Canadian healthcare

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Greenwood The Sock Monkey
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Postby Greenwood The Sock Monkey » Mon Oct 06, 2008 11:17 pm

Dreamin wrote:I'll forgive you if you change my title to GLONO Board Bolshevik.


Awesome. Congratulations on your new title! The proletariat salutes you (and your socialized medical care).

MF
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Postby MF » Tue Oct 07, 2008 12:41 am

My apologies upfront for what's going to be another long post...

As someone who's worked in and around health care policy at the federal and provincial level for nealry 15 years there are a few subtleties here that should be added.

A huge proportion of Canadian health care services are provided by for-profit private businesses. Just about every diagnostic clinic (x-rays, MRI) and labs are private enterprises as are many walk-in clinics. There are also private for profit hospitals such as the Shouldice here in Toronto, several eye clinics in Alberta (cataracts, mostly) and several outright for profit hospitals in Montreal and Quebec City.

The main point of differentiation from other health care systems is that the payments for these services come from the government and/or third party insurers (the $0.25 term for this is "monopsony" - one funder, many providers). Payment does not come out of the pockets of consumers.

The majority of doctors who practice outside of hospitals are part of for-profit businesses. Yes a fee schedule determines what they can charge and provinces set income caps by specialties, but they are considered "corporations" for tax purposes. They also have a schedule of services for which they can charge the public directly.

So before anyone gets concerned about private public partnerships, that's exactly what we've had in Canada for 40+ years.

There may be more of a creep towards users covering part of the costs, but so many studies have shown this to be avery inefficient way to management payments and transfers that I can't see it becoming a common policy. Moreover, health care really is the third rail of Canadian politics (factor in a really messy constitutional/British North American Act skirmish over federal/provincial responsibility and fundingn transfers) and I have no idea why a politician would want to be the one that wades into that mess.

As for wait times, if you need it, you'll get it. If it's a critical, urgent or emergent case you may end up getting a spot at 3AM, but the service will be delivered.

I'm currently working in critical care policy and its fascinating to see all of the behind the scenes systems that exist to ensure patients can get critical care anywhere in Ontario. They now have software that tracks every single critical care bed and every single critical care intervention in the province in almost real-time (every 10 minutes) so that transfers can be arranged between centres as quickly and efficiently as possible.

Incidentally, I used to track public opinion polling for a large provincial health care organization and one of the most interesting results was that about 80%+ of Canadians who receieved hospital care said they were extremely satisfied with the care they received. Yet these same people, who were so happy with their health care, expressed little to no confidence that a family member, neighbour or friend would receive similar services should they be required. There's been so much worry and negative media attention to health care in Canada that a huge proportion of polling respondents thought their excellent care was an anomaly.

Barabajagal
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Postby Barabajagal » Tue Oct 07, 2008 10:03 am

Very interesting MF! Thanks.

Yeah, this isn't silly. I don't claim to understand the vagaries of supplying efficient health care to vast populations of people. I do know that it's usually not the best idea to have federal government run anything it is not Constitutionally supposed to do. But I'm not too hardass on that. There's no hard line between gov regulation of markets and gov interference in markets.

(Plus, I love my parks and my public radio/television, too!)

What I wonder is, are we comparing apples to oranges when it comes to the U.S./Canada comparison? Not just the Big Pharma/lazy slob/lifestyle of the USA, but the population differences, numerically, demographically? Does that factor in?

Dreamin
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Postby Dreamin » Tue Oct 07, 2008 1:10 pm

Thanks MF, you offer some very important clarification.

MF wrote:So before anyone gets concerned about private public partnerships, that's exactly what we've had in Canada for 40+ years.

I understand this, and I do support limited private-public partnerships within our existing system (following the guidelines of the Canada Health Act), but I'm still concerned about the gradual erosion of the public system and the possibility of opening the door to US private hospital chains and HMOs if we start to move away from a publicly funded system that's delivered on a mostly non-commercial basis. When I talk about corporations, I'm not referring to doctors in private practice and small business, I'm talking about the big guys. What are your thoughts on the NAFTA issue that I raised earlier?

Incidentally, I used to track public opinion polling for a large provincial health care organization and one of the most interesting results was that about 80%+ of Canadians who receieved hospital care said they were extremely satisfied with the care they received. Yet these same people, who were so happy with their health care, expressed little to no confidence that a family member, neighbour or friend would receive similar services should they be required. There's been so much worry and negative media attention to health care in Canada that a huge proportion of polling respondents thought their excellent care was an anomaly.

This is interesting. Again, I'm concerned that public perception (not the facts) will be used to justify more privatization.
Last edited by Dreamin on Tue Oct 07, 2008 1:18 pm, edited 1 time in total.

miss carol
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Postby miss carol » Tue Oct 07, 2008 1:14 pm

Barabajagal wrote:Very interesting MF! Thanks.

Yeah, this isn't silly. I don't claim to understand the vagaries of supplying efficient health care to vast populations of people. I do know that it's usually not the best idea to have federal government run anything it is not Constitutionally supposed to do. But I'm not too hardass on that. There's no hard line between gov regulation of markets and gov interference in markets.

(Plus, I love my parks and my public radio/television, too!)

What I wonder is, are we comparing apples to oranges when it comes to the U.S./Canada comparison? Not just the Big Pharma/lazy slob/lifestyle of the USA, but the population differences, numerically, demographically? Does that factor in?


