Canada's physician density remains stagnant

Canada's physician density remains stagnant

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Everything you ever wanted to know about Canadian health care in one post

Everything you ever wanted to know about Canadian health care in one post

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Canadian doctors say fee cuts, pay inequalities will spur exodus | News | National Post

Canadian doctors say fee cuts, pay inequalities will spur exodus | News | National Post:

Despite repeated, expensive attempts to more logically divvy up fees, ophthalmologists earn almost 70% more on average than brain surgeons, who take in almost double the income of psychiatrists, according to Canadian Institute for Health Information (CIHI) figures.

“There are terrible inequities within medicine,” said Michael Rachlis, a Toronto physician and health policy analyst. “And this has really almost nothing to do with the actual value of services. It’s just that some services … often because of technological change, end up being relatively overpaid.”

Comparisons with other industrialized countries suggest that, on average, Canada is among the most generous in remunerating its doctors, though the U.S. continues to out-pay in some specialities. Statistics and recruitment agencies report a net migration of physicians into Canada lately.

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How the U.S. measures up to Canada's health care system | Worldfocus

How the U.S. measures up to Canada's health care system | Worldfocus:

"Edie Magnus: We were in a hospital that was affiliated with McGill University, and it was a regional system that had six hospitals that were affiliated with one another, and they annually have some 39,000 inpatients, and they do about 34,000 surgeries and they deliver about 3,000 babies. And managing all of this is a staff of 12 people doing the billing, the administration. What would an equivalent hospital in the U.S. take to run administratively?

Uwe Reinhardt: You’d be talking 800, 900 people, just for the billing, with that many hospitals and being an academic health center. We were recently at a conference at Duke University and the president of Duke University, Bill Brody, said they are dealing with 700 distinct managed care contracts. Now think about this. When you deal with that many insurers you have to negotiate rates with each of them. In Baltimore, they are lucky. They have rate regulations, so they don’t have to do it. But take Duke University, for example, has more than 500,000 and I believe it’s 900 billing clerks for their system.

Edie Magnus: What are 800, 900 people doing?

Uwe Reinhardt: Well first of all there’s a contract. With each different managed care contract you have different rates. You have different things that need pre-authorization, not depending on the contract. You haggle over every bill. You submit the bill, the insurer rejects it, you haggle, and it may take 90 days to settle one bill. They don’t have that in Canada. You see, we spend in this country an enormous amount of money just administering claims. It’s a huge wrestling match over the payment.

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A reality check on that Canadian "Brain Tumor" story

A reality check on a reality check:

Still, I found Holmes tale both compelling and troubling. So I decided to check a little further. On the Mayo Clinic's website, Shona Holmes is a success story. But it's somewhat different story than all the headlines might have implied. Holmes' 'brain tumour' was actually a Rathke's Cleft Cyst on her pituitary gland. To quote an American source, the John Wayne Cancer Center, 'Rathke's Cleft Cysts are not true tumors or neoplasms; instead they are benign cysts.'
There's no doubt Holmes had a problem that needed treatment, and she was given appointments with the appropriate specialists in Ontario. She chose not to wait the few months to see them. But it's a far cry from the life-or-death picture portrayed by Holmes on the TV ads or by McConnell in his attacks.
In Senator McConnell's home state of Kentucky, one out of three people under age 65 do not have any health insurance. They don't have to worry about wait times for hip or knee replacement or cancer surgery -- they can't get care. The median household income in Kentucky is $37,186 -- not quite enough for the $97,000 bill at the Mayo Clinic. CNN didn't mention that in its 'Reality Check.'"

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Bill Mann: Americans Who've Used Canada's Health-Care System Respond to Current Big-Lie Media Campaign

Bill Mann: Americans Who've Used Canada's Health-Care System Respond to Current Big-Lie Media Campaign:

"The scare ads and op-ed pieces featuring Canadians telling us American how terrible their government health-care systems have arrived - predictably.

"There's another, factual view - by those of us Americans who've lived in Canada and used their system.

"My wife and I did for years, and we've been incensed by the lies we've heard back here in the U.S. about Canada's supposedly broken system."

Read on...

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OECD Waiting Times Study Executive Summary

I realized that while I have a link to this study elsewhere, it is rather a pain to get to the information because the document is in pdf.

Now, this is from 2003, and so the UK/NHS data is now happily out of date. And leaders in Canada have seen the results in the UK and are pushing to end the bloc financing of hospitals that helped so much in the UK. But anyway, here is the summary:

• Waiting times for elective surgery are a significant health policy concern in approximately half of all OECD countries.
• This report is devoted to [analyzing waiting times]. An interesting feature of OECD countries is that while some countries report significant waiting, others do not.
• Waiting times are a serious health policy issue in the 12 countries involved in this project (Australia, Canada, Denmark, Finland, Ireland, Italy, Netherlands, New Zealand, Norway, Spain, Sweden, and the United Kingdom).
• Waiting times are not recorded administratively in a second group of countries (Austria, Belgium, France, Germany, Japan, Luxembourg, Switzerland, and the United States) but are anecdotally (informally) reported to be low.
  
