Oh Canada, here we come...? Evicore leading the way...

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SneakyBooger

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Was reading about the Inflation Reduction Act and its expected impact on medical research (hint, it's not good) and ran across this assessment of the Canadian Health System written by a Canadian economist.

I now can't help thinking, "I've been warned".

Is the US headed that way - the bio creep keeps coming. We as physicians will likely be able to afford private care in the Cayman Islands, but for the less fortunate...

I have a dear friend and colleague who trained in Canada and anytime I reference Canadian studies he reminds me with all sincerity, "Sneaky, Canada practices 3rd world medicine and therefore those results are not applicable here". He practices at an NCI designated center currently.

How Socialized Medicine Hurts Canadians and Leaves Them Worse Off Financially


"Cutting corners on facilities and using outdated drugs show up in Canadian mortality rates. Thirty-day in-hospital mortality rates in Canada are 20 percent higher than in the U.S. for heart attacks, and nearly three times the U.S. level for strokes. [ 68 ] Cancer age-standardized mortality is 10 percent higher in Canada than in the U.S.—despite far healthier lifestyles, with both obesity and diabetes rates a full third lower in Canada than in the U.S."

"A major cause of Canada’s waiting lists is the use of so-called global budgets while effectively banning private clinics and private insurance for medically necessary treatment. Global budgets, in which health providers get a fixed budget each year rather than being paid per treatment, are a form of rationing that strongly tends to lead to long wait times. [ 54 ] Meanwhile, rules hobbling private provision in Canada mean that nearly half of existing doctors would like to work more hours, but are effectively banned from doing so.[ 55 ] Both Senator Warren’s plan [ 56 ] and Senator Sanders’ plan [ 57 ] explicitly propose global budgets, and both effectively ban private insurance."

"Canada has 35 percent fewer acute care beds than the U.S., [ 62 ] and only one-fourth as many magnetic resonance imaging (MRI) units per capita—indeed, it has fewer MRI units per capita than Turkey, Chile, or Latvia. [63]"

"Beyond making patients feel dehumanized, overworked doctors risk compromising treatment. According to OECD numbers, Canada’s doctors leave foreign bodies in patients at a rate 53 percent higher than U.S. doctors, and rates of postoperative sepsis are nearly 36 percent higher.[83]"

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Was reading about the Inflation Reduction Act and its expected impact on medical research (hint, it's not good) and ran across this assessment of the Canadian Health System written by a Canadian economist.

I now can't help thinking, "I've been warned".

Is the US headed that way - the bio creep keeps coming. We as physicians will likely be able to afford private care in the Cayman Islands, but for the less fortunate...

I have a dear friend and colleague who trained in Canada and anytime I reference Canadian studies he reminds me with all sincerity, "Sneaky, Canada practices 3rd world medicine and therefore those results are not applicable here". He practices at an NCI designated center currently.

How Socialized Medicine Hurts Canadians and Leaves Them Worse Off Financially


"Cutting corners on facilities and using outdated drugs show up in Canadian mortality rates. Thirty-day in-hospital mortality rates in Canada are 20 percent higher than in the U.S. for heart attacks, and nearly three times the U.S. level for strokes. [ 68 ] Cancer age-standardized mortality is 10 percent higher in Canada than in the U.S.—despite far healthier lifestyles, with both obesity and diabetes rates a full third lower in Canada than in the U.S."

"A major cause of Canada’s waiting lists is the use of so-called global budgets while effectively banning private clinics and private insurance for medically necessary treatment. Global budgets, in which health providers get a fixed budget each year rather than being paid per treatment, are a form of rationing that strongly tends to lead to long wait times. [ 54 ] Meanwhile, rules hobbling private provision in Canada mean that nearly half of existing doctors would like to work more hours, but are effectively banned from doing so.[ 55 ] Both Senator Warren’s plan [ 56 ] and Senator Sanders’ plan [ 57 ] explicitly propose global budgets, and both effectively ban private insurance."

"Canada has 35 percent fewer acute care beds than the U.S., [ 62 ] and only one-fourth as many magnetic resonance imaging (MRI) units per capita—indeed, it has fewer MRI units per capita than Turkey, Chile, or Latvia. [63]"

"Beyond making patients feel dehumanized, overworked doctors risk compromising treatment. According to OECD numbers, Canada’s doctors leave foreign bodies in patients at a rate 53 percent higher than U.S. doctors, and rates of postoperative sepsis are nearly 36 percent higher.[83]"

How can the doctors be overworked if they desire to work more but are banned from doing so by the government?

Don’t get me wrong. Single payer is terrible for doctors especially in oncology and most especially rad onc.

You’ll never convince Canadians that private insurance can play a far larger roll than anybody would be confortable admitting and you’ll never convince liberals in the US that single payer is downright evil.

Canadians are healthier in general but it probably has nothing to do with their cancer care or better surgeons. So why spend more on it.
 
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It is a zero sum game. On the one hand you have cost containment and on the other you have utilization. You can push the slider one way or another but you have to pick a side. Canada has opted for former, US has (mainly) opted for latter.

There are so many X factors which make this even more complicated:

1. It's hard to compare nations which are ethnically homogenous (Japan) with those that are ethnically heterogenous (US). D2 dissections for gastric cancer are the perfect example.

2. A lot of geographically smaller countries have high population densities with fairly stable patient demographics. The US is almost like 50 different countries. Comparing Arkansas to California or New York to Wyoming is almost like comparing different countries.

3. Private insurers (United) have an insane profit motive to withhold/deny care. Systems like Kaiser do the same in their own way. Therefore, just because you are paying money, doesn't mean you are getting the care you paid for.

The path of least resistance is single-payer. There is no political will at present to make that happen so instead the Feds are cutting reimbursement under the guise of "quality" and expecting private payors to pick up the delta. The reality is that this approach is shutting down the little guys and forcing them to sell to academic conglomerates thereby increasing the cost of care for everyone.
 
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Canada’s doctors leave foreign bodies in patients at a rate 53 percent higher than U.S. doctors

BTW, in the US leaving a foreign body in a patient is de facto malpractice. :nailbiting:

(Does that include SpaceOAR? hehe)
 
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I can't comment meaningfully on Canadian health care.

What I can say is know the source you are reading (Heritage Foundation here) and follow up at least one of their references to see if what they are doing is just plain specious.


The above is their reference regarding CVA and MI outcomes. Please look at the overall paper
 
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It doesn’t matter if single payer leads to worse outcomes as long as politicians can blame “the other side” it will actually be advantageous to them to have another rallying cry.
 
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Paywalled...

Also 2006
Perhaps... Can read it in chrome on incognito mode but basically talked about private clinics being allowed to come in and contract with the govt to pick up the slack that the government system wasn't handling.

Just thought it was interesting, not sure of the status now
 
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Correct me if I’m wrong wasn’t there a court ruling in Canada about private clinics. I think an Ortho brought the suit
 
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