How is Canada's medical system working out?

[deadmau5]

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Are you sure about that? From my experience and other physicians from Canada, it's not a few hours but probably a few days which is a lot better than 19 weeks. This is if you're from a large city like Toronto.

Yes. Toronto hospitals will serve you within hours if you end up in the ER - if it warrants one within a few hours. I think it does depend on severity, but if you need it, even for cautionary purposes, you'll definitely get it. We also have an integrated hospital network - if you can't get the service at one hospital, they will try another.

If it's just a check up or unurgent, then yes, you will have to wait a while.

 

[Quix]

Quix did you miss the original post? Lol. You can't compare Canada with the US since they are having their own problems now. It's not only the loss of physicians that's the problem either. Now from my clinical experiences I have an example:
65 y/o M pmh CAD and HTN developed left sided hemiparesis. He was in his 2nd home in Montreal. Pt went to ER and still had hemiparesis and now dysphasia. CTA was ordered showing stenosis of several cerebral arteries.
Next step to be done? Should be emergent MRI/MRA to see size of infarct and better characterize areas for possible NIR intervention or thrombolytic treatment. Uh oh, there's a waitlist even for active stroke patients (they told him ~3 days). Family decided to ship him back to US where MRI/MRA done immediately that day and NIR was able to go in with local percutaneous thrombolytics.
Too bad it wasn't optimal timing and he still had pretty significant hemiparesis upon discharge. True story. Same goes for if you break ur leg. You better be willing to go to a major city and then wait for that surgery.

Now tell me if you had an acute problem where you'd want to be.

The U.S. has more MRI's because it focuses on acute and chronic care, rather than preventative care. This has caused some border hospitals in Canada to make working arrangements with U.S. border hospitals to be able to use these pieces of equipment. Additionally, these MRI's aren't being used at anywhere near appropriate levels of efficiency - many sit idle because the demand for them is low.

Again, this is one example, and there are systemic fixes. The fact that individual patients may receive different levels of interventions doesn't address the essence of the argument. If we recast that same example using a typical underinsured or uninsured patient in the U.S., there are plenty of folks who wouldn't even present to an ER, because the recurring data trend is that these people wait for treatment until the condition is much worse, and then don't receive the same level of care.

So I'll ask you, if you didn't have health insurance, where would you prefer to be treated for a non-emergent condition?

 

[OHMAN0125]

The U.S. has more MRI's because it focuses on acute and chronic care, rather than preventative care. This has caused some border hospitals in Canada to make working arrangements with U.S. border hospitals to be able to use these pieces of equipment. Additionally, these MRI's aren't being used at anywhere near appropriate levels of efficiency - many sit idle because the demand for them is low.

Again, this is one example, and there are systemic fixes. The fact that individual patients may receive different levels of interventions doesn't address the essence of the argument. If we recast that same example using a typical underinsured or uninsured patient in the U.S., there are plenty of folks who wouldn't even present to an ER, because the recurring data trend is that these people wait for treatment until the condition is much worse, and then don't receive the same level of care.

So I'll ask you, if you didn't have health insurance, where would you prefer to be treated for a non-emergent condition?

Still the US. You have a right to your biase but after working so many hours in residency I wouldn't want to be treated anywhere other than the US. If you were in my shoes you may agree, but considering you're not in the trenches I understand your point of view. Similarly if I did administration my whole life I'd probably make your argument. You see why there's so much debate in health care? Btw...not many docs trust/like hosp admin. I wouldn't push it on any application/interview for med school.

 

[TRN1983]

60% of bankruptcies filed by Americans are due to medical bills. http://voices.washingtonpost.com/health-care-reform/2009/06/new_study_shows_medical_bills.html

Getting cancer may ruin your credit. Imagine that.

Would you rather have your credit ruined over cancer, or wait a year in Canada for an MRI? I'd rather wait 7yrs to repair my credit than die.

Our system has problems, but as it stands our health outcomes are amazing and if you're gonna get sick anywhere in the world you'd wanna get sick here because of the outcomes.

 

[TRN1983]

So I'll ask you, if you didn't have health insurance, where would you prefer to be treated for a non-emergent condition?

And, I'd respond with this:

Where would you rather live?:
a) somewhere that is good with emergent conditions
b) somewhere that is good with non-emergent conditions

In addition:
Congressional Budget Expert Says Preventive Care Will Raise -- Not Cut -- Costs

http://blogs.abcnews.com/politicalp...preventive-care-will-raise-not-cut-costs.html

 

[OHMAN0125]

And, I'd respond with this:

Where would you rather live?:
a) somewhere that is good with emergent conditions
b) somewhere that is good with non-emergent conditions

In addition:
Congressional Budget Expert Says Preventive Care Will Raise -- Not Cut -- Costs

http://blogs.abcnews.com/politicalp...preventive-care-will-raise-not-cut-costs.html

Preventative care requires something that is extremely hard for most patients. SELF-MOTIVATION. I can't tell you how many times I've counseled someone to stop smoking and given them different strategies only to have them tell me that he knows it's bad for him but he just can't quit right now. Or how many times I've counseled an obese patient to control his diet, referred him to a nutritionist (only to have him never show up at her office) and then come to me saying if he can't eat he'd rather die. I mean seriously? Cmon.

