Wednesday, 6 June 2007

Canadian Vs American Health Care Systems

Canadian Vs American Health Systems

* * *
Image Hosted by

Americans are often heard to be envious of the Canadian Socialized Health System and on the surface it may appear we have the better deal. But what happens when you look at the systems from a somewhat different angle?

Americans do not have a universal socialized health care system therefore they must find the finances to pay for medical expenses out of their own pocket. They can obtain medical coverage either through a private insurance plan or through their employer. The insurance provider or HMO (Health Maintenance Organization) might dictate which doctors, labs and hospitals are accessible to the patient. Pre-disposing illnesses could disqualify someone from obtaining coverage and acquiring a major illness may lead to non-renewal of the policy. U.S. hospitals are for the most part private. Many lower income citizens, who may need the services most, often suffer poor health or the consequences of untreated illnesses because the price of insurance is out of reach. No money up front - No treatment!
Image Hosted by
Canada has a universal socialized health care system which is paid for by the citizens of via taxation by the Canadian government. Everything from routine visits to the doctor’s office to major transplant surgeries are covered. The ailing citizen never has to show his wallet in order to receive heath care. There are, of course, conditions. In general, medical expenses are covered for all services and procedures required to maintain or restore a reasonable level of health. Many cosmetic and some elective procedures are not covered. For other medical necessities such as vision, hearing or dentistry, private insurance is available privately or through one’s employer. This extended insurance might also cover items such as ambulatory braces, home oxygen, drugs to wheelchairs.

Let there be no misunderstanding, in a life altering illness such as my paraplegia, there are plenty of expenses not covered by any system thereby falling on my own shoulders for payment.

With aging “Baby Boomers”, the Canadian health system is becoming overwhelmed by the shear number of patients requiring treatment. Cutting edge technologies are expensive so too few sites have the equipment or the expertise in these procedures. Where applicable, some patients are already being sent to the U.S. for treatment. This increasingly greater backlog has helped create a hotly debated controversy.

Should Canadians be treated equally and only have access to the current Canadian social medical system as our source of health care? The argument is that private (medicine for profit) clinics create a “two tier” system where the more affluent citizens will be able to afford better and more timely health care than those with more limited incomes.

The government is fighting private clinics and the so called “two tier” system tooth and nail. But the fact remains that Canada has always had a “two tier system”. Does anyone believe that some professional star athlete has to wait months or even years for knee surgery? Do you think that politicians wait in line for MRIs or knee replacements? No, they go to the head of the line or have procedures paid for when treated out of the country.

Are patients who have the financial means and willing to pay and additional fee for faster service unfair for jumping the queue? Is it unfair to the less affluent public? The fear lies in the belief that once the crack between public & private health care is created, the chasm separating the two will steadily increase with intellectual and monetary investment gravitating to the private sector. On the other hand, by diverting the paying customers, private ’pay for service’ clinics may open up more spaces and speed up wait times for those who will still rely on the public social health care system.

The question now is “which system is better? The American or Canadian?”

Far from being a socialist, there are several services I do believe should be universally accessible for a nation’s citizens. Education and Health Care are two of the most important. All citizens should have unhindered access to a robust basic education and no one should have to show their wallet in order to receive medical treatment Without your health, you have nothing!

While at the Rehabilitation Hospital I noted that the gymnasium closed down during lunch hour, late afternoons on weekdays and on weekends. The equipment sat idle as did the patients, which seemed like a waste of resources and taxpayer’s money alike. Inpatients were delayed receiving some of the treatment necessary to return to society and get off of the healthcare budget.

Chatting with a nurse during one of those weekend ‘lockdowns’ we discussed this situation. The nurse commented that “yeah, we need competition as an incentive to improve”. That comment rang true.

With the American ‘pay for service’ system, each hospital vies for your healthcare dollar by being better than it’s so called ‘competitor’. As the private system exists for profit, it’s auditors are diligent in making sure waste is cut and money well spent. Yet success depends on attracting patients to their facility so they try to attract the best doctors and offer the best health care programs possible. Competition drives development, innovation and excellency.

In Canada, each procedure has a cost associated with it and every doctor and institution gets reimbursed the same amount by the government. Why improve when they all receive the same payment for services rendered. One hospital is about the same as the next to patients. Hospitals, like some ‘fast food’ outlet, offer you the same ’medical burger’ regardless of what part of the country you are in.

In the U.S. hospitals such as Rochester Minnesota’s Mayo Clinic, Boston’s Brigham & Woman’s Hospital, Buffalo’s Roswell Park Cancer Center or Los Angeles’ Cedars-Sinai hospitals are noted for their excellence and have a patients continually investigating them over others when faced with potentially life altering ailments.

So the question remains. Which is better? A system which has a tremendous backlog of patients waiting for services in an institution that has no real drive to improve yet patient expenses are covered by the government. Or is it a “show me the money” system which many cannot afford but watches its budget while encouraging excellence?

The jury is still out….
* * *

Speaking to my rehab physiotherapist, I learned that the spinal cord rehabilitation program used to treat individual inpatients up to a year before being released into the community. In an attempt to save money, services were cut back to where, in my case, I received specific therapy for my injury for just over three months. Although I had my fill of hospitals for a lifetime, in truth I could have benefited from a much longer stay. The majority of my therapy was directed at undoing the damage created by being in limbo - bed-bound for over three months. Just when motion in my limbs was returning, I was discharged..

The question arises. Which is more cost efficient? Discharging a patient as soon as medically possible or keeping a patient as long as necessary to maximize whatever recovery they may achieve? In my opinion it would benefit the government, private extended health care insurers and patient alike to achieve the maximum recovery so as the person can return as a productive member of the workforce and not a recovering invalid in the community.

* * *

1 comment:

Anonymous said...

Good post.