WOW, You Canadians and your Healthcare

[Pastiche]

Single-payer systems are cheaper because they avoid adverse selection and therefore the risk premium per capita for insurance is minimized.

Not to mention that you cultivate economies or scale with a single payer system and significantly reduce transaction costs (multiple forms, adminstrative staff, more insurance adjusters, profits, building costs, revenue and financial transaction costs ad nauseum).

I don't think anyone is arguing that a system based on American design principles is cheaper than a single payer design but I just wanted to clarify. Single-payer is cheaper.

[Bagor]

Originally Posted by Cactus Jack

It's similar to the US in that there is a 2 tiered system. There is average care available for people who can't afford better and great care for those that can afford it. It's one of the things I'm not looking forward to when I move there but I wouldn't move there unless I could afford the good care. I'm sure I won't like it because their system is plauged by the same despairity in care that exists in the US.

The difference between the countries in this example being that the world's biggest economy and richest nation can't afford to or won't take care of the health of its people. Brazil is a latin american, middle income nation plauged with centuries of corruption and is still improving its situation.

One of things I noticed when I was there was that every 6th shop or every street seemed to be/have a pharmacy and this wasn't even in a densely populated area.

Never seen as high a concentration of pharmacies in all my life. Any idea why? Can you just buy drugs there without a prescription?

[Clever_Iggy]

Originally Posted by Cactus Jack

I'll gladly take the bet, junior. I may have to wait a few months in the worst case for care, but statistically you are likely older, more obese, will have a shorter life expectancy and are debt ridden. And even though you are insuranced the chance of you being ineligible for treatment or having a pre-existing condition that will deny payment are quite good. Where do I sign up?

Originally Posted by Iowa_Flames_Fan

Well, make that gamble if you want.

Originally Posted by Iowa_Flames_Fan

Somewhere, in some office, there's an actuary who is estimating that I will live three years longer than you because I'm in Canada. There's a bet I'm willing to make.

Wow, that joke sure got a reaction. Haha.

[Iowa_Flames_Fan]

Originally Posted by Clever_Iggy

My employer covers me fully. I pay a $10 co-pay per visit. Since I'm a new employee and not yet married, my company doesn't fully cover my fiancee. But, because of how good our insurance is, we felt it was worth the expense to have her on the firm's medical plan, on my dime. Once I am employed for a certain period and we are married, the company covers 1/2.

I know the cost is still there; I pay for my fiancee's premiums! IMO (and now I think I'm just butting heads with you, redforever and Cactus) I get better access and better health care down here. You can through stats about infant mortality, life expectancy and all of that at me, and while it's somewhat valid, there are other factors influencing those stats. For me I like this system better. It's not perfect, it leaves lots of people out in the cold, it has it's downfalls, but for me it's great.

I'd agree that the U.S. does have better access to non-urgent and elective surgeries, non-urgent MRIs, etc. etc. But that's one of the reasons that costs are so high down there.

The unfairness is a big issue for me--as are the disturbing stats about infant mortality, and higher mortality across the board. If you'll permit me an anecdotal moment of my own, here is my biggest anecdotal complaint about American health care is that for me it actually cost me a lot more than it does to just pay it as a part of my income taxes in Canada. I'm not willing to pay more money for the same quality of care--that just doesn't make sense to me.

The other thing is, if I'm really sick, I know where I want to be. I can afford to wait a few months for an MRI if the payoff is knowing that I can get fantastic care when I really need it.

With that said, Canadian health care is critically underresourced, and our advantages in outcomes may quickly evaporate if our governments continue to starve the health care system.

[Iowa_Flames_Fan]

Originally Posted by Clever_Iggy

Wow, that joke sure got a reaction. Haha.

You even got called "junior"!

[Clever_Iggy]

Originally Posted by Iowa_Flames_Fan

With that said, Canadian health care is critically underresourced, and our advantages in outcomes may quickly evaporate if our governments continue to starve the health care system.

And that is my main criticism of Canada's system. To continue, IMO, taxes need to be raised which starts to erode the cost-efficiency of the system. It'll be a superior system in terms of access and care for all, but that costs a lot of dough to maintain.

