so I thought I’d give my observations.

    A lot of people complain about having long wait times or bad doctors in Canada, but I must be on a priority list or something… Any time I’ve had to go see a doctor, I’ve never waited very long, and the doctor was usually pretty good and worked to identify and fix the issue. I had to have a procedure done at the hospital in the valley once; it was scheduled for a few days later. I guess what I’m saying is that I personally have never had any of the negative experiences everyone else seems to talk about, so I can’t testify against the system. And I personally and glad to know that a homeless person can walk into a clinic and not have to worry about the costs.

    In Japan, it took me a while to get used to the idea of having to actually PAY after a doctor visit or something. I’ve had two separate medical issues since being here. One of the doctors I went to was very good, and even his English was quite good… but at 25$ per visit (and that’s on 70% covered insurance) I can’t say I was eager to visit often.
    I had to have a small operation on my head a week after the earthquake (these events were unrelated). They wanted to keep me in the hospital for 10 days!! Haha, I managed to get our earlier. Anyway, the doctors and nurses were all top-notch. I actually loved being there for 2 days because they were so much fun to talk to. Japanese nurses have this sweetness and gentleness about them, and the doctor was very compassionate and funny. And the food was really good. I’ll post more about it on the blog eventually. But the operation was about $600, again with 70% insurance, so if we weren’t able to afford that we would be in trouble.

    I guess, like everything, there are pros and cons. I have never personally experience the cons of the Canadian system, but they must be there if there are people complaining about it. Then again, I’m sure that the poorer people are glad that they don’t have to pay for their visits. Meanwhile the care in Japan is probably even better, but comes at a price that only those who can pay can afford. Then again, the salary difference in Japan is MUCH narrower. And Solveig and I have not seen a single homeless person in Japan, because the Japanese create jobs, however unnecessary (greeters at shops and banks, for example) that still pay a decent wage. But the way their handle employment is a different matter altogether.

    As for not accepting more medical students, I do find that odd… especially when they are clearly rejecting people who would be naturally talented in the field (ie Dr. Timothy Allen Cross).

    Oh, and I really like your observations about the typical Canadian reaction at the beginning. Very true, at least for people like us! 😀

    Thanks for posting!

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