Kevin, M.D. - Medical Weblog

Don't bag the Canadian system with a blanket statement. I'm an American doc that has experience in both. The propaganda does no one any good.

No, it's not perfect there. But the grass, from the perspective of public health, is a whole lot greener.

It would be a flaw in reasoning to attribute the problems they face with the sole fact that they have a single payer system.

1. They need more controls around utilization (we actually have much tighter regs via managed care in this country), and could use greater efforts in disease management, etc. They do need copayments, guidelines, etc.

2. The single payer component actually reduces overhead and improves accounts recivable significantly.

3. They have much less med school debt (if any).

4. They have much lower malpractice costs.

5. One can't generalize, as the problems differ by province (as does the way in which physicians are paid)...the provincial governments that have implemented salary caps for primary care physicians are insane.

6. Some provinces face a problem with churning by physicians, over-referral, over-utilization to feed the churning beast (downstream churning to specialists, etc.)

7. My take is that there is too much choice and too much freedom in the Canadian system, and that tighter controls and true management of care (cost & value) is what's necessary. I also think competition needs to be amped up.

Too much freedom and too little "management" of care with skewed incentives (again insufficient rewards for primary care docs to manage care and to manage populations) are the issue....NOT the single-payer methodology alone.
 

I am from Canada and agree completely. My family doctor left her practice to teach at university, and since then, I have not been able to find a new doctor to replace her.
 

Let me also refer everyone back to a great post from Maggie Mahar's blog a while back...one that does some "myth-busting"

http://www.healthbeatblog.org/2008/02/how-much-do-we.html
 

"More than two-thirds of Canadians think the health-care system needs major repairs or a complete overhaul.... most professionals who provide health care agree with the sentiment."

Honest widespread reporting of this in the US mainstream media? Any of the pathetic array of US Presidential candidates addressing this? (....sound of crickets chirping)

Ed Sodaro MD
 

Healthp Punk: Is it true, docs have maximum yearly incomes? If busy, and they reach the income limit in August, they work for free. So most go on vacation the rest of the year. Do not get sick late in the fiscal year, in Canada. What do doctors make in Canada, anyway, like nurses here? I think my landscaper is doing better here.

Commie Care is cheap care. If cares costs dozens of dollars, no problem. One waits for care costing hundreds. One will not get care costing thousands.

In Canada, people die waiting for operations. People live in agony and never get their procedures. Doctors get ordered to go to remote clinics. Mounties help them move if they refuse.

As a patient, I want no part of Commie Care.
 

Supremacy Claus, you are very wrong.
I am a Canadian family physician. What do doctors in Canada make? In my case, about $160-180K/year, but I work much less than I could, because I value my family time more than I value increased income. If your landscaper is doing better, I think you're overpaying them.
There was one province (quirky old Quebec), which suggested forcing doctors to work in underserviced areas. It didn't fly. If the mounties are at my door, it's probably by buddy Constable T. coming over for a beer.
 

Canadian Supreme Court, about their health care system: sucks.

http://online.wsj.com/article/SB112381432071311723.html?mod=opinion&ojcontent=otep
 

Here's a good article on what Canadians think of their healthcare system
http://www.longwoods.com/product.php?productid=17379&cat=310&page=1

According to Hoechst Marion Roussel's second annual Canadian Consumer Survey on Healthcare, Canadian group benefit plan members give these high marks to their publicly funded healthcare system: 78% rate Medicare as "good" or "very good." Compared with last year, however, slightly fewer are calling it "excellent" and marginally more are rating it "very poor." Only 7% overall judged it "excellent" this year, a slight drop from last year's 9%. Last year's survey results showed that 66% of Canadians deemed healthcare "good" or "very good."

Also interesting to note that Canada has a federally sponsored, publicly funded Medicare system, with most services provided by the private sector. Each province may opt out, though none currently do.

http://en.wikipedia.org/wiki/Health_care_systems

So, while not perfect, they must be doing well enough so that no one wants to opt out.

Also, the Canadian single-payer systems is not "socialized medicine" but "social insurance" systems, because doctors are in the private sector.

I am self employed and living in the US so I am basically "uninsured". I do have a major medical plan but it doesn't kick in until my doctor bills amount to 5000 dollars a year. So basically I cover all my own expenses and pay the insurance company 9000 dollars a year just to protect me from a one night's stay in the hospital...which, for a pacemaker replacement, can cost up to 50,000 dollars.

My wife and I have started taking yearly trips to Thailand to take care of our medical and dental needs...that aren't urgent.
The cost there can be 1/5-1/10 the cost of the same service in the US...We've found the service to be top notch and some of the hospitals even have American Accreditation