Contradictory Reports on Universal Health in Canada?

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Contradictory Reports on Universal Health in Canada?

Post by Boyish-Tigerlilly »

I have a question about the Canadian system of healthcare. I am trying to research it and how it operates, but I really am at a complete loss for how to tell if groups are lying or telling the truth.

Some sources have 'studies' and 'statistics' that show one thing, and other source has something that says the exact opposite. For example, I researched some news articles on Canada's expenses, quality of care, waiting periods, and it doesn't seem all that bad.

However, the Frasur Institute of Canada quotes the Canadian Medical Association as saying the waiting lines are becomming "unconsciounably long" and that canada uses dilapidated, old technology in addition to ever-increasingly strict rationing. I see this organization quoted often with its statistics.

For example, it claims:

1. "Canada ranked 24th out of 27 OECD countries in 2002 for the number of doctors per 1,000 population. It had 2.3 compared with an OECD average of 2.9"

2. "As for waiting periods: "the Fraser Institute, found that, for patients requiring surgery, the total average waiting time from the initial visit to the family doctor through to surgery was 17.7 weeks, a significantly more than the 16 weeks found in 2001. Median waiting times remain higher in every category than are deemed ‘clinically reasonable’ median waiting times by physicians in 2005. (Fraser Institute, 2005, Chart 14.) Overall, 85 per cent of median waiting times are higher than clinically reasonable waiting times. (Fraser Institute, p. 27.)"

3. "An assessment in 2000 by the Canadian Medical Association (CMA) argued that shortages have led to an “unconscionable” delay in the diagnosis and treatment of diseases such as cancer, heart disease, and debilitating bone and joint ailments (Gratzer, 2002, p. 88 ). “We’re
not talking about Ferraris and Lamborghinis here,” according to Dr Hugh Scully, the head of the CMA. “We’re talking about the Chevrolets and the Fords that are necessary to make it [diagnosis] accessible and reasonable for everybody. To use Dr Phil Malpass’ phrase, medicare is “functionally obsolete”

4. I don't know if this is true, or how to counter it, but they claim: "The Canada Health Act explicitly forbids any Canadian from
buying from the private sector a medical service that is already covered under the public health system. Private insurance plans are not allowed to cover “core services” and may only cover “non-core services.” As a result, the role of private medical insurance in Canada is
limited to supplemental care. The role of the private sector is further discouraged by the regulation of private physician practice and private insurance plans."


5. Their 'studies' seem to suggest that, of those polled, most favour the addition of user fees and private insurance. "In 2002 the Canadian Medical Association sponsored a poll on user fees. Its results were far from expected; 57 per cent supported user fees (Gratzer, 2002, p. 19). A further Michael poll in August 2001 found that a clear majority of Canadians support both user fees and a private insurance option. (A first,
similar poll in 1991 found only a small percentage of the public accepting such ideas.) (Gratzer, 2002)

The 2005 Health Care in Canada survey by the public opinion research firm POLLARA shows that 49 per cent of the public said they would be willing to make out-of-pocket payments to purchase faster access to health care. A majority also believe that expanding
private insurance would: result in shorter waiting times (68 per cent), provide better access to healthcare (59 per cent) and improve quality (60 per cent)."



This rather seems to be a concise summary of the "findings" and so-called "mythbusting."


1. The Canadian system has many fans, and not just within Canada. Like the NHS to Britons, medicare is a quasi-religion to Canadians. Both systems are regularly subject to the claim that they are the best in the world. And just as the main argument in defence of the NHS is that it is free at the point of use, and as such theoretically the most equitable
system possible, so the argument goes that, in comparison with the market model of the US, the Canadian system places a justified premium on fairness.

• Canadians have traditionally mistrusted the involvement of the market in health care. Comparison with the US is geographically and ideologically understandable, but unfortunate. Firstly because opinion of US health care is largely based on myth (many Americans believe these myths too), and secondly, because Canadian system performance should be assessed by looking at other publicly funded systems.

Unfortunately – as with the NHS – the practice leaves much to be desired. Both the NHS and medicare have founding and guiding principles which they systematically fail to meet or abide by. Hence the charge in Canada that “everything is free but nothing is
accessible”.