Calling Canada socialist or communist or Marxist is silly; indeed, it's quite ignorant of the facts. Be aware too that the Canadian constitution, the history not only of the nation's founding but its government is completely different to that of the United States---for better or for worse. I'll leave that part of the discussion (as well as Chris G's predictable rebuttal) to someone with more time and resources. Suffice to say there is some cultural overlap, but I believe that one would have to live here a while to fully understand the differences between the two countries: a couple of hours listening to CBC won't cut it. Perhaps reading some history books written by Canadians is in order. I know...I ask a lot in this day of instant info.

And now, back to work.

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Postby Chris G » Tue Oct 07, 2008 1:24 pm

miss carol wrote:
Calling Canada socialist or communist or Marxist is silly...



I never called Canada Marxist. I said that Dreamin's diatribe was Marxist:

That everyone should be coerced by government force to use only the state owned system, and all private healthcare services should be outlawed.

The 'from each according to their ability, to each according to their need', bs.

I never said Canada's system was Marxist. What Dreamin proposes wanting to turn Canada's system into is pure Marxist. And it is.


.

miss carol
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Postby miss carol » Tue Oct 07, 2008 2:01 pm

Chris G wrote:That everyone should be coerced by government force to use only the state owned system, and all private healthcare services should be outlawed.


Well, stay in your country and vote that way. And keep your hands off our laws.

Thank you.

MF
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Postby MF » Tue Oct 07, 2008 2:19 pm

Dreamin wrote:What are your thoughts on the NAFTA issue that I raised earlier?


I don't think the NAFTA issue is a legitmate concern.

First of all, what's the tipping point in terms of "fully publicly funded"?

In Ontario, the government only provides about 80% of hospital funding on the patient care side. It's far less on the capital budget side (cleaning, heating, lighting, medical equipment). And in some cases it's marginal for specific areas of hospital care: dentistry, assistive devices, rehab, OT, PT, etc.

Last time I checked, 80% (at the top end) isn't "fully publicly funded"

The second reason I'm not worried about the NAFTA thing is what Canadian politician would let this go down on their watch? Their party would be vilified for a generation. As strange as it may seem to the Americans on this board, universal health care is the Canadian equivalent of apple pie and baseball. It's a defining characteristic for Canadians.

I also think the math in that blurb you posted really need some footnotes.

For example it says, "one-third of all Canadian health care spending is now private, as services are de-listed and doctors opt out of medicare."

What's included in the one-third number?

Ontario hasn't de-listed a medical service since 2004. At the same time, the number of regulated health professionals and their services being brought under the umbrella of public health care is growing. Traditional Chinese Medicine is now a regulated insured act/profession in Ontario and Naturopathy, psychotheraphy and a host of other previously private for-pay services will soon be publicly funded as well.

It should also be noted that it's extremely rare for a doctor to opt out of the public insurance system.

"There are now at least 240 health care corporations, many of them American, operating in Canada."

As per my previous note, this likely includes diagnostic centres and labs. They are premitted to do this under the Canada Health Act so long as the government is paying the bill and costs are not borne by the patient. They also provide an extremely efficient service to the public help eliminate waiting lists. There's nothing wrong with any of this.

"There are also 140 private health insurance companies operating here; the Canadian Life and Health Insurance Association says that at least 37 of them are American."

Again, so what? This strikes me as xenophobia. The entire Canadian marketplace is smaller than California. I have no problem with international firms providing options for insurance, be it car, health, dental, fire, etc. Competition in the marketplace is good for consumers.

"There are also 663 private home care agencies, and private companies now control at least 10 per cent of the MRI market. "

Again, so long as the fundamentals of the Canada Health Act are upheld and services are universal, accessible and publicly funded I have no issue with any of this...

Do you know when Barlow wrote this? It seems rather dated...

Chris G
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Postby Chris G » Tue Oct 07, 2008 2:43 pm

miss carol wrote:
Well, stay in your country and vote that way. And keep your hands off our laws.

Thank you.



Because you certainly never comment on US laws here on this board. No, that never happens.


.

Dreamin
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Postby Dreamin » Tue Oct 07, 2008 3:11 pm

Chris G wrote:I never said Canada's system was Marxist. What Dreamin proposes wanting to turn Canada's system into is pure Marxist. And it is.

Chris, I was essentially saying that I support the Canada Health Act, and I don't want to change the system that we currently have in place. It's really not a radical notion (here anyway).

Canada's national health insurance program, often referred to as "Medicare", is designed to ensure that all residents have reasonable access to medically necessary hospital and physician services, on a prepaid basis. Instead of having a single national plan, we have a national program that is composed of 13 interlocking provincial and territorial health insurance plans, all of which share certain common features and basic standards of coverage. Framed by the Canada Health Act, the principles governing our health care system are symbols of the underlying Canadian values of equity and solidarity.


MF wrote:so long as the fundamentals of the Canada Health Act are upheld and services are universal, accessible and publicly funded I have no issue with any of this...

I agree. It's good to hear your perspective and it does ease my worry a bit.

MF wrote:Do you know when Barlow wrote this? It seems rather dated...

I think her book was published in 2005, so it's likely that those numbers are getting old. You raise some really good questions that I wish I knew the answers to.
Last edited by Dreamin on Tue Oct 07, 2008 10:40 pm, edited 4 times in total.


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