What is wrong with health care?

[Argus]

All we ever hear about health care is that it's underfunded. Yet my understanding is that Canada spends as much or more than almost every other OECD state on health care. I have taken people to hospital twice in the last year with broken limbs, and both times we were in there for about 7-8 hours. I am told this does not happen in most of Europe. You don't wait eight hours to get your broken arm set in Germany or France or Sweden or Norway or Belgium. So why do we have such backlogs here when our spending is near the top? Misuse of money? Too much bureacracy? What?

We can't simply keep throwing more and more money at the problem. It's already having an enormous impact on provincial budgets, sucking money away from every other worthwhile spending project, from road building to education. As the boomers age health care is only going to become more and more expensive.

[Michael Hardner]

It would be nice to see some comparison figures.

I already showed in another thread that the US spends about twice as much per capita for about half the coverage. How about Europe ?

Wait times ? Costs per capita ?

[CanadaRocks]

Is the law of supply/demand a valid issue when it comes to the shortage of doctors?

Could we not raise a crop of doctors with low cost or free education for those participating provided they bond to service for Canadians for X years in X area for X amount?

[August1991]

In 2001, on all health care:

Canada spent equivalent US $ 2792/person or 9.7% of GDP.

US spent US $ 4887 or 13.9% of GDP.

Switzerland spent equivalent US $ 3322 or 11.1% of GDP.

UK spent equivalent US $1992 or 7.6% of GDP.

France spent equivalent US $2561or 9.5% of GDP.

OECD Health Data

The high US numbers seem odd.

Some have said this is because the US is richer and health is something that rich buy proportionately more. (In 1960, Canada only spent 5.4% of GDP on health care and in 1980, 7.1%.)

It is also true that the US "exports" health care since many non-Americans go to the States for treatment.

Of course, some argue that the US spends more but gets less - and then cite the millions "without health insurance".

I am inclined to suspect data is collected differently. (How is an expenditure classified as "health"? In the US, clinics advertise to attract patients. Does that count?)

IMO, compulsory government-operated health insurance makes good sense, with the premium paid from general tax revenues. We should also have a small "deductible" - that is, we should pay a small fee each time we receive a health service.

IME, Canada's hospitals and clinics are too bureaucratic and the government tries to micro-manage them. Private-for-profit operation would make a big difference. (Nothing beats a few GPs running a small clinic as a small business and billing the Health Ministry.) In Quebec, you can schedule an abortion but you cannot schedule a live birth.

[Slavik44]

Perhpas we are hospital happy in Canada? Or the rest of the world is hospital happy. I mean Sure thats what we pay, but what is the average daily "attendance" at a canadian hospital (yes it is a sporting event, tickets for the neuro surgery are on for $14.99), this in comparison to some other country, perhpas an explanation could be found there.

[Bro]

The problem with healthcare is the fact that the lieberals cut their portion of healthcare dollars to the provinces in order to make a balanced budget,and Canadians bought it for the whole time the Chretien regime was in power.

Canadians voted him in for two majority governments.

They're just realizing now the Liberals might have duped them by robbing the healthcare system to balance their books.Wake up Canadians!

[Argus]

It would be nice to see some comparison figures.

I already showed in another thread that the US spends about twice as much per capita for about half the coverage.  How about Europe ?

Wait times ?  Costs per capita ?

Health stats

I know some won't enjoy the source but the figures ultimately quoted are from the OECD. According to them Canada is very close to the top in the world in terms of health care spending. Now I don't have absolute facts about deliverables, but from what people in Europe have told me waiting times of 6-8 hours are virtually unheard of, especially for serious injuries such as broken limbs. Here they are standard. So why is that? And above all, why are we not looking at Europe? Why is it that any time anyone suggests changing our system all we get are howls of terror because people think the only alternative is a US style system?

[Argus]

The problem with healthcare is the fact that the lieberals cut their portion of healthcare dollars to the provinces in order to make a balanced budget,and Canadians bought it for the whole time the Chretien regime was in power.

That is "A" problem, but not "The" problem. I believe we have a number of problems, principally that we have useless politicians, especially on the left, who have used health care as an ideological weapon to beat at their opponents rather than doing anything to develop new policies and procedures. The Canada Health Act is not the bible. Our idiotic insistence on banning private for-profit health care puts us in a small group of nations (3) with Cuba and North Korea. No one else thinks that's a good idea. Why do we? We need to divert people from hospitals into clinics by charging a small fee for non emergency visits. We need to stop people who abuse the system by charging healthy people for repeated doctors visits. If you want to go to your doctor because you have the sniffles you should damned well pay for it.

Another idea. Why do we have expensive, university educated nurses changing sheets and wiping bottoms? In some European countries, ie, Finland, they have more assistance for nurses. The RNs, who are experts in drugs and health, are not wasted on menial labour type jobs. Those are done by far lower paid health care aids. You don't need a university degree to feed someone, to plump their pillows, to crank their beds, to fetch them water, or change their bed pans.