• Gratzer (2001) highlights three problems within the Canadian single-payer (government) healthcare model. First, accountability is poor and aggravated by the Federal structure. Second, decision-making is politicised. Third, single-payer government control leads to a lack of innovation. These three lead to a lack of responsiveness to
patient needs or wants.

• Aba et al (2002) argue that Canadian health care is inefficient in that financing (lack of direct payment) does not encourage users and providers of health care to be accountable for the economic benefits and costs of services.

• Single-payer tax financed healthcare lends itself to rationing. Waiting times (owing to rationing by queuing) are a serious concern to Canadians. These are often caused by the lack of availability to medical technology. Again, this is reminiscent of the UK: A recently released report from the UK Audit Commission (2002) reveals “there are relatively short waits for general X-rays but waiting times for some other examinations
are excessive. For example, the average wait for general ultrasound is eight weeks and 20 weeks for MRI scans, with a quarter million people waiting for these examinations alone. Tellingly, usage of different items of equipment varies by a factor of two or more across similar departments. For example, some MRI scanners are used for 4,000 examinations a
year, but others are used for fewer than 2,000 examinations”. Such scenarios can be found with ease in the Canadian press.

• Despite poor availability in Canada of advanced medical technology, international comparison reveals pretty good healthcare outcomes – generally better than those in the USA and the UK and more akin to those associated with high spending European social insurance systems such as France and Switzerland (OECD). Life expectancy is high, cancer survival rates are good and deaths from IHD and stroke are average.

• So yes, it ‘works’, in that on many measures it delivers a broadly acceptable level of healthcare. But so much depends on what one wants from a health system. On most objective measures the Canadian system at best disappoints, and at worst is simply unacceptable in a wealthy, modern nation, particularly when expenditure is considered. The Dutch with their highly regulated system have recently begun to feel this more
strongly and look set to embrace markets with renewed vigour in order to get more for their money and to enable healthcare supply more closely to reflect demand.

• So why does Canada perform relatively well? Studies have shown that a number of non-health system related factors affect health outcomes. Perhaps the high level of expenditure is important. Canada also benefits from lower levels of income inequality than the US and UK. Tobacco consumption is low in comparison to OECD member countries.

• On an ideological level some might consider the Canadian system attractive, however, Page 6 the reality is that the Canadian tax-funded single-payer model restricts expenditure to such an extent that healthcare supply far from matches demand. Though private expenditure has increased significantly to plug some of this gap, other healthcare funding
systems have done so much more successfully.




Link

I just seem to be getting contradictory information. One seems to paint a doomsday scenario, and the other something very different. I just thought I would mention this, since we have had a few discussion on it and I say verily that I am thorougly confused, especially since they admit Canadian health and statistics are good, yet the system they claim is poor in care, technology, and waiting periods.


:cry:
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Post by Imperial Overlord »

The Fraser Institute is a right wing think tank in British Columbia. It can be relied upon to say anything the right wants to be said. Its wortheless as a source.
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Post by President Sharky »

Then so are studies made by left-wing interest groups and advocacies.
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Post by Einhander Sn0m4n »

President Sharky wrote:Then so are studies made by left-wing interest groups and advocacies.
Only if they contradict science, moron. :roll:
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Post by Broomstick »

Like any healthcare system, the Canadians excell at some things and suck at others.

For instance, if I could go anywhere in the world for hernia surgery I'd go to Canada. Specifically, to the Sholdice Clinic (whose name I'm sure I misspelled) because they are by far and away the very best in the world in regards to outcome - and also cost but it's the outcomes that are really attractive. There is no one better in the world at pancreas islet cell transplants than Dr. Shapiro in Edmonton - the only pity is that he can't train even more people in this work than he already is. Canada far exceeds the US in prenatal care and neonatal health at a fraction of the cost the supposedly better, private US healthcare system does.

On the other hand, if I neede a cardiac bypass I think I'd rather by in the US system. As long as I had insurance. If I didn't have insurance, then I'd rather be back in Canada.

You also have to consider any possible bias this Fraser Institute may have.

