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?