Canadian Health Care System

Canada's National Health System A Disaster

Sooner or later, Canada is going to be forced to reform its "free"-care-for-all national health system, many observers predict. Citizens critically in need of care have died while waiting for surgery or to see a doctor, critics report.

  • It takes nearly 25 weeks to get an appointment with an ophthalmologist in Canada, almost 21 weeks to receive orthopedic care, more than 18 weeks to get a heart by-pass, over 16 weeks to see a neurosurgeon, and nearly 12 weeks for a gynecological exam.

  • Experts attribute the delays to everyone wanting as much health care as he or she can get -- since it's free.

  • During the 1980s, real public health costs in Canada came close to tripling.

  • Bureaucrats have sought to ration supply by shutting hospitals, reducing medical payments and limiting the hours doctors can spend in surgery.

From Montreal to Vancouver, doctors -- whose pay has barely budged since 1993 -- have staged or threatened job actions this year. On July 30, physicians across British Columbia shut their offices for five days and pledged to repeat the process monthly. Virtually all obstetrician-gynecologists in Alberta, furious at the $185 cap on delivery fees, warn that they will opt out of the state-run system.

Source: Joseph Weber, ";Canada's Health-Care System Isn't a Model Anymore,"; Business Week, August 31, 1998.

Canada's Hidden Health Costs

Does it cost less to administer Canada's national health insurance system than the private health insurance system in the United States? Official accounting statistics indicate that the net cost of administering private health insurance in the United States is roughly 7.6 percent of benefit payments, compared with 0.9 percent for Canada's system.

But these numbers do not include certain hidden costs in Canada. Canadian patients incur extra costs because they have to visit their doctors more often than U.S. patients for the same services and they sometimes face longer waits for hospital services. The system also results in lost productivity of patients and their families because of the inability to get medical care promptly.

Fee schedules for Canadian physicians have not kept pace with inflation, so physicians tend to require patients to make multiple short visits to receive services that would be provided in a single visit in the United States. Each visit requires the costs of travel as well as waiting in the doctor's office. And because access to acute care services is more limited in Canadian hospitals, large numbers of patients are waiting for major surgery or surgical procedures.

  • The Canadian system allows physicians to bill only for medical evaluations in their offices, so they do no surgical procedures there and patients usually must go to the hospital for even minor surgery.

  • In Quebec, in the two years immediately after the introduction of universal health insurance, physician time spent per office visit declined by 16 percent and office visits rose by 32 percent.

  • In 1989, the income loss in British Columbia for patients who had difficulty working because they were awaiting medical treatment was about 7 percent of total hospital expenditures.

This income-loss measure did not take into account reduction in "quality of life" - for example, the additional time other family members spent in caring for an elderly person who could not get a hip replacement.- David R. Henderson.

Source: Patricia M. Danzon, "Hidden Overhead Costs: Is Canada's System Really Less Expensive?" Health Affairs, Spring 1992.

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