I found the following on RN salaries

Salary

According to the collective bargaining agreement signed by the Ontario Nurses Association and participating hospitals, salary for an entry-level RN starts at $21.75 per hour. An RN with eight years experience in a staff nurse position reaches a salary of $32.71 per hour. Advanced practice nurses and nurse managers (who have earned Masters degree or higher) earn significantly higher salaries.

IMHO that's an awful lot of money when you multiply all those nurses making $60k per year. We have far, far more RNs than RPNs, when it seems to me it should be more the reverse, or at least equal. Our doctors, btw, also earn considerably more than doctors in many western european countries.

[Bro]

True, but the liberals cut in funding is the"A"problem.

[August1991]

Martin wants to add $9 billion over 5 years to health care. Layton wants to add $29 billion to health care over 5 years.

Total expenditure on health care between 1996-2001

1996 $74.2 billion

1997 $77.3 billion

1998 $81.9 billion

1999 $87.9 billion

2000 $96.5 billion

2001 $104.3 billion

On average, we are now adding about $7-8 billion every year to health care.

Is this too much? According to Jeffrey Simpson, health care expenditures are out of control.

But on a per capita basis, in 2001, we spent 9.7% of GDP on all health care whereas the Americans spent 13.9%.

As incomes rise, health care takes a bigger proportion of expenditure since health care is a luxury good. In a sense, we are catching up to Americans.

The real issue with health care is not the dollars spent but how disorganized the medical "system" is. I think that's the main gist of David Frum's article once you get past his smarmy take on "socialized" medicine.

We can expect increasing billions to go to health care in the future. That's normal. What is maybe more important is for provinces to experiment with delivery.

[Sully]

Do what you have always done and get what you have always gotten.

Throwing money at the health care system without a a major overhaul is a waste of money. The system as it stands right now is a cash eating machine in its present form. The scary fact is that if these reforms are delayed, future generations will have to pay for this. With an aging population, bad diets, laziness, obesity and in general poor lifestyle choices, the demand for health care is going to increase substanially. Our health care system needs to take a proactive stance, rather than reactive when its comes to delivering health care. Incentives should be applied to people who take an approach to a healthier lifetstyle, its better to keep them out of the hospital in the first place. Enough with spending millions on reports and then having them sit on the shelf, its time to open up more seats in universities for doctors now to meet future demand, its time to make sure wages for health care staff, are equitable and fair and not out of line, its time to get politicians away from using the system for political gains.

There is plenty of room for change from a BC perspective.

Doctors (meeting demand)

Institute programs for immigrant doctors that train them in Canadian practices and standards thereby helping them meet Canadian certification standards sooner.

Increase the number of university seats for doctors and other health care professionals who are in demand.

Set up a lottery for education grants for positions that are in provincial demand (i.e. doctors), if it would encourage more students to enter those professions if they got part or all of their education paid for. A modest two million dollar investment could pay for the training of 80 students annually @ $25,000/year. The stipulation is that these doctors would have to work in the province that subsidized their education for a certain period of time in order for the province to get a siginificant return from the doctors. This way we would have Canadian trained, Canadian experienced and Canadian certified doctors immediately, without the worry of them leaving after graduation for greener pastures.

Health Managers

Cannot increase their own pay, while asking the people they manage, nurses, aides etc. to take benefit or pay cuts.

Stricter rules on overtime, in order to get overtime pay you actually have to work it.

Streamline the management bureaucracy, less is more for management, we cannot be laying off numerous front line workers and maintaining the same number of managers.

Have strong and useful independent bodies within the hospitals where workers can make complaints without fear of unions or managers retaliating. Complaints about poor management, useless co-workers, and recommendations for improving the hospital could be aired in this free thinking forum.

Society Reforms (Prevention)

Tax breaks on certain food items, gym memberships (which means you have to actually use the gym) etc.

Schools must implement mandatory nutrition programs and fitness programs.

There are so many areas that can be reformed and I have only touched on a select few. Unfortunately some peoples feathers may get ruffled in the process, but something has to be done now before its too late and we have to implement a two tier system in Canada, just in order to have a health system.

[Sully]

Oh one thing I forgot is that the federal government should keep track of the movement of Canadians through inter-provincial migration. BC is a haven for retirement and as such this influx of an older population increases the burden on the health care system in this province. A formula should be derived that accounts for these increases in health care costs to this province by an increase in transfer payments.

[August1991]

Tax breaks on certain food items, gym memberships (which means you have to actually use the gym) etc.

I agree Sully.

We accept that certain people pay higher car insurance premiums - young men, people with accident histories.

The same applies to health insurance and in fact we do this now through cigarette taxes - a form of higher health insurance premium. The Ontario Liberal tax on certain food would be the same. What about a special tax on motorcycles too?

