Canada has a single payer system but the provinces have the bulk of the responsibility of running the health care system for their own residents. In order to qualify for federal funding, each province must meet the following criteria.
- Universality. Available to all provincial residents on uniform terms and conditions;
- Comprehensiveness. Covering all medically necessary hospital and physician services;
- Portability. Allowing residents to remain covered when moving from province to province;
- Accessibility. Having no financial barriers to access such as deductibles or copayments; and
- Public administration. Administered by a nonprofit authority accountable to the provincial government.
Nevertheless, the 2005 Canadian Supreme Court ruling striking down Quebec's prohibition on private insurance contracting may foreshadow significant changes in Canada's health care system.
Percent Insured. ~100%
Funding. Funding is provided jointly by the federal and state governments. The federal government uses funds from general revenue to provide a block grant to each of the provinces. The block grant finances only about 16% of each province's health care expenditures. The remainder is funded by provincial taxes: mostly personal and corporate income tax. Health care spending makes up between one-third to one-half of provincial social welfare spending. For the nation as a whole, health care costs only 9% of GDP.
Private Ins. "At one time, all provinces prohibited private insurance from covering any service or procedure provided under the government program. But in 2005, the Canadian Supreme Court struck down Quebec's prohibition on private insurance contracting." Private clinics are barred from offering medical services which are covered by the Canada Health Act, but many begun to offer services in the black market.
Physician Compensation. Physicians work in private practice and are paid on a fee-for-service basis. Since these fees are set by a centralized agency, wages are fairly low which has lead to a physician shortage. There are only 2.1 physicians per 1,000 people. This is far less than the OECD average of 3.0 physicians per 1,000. Hospitals are funded on a global budget basis. Capital expenditures are reviewed and approved on a case-by-case basis.
Physician Choice. Referrals are required for all specialist services except the ED.
Copayment/Deductibles. There are generally no copayments or deductibles for services. However, British Columbia, Alberta and Ontario charge insurance premiums (although health services cannot be denied because of inability to pay).
Technology. The U.S. has five times as many MRI machines per capita as Canada and three times as many CT scanners. However, because of Canada's proximity to the U.S., many Canadians do have the option of coming to the U.S. for treatment.
Waiting Times. In a 2005 decision striking down part of Quebec's universal care law, Canadian Supreme Court Chief Justice Beverly McLachlin wrote that it was undisputed that many Canadians waiting for treatment suffer chronic pain and that "patients die while on the waiting list." For instance, the Fraser Institute finds that 800,000 Canadians are waiting for treatment at any given time. "According to [the Fraser] survey, treatment time from initial referral by a GP through consultation with a specialist, to final treatment, across all specialties and all procedures (emergency, nonurgent, and elective), averaged 17.7 weeks in 2005."
If you are interested on more information about the Canadian health care system, see my October 2, 2007 post.
- Tanner, Michael D. (2008) "The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World" Cato Policy Analysis no. 613.
Your article on the Canadian Health Care system paints a negative picture that is certainly far from the truth. Members of my family have experienced health service that has been timely and effective. There has been no restriction in choice of hospitals or doctors.
The waiting time matter seems to be blown out of proportion. My experiece has been that if you need the service you get it. I remember as a child who had corrective surgery for a club foot, in the years before we had a public health system in Canada. I would go for a semi-annual check up at the childrens hospital and it would be an all day affair. Today people go to a clinic and if the line up is to long they walk out. In fact there have been a number of incidents in Calgary where parents have left the emergency room at the hospital with their children, because they had to wait, but by being impatient they put their child's life in jepordy. I know that waiting might seem live threatening. Here we are in a society (North America) that has an oversupply of automobiles that we spend horrendous amounts on and critical shortage of doctors and nurses that we do not want our taxes increased to alleviate.
This was never more evident that in the state of Nevada, where my son is attending dental school.
The state government has been complaining for years about the money spent on the dental school and members of the party in government stating that it would be more beneficial to take the funds from the dental school and put them into an auto technological school to produce more car jockeys.
I agree that the medical staff is under stress both here in Canada and the US. Doctors on both sides of the border have set up shop to serve a smaller client base and to charge more for their service, by supposedly spending more time and being more available for the client. At least for those who have the means to pay for it.
As far a medical insurance goes, you complain that a public health care system takes away choice. What do you think the insurance companies do, unless you can afford a gold plated plan. The insurance companies call the shot on what hospitals and doctors you can go to and ultimately what service you receive. Then if they figure that they making money on you, the insurance company will more that likely drop you.