• This paper contains a comparative analysis of these two groups of countries and addresses what factors may explain the absence of waiting times in the second group. It suggests that there is a clear negative association between waiting times and capacity, either measured in terms of number of beds or number of practising physicians. Analogously, a higher level of health spending is also systematically associated with lower waiting times, all other things equal.
  
• Among the group of countries with waiting times, it is the availability of doctors that has the most significant negative association with waiting times. Econometric estimates suggest that a marginal increase of 0.1 practising physicians and specialists (per 1 000 population) is associated respectively with a marginal reduction of mean waiting times of 8.3 and 6.4 days (at the sample mean) and a marginal reduction of median waiting times of 7.6 and 8.9 days, across all procedures included in the study.
  
• Analogously, an increase in total health expenditure per capita of $100 is associated with a reduction of mean waiting times of 6.6 days and of median waiting times of 6.1 days.
  
• In the comparison between countries with and without waiting times, low availability of acute care beds is significantly associated with the presence of waiting times. Also, evidence from this and other studies suggests that fee-for-service remuneration for specialists, as opposed to salaried remuneration, is negatively associated with the presence of waiting times. Fee-for-service systems may induce specialists to increase productivity and may also discourage the formation of visible queues because of competitive pressures. In addition, evidence from this and other studies suggests that activity-based funding for hospitals may also help reduce waiting times.

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EzraKlein Archive | The American Prospect

EzraKlein Archive The American Prospect

This is just too fun. Fraser Institute puts on prominent Canadian physician to dis Canadian health care, which he does, mildly IMHO, but then proceeds to dis the American system even more!

And Dr. Day (former CMA President) makes some great points:

1. Waiting times are a function of the way Canada funds hospitals, by bloc grants to hospitals rather than having money follow the patients as in the rest of the world.

2. Waiting times cost more, particualarly in terms of patients illness progression and economic costs of lost work, wages, productivity, etc.

3. Britain has essentially fixed its waiting time issues by dispensing with the bloc system.

4. “I think this is what people tend to forget. They equate alternatives to the Canadian health care system with ‘Americanization,’ which is not what we’re talking about. We’re talking about countries like Belgium, and Switzerland, and France, and Austria.”

5. One should be able to buy private health insurance (in Canada) to supplement the Candian Medicare system.

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Candian Medical Association Looks to Europe to Improve Health System

Letter to members kicks off CMA debate:

The Canadian Medical Association is looking at European health systems for ways to improve.

The CMA won't launch its online consultation about transforming Canada's health care system until April 6, but if the initial response to President Robert Ouellet's March 6 letter announcing the endeavour is any indication, the consultation website should be a busy place.

Within five days of emailing the letter to members and posting it on cma.ca, the CMA had received 149 emails, many containing lengthy comments.

In his letter, entitled Status quo, or transformation?, Ouellet suggested that if Canada wants 'a sustainable, universal health care system, we have to transform the one we have.' It was first emailed to 45,000 members and posted on cma.ca, and then sent by regular mail to a further 25,000 members.

The link the the letter is at their website, and a few choice comments are there, and here:

• "I kindly disagree with you. The problems in our system will not be solved by privatizing the most lucrative parts of it. Canadian doctors want to practise medicine, not run businesses."
• "I was delighted with your comments. The constant arguments that any changes in our system will make us like the US have been misleading and frustrating."
• "It is about time care and money be patient based. Bring on the new system you suggest - it cannot come soon enough for me."
• "I'm baffled how we are like sheep and accept the wait times in our country when other countries far surpass our achievements."

It's funny, isn't it? Canada has the sense to look past the end of its collective nose for solutions, while we continue to try to tweak our system as it continues on its glide-path into the mountain.

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Fraser Institute still allowed space in WSJ

A friend sent me this piece from the WSJ from the seriously delusional Fraser Institute (whom I may have to give their own subject tag at this point, but I'll stick them in with the Right Wing Noise Machine for now). My reply:

I love how these people love to site anecdotes. I note they never site the horrible anecdotes from the US.

I have some collected here: http://cmhmd.blogspot.com/search/label/%22Anecdote-Off%22

The first entry on my blog in my "anecdote-off" section is from a BBC documentary on US healthcare from January.

Have fun. See how many anecdotes you can count in this brief half hour program. I think there are at least a thousand if you count all those poor people at the RAM Medical program. But there are stories every bit, actually worse, than any Canadian anecdote I've ever seen.