 

[TRN1983]

Bingo! So brilliant.

The most effective component of preventative care is a choice. No doctor can follow thousands of patients around and force them to eat health, hit the treadmill, etc.

And, as for your patient, it's sad he's in poor health but in all honesty if he wants to make the conscious decision to eat himself to an early end and he's happy with that decision, then what's wrong with that? We're told all the time we can't tell people how to lives their lives... why is it any different when their health is concerned?

 

[zayka]

Canada has a problem with obesity as well, but not as much as the US.

However, I do not think that this is because of doctors and preventative care, but more like private health/fitness companies. For example, in Toronto, we have a gym called Extreme Fitness that has opened a location on almost every block downtown, they offer $15/month for the first three months, and have hot girls on the street recruiting people to join. Portion sizes at restaurants are much smaller at most places than in the US as well. Also, just about everyone in Toronto is an immigrant, and immigrants (usually) do not like to eat bacon and eggs, pancakes, burgers, etc. - in a "country" type place people are just as unhealthy as Americans, but the population size there is very small. We are also cold, so shivering burns quite a few calories (unfortunately). Just my observations.

Also, note that Canadians are taxed 50% or so of their income, and everything you buy is also taxed 15%. A lot of things like physiotherapy and some vaccines are not covered either, but you can actually get a nose job if you're under 18 😕 by government insurance

 

[sindadel]

Would you rather have your credit ruined over cancer, or wait a year in Canada for an MRI? I'd rather wait 7yrs to repair my credit than die.

A YEAR now???? Having your credit ruined over getting cancer is a REALITY in the US. Waiting a year for an MRI in Canada is not.

Also, note that Canadians are taxed 50% or so of their income, and everything you buy is also taxed 15%. A lot of things like physiotherapy and some vaccines are not covered either, but you can actually get a nose job if you're under 18 😕 by government insurance

What nonsense! The average tax on an income of $50,000 is 19% in Ontario. On an income of $150,000 the average tax is 34%. On an income of $350,000, the average tax is 41%.

This calculator is quite helpful:
http://lsminsurance.ca/calculators/canada/income-tax


Ontario sales tax is quite high (5-12%) depending on what is being purchased. Federal sales tax is only 5%, and some provinces (like Alberta) have no sales tax.

 

[TRN1983]

A YEAR now???? Having your credit ruined over getting cancer is a REALITY in the US. Waiting a year for an MRI in Canada is not.

Looks like waiting a year for an MRI in Canada is a reality, too. Given that, please reconsider credit vs. life.

http://www.ctvbc.ctv.ca/servlet/an/local/CTVNews/20090603/bc_mri_waits_090603/20090603/The Listener

MRI wait lists reaching one year in B.C.

Updated: Wed Jun. 03 2009 18:51:30

ctvbc.ca
MRI wait lists in British Columbia are approaching one year - and expensive private clinics may be the only alternative.
Victoria resident Vicki Clark is reeling from an old sports injury. Doctors say she needs an MRI scan to diagnose the problem, but Clark was shocked when she learned how long she would have to wait.
"I have an appointment for 7 a.m. in Victoria, March 20, 2010," Clark said.
Mike Conroy, of the Vancouver Island Health Authority, had a similar reaction.
"I was a little surprised by that," Conroy said.
In 2008, the province gave the health authorities $120 million in one-time funding to clear up MRI wait lists - and it worked. But now the money is drained up, and wait lists have shot up dramatically.
Clark also called a private clinic. She was told she could receive the same scan within a week - but for a cost of more than $1,200.
"I'm not adverse to private treatment, but at the same time I think our health system should be revamped," Clark said.

 

[sindadel]

Because an old sports injury (knee?) is definitely life threatening. I'm sorry to hear that BC has such outrageous waiting times for non-urgent diagnostic MRIs. That is definitely not ok. Of course, it's news because it's sensational and unusual, you know...

AGAIN, if you need an urgent MRI in Canada, you will get one much more quickly than that. So if it is a matter of life, as you say, you will not need to wait for a year, even in Victoria.

 

[OHMAN0125]

Because an old sports injury (knee?) is definitely life threatening. I'm sorry to hear that BC has such outrageous waiting times for non-urgent diagnostic MRIs. That is definitely not ok. Of course, it's news because it's sensational and unusual, you know...

AGAIN, if you need an urgent MRI in Canada, you will get one much more quickly than that. So if it is a matter of life, as you say, you will not need to wait for a year, even in Victoria.

What about to look for a possible tumor in liver although patient's life isn't threatened and he's doing fine. I hope it's not a couple months.

