Canadian Health Care vs American Health Care

By most indicators of how a nation's health care system is functioning the US doesn't get much bang for the buck. That doesn't mean the top level care isn't great (obviously the chief concern for many), but the middle of the road and lesser health coverage isn't as good for the money w/o question.

As for prescription prices (US underwriting other countries), I was suprised to find less than a 15% difference for many drugs in Mexico (e.g., may parents use the big money making Lipitor for instance and the price difference accross the border was much smaller than I expected). I think it is true other countries really benifit by our NIH/taxpayer funded research, but I don't think they are getting near as huge breaks from Pharm Co.s on drugs--those co.s are in the money making business and won't sell at a non-profitable price anywhere unless it would be a public relations fiasco. Further, even in our country HMO are getting into price wars with Pharm Co.s over drugs as we speak and just flat deciding not to cover some--that is going to happen here regardless of whether we try to move our whole system towards a national one.

What is not mentioned here is in Britian you can still seek your own health insurance/care (I assume this is true for most every other advanced Western country) and pay for what you think is top notch care at your convience. Nobody is forcing others to use the national systems, it is not like a communist system where you don't have the freedom to seek the care you want provided you pay its actual costs. Given as wealthy as some Americans are, there would be plenty of people who opt out of the national system and seek private elite facillities and medical care that revolves around their schedule. It would cost more--just as Harvard, Stanford and Yale costs more than state schools, but just as there is no shortage of tuition paying applicants at those schools we would still have freedom to choose health care routes different that the government administered one.

Also, you could argue recessions cut both ways--in Canada people may get reduced quality of health care where in America people may lose their insurance with layoffs--pick your poison.

 

Haystreet: While there is some truth in what you say, I don’t think the criticism of the American system is because it is American. We used to have a similar system but changed to a public system in the 60’s. The one you have is just a reminder of where we came from.

I don’t doubt that the Britts complain. Our systems are far from perfect, but is anyone there suggesting adopting the American model? Not very may I suspect.

Cohen: There’s a lot of information out there. I just didn’t have time to filter it all for you so gave you one article that popped up. I’ve posted better links in previous threads we’ve had on the topic. I’ll dig them up if I get a chance. (I’ll also point out that you don’t backup anything you say either.) In the meantime I’ll revert to high level issues that are fairly obvious.

Profits: The obvious one. The profit nature of the for-profit system not only arguably diverts attention away from the objective of providing the best care, it adds a cost to the system that doesn’t exist in public systems. Ah, but the profit driver leads to innovations and efficiencies, you say.

Efficiency and Innovation: Health care is very capital intensive, therefore the cost of capital is a significant issue. Governments can borrow or otherwise supply capital much cheaper than any private company. I don’t have the numbers handy, but these savings are significant. The other big expenditure is for labour. This could be a whole other area of debate, but cutting labour costs generally means using less skilled and non-union labour. This often (not always) results in a lower standard of care. (I’m sure you’ll dispute this, but we’ll need to get into some harder statistics to solve this one.) With regard to innovation, we’re not talking about software development or some venture capital project. We’re talking about health care. Most treatment in hospitals is based on hard science that is available to all. There just isn’t that much room for innovations that lead to significantly reduced costs, at least not enough to compensate for the other factors. And I’ll also add that innovations occur in our system. Health care workers typically get in to that profession to help people. Just because there may not be a way for them to make a buck out of a given change or innovation doesn’t mean they don’t care about it and won’t push for it.

Overhead, administration, redundancy: This is a big loser for you. Almost all of the administration associated with your insurance system, devising and administering different plans, competing insurance companies, claim processing, payment, collection, advertising, etc. is eliminated in our system. All adult citizens in Canada are issued a health card that proves you are a Canadian citizen, and shows what province you live in. (There is a provincial component to the funding.) To get health care, walk into a doctor’s office or hospital and present your card. That’s it. Children are covered by their parent’s cards. Since the hospitals don’t compete with each other, we only build enough to service the population, not more, so very little redundancy exists.

Access: We build rural hospitals in places where they would not be economically justifiable. This doesn’t help our bottom line, but it saves lives, and we like that.

Our system isn’t perfect. There are many problems I haven’t gone into, but the basics of its structure are sound. In its present state it’s been around nationally for 35 years, and just needs some refreshing to ensure that it operates as efficiently as we would like it to.

DS: Interesting comments. In Canada you can buy extra insurance that will provide you with private rooms in hospitals and other extras, and you can pay for things like MRIs at private clinics, but you can’t pay to jump the cue to see a specialist. Specialists can’t work outside the system. Allowing them to do so would create the two tier system that is currently under debate. In practice we have a two tier system, because anybody who has the money and doesn’t want to wait goes to the US. The wait fadeaway is facing sounds long, but Nfld. has been a poor province (although good times seem to be on the horizon now) and so I suspect the provincial government has been pinching the system. This is one area where I think we need some reform. We need maximum wait times.

 

The existence of profits is a good thing, unless quality and value cannot be assessed. That is why it has not worked as well as it can in healthcare, not that it 'diverts attention away from...providing the best care'.

If information flowed freely, do you think that health plans with a crappy track record would turn a profit?

Yet the government faces no such repurcussions.

The capital savings are not the main cost issue. Delivering appropriate and necessary care can drive down aggregate expenses by an estimated 30%.

