What’s Wrong With Canada’s Healthcare System?

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    Mar 26, 2011 5:49 AM GMT
    March 13th, 2009 by Dr. Val Jones in Health Policy

    This post is a continuation of my discussion of healthcare systems, and what the we can learn from them… I’ve summarized one particularly provocative and outspoken Canadian’s opinion below:

    Is Canada’s healthcare system a political monopoly?

    Dr. Brian Crowley is the Founder and President of the Atlantic Institute for Market Studies in Halifax, Nova Scotia. He describes the Canadian healthcare system this way:

    Canadian Medicare operates in an unregulated, tax-financed, pay-as-you-go model. Our provincial governments are our monopoly provider. They not only pay for necessary care, but they also govern, administer, and evaluate the services that they themselves provide. They define what we call “medically necessary services” and pay for 99% of all physician services. They also forbid the use of private insurance for medically necessary services. They set the budgets for nominally private healthcare institutions. They appoint the majority of their board members and have explicit power to override management decisions.

    Under these circumstances, no hospital or hospital administrator can be expected to take any responsibility or initiative because decisions will always be second-guessed by those in political power.

    Before the advent of competition in the US telephone industry, dissatisfied customers faced the massive indifference of a bureaucracy that took their business for granted, despite some theoretically powerful regulatory agencies. Administrators of the Canadian healthcare system likewise suffer no direct consequences for poor customer service. They aren’t even answerable to a regulatory agency. Accountability is a vague political concept which cannot be enforced in any meaningful way. Like all monopolists, Canada’s healthcare authorities abuse their positions of power.

  • charlieviiper...

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    Mar 26, 2011 6:47 AM GMT
    But have there not been consequences for "poor customer service"?

    ie) Chaoulli vs. Quebec?

    I think the courts can act as a pretty good check on the Health care system.
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    Mar 26, 2011 1:04 PM GMT
    charlieviiperi saidBut have there not been consequences for "poor customer service"?

    ie) Chaoulli vs. Quebec?

    I think the courts can act as a pretty good check on the Health care system.


    Ok so you're sick, or perhaps with a long term debilitating disease. You're waiting for say an oncology (Cancer) a specialist and can't get one. Surely you're not saying that you think that deferring to your lawyer and mounting any expensive legal action that could take years is a pretty good check on the Health Care System?
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    Mar 26, 2011 1:21 PM GMT
    If that were true, then why are Canadian Healthcare costs so cheap?

    After all, monopolies have no incentive to keep prices low, right? Why isn't Canada more expensive than the US for healthcare [if that were possible!]

    I call bullshit.
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    Mar 26, 2011 1:28 PM GMT
    TigerTim saidIf that were true, then why are Canadian Healthcare costs so cheap?

    After all, monopolies have no incentive to keep prices low, right? Why isn't Canada more expensive than the US for healthcare [if that were possible!]

    I call bullshit.


    While I'm not sure I agree with the conclusions, regulated monopolies don't necessarily mean expensive. For instance, in Ontario, consumer electricity rates are oddly subsidized by the Ontario Government (ie taxpayers) and business rates.
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    Mar 26, 2011 1:46 PM GMT
    Just put the U.S. Department of Interior over them and they will get the fuck regulated out of them.
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    Mar 26, 2011 1:52 PM GMT
    <
    TigerTim saidIf that were true, then why are Canadian Healthcare costs so cheap?

    After all, monopolies have no incentive to keep prices low, right? Why isn't Canada more expensive than the US for healthcare [if that were possible!]

    I call bullshit.


    Our healthcare dos not have a profit layer added at each step, which lowers costs.

    Insurance processing done by civil servants is not a cost to be built into prices that get passed on to recover costs for an insurer and make a profit too.

    It is not at all odd for an essential public utility in a province the size of Ontario to be subsidized by tax dollars because it would not be cost recoverable otherwise to string power lines through the vast but sparsely populated tracts of Ontario.

    What is odd is a Canadian living in Ontario who does not grasp that instinctually. but I guess riddler has never been through Algonquin Park or done the drive to northern Ontario. (A lot of Torontonians have never left the urban area so have no concept of the chasmic urban/rural divide.

    Rural Canadians understand through to the very fibre of our identities being so insignificant relative to our land mass.

    Torontonians are the quintessential urbanites in Canada,out of touch with rural Canada (much larger demographic) so Toronto is the focus of national rural resentment. They totally don't get it in Toronto. maybe that is why riddler seems so out of step with the other Canadians on here. It could be urban myopia.


    The article makes good points but it is not a convincing conclusion, and here us why:


    * I worked on the healthcare administration side for a few years and I don't think this doctor has direct experience with the constant scrutiny and accountability we had. Any time their was an "undesirable outcome" the scrutiny was intense

    * The author overlooks the fact hat all those rgulators and peope making those decisions are drawn from the medical profession itself, so it is his senior peers who are making those decisions, not politicians.