 

[shindotp]

60% of bankruptcies filed by Americans are due to medical bills. http://voices.washingtonpost.com/health-care-reform/2009/06/new_study_shows_medical_bills.html

Getting cancer may ruin your credit. Imagine that.

60% of bankruptcies being caused by medical bills is not the logical equivalent of 60% of Americans going bankrupt because of medical bills. Only 0.3% of Americans file for bankruptcy a year.

 

[dingyibvs]

Still the US. You have a right to your biase but after working so many hours in residency I wouldn't want to be treated anywhere other than the US. If you were in my shoes you may agree, but considering you're not in the trenches I understand your point of view. Similarly if I did administration my whole life I'd probably make your argument. You see why there's so much debate in health care? Btw...not many docs trust/like hosp admin. I wouldn't push it on any application/interview for med school.

I'm not sure I understand your argument. Clearly the point he and just about every other critic of the U.S. healthcare system made was not against the quality of the care provided by U.S. physicians, it is against the availability of the care. While it's true that your hours in residency have given you an appreciation of the quality of the care you and your colleagues can provide, it simply does not justify the absurd cost incurred on an UNINSURED person, as specified by the previous poster.

Based on my financial situation right now(I'm uninsured and not making much money), I would be bankrupt if I had to have an appendectomy. I think I'd take my chances with possibly marginally worse care in Canada rather than surefire bankruptcy in the U.S.

 

[dingyibvs]

Canada has a problem with obesity as well, but not as much as the US.

However, I do not think that this is because of doctors and preventative care, but more like private health/fitness companies. For example, in Toronto, we have a gym called Extreme Fitness that has opened a location on almost every block downtown, they offer $15/month for the first three months, and have hot girls on the street recruiting people to join. Portion sizes at restaurants are much smaller at most places than in the US as well. Also, just about everyone in Toronto is an immigrant, and immigrants (usually) do not like to eat bacon and eggs, pancakes, burgers, etc. - in a "country" type place people are just as unhealthy as Americans, but the population size there is very small. We are also cold, so shivering burns quite a few calories (unfortunately). Just my observations.

Also, note that Canadians are taxed 50% or so of their income, and everything you buy is also taxed 15%. A lot of things like physiotherapy and some vaccines are not covered either, but you can actually get a nose job if you're under 18 😕 by government insurance

Well, actually, based on my experiences living in Florida, hot climate actually promotes healthier bodies. One of the reason is because we have to wear little clothes all year long, and flabby bodies can't hide under coats as is possible up north. Another is because outdoor activities are available all year long. These are especially true for girls, which is awesome 😍

 

[OHMAN0125]

I'm not sure I understand your argument. Clearly the point he and just about every other critic of the U.S. healthcare system made was not against the quality of the care provided by U.S. physicians, it is against the availability of the care. While it's true that your hours in residency have given you an appreciation of the quality of the care you and your colleagues can provide, it simply does not justify the absurd cost incurred on an UNINSURED person, as specified by the previous poster.

Based on my financial situation right now(I'm uninsured and not making much money), I would be bankrupt if I had to have an appendectomy. I think I'd take my chances with possibly marginally worse care in Canada rather than surefire bankruptcy in the U.S.

You know you can always come out of bankruptcy right? It's not a permanent thing. Most pt's without insurance will never pay the bill from the hospital or the other credit card bills they have. They then file for bankruptcy protection and then can start again if they take initiative to organize their life. Generally an appendectomy won't bankrupt you (even if you don't pay) unless you have debt from other sources. Also, when you're in the hospital without insurance, social workers are always called in to help you apply for federal government and state funding so majority times the SW are able to come up with some type of payment for the patient.

Again, he asked me my opinion and gave it. I wasn't presenting any argument since I said he's also entitled to his opinion. Read more carefully.

 

[Parts Unknown]

You know you can always come out of bankruptcy right? It's not a permanent thing.

Wow, that's very comforting. Thank you. I'm not sure that medical debt needs to be brought up ever again.

Most pt's without insurance will never pay the bill from the hospital or the other credit card bills they have.

The most recent scientific article on this topic can be found here: Medical Bankruptcy in the United States 2007: Results of a National Study.

The abstract is rather disturbing (although not surprising if you have been following this stuff for the last 10 years):

Most medical debtors were well educated, owned homes, and had middle class occupations. Three quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical problems rose 49.6%.

 

[OHMAN0125]

Wow, that's very comforting. Thank you. I'm not sure that medical debt needs to be brought up ever again.



The most recent scientific article on this topic can be found here: Medical Bankruptcy in the United States 2007: Results of a National Study.

The abstract is rather disturbing (although not surprising if you have been following this stuff for the last 10 years):

Obviously that's not what I meant. Want to extrapolate more please? I'm just saying it's not the end all be all. My uncle came out of bankruptcy just fine and now owns 3 restaurants. Granted he's a businessman so he always takes risky moves but you get what I mean.