Keep scrolling down, you'll get the idea. If you are uninsured in America, you may as well be in Cambodia until you're sick enough for the ER.

Oh, and hip replacements in the US do have a short waiting time, thanks to OUR single payer system, Medicare, which is funded well enough to make it so,

And finally, the Fraser Institute is full of poopy-heads, and dishonest ones at that. ;-)

I love you, but aren't you seriously tired of being systematically manipulated by Fraser, Heritage, Club for Growth and the rest of the noise machine?

Cheers,

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Interview with Uwe Reinhardt on Inauguration Day | Worldfocus

How the U.S. measures up to Canada's health care system Worldfocus:

"The Worldfocus signature story Canada’s hospitals cut the paperwork, emphasize care explores Canada’s health care system.

"In this extended interview, Uwe Reinhardt, a leading adviser on health care economics and professor of political economy at Princeton University, compares the Canadian and American health care systems. Reinhardt criticizes the U.S. health care culture and expresses his optimism about the Obama administration.

"As part of Worldfocus’ Health of Nations signature series, correspondent Edie Magnus conducted this half-hour interview with Uwe Reinhardt on January 20, 2008, the day of President Barack Obama’s inauguration."

Terrific interview! Highly recommended!

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The Health Care Blog: POLICY: Oh Canada

The Health Care Blog: POLICY: Oh Canada

"This article is about Canada's health system and its relationship to the US health policy debate. It is not meant to be an endorsement of Canada's system, or an endorsement of single payer for the US."

Very well done, but a few years old. Most of the information is still pertinent. Very nice, very detailed compare/contrast piece on US vs. Canadian Healthcare systems.

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Ohio.com - Health-care matchup finds Ohio falls short

Ohio.com - Health-care matchup finds Ohio falls short

From the article, which is a nice overview of US (Ohio) vs. Canadian (Ontario)

To explore how Ohio compares to the nation and the world, the Beacon Journal looked 60 miles across Lake Erie to the Canadian province of Ontario.
How does Ohio measure up to its neighbor?
Not very well:
• A 65-year-old Ontario resident can look forward to living about 20 more years — three years more than an Ohioan the same age can expect. At birth, the difference in life expectancy is greater — 76.4 years for Ohioans, compared to 80.7 years in Ontario.
• In Ohio, nearly eight of 1,000 newborns die each year — significantly higher than the U.S. rate of 6.8 deaths. In Ontario, the infant mortality rate is 5.5
• Ontario also has lower death rates for each of the top six causes: heart disease, cancer, stroke, emphysema and other chronic lower respiratory diseases, diabetes and accidents.
Overall, the gap in these key health-care yardsticks was wider between Ohio and Ontario than between the two nations as a whole in all but two categories: strokes and accidents.
That difference was striking because the state and the province are so similar demographically.
While the 300 million people in the United States are nine times more than Canada's head count, Ohio and Ontario are close in population, overall economic size and demographic measures such as median age, average household and family size, and education.
Ohio and Ontario also have similar economies, with almost the same percentage of both work forces employed in manufacturing and retail and wholesale trade — the two largest industry categories. Wages and salaries also are comparable.

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Rent hikes forcing out city (Calgary, Canada) doctors

Rent hikes forcing out city doctors:

"'It's scary,' said Dr. Linda Slocombe, president of the Calgary and Area Physicians' Association, who notes that doctors, unlike most other small businesses, can't raise their prices to offset rising costs. 'In another two or three years we're going to have a real drastic shortage of family doctors.'

The study, which was commissioned by CHR last summer but only became public during a recent meeting of Calgary family physicians, comes as the city already struggles with a doctor shortage.

An estimated 200,000 Calgarians don't have a regular family physician, a problem that has been compounded by at least 41 doctors who have closed their practice in recent years.

Experts say the physicians are retiring or leaving to pursue other jobs in medicine, where they earn a good salary and don't have the hassle of operating an office."

Posting this in keeping with my "warts and all" policy of reporting the good and the bad of other systems.

BUT, does any of this not apply to PCP's in America? Can't raise our prices? The hassle of operating an office? (And they don't even have to deal with dozens of private health insurers, so they are mainly talking about the other hassles.)

Cheers

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Doctors demand action on private health insurance

CNW Group CANADIAN DOCTORS FOR MEDICARE Doctors demand action on private health insurance:

"TORONTO, March 12 /CNW Telbec/ - Canadian Doctors for Medicare today called on the federal and provincial governments to immediately take all necessary steps to stop the spread of private health insurance for medically necessary services in British Columbia.