Re. labor, do American physicians make less than Canadian physicians? Why do so many come here to work? It sounds like a concern for Canada, not the US.

Re. innovation: this is where your opinion falls apart. You claim that healthcare is 'hard science' and 'isn't that much room for innovations'. No offense intended, but it is quite obvious that you have an uneducated opinion about healthcare. You couldn't be farther from the truth.

Again, as much of 30% of healthcare is waste: either unecessary or inappropriate. The state of information and knowledge capture and dissemination is deplorable. One indicator of this is that Physician's practice patterns are more closely correlated with their peer group than with which medical school they attended or which journals they read. Quite often, the 'lead' physicians in a peer group determine the group's practice.

Another example of the state of information in this industry was a study that sent about 80 back patients with identical symptoms to 80 different physicians. The result was 80 different therapies.

So what about this 'hard science'? Where is it? Clinical studies? Even under the best of circumstances, there are caveats, assumptions, and statistical variations to consider in the best of clinical research. Worse...lets include some people with a so-and-so affliction for the study, but we have to remove all who have any type of comorbidity. Is that real world? The doctors will see a patient with so-and-so illness, but may very well have multiple comorbidities and already taking other prescriptions. Quite often when you merge prescriptions, the doctors have no research to rely on at all.



The waste in health care won't all disappear until their is perfect information and knowledge, and that won't happen in our lifetimes. But it will get a lot closer a lot quicker in a market system long before nationalized healthcare. Just be thankful that the Canadian system will benefit from much of what is developed in the States (unfortunately, I think that's what really irks you the most).

I certainly don't like eveything about the US Healthcare System, but don't think that the Canadian system is the answer for Americans. They would never accept it.

 

Make no mistake, our health care system is something Canadians hold near and dear to their hearts. Governments have been elected and defeated over health care issues. We hold them very much accountable.

Yes, your physicians make more, and that’s why many go. I have a little beef with that that is somewhat related to this issue, so I’ll stick it in. Our secondary education system is heavily subsidised here too. I don’t have a problem with that because educated people tend to be productive and add to the economy and to society, and the investment will also be recouped in the increased income taxes that person will pay. BUT, when someone who has accepted the thousands and thousands of dollars of dollars the government provides to train a doctor, then turns around and heads to the US for the bigger $$$, the Canadian taxpayer isn’t getting their money’s worth. I can’t really blame the individual for wanting the best of both worlds. The problem is the system that has us subsidising the education of your doctors. This goes for other professionals like engineers too. I think we need to find a way to recoup the education costs of those who chose to head south.

That’s very interesting, and worthy of a discussion on it’s own, but with respect to this discussion, you don’t provide any information here to suggest these inefficiencies could be dealt with any better in a private system than a public system, or visa versa. Are these a function of the state of western medicine in general? Are there large differences between doctors, between hospitals? The training the doctors receive in both countries is essentially the same. The treatment and care systems are essentially the same, I believe. Where would the differences that relate to these inefficiencies lie? Btw, what’s is your connection to the medical world? If you’re claiming to have a more educated perspective, you might as well fess up to what it is.

If all you have is your opinion on this I will have to respectfully disagree. We have a large national commission travelling the country now looking into our system and ways to make it more efficient and effective.
http://www.healthcarecommission.ca/default.asp?DN=cn=2,ou=Stories,ou=Suite247,o=HCC
Part of this has involved examining various European systems as well. Would any private provider in the US spend this kind of time and money researching the reform of their system? Or are they bound to the current system? I think we may actually have more flexibility, more resources to spend on this kind of research, and more of a will to change the system in a way that benefits the majority of the people.

Um, not sure what you’re referring to, but I see research as a separate issue. It is funded in an entirely different way in Canada.

You may be right, but I don’t know why they wouldn’t. Every other first world country I can think of uses some variation of it, and have done so for a long time, so there is a well established track record. The US is oddball on this one. This is one of the things that puzzles me most about Americans. Why would you not want such a system?!

Here is a pretty good much more indepth backgrounder, with some figures. I’m not familiar with the site, but the article seems pretty accurate.
http://www.newrules.org/journal/nrwin01health.html

 

The inefficiencies can be dealt with better in a market system with market forces at work. Don't get me wrong, I don't believe that the market forces are in any way 'normal' in healthcare. There are perverted incentives, inverse supply-demand relationships, purchasers with imperfect knowledge and sometimes erroneous expectations, vendors (physicians) with conflicting incentives, etc. But I am convinced that a federal government cannot tackle the momentus task of improving healthcare. The 'market' is screwed up enough, you don't need to add politicians to the mess.

In response to your questions, yes, there are substantial differences in the way physicians practice, and from hospital to hospital. The treatment options are not the same and can differ greatly, not just from country to country but between States, Counties, Medical Groups, and individual physicians. As I mentioned previously, a physician's medical school is not the most dominant determinant in how the physicians will practice.

As far as my association with heathcare, after completing an MBA 15 years ago, I received 6-month special training by my first employer in all aspects of a health plan. In 1995 I started my own software and consulting firm which provides data warehouse, reporting, data analysis, decision support, etc. to healthcare firms. We identify areas for quality and cost improvement. I am fairly well read on clinical research dealing with practice patterns, esp. any pertaining to inappropriate or unnecessary care. My favorite readings are the seminal works of Donabedian and Eisenberg. They both were great meta-analysts.