 

[novastorm]

Aside from a few snide comments and bickering this is one of the most thoughtful and informative posts I've seen on SDN regarding healthcare for quite a while. With that said I would like to put in a few talking points.

In Canada do they have "best practices" so the government wont pay unless you do x and y? Is the government at all liable if you say die on the waitlist for a MRI? Why did they feel it was necessary to bar private care? How do prescriptions work in Canada? Ultimately who makes the decisions for your care, the canadian government, provincial government or a medical board?

To draw my line in the sand, I'm not a fan of any health reform in the united states the reduces the quality of care, regardless of its benefits to access or cost.

From what I've observed is that universal care really nails down primary care at the cost of acute care, is that worth it?

 

[Parts Unknown]

Obviously that's not what I meant. Want to extrapolate more please? I'm just saying it's not the end all be all.

Perhaps not, but it does do irreparable harm to the lives of people who did nothing wrong other than be unlucky, and it's an enormous embarassment for the wealthiest nation on the planet to be the only one struggling with this issue.

The first step, as they say, is admitting you have a problem.

 

[sindadel]

In Canada do they have "best practices" so the government wont pay unless you do x and y? Is the government at all liable if you say die on the waitlist for a MRI? Why did they feel it was necessary to bar private care? How do prescriptions work in Canada? Ultimately who makes the decisions for your care, the canadian government, provincial government or a medical board?

You and your dr decide what care you will receive. For some very expensive AND experimental (not very effective) treatments, there may be need for ministerial approval. Also if you need treatment which is not available in Canada, the gov't will fly you to where it is available.

Prescriptions are not covered for the bulk of people (you can get additional coverage through a work insurance plan, or on your own). I think prescriptions for seniors are covered (or maybe 80%). I think that's a flaw actually - I think chronic/preventative prescriptions (like insulin) should probably be covered.

You have to bar private care, so the argument goes, because if you allow two tier care then the "best" doctors will naturally migrate to where they can charge more money. So any procedure covered by provincial health care may only be billed at the gov't rate. The gov't pays you within 2 weeks, by the way. Extra-health care operations, like LASIK, elective plastic surgery etc. can be billed at what the market will bear.

Just like when someone dies in the ER in the US waiting for care, there's a media hullabaloo. You certainly could sue the government. How often do people sue their private insurance companies in the US when a treatment is not covered and the person dies? I'm not far enough along the training path to know when you would absolutely need an MRI to check for liver mets. I don't know if other imaging modalities give you just as much useful information, if not such a gorgeous picture. I can say, I haven't heard of it happening in local news, FWIW.

To draw my line in the sand, I'm not a fan of any health reform in the united states the reduces the quality of care, regardless of its benefits to access or cost.

Quality of care for whom? You and other well-off people? A large number of people in the US are UN or very UNDER insured. Their quality of care stinks.

got to run to catch my bus - hope that was a little helpful.

 

[Parts Unknown]

To accurately conceptualize Canada's health care system (or any, for that reason), I find it helpful to partition out three aspects:

1. The macro-structure of the overall system
2. The functioning of the individual components at the micro- level
3. The funding level of the overall system (and the allocation of resources)

I find the structure of Canada's system to be quite good in many ways. Despite the moniker "single payer" money is actually distributed to each province. The vast majority of funding is derived from taxes, and the entire system is run with the supposition of universal coverage. Billing is relatively simple (especially compared to the mess we have here).

The functioning of the individual components is the most difficult to speak on authoritatively, as it requires a fair amount of detailed knowledge. This aspect encompasses the small and medium size decisions made within the system to allocate and utilize resources effectively.

This brings up the word I would use most synonymously with Canadian healthcare: underfunded. The structure is reasonable and relatively efficient, but the Canadian Government made a coldblooded decision in the 1990's to slash social spending and balance the budget. It worked; Canada ran annual budget surpluses until this past year. On the downside, this left the health care system financially starved for years. The consistently came in the bottom half of the OECD measures during this period.

Conflation of these issues leads one to believe that single payer necessarily leads to long wait times, but I think that assessment is unfair. Even the best system will strain and eventually fail if not provided adequate resources to carry out its mission. Even as recently as 2006, per capita health spending in Canada was 53.4% that of the United States. IMHO, if Canada doubled its expenditure and managed its system in a semi-competent manner, in a decade they would have the world model for universal, efficient, state-of-the-art health care.

 

[novastorm]

Quality of care for whom? You and other well-off people? A large number of people in the US are UN or very UNDER insured. Their quality of care stinks.

I do detest quoting but the rest of your post is informative and very helpful. Why do I take my stance?
Well first of all the truly well off people in this country don't have insurance, they pay cash because they can achieve greater care then even people with insurance can obtain.