    The article strikes me more as a guy jealous of being passed over for these oversight posituons when his classmates or colleagues friends get them. So he writes vague complaints like the above.

    I'll google him. It will tell me a lot just seeing when he graduated andwhere he is now.


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    Mar 26, 2011 2:13 PM GMT
    hmm.....well there IS private health insurance in Canada and we are bombarded with ads regularly. There IS private healthcare in Canada and you can pay cash to get it then make a claim on your private insurance (which is often denied based on pre-existing conditions crap).

    Here, personal anecdotes are reality, pontificating market studies by private industries aren't.

    Sid, a friend, needed micro surgery to remove cartilage from under his kneecap. The wait for this non emergency surgery was about a year, he was told. A private clinic offered it for $2500.00 cash. So he went private. He also had a supplemental private insurance. He had to wait 2 -3 months. They did it. There were problems later. They had to inject silicone or some such thing later into the knee to stop the 'grinding'. His private insurance denied his claim because the problem had already been there in a much smaller degree years before when he first got this insurance.

    Now let's hop across the street. Val, a gal I know, had her son come over from Victoria. He needed the same surgery. He was told a year. Then the Libs paid some money into the plan (Campbell was going down in flames, so this was an attempt to woo the constituency) instead of diverting it into pet projects like convention centers. Voila , his surgery happened in a month. They did a VERY good job (being publicly paid, the system wants you WELL, not a revolving door customer to get more money out of as in private industry). He was up and walking in several days and no complications, rapid recovery, adequate follow-ups etc.

    It was rather interesting watching these two stories play out at roughly the same time right here on our street.

    -Doug

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    Mar 26, 2011 2:22 PM GMT
    Val Jones, M.D.

    Val Jones, M.D., is the CEO of Better Health, LLC, a medical blogger network and education company. Most recently she was the Senior Medical Director of Revolution Health, a consumer health portal with over 120 million page views per month in its network.

    Dr. Jones is the author of the popular blog, "Getting Better with Dr. Val", which won The Best New Medical Blog award in 2007 and was a finalist in the health policy and ethics category for 2008.

    Dr. Jones has been quoted by various major media outlets, including USA Today, The Wall Street Journal, the New York Times and the LA Times. She has been a guest on over 20 different radio shows, and was featured on CBS News. Dr. Jones volunteers as a rehabilitation medicine physician at Walter Reed Army Medical Center and is a graduate of Columbia University College of Physicians and Surgeons.


    So she is an American doctor (out of the profit model), works for an LLC (a profit model - outlawed in Canada for practice so take her opinion comes from in that context.

    She is a darling clearly of the American right wing media but is not sourced by Canadian media.


    She is a General Practioner (not a specialist) - so has not advanced high yet in the ranks of her profession. She BLOGs, and holds no appointed position from the public trust.

    In short, she is a self-interested party in the profit model of care.

    No wonder then the article seemed weak and ignorant of what scrutiny processes actually occur happens at upper levels

    (I've been part of those preparing those reviews. they are thorough - detailed, time consuming, and very medical, supported by rooms full of files and doctors testifying. They are quite like legal proceedings, but not under the legal sysyem. It isdone under professional standards.

    The LAW does not govern a doctor's actions nessessarily so much as the rules of the College of Ohysicians and Surgeons. It the peers who make determinations wwhether proper care was given.
    Government officials only care about the budget and that money given is spent solely for the purpose it was given

    Only the College can rule on medical matters. The police will deal with criminal improprieties.

    I would not assign much credence to this article by Dr Val Jones.
  • roadbikeRob

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    Mar 26, 2011 2:37 PM GMT
    Toronto and nearby Hamilton don't understand the rest of Canada, especially rural Canada because both these Ontario cities are too strongly influenced by Americans.
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    Mar 26, 2011 2:52 PM GMT
    Out of curiosity, what is a doctor's - say, a general practioner... income in the USA vs Canada?

    In other words, is there the same financial incentive for the effort to become a doctor in both countries regardless a public or for profit model?



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    Mar 26, 2011 2:58 PM GMT
    Dr. Jones volunteers as a rehabilitation medicine physician at Walter Reed Army Medical Center

    This doesn't fit with her being a GP or not having finished a residency. I just have a hard time believing a place like Walter Reed is going to let someone volunteer, particularly as a rehabilitation physician, which generally requires residency training in physical medicine and rehabilitation without such training.
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    Mar 26, 2011 4:08 PM GMT
    alphatrigger saidOut of curiosity, what is a doctor's - say, a general practioner... income in the USA vs Canada?

    In other words, is there the same financial incentive for the effort to become a doctor in both countries regardless a public or for profit model?





    You can find this info by doing a simple search. $170k in the U.S. and $45k (Canadian) in Canada.