The dark secret of health care is that women use it more than men. Should women pay more than men? Men typically pay higher life insurance premiums?

As to your other point about Health Managers, it seems to me that the person on the ground has the best information to make a decision - if the incentrives are set right.

There is no one size that fits all. A centralized bureaucracy is forced to standardize and then all the advantage of local information is lost.

In Montreal, the provincial government wants to build two new "superhospitals" - this is a typical Soviet approach to the problem.

Between Harper and Martin, I suspect health care will get the dough. The difference is that Harper will let the provinces decide how to spend the money, experimenting as they do.

Throwing money at it? The US private sector will funnel billions of new greenbacks at health in the next few years. Health care is a growth sector, like travel and tourism. That's what richer people buy with their higher disposable incomes. Don't be surpised.

[August1991]

This post answers in this correctly named thread a post in a different thread (Conservatives and Bilingualism) that went off on a tangent. (IMV, thread names - and logos - matter.)

Would you care to explain the "it sucks" part of your message?

Europe is two tier. If you have money, you get immediate service. Otherwise, you're in the State bureaucratic take-a-number-and-wait nonsense. This is true for both East-West Europe before-after the Berlin Wall. (Heh, this is Europe...)

I told East Europeans that the wives of Canadian PMs (Mulroney and Trudeau) had children in the same hospital I would go to. They said Canada was a communist country!

In effect, we're now no different from Europeans. Our second-tier is the US. That's where Bourassa went for cancer treatment.

Martin's Medisys thingy is more recent. It's a private clinic ostensibly offering services to foreigners in Canada but also offering services to "select" Canadians - at Health Ministry rates. PM PM gave these guys a good plug but they don't need it.

I'm waiting for a full-fledged private hospital to open in Canada, as in Bulgaria or Switzerland, offering abortions, plastic surgery and other medical services to rich third-worlders. For the dumb left, it would be a "job creation hi-tech export sector".

[willy]

Here are a couple of thing floating around BC on reforming health care.

http://www.boardoftrade.com/events/present...tesi28apr04.pdf

http://www.boardoftrade.com/vbot_speech.as...et=&speechfind=

[Argus]

Would you care to explain the "it sucks" part of your message?

Europe is two tier. If you have money, you get immediate service. Otherwise, you're in the State bureaucratic take-a-number-and-wait nonsense.

Which is where we are now. You obviously don't like the idea of "two-tier", even though you acknowledge that we effectively have one now anyway. Fine.

My question is: is it better for most people?

If you go to a hospital ER in France, Sweden, Belgium or Germany with a broken arm, are you going to wait 6-8 hours before you see a doctor as I have done twice in the last two years in Ottawa?

Do you have to wait three months to see a specialist, then another five months to get scheduled for an MRI, or some other diagnostic tool, then another year before you get treated? Are the wait times - not for the rich, but for the people on public health care, as bad as they are in Canada or better? I have been unable to find much citable information, but what I have found seems to indicate the wait times are not nearly as bad as they are here.

I told East Europeans that the wives of Canadian PMs (Mulroney and Trudeau) had children in the same hospital I would go to.  They said Canada was a communist country!

And were you telling the truth? Chretien had surgery in the US. Martin goes to a private, fee charging clinic. Do you honestly think either of them or their families would wait a year and a half to get hip replacement surgery?

I am a practical man. I want the system that works best for most people. If that is our system then how do we improve it? If it is a European system why don't we adopt it?

One thing for sure; our present system is not working, and it is getting worse. Waiting times have grown, and will skyrocket as the boomers age. Costs are already skyrocketing and will only get much, much worse.

[CanadaRocks]

Canada spent equivalent US $ 2792/person or 9.7% of GDP.

US spent US $ 4887 or 13.9% of GDP.

Switzerland spent equivalent US $ 3322 or 11.1% of GDP.

UK spent equivalent US $1992 or 7.6% of GDP.

France spent equivalent US $2561or 9.5% of GDP.

These are interesting figures, but misleading?

Heathcare should be measured by services of the same quality available to all Canadians recieving public health insurance is it?

When;

we cut back on the availability of health care,

we cut back on the types and quality of medications paid

we cut back on the services offered

we cut back on medical staff replacing them with delays

we cut back on spending and lower wages drastically

clients to the health care face longer and longer waits

we degrade our healthcare system

Why measure ourselves by "the other guy" ?

Why not measure ourselves by what we think is right?

You go to hospitals time to time, for yourself, for others.

Measuring not by the standards of your private healthcare insurance, but by those things controlled and in place for public health insurance alone, .. do you feel that "our healthcare rocks!" or do you feel .."this sucks"?

If it rocks on 100x less than other countrys are spending then fine, why pay more just because they are?

and by similar measure

If our health care is sucking on 100x more than the other countries are spending then too bad, looks like to have the health care quality we consider to be appropriate, why spend less and have less, just because they don't?