Secondly until very recently (last time i saw it) 75% of people in this country have (employer based?) insurance (forgive me if thats incorrect). The majority of the "47 million" people without it do so voluntarily and a larger then necessary portion are people who are either too lazy or to stupid to sign up for medicare/caid.
That number also includes people who are not citizens or are here illegally.

A much more realistic number that I support would be 15 million
(people who truly have no ability to afford insurance), simply call me heartless but I am unwilling to compromise the care of 285 million people with radical legislation to care for 15 million, how can you possibly justify doing that?

The problem in this country stems simply from cost and nobody is trying to understand and fix that problem and that is simply beyond me.

I think you misunderstand my stance I support the idea of universal care but not the proposed forms of it.

 

[Quix]

Still the US. You have a right to your biase but after working so many hours in residency I wouldn't want to be treated anywhere other than the US. If you were in my shoes you may agree, but considering you're not in the trenches I understand your point of view. Similarly if I did administration my whole life I'd probably make your argument. You see why there's so much debate in health care? Btw...not many docs trust/like hosp admin. I wouldn't push it on any application/interview for med school.

I worked in the trenches for 2 years. Bedside, direct patient care. I also worked in administration. I've seen the issue from your point of view, and I still maintain my position. 🙂

 

[OHMAN0125]

I worked in the trenches for 2 years. Bedside, direct patient care. I also worked in administration. I've seen the issue from your point of view, and I still maintain my position. 🙂

I don't have a problem with your position, but I do want to say that you could NOT have seen the issue from my point of view unless you were a resident physician? Just like it's not possible for me to see things exactly from your point of view. Please don't try to pull the "I've done both and that's why I know what I'm talking about. This resident is stupid and doesn't understand how health-care works".

I'll agree to disagree with you. That is all.

 

[zayka]

Well, actually, based on my experiences living in Florida, hot climate actually promotes healthier bodies. One of the reason is because we have to wear little clothes all year long, and flabby bodies can't hide under coats as is possible up north. Another is because outdoor activities are available all year long. These are especially true for girls, which is awesome 😍

Damn... I'd love to live in Florida! I like warm weather.

 

[Quix]

I don't have a problem with your position, but I do want to say that you could NOT have seen the issue from my point of view unless you were a resident physician? Just like it's not possible for me to see things exactly from your point of view. Please don't try to pull the "I've done both and that's why I know what I'm talking about. This resident is stupid and doesn't understand how health-care works".

I'll agree to disagree with you. That is all.

I'm not trying to say that I have a resident's perspective, just that I've done everything from wiping a patient's posterior and assisting with ADL's to case consultation to administration. I've had patients die under my hands as part of the Code team and I've made decisions that have determined whether someone is still breathing next week. I'm just saying that I've been in the trenches, understand what it is like, and use it to inform the decisions I make about health care policy.

 

[LiveUninhibited]

how does regulation lead to more innovation?

Not regulation per se but proper regulation. In this case the most important change in regulation would be requiring them to do head-to-head trials and show improvement (in any population) when there is already rx for what the drug is intended to treat. Currently they only have to show improvement over placebo, which is not useful and actually counterproductive given that a drug which shows no clinical benefit beyond what exists may merely introduce unforseen longterm complications. The drugs usually prevail in American markets via advertising as much as merit. While DTC isn't entirely bad this makes it a double-edged sword. It is disallowed in most of the world.

Regardless of wait-times or whatever. The president of the CMA (who i'm sure is more knowledgable and experienced with Canada's system) has stated the system is in peril. Why are there individuals who only think US's system is crap? I know physicians in England and Australia, they all tell me the systems are problematic and in trouble there as well. There just isn't enough money and resources available. Take home point? Medical care is expensive in the modern era and there's many issues with health care delivery in many modernized nations. US isn't the only place. People need to stop looking at the other side of the fence. The grass is ALWAYS greener.

And why do conservatives consistently cite Canada and UK, as opposed to France or Japan, when discussing universal health coverage?

I agree completely. If the government wants to fix healthcare, they have all the tools to tackle each issue independently.

The last thing we need is another government run anything. Government run healthcare in the United States might fix a hundred problems, but it would create thousands more.

Pretty sure nobody of any significance has proposed government-run healthcare, but rather government-funded healthcare.

 

[TRN1983]

And why do conservatives consistently cite Canada and UK, as opposed to France or Japan, when discussing universal health coverage?

Pretty sure nobody of any significance has proposed government-run healthcare, but rather government-funded healthcare.

The bill is government run. Without even considering anything else,w hen they control the money they control everything.