    GPs in the U.S. are capable of making much more than the average salary provided above. My partner and I know a GP who does extremely well for himself, earning far more than $170k.

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    Mar 26, 2011 5:03 PM GMT
    As someone who has spent 30+ with a doctor working in a large university hospital I know what they make, and it can be many times that 170k number.

    I also know that many young physicians who went south looking for more money, have come back so they can practice proper medicine, and not just cover their asses from vicious lawyers.
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    Mar 26, 2011 5:14 PM GMT
    My aunt trained in Toronto, got both her license in oncology in Canada and the US, and practised for a while in both. Went back to Toronto to become head of head/neck oncology in a hospital there. I asked her why, and she said: no stupid paperwork from multiple insurance companies to deal with, and sane (not exclusively defensive) medicine.
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    Mar 26, 2011 5:19 PM GMT
    wrerick saidDr. Jones volunteers as a rehabilitation medicine physician at Walter Reed Army Medical Center

    This doesn't fit with her being a GP or not having finished a residency. I just have a hard time believing a place like Walter Reed is going to let someone volunteer, particularly as a rehabilitation physician, which generally requires residency training in physical medicine and rehabilitation without such training.


    A GP has in fact completed residency as part of training to become a doctor.

    From there they specialize then subspecialise.

    (eg. a young student trains to become a doctor. Once certified he can go into General Practice or continue education to become a specialist to make more money-
    So the doctor mnight eschew setting p a General Practise to become, say, an Ear Nose & Throat specialist. in Ottawa there are about 30. The top ones number 6 and they are up there on the ladder in money and prestige.

    Once specialized, they then subspecialise - one of those 6 subspecialised in cancer and reconstructs faces lost to cancer. He is at the highest rung - gets paidthe most, was elected by his peers to be in charge of ALL the ENTs in Ottawa.

    Another sunspecialised in noses and ear reconstruction and has a lucrative cosmetics practise. He does not bother to see patientswith mundane snoring problems. Those are for the other 25 or so.




    Another subspecialised in the cochlear implant. It isall he does. and anyone in eaytern Ontario with on hadtheir hearing turned on by him . He dos opt bother to see patients wirh mundane ear infections or inflamed tympanic mermbranes. thst is for the other 25 or so too.



    The huy in the top prestige post, when famous singers are on tour and have a tthroat problem, He iscalled for

    (yes they are taking a shotgun to a mouse but when you are LolaFalana or Placido Domingo you call out a rpivate army to swat flies with a cannon. if you want.

    Meanwhile his colleagues just envy him


    His son isstarting out in his own specialty practise -- he never hadto go into general Practise - poppa could afford to finance him all the way through to fellowships. His own offices sate in a huge building hid dad now owns and one day he will own it.


    So our doctors can indeed become veery7 wealthy and politically connected. The method of getting there differs only a little from the US for the doctor.



    In a nutshell, that is thecareer path of a top flight physician.

    This particular doctor I am describing bought the building that housed his general practise, then he rented space to other starting doctors He is now prestigious, weaklthy and politically connected.


    (What Senator doesn't want to say he had the same doctor as Placido Domingo - they are status seekers too).


    He could end up being tapped as a Senator himself, or drafted to run for Parliament andthen be tapped Minister of Health (if he were so inclined)


    General Practioners are not lesser doctors - it just describes what they do - they elected to be the first line of treatment in patient care. They refer to specialists, who then refer to subspecialists.

    GPs make less money, but their education cost them less, they are earning sooner, but they end up owning smaller building that house only their own practise.



    (this is why the need to golf together -- doctor A gets to pick who to send his pt to -- that will beincome to the specialist - so connectionsand networking is vital.

    Piss off your colleagues and your referrals dry up. you end up with only your General Practise bringing in income with the same overheads and you soon fallinto line.

    Or you do someting else like becopme a medical blogger and try to start a business around a different model (like a web portal)

    That alone tells us she might be in a certain disfavour with her colleagues. icon_lol.gif



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    Mar 26, 2011 9:22 PM GMT
    Does any one have a list of all the bloody taxes canadians pay; it's a bloody long one. This must go towards their health care to help support it, because someones paying for it, it's not free; albeit it may seem cheap.

    He's not heavy his my brother, but this does not make me his keeper too.
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    Mar 26, 2011 9:35 PM GMT
    50% of our revenue go in taxes here in Quebec!

    I believe health care should be almost free,but they need to find a way to regulate it because the population is getting older and more sick and they cant tax us more than that...
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    Mar 26, 2011 9:46 PM GMT
    RiverRising said
    alphatrigger saidOut of curiosity, what is a doctor's - say, a general practioner... income in the USA vs Canada?

    In other words, is there the same financial incentive for the effort to become a doctor in both countries regardless a public or for profit model?