[Clever_Iggy]

Originally Posted by Iowa_Flames_Fan

You even got called "junior"!

I know! And then he said that "statistically, [I'm] likely older" and therefore won't live as long. Very confusing.

We all need to get back to something we can agree upon - KLowe runs the Oilers like the US government runs healthcare.

[Iowa_Flames_Fan]

Originally Posted by Clever_Iggy

And that is my main criticism of Canada's system. To continue, IMO, taxes need to be raised which starts to erode the cost-efficiency of the system. It'll be a superior system in terms of access and care for all, but that costs a lot of dough to maintain.

Agreed. I actually think "reform" is the answer, but I'm not really expert enough to be more detailed than that. Overhead costs are lower than in the U.S., but they're still too high. Somehow we need more of the dollars we spend to be spent on actual health care, but I'm not smart enough to figure out how.

The good news is that I'll have three extra years to come up with an answer, though...

[Dion]

Originally Posted by Clever_Iggy

And that is my main criticism of Canada's system. To continue, IMO, taxes need to be raised which starts to erode the cost-efficiency of the system. It'll be a superior system in terms of access and care for all, but that costs a lot of dough to maintain.

Add to the fact that unions are doing a great job of driving up the costs of our healthcare. Then you have the top heavy management end where some of the fat could be trimmed.

[Iowa_Flames_Fan]

Originally Posted by Clever_Iggy

We all need to get back to something we can agree upon - KLowe runs the Oilers like the US government runs healthcare.

You mean they pay too much for a product that is too crappy?

[LChoy]

Healthcare guy here

I skimmed most of the thread and wasn't sure if I should wade into the discussion.

- Private vs public: Our system (Canadian) is a lot more private than most people think. Almost all our healthcare is provided by private providers, it is just that it is paid for by the public purse (through taxes). However, the new trend, esp in BC and Que is a more private/private clinic style, where a patient pays a membership fee to a clinic in return for access to the healthcare providers of the clinic. It is a loop hole in the Canada Health Act, but still for now legal provided that the patient isn't paying for services covered, just for access. There are pros and cons to this, but I'll get into that another time
- The big push right now in Canada is to increase the efficiency in our care. The biggest drain on time and resources is Chronic Disease and continuing care. We just don't have enough space to house people with chronic conditions or in their late stages of life. With no place to go, these people stay in ER rooms and adds to the backlog.
- Increasing Access: There are many initiative being developed to help with this. There are 30-40% of the population in some places that don't have access to primary care services (family doctors). Mediclinics and walk ins help, as does PCNs (Primary Care Networks). We are also looking at how we can allow health professionals to practice to their full scope of practice. Nurse Practioners can actually do the job of most family physicians on a day to day basis (checkup, advice, medication refill, BP/Glucose testing..). We are giving Pharmacist increasing powers as well. This frees up more time more doctors to handle more serious matters as well as giving patients more 1 on 1 time with a health professional, not necessary the 3 min with their family doc
- I have to watch what I say since this is a public board, and I work for health, but a lot of the things I said above, are being fought against by "powerful forces"
- Primary Care/Prevention: Someone asked about primary care and prevention. There is a focus on getting people to stay healthy and avoid Chronic disease. The sad reality is that squeaky wheel gets the grease. our health budget in AB last year was $14B but most of the priority will always be with acute care, rather than preventitive care. However, there are incentives for physicians to add prevention and population health to their practice, even if it's just spending an extra min to advise their patients on reducing their cholesterol, BP, and other simple measures

- urban vs rural: It's hard to compare the States to us in Canada. Not only due to population, but the fact we have a lot of people that live in rural areas. City/urban hospital admission rates are in the 90% range if not always full. In rural hospitals, figures can be as low as 40-60% range. We're working to get more specialist to practice in rural environments, but most tend to operate in our cities forcing people to go to Edmonton or Calgary for major surguries.