And, since you want to know about Japan, that is a perfect example of how the money runs things. The result: average physician makes about $120k/yr. 80% of hospitals are privately run, but every dime of spending is controlled by the government and revisited every two years.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=516099
"Doctors in Japan have warned that there could be an exodus from the medical profession unless the of health and welfare ministry increases the fixed fees that doctors receive for treating patients.
The ministry—in Tokyo—sets the sums that doctors and hospitals are reimbursed for consultations, treatment, and operations by the country's social security system.
But the Japanese Medical Association says that hundreds of hospitals and general practice clinics are now facing financial ruin because they are being forced to rely on very low, government fixed prices for their income. The situation has become critical, they say, because the cost of treating patients is soaring while the fees have continued to languish at a low level for decades.
Moreover, the association says that doctors' representatives are being overruled by the government members of the Central Medical Council on Social Insurance, the advisory body that regularly reviews the level of fees that doctors and hospitals can receive.
The association—which represents 156 000 doctors (about 60% of all licensed physicians in Japan)—has said that it will continue to lobby the national parliament and health ministry in a bid to improve the pay for doctors.
The health ministry says that it is obliged to tighten the fees for doctors and hospitals because of the recent prolonged economic downturn in Japan.
It said the country's expenditure on health care has increased rapidly in the past few years—outpacing the growth rate of the national income—mainly because of the need to care for a progressively ageing population. Japan has experienced one of the largest increases in life expectancy, with the average life expectancy of Japanese women increasing by 22.4 years and of men by 17. 5 years since 1960. Since 2002 the average life expectancy in Japan has been 85.2 years for women and 78.3 years for men.
However, medical associations in Japan say that doctors should not be forced to bear the brunt of cuts in the healthcare sector while the government continues to treat the pharmaceutical industry relatively generously by allowing lucrative high fixed fees for drugs.
Under the social insurance system in Japan, the entire population is covered by some form of medical insurance, and people can choose a medical institution to receive medical care at prices set by the government."

 

[Parts Unknown]

The bill is government run. Without even considering anything else,w hen they control the money they control everything.

That's how it has been since the first third party payer set up shop. We're damned if we do and damned if we don't, but I'll be a slave to the entity with no profit motive and a responsibility to voters over multiple entities with strong profit motives and responsibilities to shareholders.

And, since you want to know about Japan, that is a perfect example of how the money runs things.

Japan has per capita spending that is 38% that of the US. When medical services fall to levels the public finds intolerable they will move to restore funding. Nobody likes an unhappy populace.

How about we discuss a country that actually drops some coin on health care, like Switzerland?

 

[LiveUninhibited]

Overall Japan does quite well considering their spending and aged population. The fact that the JMA sounds the alarm in order to get what they want is a little unconvincing, I'd at least need to see evidence of real consequences.

And what about France? Whenever I bring up France nobody has anything to say about it.

 

[MissMuffet]

Overall Japan does quite well considering their spending and aged population. The fact that the JMA sounds the alarm in order to get what they want is a little unconvincing, I'd at least need to see evidence of real consequences.

And what about France? Whenever I bring up France nobody has anything to say about it.

Maybe because their plan isn't sustainable, either. Their health system

"has been in the red since 1989. This year the annual shortfall is expected to reach €9.4 billion ($13.5 billion), and €15 billion in 2010, or roughly 10% of its budget."

http://online.wsj.com/article/SB124958049241511735.html​

eta another interesting read: http://reason.org/news/show/the-myth-of-free-market-health

 

[OHMAN0125]

Overall Japan does quite well considering their spending and aged population. The fact that the JMA sounds the alarm in order to get what they want is a little unconvincing, I'd at least need to see evidence of real consequences.

And what about France? Whenever I bring up France nobody has anything to say about it.

People have been giving sources on why Japan's system isn't optimal either. Maybe you should provide some sources for why you think differently and on France's system.

 

[Simplify]

What? The burden of proof is only on opponents of government healthcare!

 

[NoMoreAMCAS]

It's awesome!

<-----------Canadian

If I ever feel sick, I just visit the nearest clinic. When I get there, I swipe my "health card", and I get checked up after 15-30 minutes.

No cash/credit/debit...nothing....

What are your tax's like? If they're lower than ours I'm moving to Canada.

 

[Obnoxious Dad]

If Natasha Richardson had taken her fall in Portage Wisconsin instead of Quebec she'd be alive today. Portage which is 40 miles from Madison and has a population of 10,000 has a hospital with CT scanner. She could have been scanned, evaluated and if necessary flown via helicopter to University Hospital in Madison. There was no CT scanner at the hospital near the ski area where she fell and when the folks at the local hospital realized that she was in trouble she was taken via ambulance to Montreal. If you've ever driven in Montreal you'd know that can be a mess especially in the winter.

Canada, the birthplace of my parents, mooches off the US system continuously. The US serves as a backup to Canada for expensive equipment and hospital capacity. Canadians have won exactly two Nobel prizes in Medicine while winners from the US have numbered in the dozens. We underwrite pharmaceutical research for the Canadians because Canada will only agree to pay for manufacture and distribution.

 

[TexasFight]

Would it be unethical to ask other countries to share the R&D costs for new drugs? And deny them access if they don't? I just think it's unfair that the US has to sell its drugs at ridiculously low prices to suck highly developed countries. There are many exceptions, of course, but I'm talking about U.K., Canada, etc.