'The recent exposé that Acure Health Corp is selling 'Medical Access Insurance' for services already covered under Medicare undermines the public health care system to the detriment of the vast majority of Canadians, and contravenes the Canada Health Act', said Dr. Danielle Martin, Chair of Canadian Doctors for Medicare.
...
"Those who think private health insurance is a panacea for our system should take a look at the Australian experience. The major beneficiaries there have been higher income Australians, private insurance companies, private hospitals and medical specialists - and not the wider Australian community," said Dr. Martin.
...
"In its 2006, in its discussion paper "It's About Access", the Canadian Medical Association reviewed all the evidence and found: - Private insurance for medically necessary physician and hospital services does not improve access to publicly insured services
- Does not lower costs or improve quality of care
- Can increase wait times for those who are not privately insured; and
- Could exacerbate human resource shortages in the public system."

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heritage foundation - Moral costs of socializedmedicine

Vindy.com News – Youngstown, Ohio - Moral costs of socializedmedicine:

"Anyone who considers Canada’s health system a role model for the U.S. should consider the case of Samuel Golubchuk. His case shows the inevitable collision course between government-controlled health care and the rights of private conscience."

Typical hack rubbish. My comments are on the Vindy web site below the article...

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Quebec commission makes recommendations

Quebec commission makes recommendations:

"Quebec - The Castonguay task force on health care proposes a $25 charge for every visit to a doctor and an increase up to one percentage point in the Quebec sales tax to help pay for medicare.

Claude Castonguay, the chair of the task force, notes that health care, as a share of the provincial budget is growing 5.8 per cent a year, while total government spending increases 3.9 per cent annually.

He proposes capping health spending at 3.9 per cent and making up for the shortfall with a new health-stability fund, financed by the $25 doctor's charge and the sales-tax increase.

Extra billing for health care is currently illegal under the Canada Health Act, which Castonguay concludes 'hampers the evolution of the provincial public health systems.'"

In keeping with the "warts and all" approach to comparing helathcare systems...

The feedback to the story was mostly negative.

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AlterNet: 10 Myths About Canadian Health Care, Busted

AlterNet: 10 Myths About Canadian Health Care, Busted:

"2008 is shaping up to be the election year that we finally get to have the Great American Healthcare Debate again. Harry and Louise are back with a vengeance. Conservatives are rumbling around the talk show circuit bellowing about the socialist threat to the (literal) American body politic. And, as usual, Canada is once again getting dragged into the fracas, shoved around by both sides as either an exemplar or a warning -- and, along the way, getting coated with the obfuscating dust of so many willful misconceptions that the actual facts about How Canada Does It are completely lost in the melee.

I'm both a health-care-card-carrying Canadian resident and an uninsured American citizen who regularly sees doctors on both sides of the border. As such, I'm in a unique position to address the pros and cons of both systems first-hand. If we're going to have this conversation, it would be great if we could start out (for once) with actual facts, instead of ideological posturing, wishful thinking, hearsay, and random guessing about how things get done up here.

To that end, here's the first of a two-part series aimed at busting the common myths Americans routinely tell each other about Canadian health care. When the right-wing hysterics drag out these hoary old bogeymen, this time, we need to be armed and ready to blast them into straw. Because, mostly, straw is all they're made of."

Read on...

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Joint Canada/United States Survey of Health: Findings and public-use microdata file: Analytical report

Joint Canada/United States Survey of Health: Findings and public-use microdata file: Analytical report:

"Overall, most Canadians (88%) and Americans (85%) reported being in good, very good or excellent health. However, the range of health status was more polarized in the United States. More Americans reported being at either end of the health status spectrum – in excellent health (26%) and in fair and poor health (15%) – compared with Canadians (24% and 12% respectively)."

I saw a post arguing that this data proved the US system is better, and I just wanted to post the summary report for reference. Follow the link for the rest of it. It's worth remembering how much more we spend here than there as you review the numbers, and it's worth restating that we want to build an American system that is the best in the world in its totality, not just in niches of high tech and procedural related care.

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The McGill Daily - Hyde Park: When universal healthcare isn’t

The McGill Daily:

"But as any medical professional will tell you, this vaunted Canadian universalism is gradually being attenuated. As I recently discovered, universal in Ontario does not always translate to universal in Quebec. Specialized doctors are increasingly compelling their out-of-province patients – a group that includes many university students – to pay out-of-pocket for medical services.

"Specialists are adopting this practice because it relieves them of the cost of processing out-of-province claims and protects them from the occasional loss should a patient turn out to lack provincial health coverage. While out-of-province patients are still entitled to reimbursement from their home provinces, they must seek recovery on their own, a process that can take many weeks. If an out-of-province patient fails to pay, however, the specialist may refuse treatment, a course of action that carries no disciplinary consequences. "

Another caveat. Makes state by state action less appealing. Medicare-for-all looks better as Medicare causes no trouble when traveling to say, Florida for part of the year.

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