Yes, as a matter of fact, I do have some familiarity with the health care system in Canada. My wife is Canadian, works for the DND in health services, lives in Ottawa (now), and I've been studying the situation there for some years.
When my wife was working in Kingston, ON, she was unable to obtain basic health care for well over a year - despite having provincial insurance. There were no primary care physicians (the required gateway, other than ED's, to all health care in Canada) who would accept additional patients. For more than a year, for routine health care she had to take a day off from work and go to Ottawa to see her PCP.
When I visited Kingston in December, 2003, I developed a sinus infection, and decided I needed abx. I was on my way to the emergency department at Hotel Dieu (the closest ED to where we were) when I passed a GP's office. I stopped in, and the physician was sitting at the front desk (it was pretty late in the afternoon, just before Christmas, and she was closing the office for the holiday). I explained that I was from the United States, visiting, and had a sinus infection, and asked if she could write me a script for azithromycin.
She did, I was able to pay cash for the office visit (CDN 40), and we talked for about an hour - about the difficulties she had with provincial pay, capping her ability to make money, and all the rest of her difficulties. I realize that an anecdote is not data, but I've seen many similar stories reported in the press (including CBC, and the CMA) and in blogs.
The Fraser Institute documents many of the shortfalls of the Canadian System. Their annual report is a must read for me.
http://www.fraserinstitute.ca/shared/readmore.asp?sNav=pb&id=782
They document the delay in diagnostic services with hard numbers, yours are quite different from the averages for all medical specialties, the advantage of your limited experience in one of the least impacted specialties. The median wait time between referal by a GP to the first appointment with a specialist was 8.3 weeks in 2005 (table 2) and from an appointment with a specialist to treatment (not counting any delays that may have occurred while the specialist diagnosed the condition) is an additional 9.4 weeks (table 4)
http://www.fraserinstitute.ca/admin/books/chapterfiles/WYT2005pt2.pdf#
BTW, those numbers do not include whatever the number of non-referals by PCP's is because the PCP knows that there is no chance the patient will actually see a specialist, due to scarcity....How many specialists (especially surgeons) max out in Canada every summer and work the rest of the year in Britain or the US?
Also, in New Brunswick the province sends out appointment reminder cards with a pre-printed appology if you've already died.
http://www.cbsnews.com/stories/2005/03/20/health/main681801.shtml?cmp=EM8705
As far as the delays, heres what the Canadian Supreme Court found:
http://www.cbc.ca/news/background/healthcare/
Here's some more about Canadas health care:
http://www.opinionjournal.com/editorial/feature.html?id=110006813
The new head of the Canadian Medical Association is pro-private health care:
http://www.healthcoalition.ca/cma-2006a.pdf at page 2
In any system that rations health care, the state decides that line between medical necessity and not. The average waiting time for referal for orthopedic surgery in Canada (table 2, above) is 25.3 weeks, and an additional wait until surgery of 40! weeks, for a total of 65.3 weeks. You may not think that a hip replacement is important until you or a loved one needs it, but after a year in bed they're generally so debilitated that recovery is unlikely. Keep in mind thats just the MEDIAN wait, half are longer than that. Even a less critical (say, knee replacement) after a years wait is still significantly deblitating with poor outcomes compared to rapid interventions.
In 2001 an older friend of mine (he was 64) fell and broke his R femur at the head. He lacked insurance, a PCP, etc. He was able to walk on the fracture (at least at first) for a couple of days but the pain finally made him go to an emergency room. He received a surgical repair within 48 hours of admission, nursing and rehab care, PT, the works and was back to normal within 12 weeks of his initial injury. In the US, without insurance, and without payments (the insurance company of the store he fell at finally paid his medical bills, of some $12K total). OBTW, he was treated at Harbor-UCLA hospital, a county hospital in Los Angeles with UCLA residencies, and the quality of his care was excellent.
In 2004 I developed a nerve entrapment in my shoulder - I was able to get seen (that day) by a PCP, with x-rays, and a CT scan and MRI of my shoulder the next morning....All within 5 miles of my home, in a suburb of Los Angeles. But, there are more CT scanners in California (population ~33mil) than all of Canada (population ~33 mil), in fact there are more scanners in Rochester, Minn (population ~135K) than all of Canada. BTW, once the problem was diagnosed, fixing it was a few physiotherapy treatments.
Who do you want deciding if your mother gets a new hip or dies from septicemia secondary to decubitus ulcers? A nameless bureaucrat who is unaccountable to anyone?
Yet, Canadians pays an unknown, hidden, amount for their health care...I have many Canadian fellow students and of the ones that actually have a clue about Canadian taxes (the ones that have had serious jobs or owned businesses) they are as sure as my wife and her family are of how much Canadians pay for their rationed health care: Much more than the official government figures indicate. My wifes tax rate is somewhat more than 50% of her income, by the way, including federal and provincial taxes.