 

[THX]

What are your tax's like? If they're lower than ours I'm moving to Canada.

Our taxes are not great, but hell I pay 7000 in tuition for first year med school (3000 by year 4) and the government gives me 12k in bursary + 4k in interest free loans per year. It's not a bad deal.

I also have the same experience as the other Canadian poster. I can get an appointment with my family doctor within a day or two, give them my health card, wait 10 minutes in the waiting room and then see my family physician for 10-15 minutes. I've never seen a health care bill in my entire life.

The emergency room is hit or miss though, if you are seriously ill they will see you right away. But if you show up with a broken arm expect to wait 4-6 hours.

Elective surgery (ie. hip replacements), can take a number of months. I think my grandmother waited 3.5 for hers. But again, things that need immediate attention receive immediate attention. I can only think of my family members, but various surgeries/procedures of some necessity were all done (as far as I know) very promptly.

I live in Quebec, so the MRI issues don't exist to the same extent. We have clinics here where you can pay 700 and have a scan done on the same day. In theory, the public MRI waitlist is reduced by people going private for diagnostic imaging.

Anyways, our system isn't perfect but it's not what the right wing lobby groups in the states make it out to be. I wouldn't trade our system for what you guys have. That said, you shouldn't be copying our system but the French model instead.

 

[TRN1983]

...She could have been scanned, evaluated and if necessary flown via helicopter to University Hospital in Madison. There was no CT scanner at the hospital near the ski area where she fell and when the folks at the local hospital realized that she was in trouble she was taken via ambulance to Montreal...

And, other than massively expanding government power, that's my biggest concern. Healthy people will love socialized medicine (if the US is capable of keeping costs in control; unlike Japan and Canada, we have massive immigration issues to deal with that complicate our situation a little more), but I fear that the sick and the seriously injured will be the ones to suffer the most, and they're precisely the ones we're trying the hardest to save. I know that's why I went to med school. I'm not here to treat a runny nose.

As an aside, france is a perfect example of what socialized medicnie costs with a huge immigration problem (they're not nearly as efficient as Japan, Canada, etc):

...But soaring costs are pushing the system into crisis. The result: As Congress fights over whether America should be more like France, the French government is trying to borrow U.S. tactics. In recent months, France imposed American-style "co-pays" on patients to try to throttle back prescription-drug costs and forced state hospitals to crack down on expenses...

http://online.wsj.com/article/SB124958049241511735.html

 

[NoMoreAMCAS]

Our taxes are not great, but hell I pay 7000 in tuition for first year med school (3000 by year 4) and the government gives me 12k in bursary + 4k in interest free loans per year. It's not a bad deal.

I also have the same experience as the other Canadian poster. I can get an appointment with my family doctor within a day or two, give them my health card, wait 10 minutes in the waiting room and then see my family physician for 10-15 minutes. I've never seen a health care bill in my entire life.

The emergency room is hit or miss though, if you are seriously ill they will see you right away. But if you show up with a broken arm expect to wait 4-6 hours.

Elective surgery (ie. hip replacements), can take a number of months. I think my grandmother waited 3.5 for hers. But again, things that need immediate attention receive immediate attention. I can only think of my family members, but various surgeries/procedures of some necessity were all done (as far as I know) very promptly.

I live in Quebec, so the MRI issues don't exist to the same extent. We have clinics here where you can pay 700 and have a scan done on the same day. In theory, the public MRI waitlist is reduced by people going private for diagnostic imaging.

Anyways, our system isn't perfect but it's not what the right wing lobby groups in the states make it out to be. I wouldn't trade our system for what you guys have. That said, you shouldn't be copying our system but the French model instead.

Yeah, that's not gonna cut it. I'd rather have more of my income in my control, so I can decide what to spend it on.

What are physician salaries like in Canada? Are they higher than American physician salaries in order to compensate for the increased tax rate?

 

[womp]

As a former government and military employee, I can tell you with some authority that efficiency isn't even in the government's playbook. If you think government can cut costs you're utterly delusional. The U.S. government, at all levels, works on a "use it or lose it" fiscal philosophy. In order to maintain their fiefdoms, managers overspend in the current year and overproject for the next. This is why government programs always balloon in size until they are eventually cut or killed.

Oh God, you completely summarized our government contracts at my old firm.

Anyone who dismisses this fundamental problem regarding the U.S. government's fiscal management should rightly be called a naif. One really needs to work a little with the government to get a taste of the utter waste and circle jerk.

 

[Bowl of oranges]

Well you are quoting two extremes. Neurosurgeons don't generally make 900k and PCPs don't really make 100k. It's closer to 600k and 150k. That's 4 times as much. And to be honest, neurosurgeons deserve every penny of that 600k. As for "I'm sure neurosurgeons can live with making 500k", that's exactly the type of mentality that's growing in Washington right now. People who don't know the work that's put in to earn that salary. A neurosurgeon doesn't get paid as much as you think when you account for how many hours they work, how many hours less a night they sleep than other doctors much less the average person, and how many hours of valuable family memories they miss out on. If you say neurosurgeons still shouldn't earn 600k, I agree. They should earn more. After 7 years of post-med school training, what other speciality has you working more hours after residency?