Enough of the flowery gingo about freedom of choice and the evil of a public health care system. The bottom line is Canadians receive fair and timely service without having to rely on insurance companies that mandate their treatment. Not everyone is super rich to pay for medical treatment.
I remember years ago Jesse Jackson, making a statement that nurses and hospital staff not being able to get treatment at the very institutions that they worked at because they could not afford it. That is the fundamental problem, not this freedom of choice issue that you are raising. Generally the health care system in the US has been in private hands but I do not see it getting any more affordable or accessable for the general population, other that those that can afford it out of their own pocket.
I have to agree with the comment above me. I have never had any problem with health care in my country. It's very simple, health care for everyone. I walk into a hospital no questions asked, fast, simple and preventative health care. I can get into my doctors office just about any day if I want to. As far as procedures go, I usually don't have to get anything major because any ilnesses which I get are usually intercepted before anything important becomes of them.
I've had to wait at clinics, sometimes for an hour or two though the important thing was that it wasn't crucial because I went as soon as I had felt symptoms and I could have left and returned the next day if I had wanted to.
Murray Meyers is fortunate to have had good experiences with the health care system in Canada. What is disturbing is that he, like many others in this country, keep turning to government to solve problems that the government itself helps to perpetuate. If the insurance companies weren't so heavily regulated by the government, they would be allowed to compete more fairly with each other. Then I would be allowed to shop for policies outside of my state to get a better plan. I would also be allowed to customize a policy based on my own health needs. But the laws that the government has put in place prevents me from doing so & has once again hurts the very people it claims to want to help by taking competition out of play.
I would like Mr. Meyers to tell me one thing the federal government runs that is solvent or efficient or promotes incentive where excellence is rewarded. The USPS (Postal Service) is looking to drop Saturday deliveries because it can't keep cost down. Health care cost will indeed skyrocket when the government takes over and takes competition out of play. Quality (& quantity)of doctors and nurses will decline as their pay will be regulated and capped which will lead to less incentive for good people to enter the profession.
Other government controlled entities worth note: Social Security, Medicaid, Fanny Mae, Freddie Mac, Amtrak, public schools. How are these working for ya! And now soon to be in this elite group; Auto industry, banking industry, & the Insurance industry.
We used to turn to ourselves when things needed to get done. When a school's walls needed patching and painting the local community would band together and get it done. Now they let the walls crumble waiting for the federal government to come save the day. This is what happens when we depend on a bloated, centralized government. This is what will happen when universal health care takes over.
I very much doubt that if you were able to suvey Canadians and ask them if they would give up our present health care system and adopt the American one you would find many who would wish to do so. Sure, there are some problems, but the main thing is that 100% of Canadian receive health care and that is not true in the USA. There are always complainers and ,yes, sometimes there are wait time problems. But all those people do receive care. My personal health care experience, and those of people I know, has been great. I'm old enought to remember what it was like before Canada adopted universal health care.
The life expectancy rate in the U.S. is 41st among all countries in the world. Canada is 7th. Need I say more?
Further to Dave's point, Canadians also pay less per capita for our universal health system as compared to the US where taxpayers pay more for a system that delivers less (medicare). And speaking as someone who has suffered a life threatening illness, my experience was that the government did a pretty good job of organizing care for me; they arranged a comprehensive care plan for both my hospital stay as well as after my release. So let's recap: Canadians live longer, we pay less and we have an efficent health care system. What's the problem again?
Is universal coverage vs. private care the critical factor in life expectancy? Or is it life style choices?! Bill Gairdner in his 1990 "Trouble With Canada" cited that even with their similar health care systems, two neighbouring US states, Utah and Nevada, were at opposite ends of the life expectancy chart. Nevada being a booze and gambling center was way down the list, while Utah being the tee-total Mormon heartland was way up on the list. Whatever their colour, creed, nationality and whatever their insurance coverage, when people eat right, do not smoke, and abstain from alcohol they live long!
Calgary's quads: Born in the U.S.A.
A rare set of identical quadruplets, born this week to a Calgary woman at a Montana hospital, are in good health and two of them were strong enough to be transported back here Thursday.
By The Calgary Herald August 17, 2007
A rare set of identical quadruplets, born this week to a Calgary woman at a Montana hospital, are in good health and two of them were strong enough to be transported back here Thursday.
The naturally conceived baby girls -- Autumn, Brooke, Calissa and Dahlia -- were delivered by caesarean section Sunday in Great Falls, their weights ranging between two pounds, six ounces and two pounds, 15 ounces.