- My own opinion. Both the US style and Canadian style have their strenght and weakness. As someone mentioned, it's unfortunate that the ideas around these two systems have become so entrenched. From the gov't perspective, esp in Alberta, we are much more pragmatic and willing to experiment with some aspects of the US system. For instance Health organizations such as Kaiser Permanante offer some excellent models on how to use multidisciplinary teams for patient care. We adapted that into our PCN models here. Same goes for programs such as physician and clinic incentives, Pay for performance, Medical assistance. For the States, they are learning about how we streamline administration, triaging, homecare, drug registration and approval

- That woman in that US commercial has irked a lot of people here in government, not only in Ontario. The official word is that if her tumour wasn't benign and her health was in dire shape, she would have gotten it removed right away, probably within the week. pre-op, surgery, drugs, and outpatient care (including future monitering) would all be covered by her insurance. In a private insurance model, it is this sudden emergency that forces a lot of people into financial trouble. However, because hers was more of an chronic rather than urgent, we're not as good with dealing with chronic conditions, so that part the States is probably a better model, provided she can pay for it. However, she would have gotten it removed eventually if she waited. The non-urgent nature of her surgery was the reason why her lawsuit was rejected.

- To be truely honest, if you were upper class to upper end of middle class with a great insurance plan, the States are probably better for you. They have access to up to date technology and drugs and you'll probably wait less and have more time with a team of health professionals.
- However, if you were middle to lower class, the Canadian system will look after you with or without insurance. You may have to wait, but the desperate and urgent will get seen


I'll try to keep up as much as I can on this thread, but if anyone has questions about the AB system, or the Canadian healthcare in general, PM or just quote me

PS. Spell check doesn't work on my browser, excuse my mistakes please

[Cactus Jack]

Originally Posted by Bagor

One of things I noticed when I was there was that every 6th shop or every street seemed to be/have a pharmacy and this wasn't even in a densely populated area.

Never seen as high a concentration of pharmacies in all my life. Any idea why? Can you just buy drugs there without a prescription?

To be honest, i'm not as familiar with the system as I should be given that I will be moving there but my girlfriend is a local so I'll ask. They do have an ass load of pharmacies all over the place.

[FireFly]

The problem with comparisons is that everyone has a different experience. I hate to make such a simple comparison, but it's like your telephone company. Some people swear by Telus, some hate Telus, some like Bell, some hate Bell. It's based on your experience. I've never had an experience where I had to wait a long time. In fact, I went for an unrelated ultrasound in April, and they found a kidney stone. Since it wasn't bothering me at the time, I booked an appointment with a specialist for a month later. When it started to bother me two weeks later, I went to the ER and they took it out. No need to actually wait for the specialist appointment at all.

[nfotiu]

Originally Posted by Iowa_Flames_Fan

You can't use anecdotal evidence to contradict statistical evidence.

I could as easily point out that in Boston I could not get a doctor to take my complaints of back pain seriously. I went to see my doctor several times, and each time I waited for an hour and a half to see him for 5 minutes while he pretended to listen and then quickly wrote a prescription for an NSAID that rotted my stomach away.

In Canada, I saw a doctor within a week, waited ten minutes and walked out with a referral for Physio--I was in physio within a week and feel a lot better already.

But the thing is, that's meaningless: it's an anecdote. You have to look at the statistical outcomes across the board, and that's where the news becomes grim for Americans.

Somewhere, in some office, there's an actuary who is estimating that I will live three years longer than you because I'm in Canada. There's a bet I'm willing to make.

If you're actuary was smart he would look into the demographics of where you live. If you lived in the ghettos of Richmond,VA (where I live) you'd probably be a long shot to make it to 40-50, however if you lived in an upper middle class suburb around here, you'd probably be a good bet to live into your 80s. You live in an area where everyone's on crack, kids routinely shoot other kids when they get off the bus, and they have no health insurance, they are probably not going to live nearly as long. Canada doesn't have those kind of neighbourhoods to drag down their stats. The US has way too many areas that don't really have access to the benefits of being in a Western society.

I think it is safe to say that people who have good health insurance in the US generally get better care than Canada, better access to technology and top experts. While the poor get far worse access than Canadians. Same thing applies to schools.

[Cowboy89]

Originally Posted by flameswin

Yeah, and I have to get audio of me drunkenly screaming Blink182 lyrics out of your brothers phone.

edit: You are Lambeburger's brother right? I remember him saying it was cowboy something.

I am Lambeburger's brother!