Canadian Health Care System
There are hundreds maybe even thousands of different opinions and studies that have been done over the years, on the advantages and disadvantages of Canada’s health care system. The disadvantages tend to focus on the significant problems throughout the system. The one that tops most lists, as one of the biggest problems, is the waiting time for medical care. To focus on this problem and to explain some of the measures that have been and still need to be completed, we first need to understand the basics of the Canadian Health Care System.
Canada’s health care system has been a work in progress since its inception. Reforms have been made over the past four decades and will continue in response to changes within medicine and throughout society. The basics, however, remain the same – universal coverage for medically necessary health care services provided on the basis of need, rather than the ability to pay. The system operates without a private insurance industry (Health care system, 2008).
Canada’s publicly funded health care system is best described as an interlocking set of ten provincial and three territorial health insurance plans. All of which share certain common features and basic standards of coverage. Roles and responsibilities for Canada’s health care system are shared between the federal government and the provincial-territorial governments. The federal government provides funding to the provinces and territories for health care services.
Canada’s national health insurance program, known to Canadians as “Medicare,” provides access to universal, comprehensive coverage for medically necessary hospital and physician services, on a prepaid basis (Health care system, 2008).
Health Canada is the Federal department responsible for helping Canadians maintain and improve their health. Among other activities, Health Canada’s responsibilities for health care include setting and administering national principles for the health care system through the Canada Health Act and delivering health care services to specific groups. Working in partnership with provinces and territories, Health Canada also supports the health care system through initiatives in areas such as human resources planning, adoption of new technologies and primary health care delivery (Health care system, 2008).
The Canadian health care system is not socialized medicine. Socialized medicine is a system in which doctors and hospitals work for and draw salaries from the government. Doctors in the Veterans Administration and the Armed Services are paid this way. The health systems in Great Britain and Spain are other examples. But in most European countries, Canada, Australia and Japan they have socialized health insurance, not socialized medicine. The government pays for care that is delivered in the private (mostly not-for-profit) sector. This is similar to how Medicare works in the United States. Doctors are in private practice and are paid on a fee-for-service basis from government funds. The government does not own or manage medical practices or hospitals (Rodberg, n.d.).
The term socialized medicine is often used to conjure up images of government bureaucratic interference in medical care. That does not describe what happens in countries with national health insurance where doctors and patients often have more clinical freedom than in the U.S., where bureaucrats attempt to direct care (Rodberg, n.d.).
History of the Canadian Healthcare System
Canada’s health care system, started to take shape in the 1950’s and 60’s. Founded on five principles of universality, accessibility, comprehensiveness, portability, and public administration, the system was considered the crown jewel of Canadian social programming and enjoyed both massive public support and international admiration. Its achievements seemed particularly impressive compared with those of its U.S. neighbor, which realized none of these five principles despite much higher costs (Lewis, Donaldson, Mitton, & Currie, 2001).
By the late 1960’s Canada essentially had a universal health insurance system covering all services provided by physicians and hospitals. To implement universal coverage the federal and provincial governments took over full funding of both hospital and physician services, setting physician fees and hospital budgets.
During the 70’s, physicians, dissatisfied with the official fee amounts, chose to work outside the system and bill patients at higher amounts. But with the passage of the Canadian Health Act of 1984 Canada outlawed extra billing and became a rigid single-payer, one-tier system which restricted the provision of any “core” services outside the public’s so-called “Medicare” system (Health care system grudge match: Canada vs. U.S., 2007 )
Waiting Times for Health Care is a Significant Problem
Over the past decade or more the system increasingly has not met the needs of Canadians within a reasonable time frame. Through the Canada Health Act and provincial legislation, the key aspects of diagnostic services and surgical procedures for medically necessary conditions have been restricted to those funded by government. With an aging population and advances in health care requiring ever-increasing funding, governments have not had the finances available to meet demand.
Wait lists have grown substantially, and have the effect of rationing health care. Waiting times vary across Canadian provinces depending on the type of treatment needed. Waiting lists are consequences of the way the Canadian health care system is structured, not a lack of money, critics say. The situation has reached crisis proportions, as acknowledged in a landmark case decided by the Supreme Court of Canada in June 2005 (Reforming the Canadian Healthcare System, 2006).
An excerpt from the 2006 Supreme Court ruling describes the situation. “The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health are. The evidence also demonstrates that the prohibition against private health insurance and its consequence of denying people vital health care result in physical and psychological suffering that meets a threshold test of seriousness (Reforming the Canadian…, 2006, p.1)”
The Fraser Institute Report: 2008 Waiting Times List
The median wait time for Canadians seeking surgical or other therapeutic treatment dropped to 17.3 weeks in 2008 from 18.3 weeks in 2007, according to new research published today by independent research organization the Fraser Institute. Throughout Canada, the total number of procedures for which people are waiting in 2008 is 750,794, a decrease of 9.3 per cent from the estimated 827,429 procedures in 2007.
“Despite the small improvement, many Canadians are still waiting 121 days or more for necessary medical treatment. Is this something we should be proud of? Absolutely not. A seven day reduction in total waiting times is far removed from the goal of providing timely access to health care,” said Nadeem Esmail, Fraser Institute Director of Health System Performance Studies and co-author of the 18th annual edition of Waiting Your Turn: Hospital Waiting Lists in Canada (the Fraser institute: Surgical wait times…, 2008, para.2).
Other examples of situations where patients have to wait for much-needed services are abundant. A few examples include: after a Canadian has been referred to a specialist, the waiting list for gynecological surgery is four to 12 weeks, cataract removal 12 to 18 weeks, tonsillectomy three to 36 weeks and neurosurgery five to 30 weeks.
Toronto-area hospitals, concerned about lawsuits, ask patients to sign a legal release accepting that while delays in treatment may jeopardize their health, they nevertheless hold the hospital blameless.
Canadians have an option that other universal health care patients don’t have: the close proximity of American hospitals. In fact, the Canadian government spends over $1 billion each year for Canadians to receive medical treatment in the United States. I wonder how much money the U.S. government spends for Americans to be treated in Canada (Williams, 2009 ).
What Caused the Waiting Time Problem?
The condition for shortages was enhanced because of the provision in the 1984 Act that decreed that any service that the single payer provides, no matter how much in short supply it may be, cannot be privately insured or produced and sold in Canada.
Since all hospital and physician services are free, the demand surged in Canada leading to skyrocketing costs and backlog of available health care. This led to government spending cuts in the 1990’s; shortages and waiting lines resulted (Health care system grudge…, 2007).
Health care spending in Canada was projected to reach $160 billion, or 10.6% of GDP, in 2007. Canada’s health care spending was expected to reach $171.9 billion, or $5,170 per person, in 2008. As health care costs rise, cuts are made and the trickle down effect causes longer wait times for everything from family physicians, non-urgent specialized services, specialist visits for new illness/condition, emergency room services, and surgeries.
Other causes of wait times could be the increase of more patients than the system can treat at the same time due to Canada’s population ageing, needs for more health care, and a shortage of health professionals. The severe shortages include doctors and nurses as well as the highly-skilled health professionals who deliver life-saving diagnostic, clinical, rehabilitation, pharmacy, and emergency services. To succeed, the Canadians must develop a strategy to address all of these shortages, not just doctors and nurses (Clancy, 2007).
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