This is exactly right. The market rewards individuals for specializing, they are rewarded for providing a service that not many people do. To become specialized it takes years this keeps the competition down, and wages up.
America does have the best medical care, IF you can pay for it. It is the best because non urgent patients don't wait 3 months for surgery, they get their insurance companies to pay for it. And the big reason is that a bigger profit motive drives large innovations.
Edit: Wow just realized how many posts there were.

 

[THX]

Yeah, that's not gonna cut it. I'd rather have more of my income in my control, so I can decide what to spend it on.

What are physician salaries like in Canada? Are they higher than American physician salaries in order to compensate for the increased tax rate?

In my opinion, the salaries here are pretty good. Off the top of my head, after 3 years the average EM salary is about 240k, Gen Surg 250k, Cardiology 300k, Internal Medicine 180k. You can make more than that if you work in underserved/rural areas. Obviously these are not higher than American salaries, but this is somewhat offset by very minimal malpractice/malpractice insurance. If you have a family and are in the 'average', it probably comes out to the same when you factor in the cheaper cost of living in Canada (over a lifetime).

If your eye is on the coin, the states is better because you have the potential to make ridiculous sums if you are business savvy/reputable/in the right field. In Canada, you won't make the millions per year but you are still in the top 1% income bracket - which is good enough for me.

 

[TRN1983]

Those are good figures; some even better than in the states. I may have to look that one up... see it before I believe it, lol.

 

[chocolaterie]

There are inherent benefits and flaws in the Canadian health care system. I'm a Canadian citizen with US permanent residency and it's been interesting to compare the two systems.
Being human I do tend to use my own experiences. When my mom had a tumor, she was not waiting in line for a year to have it removed. We never had to worry about health care bills and I never had trouble seeing my pcp. I also noticed that the doctors focused more on preventative care.
In the US, it's nice to have private health care bc you get all those "extra things". I had a surgery done at the Mayo Hospital and the treatment I received was excellent. I went back to see my grandma in Toronto at a very large hospital and I was shocked to meet nurses who could not speak proper English. But, I think my grandma would have fallen through the cracks if she lived down here. So for me it's about providing affordable health care for the masses, or separated health care depending on what you can afford. I know there are services in place to help those who can't afford it, but you have to apply for these services... which means you have to know they exist.
In either scenario (american or canadian) neither one is close to perfect. However, I do plan to return to Canada to practice. Insurance companies irk me.

 

[THX]

Those are good figures; some even better than in the states. I may have to look that one up... see it before I believe it, lol.

Here are a few examples, these are for smaller cities though (but most are not part of any rural incentive program that ups salaries. Family docs can make 360k under those programs, with 2 months off per year). It's more difficult to find out the salaries for big urban centers. Smaller cities give this info as a way to market themselves to doctors.

EM:
http://www.healthmatchbc.org/hmbc2_...y_ID=7625&pageid=659&region=Thompson Okanagan

Neurology:
http://www.healthmatchbc.org/hmbc2_...y_ID=7224&pageid=659&region=Thompson Okanagan

Internal medicine:
http://www.healthmatchbc.org/hmbc2_...y_ID=6741&pageid=659&region=Thompson Okanagan

Nephrology:
http://www.healthmatchbc.org/hmbc2_...y_ID=7485&pageid=659&region=Thompson Okanagan


Peds:
http://www.healthmatchbc.org/hmbc2_...vacancy_ID=7217&pageid=659&region=The Rockies

Some seem a bit on the high (Nephrology, 450k?). But you get the idea, salaries are good. I don't think any doctors here complain about how much they are making.

 

[LiveUninhibited]

People have been giving sources on why Japan's system isn't optimal either. Maybe you should provide some sources for why you think differently and on France's system.

Well that just means I'm benefitting more from the exchange, huh? I'm not here to prove my uber-l33t debate skills on the internetz.

And their 1st source on France already did that. I mean, what do you expect me to say when their source cites some of the same problems we have here but on a much smaller scale, and not without significant advantages in coverage and cost, and quality in a few areas such as some forms of cancer (that part isn't in their source). If you had actually read their WSJ source (obviously not a liberal source), you would have seen it fell far short of declaring America>France on healthcare. Yes, no system is perfect. But are the advantages America does have due to our reliance upon private employer-based insurance for basic coverage? Hell no.

 

[Simplify]

Well, how much of Canadian doctors' salaries are due to American competition? If it weren't for higher salaries in the U.S., what impetus would the Canadian government have to pay its doctors appropriately? You should thank the U.S. and pray that we don't pass universal healthcare.