    You can find this info by doing a simple search. $170k in the U.S. and $45k (Canadian) in Canada.

    GPs in the U.S. are capable of making much more than the average salary provided above. My partner and I know a GP who does extremely well for himself, earning far more than $170k.


    Where did you get that Canadian figure? My simple search showed that the average Canadian physician made $250K. Nurses could possibly start at $45K. That's around the median adult Canadian salary, regardless of industry.
  • Cdnontherun

    Posts: 69

    Mar 26, 2011 10:00 PM GMT
    Are there problems with the Canadian (and we have to be careful to say Canadian because each province runs their own systems within federal guidelines) healthcare? yes. Is it perfect? No. but what I do know is that I never had problems with it and I had two friends die prolonged horrible deaths and they received excellent care and when it was over, their families weren't bankrupt. Everyone in Canada is covered and pretty much at the same level. There are not millions of citizens uninsured or millions more with inadequate health insurance. So all in all, I'd give our system a "thumbs up" warts and all.
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    Mar 26, 2011 10:04 PM GMT
    Cdnontherun saidAre there problems with the Canadian (and we have to be careful to say Canadian because each province runs their own systems within federal guidelines) healthcare? yes. Is it perfect? No. but what I do know is that I never had problems with it and I had two friends die prolonged horrible deaths and they received excellent care and when it was over, their families weren't bankrupt. Everyone in Canada is covered and pretty much at the same level. There are not millions of citizens uninsured or millions more with inadequate health insurance. So all in all, I'd give our system a "thumbs up" warts and all.

    Win.
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    Mar 26, 2011 10:05 PM GMT
    True_Blue_Aussie saidDoes any one have a list of all the bloody taxes canadians pay; it's a bloody long one. This must go towards their health care to help support it, because someones paying for it, it's not free; albeit it may seem cheap.

    He's not heavy his my brother, but this does not make me his keeper too.

    How would you feel if you were in their shoes, hmm? Would you not be glad that taxes pay for healthcare?
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    Mar 26, 2011 10:09 PM GMT
    Cdnontherun saidAre there problems with the Canadian (and we have to be careful to say Canadian because each province runs their own systems within federal guidelines) healthcare? yes. Is it perfect? No. but what I do know is that I never had problems with it and I had two friends die prolonged horrible deaths and they received excellent care and when it was over, their families weren't bankrupt. Everyone in Canada is covered and pretty much at the same level. There are not millions of citizens uninsured or millions more with inadequate health insurance. So all in all, I'd give our system a "thumbs up" warts and all.


    Same here.
    My eldest sister was born with major heart defects way back in the 50's and required lifelong monitoring, a few operations as she grew, later pacemakers etc. and on top of that she was struck with severe rhumatoid arthritis in her late teens leaving her permanently disabled and unable to work. The care she received over her life thru our local small hospital and Toronto was excellent. There was one incident where she had some routine testing done in Toronto and came home, a 3 hr train ride. When she got home that night at 11pm she had a message to call the Toronto hospital immediately on getting the message. She did.. They said they found something in her tests and she had to return to the hospital immediately. 3 hrs away at 11pm.. she doesn't drive, etc. they arranged an ambulance to come get her right away, off to the airport and they sent an air ambulance to pick her up. No bills, no paperwork, fixed.. how can anyone complain about that.
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    Mar 26, 2011 10:49 PM GMT
    I believe our system has been successfull and continues to improve. People have asked for better service and it has happened!

    And as with any system there are the few who have a bad experience. You cant please everyone 100% of the time!

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    Mar 26, 2011 11:25 PM GMT
    yourname2000 saidI used to be a bigger fan of our healthcare system, however chronic underfunding has left it so addled that it is at best "universal emergency care". If you end up going to Emergency, you'll probably do fine and appreciate a pretty decent experience. But try to find a family doctor in Canada....there just aren't any taking on new clients. I believe the figure is that 30% of Canadians are without a family doctor. This has the impact of removing all preventative care and situations are more likely to not be dealt with until they're many orders of magnitude more expensive. So I'm concerned that the Canadian healthcare system is woefully unsustainable. If it can't keep up now, once the baby-boomers are all seniors there won't be a hope.



    That's a huge generalization speaking for the whole country like that? Perhaps it is in Burnaby but I had no problem finding a doc in Calgary and when I didn't like the first one got another. When I moved here to Ontario I had people saying to me the same thing.. oh you'll have trouble finding a doctor.. hell I found one right away again.. I just made a call to the local health clinic type place and asked them for doctors who are taking n ew patients and they gave me names. People here in this city go on saying that stuff.. when there ARE doctors here taking new patients everyday.. what is with that?

    Actually I can answer for some of it.. the doctor I have here is black. I told a couple of people that back at the time and believe it or not they said they wouldn't go to a black doctor.