This one is for all these dreamers who want to socialize a whole sector of the American economy:
JEFFREY NACHT, M.D.Published: December 9th, 2007 01:00 AM at http://www.thenewstribune.com/opinion/insight/story/224748.html
As a half-time practicing orthopedic surgeon in Tacoma and a half-time faculty member in the Department of Medicine at the University of British Columbia in Vancouver, I have come to appreciate the differences of these two health care systems, both of which are often touted as the very best.
As I have spent more time in Canada, I have started to appreciate the way its system affects doctors and their patients. The revelations have been nothing short of astonishing.
We hear a great deal about how much less Canadians spend on health care and what a wonderful system they have where everyone has access to “universal health care.” But how they accomplish this is not exactly as advertised.
According to no less a source than the World Health Organization, Canadians, for the price they pay, now have the worst health care system in the world. WHO ranks Canada’s health system as the third-most expensive system in the world, and rates it 30th in efficiency and 18th in access to care.
How does this affect its physician work force? The answers might shock you.
Surgeons are “controlled” by limiting access to operating rooms. In British Columbia, all elective operating rooms shut down at 3 p.m., except at Vancouver Hospital (the tertiary care center for all of the province), which shuts down at 5 p.m. except for emergencies.
Surgeons are given a very limited number of surgical “block times” in which to do their work. Younger surgeons get less time, and senior surgeons get the prime slots, just as in Britain. Each surgeon has a waiting list or “queue.” When a surgeon does an emergency case, the patients on his waiting list are pushed back by one slot for each emergency he does. That way the hospital’s budget for the number of surgeries it must pay for is not impacted by unexpected additions to the schedule.
Patients often try to call in favors or use their influence with their surgeon to find ways to “jump the queue” or move up in the list. Waiting times can be shocking.
In most major metropolitan areas, a patient will usually wait for nine to 12 months for a smaller procedure such as carpal tunnel surgery or a hernia repair, and 14 to 18 months for a major procedure such as a total joint replacement or cardiac valve replacement.
Somewhat more urgent cases do not fare much better. My wife’s aunt developed symptomatic coronary artery disease a few years ago. She was referred to a cardiac surgeon at Vancouver Hospital, who recommended that she have a two-vessel bypass. He put her on the “wait list” and estimated that she would have her surgery in eight months.
Because of emergencies that kept adding delays to his “elective” schedule, the aunt finally had her surgery 18 months later. By that time, she was virtually a cardiac cripple and required a four-vessel bypass. Due to her severely deteriorated condition by the time she got to surgery, she did not survive.
My Canadian father developed a large abdominal aortic aneurysm when he was about 70. He was referred to a vascular surgeon, who scheduled him for repair of the aneurysm nine months later. He finally had his surgery 13 months after the decision for surgery was made. Three times he was admitted to the hospital for the surgery and sent home when an emergency bumped him off the schedule.
Imagine how that would work here in our community.
To make matters even more difficult, the provincial government started additional budget-cutting measures a few years ago, dictating that half of the elective operating rooms in the entire province close for eight weeks each year to save money. Each hospital was allowed to choose which eight weeks it would close.
Economic decisions like these are based on the fact that for hospitals, patient care is a liability that must be limited whenever possible to remain within their budget, not a source of revenue as it is here in the U.S. This turns the equation of health care economics upside down and leads to the worst kind of rationing.
Internists and primary care physicians have another set of issues. The government limits how many patients each doctor can see and bill for each day. If you exceed the government’s quota, you simply won’t get paid for the additional work.
However, there is a work-around. Many physicians do their office practice and quit when they see their “limit.” They then travel to another community and work in an urgent care or after-hours clinic. As long as it is in another municipality (an outlying community with a health care need) they can bill additionally and get paid. This often means traveling 50 miles or more to work in a clinic distant enough to circumvent the quota rules.
Similarly, services are often limited by available resources. There are only a few MRI machines in the whole province, so the waiting list for these studies can be six to 12 months. CAT scanners and ultrasound units are more readily available and might only take a few weeks to schedule.
In the Foot and Ankle Reconstruction Centre in Vancouver, I work alongside three full-time orthopedic specialists who do most of the complex surgery of this type for all of southwestern British Columbia, which has a population base of about 2 million people. These poor guys have a waiting list of over 5,000 patients who need surgery. Their waiting list for elective cases exceeds three years.
So how do Canadians like their health care system? Surprisingly, most think it’s great, at least until they need access to care. There is a pervasive socialist mentality that most Canadians subscribe to. Even though there are long waits and limited available high-tech services, at least everyone waits the same amount of time.
There is no deductible or co-pay, so when patients do need care, it’s essentially free. Canadians do pay for health insurance, but the premiums are graduated, based on income, and even the highest premiums are only a fraction of what Americans pay for private insurance. If you make less that modest income, your premiums are waived altogether.
However, you can’t access care outside of the system. Tiny pockets of “private health care” have emerged here and there. However, these centers take no government payments; it’s cash only. They treat primarily workers’ compensation and “third party injury” cases, as well as patients from outside the province.
So do Americans really want this type of system? More pertinently, do American doctors want to work in this environment?
The answer, once you’ve looked at the dirt swept under this rug, is likely to be absolutely not.