Their mother, Calgarian Karen Jepp, was transferred to Benefis Hospital in Montana last week when she began showing signs of going into labour, and no Canadian hospital had enough neonatal intensive-care beds for all four babies.
the entire country of CANADA couldn't accommodate the quads but Montana could? ROFLMAO
I REST MY CASE :)
When Canada can't accommodate people, they send them to the USA. Where are we going to go when our SOCIALIZEd system can't accomodate us... CanaDUH? HARDLY :)
In contrast to the United States, Canada has a program of universal health insurance. But while the United States may look to the Canadian program for lessons in providing health care for the nation, Canada also looks to the US to provide some of its health care. The problem involves the system of queuing for elective surgery. To provide for the orderly delivery of services such as coronary bypass surgery, Canada instituted a first-come, first-served system which keeps people ''in line'' waiting for surgery to become available. The length of the wait has become so long that some have suggested that the queues are in actuality a form of rationing of services. The province of British Columbia on Canada's west coast entered into agreements with four hospitals in Seattle, Washington, to provide bypass surgery for 200 heart patients. An investigation revealed that the cause of the inability of Canadian hospitals to keep up with the demand for bypass surgery was not due to a lack of funding for the surgical procedure itself. Rather, the hospitals were not prepared to absorb an increase in the number of patients who would place increased demands on the facilities, since these patients would require not only surgery, but beds in the intensive care unit as well as recovery beds. Furthermore, there were occasional shortages of trained critical care nurses and technologists skilled in the necessary techniques of heart perfusion (keeping up the blood supply to the heart during the surgery). The situation reveals problems not in the funding of surgical procedures but in the investment of capital and the expansion of facilities. Another problem is revealed by the situation, however. There is an underlying tension between physicians and surgeons, on the one hand, and those who pay for their services on the other. Physicians tend to regard the long queues of people waiting for surgery as demand which is being unmet. In contrast, administrators may view the same queues as indications that physicians will always expand the delivery of health care until it meets the limits of facilities and funding. (Consumer Summary produced by Reliance Medical Information, Inc.)
Where are we in the USA going to go when we can't be accommodated? Can Canada help us?????? hahahahahha
As an American who has lived in Canada and who has experienced Canada's health insurance system, I can honestly say that it is NOT the horror story that people make it out to be.
Every year, millions of Canadians are treated in a timely and satisfactory manner. The majority of Canadians have never gone to the US for treatment, nor have they even considered it.
While living in Canada my doctor discovered that I had melanoma. This is a deadly form of skin cancer, and if left untreated it WILL kill you. I was referred to a dermatological surgeon who had an available appointment in two weeks.
After two weeks, I was examined, and scheduled for surgery to remove the melanoma three weeks later (a total of five weeks after first being diagnosed).
My family back in the US complained that I was being made to wait five weeks before the cancer was being removed. I contacted my doctor to ask why I had to wait so long. The doctor told me that HE (not the insurance system and not the government) prioritized the removal based on the fact that my melanoma was in very early stages and was slow growing. He (the doctor) said that if my melanoma had been larger , then he would have had removed it sooner. But during those five weeks, he was able treat his other patients who did have a higher need for his available time. The need to prioritize is a resource issue, not a rationing of service by the government.
This was a full blown operation in a hospital under general anesthesia, not an an outpatient procedure and I am happy to say it was a success. After three years I am still cancer free. And not once was I sent a bill or was the issue of whether I could pay for it, or not, an issue.
Similarly, a good friend went to the hospital with heart pain, and he was admitted that day for surgery because he needed it that day.
To Kate
Re: Story on Karen Jepp
The real reason why she could not be accommodated at Foothills Medical was because the Calgary area had grown to fast for the Centre to handle them. A very unique situation (Calgary is in "oil country"). See entire story here: CTVNews/20070817/alberta_quadruples_070817/20070817/?hub=Health&subhub=PrintStory
Re: Calgary's quads: Born in the U.S.A.
Additionally, it's not as if the woman who was pregnant with quadruplets was simply told to go away by her doctor in Canada. In reality, her doctor and hospital arranged for the mother to go to the US for the birth AND her province of Alberta health insurance paid 100% of the cost.
It cost C$30,000 for each day Karen Jepp and her babies received care in the Montana hospital. In Calgary, it would have cost less than C$11,000 per day, but her government health insurance paid for it, anyway. I don't see how that is any sort of problem.