Saturday, February 04, 2006

An American Doctor in the Canadian Health Care System

As an Emergency Room doctor, I have been able to practice in several countries including Canada. And while the fish may be bigger in Canada, the grass is not greener and the health system is not better than in the U.S. First of all, primary care is easily available in Canada. Thereafter, specialty care is a real challenge. I will never forget having to call every day to a cardiologist's office to try to get a patient of mine bumped up the list to get an angiogram because he was having chest pain just getting to the bathroom. Somewhere about the time I learned the names of the receptionist's goldfish, I finally got him an appointment. He could easily have died waiting in line - something bureaucrats don't mind in big systems. I saw that both in Canada and in Saudi Arabia (for the non-VIPs) - the line meant health care was available ... eventually, if you survived.

Secondly, if you compare the space and equipment in a Canadian Hospital (outside a few key cities) to a US Hospital, you will think that you were going from a high mileage Volkswagen to an almost new Chevy Tahoe. Everything is better on this side of the border, which is why all of the hospital elite cross the border for their care (money often out of pocket). The Mayo Clinic has thrived due to Canada more than Minnesota.

Third, the decision making in Canada is made to look like it is citizen based. But it is really very centralized with a group of rotating urban consultants that show up in rural garb with all the facilitator gab about patient empowerment. The one I got to work with brought some ten inches of documents with him which quickly depressed the citizen committee. He offered then to help the people by simplifying all the issues. Then he gave the committee the summer off as he reported montly meetings wherein their input was being garnered - all lies. In the end, the citizens were told that they had approved closing urgent care in the snowbound area of Emo, Ontario. I helped mobilize 600 citizens to suddenly join and take over the hospital district board of three hospitals in angry reaction. It was all bogus.

Fourth, Canada hired a US consultant to come in to Winnipeg and downsize the main hospital - the one that already had lines waiting. This was necessary because the federal government was no longer willing to match the provinces 50:50 in funding. Government knows that distant consultants can come in, downsize, and go home - never caring about outcome. Most Canadians thought the health system was one of the dimmest rather than the brightest of the crown jewels.

Fifth, the physicians were all grouped into a giant IPA for each province. If they went over budget in patient expenses, they were billed for the difference. I still ignore my Ontario bill that tries to follow me. So the docs are programmed to say "No", just as the Permanente physicians do - and for the same reasons.

Sixth, medical malpractice suits are almost unheard of even though malpractice is quite common. I witnessed one of my patients who got an ectopic pregnancy on each side of a supposed tubal cauterization. Another patient had a poorly repaired ankle fracture with life long pain. The richest surgeon in the province was near our small town because he offered to do all specialty cases - messing up ortho, then urology, etc. I helped him retire as I left by simple patient empowerment. But no one else cared - he saved the other docs money.

Seventh, the local docs tried to "get me up to speed" and also pointed out that I was like a "K-Mart" coming to town and sending my income south of the border. The unfilled position should have been left empty. I got up to my own speed and shared my opinion with the public. I am a team player - I just formulate my team with mostly patients.

So go ahead and believe that everything is great where the rivers flow north. But for those who want to dig deeper, look to the source of the comments and find out how they would individually benefit by a national health system here. Anticipate global mediocrity. Everyone would be on board, but the train would run a lot slower - some dying in the journey.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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