You also have to consider how they consider their questions. For example, waiting for an MRI isn't necessarially a bad thing. A LOT of the MRI's done in the US are completely unnecessary from a medical viewpoint and are basically done because 1) the doc is covering his ass from fear of malpractice and 2) the machine is there an available. Over-use of diagnostic technology can be a problem, particuarly with CT scans which utilize x-rays, which if used to excess can cause damage or death. PET scans utilize radioactive "contract agents" - justified in some cases, but unless there is a compelling medical reason injecting radioactive stuff into your body is best avoided. More medicine is not necessarially superior medicine. That could account for why the Canadians' health is so close to that of Americans despite having fewer doctors - the US may well be oversupplied with doctors, and in some locations there are more than are needed (while in other US locations there are too few doctors... this does get complicated).

Does medical rationing occur in Canada? Do delays occur? Yeah, they do - the dirty secret is that they occur EVERYWHERE. In the US organ transplant is the big rationing item at present - we don't have enough to go around so some hard choices are made and some people die while on the waiting lists. I remember back in the 1970's when cardiac bypass surgery was still considered experimental - my mom was put on a 6 month waiting list. Why? Not enough trained surgeons. That's rationing. As it happens, mom got her surgery in 4 months, not 6 - because a bunch of people on the list ahead of her died. Rationing comes down to a lack of resources. We do not have infinite resources. We never will.

So... yeah, you can find real evidence that the Canadian system is both the best and worst of all possible worlds. Just like for the health systems in a lot of other countries.
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Post by Straha »

Einhander Sn0m4n wrote:
President Sharky wrote:Then so are studies made by left-wing interest groups and advocacies.
Only if they contradict science, moron. :roll:
Then why are you rejecting this simply for its source? Attack the statistics and methodology if you want to attack it, don't simply say "It comes from a source I don't like, so I'll handilly ignore it" like so ever many fundies do.
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Post by Imperial Overlord »

Straha wrote: Then why are you rejecting this simply for its source? Attack the statistics and methodology if you want to attack it, don't simply say "It comes from a source I don't like, so I'll handilly ignore it" like so ever many fundies do.
The Fraser Institute has a history of manipulating data to fit its ideologically driven conclusions. It has nothing to do with the source being one I dislike, it has everything to do with the source being habitually dishonest.
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Post by Darth Wong »

President Sharky wrote:Then so are studies made by left-wing interest groups and advocacies.
Such as?
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Post by Einhander Sn0m4n »

Straha wrote:
Einhander Sn0m4n wrote:
President Sharky wrote:Then so are studies made by left-wing interest groups and advocacies.
Only if they contradict science, moron. :roll:
Then why are you rejecting this simply for its source? Attack the statistics and methodology if you want to attack it, don't simply say "It comes from a source I don't like, so I'll handilly ignore it" like so ever many fundies do.
I'm not sure if you aimed this at pResident Sharky or me, but if you are aiming it at me, I have the following to say: I never said that I reject something because of their source, I say I reject them if they contradict science.

If you weren't aiming at me (which I get the feeling you weren't), I say: That's why I said to reject it if it contradicts the science. Statistics and methodology can be 'thrown' to an extent to skew the results. Right-wing political ideologies seem to encourage this in attempts to 'fit the facts with the preconception'.
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Post by Darth Wong »

Quite frankly, I tend to distrust all of these goddamned "think tanks." If I want to see a study on health care, I want to see it coming from an actual health-care organization, see it in a medical journal, etc. The idea of a health-care study coming from a political "think tank" is rather questionable at face value.
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Post by President Sharky »

Imperial Overlord wrote:
Straha wrote: Then why are you rejecting this simply for its source? Attack the statistics and methodology if you want to attack it, don't simply say "It comes from a source I don't like, so I'll handilly ignore it" like so ever many fundies do.
The Fraser Institute has a history of manipulating data to fit its ideologically driven conclusions. It has nothing to do with the source being one I dislike, it has everything to do with the source being habitually dishonest.
What history of manipulating evidence? Care to prove that asshole? It is well known that the Frasier Institute promotes right-of-centre ideas, but this is not a valid reason to completely reject the findings of its research. I want definitive proof that it has deliberately manipulated evidence.
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Post by President Sharky »

Darth Wong wrote:
President Sharky wrote:Then so are studies made by left-wing interest groups and advocacies.
Such as?
The Tommy Douglas Research Institute, Friends of Medicare, and the Canadian Health Coalition organizations among others have dealt a steady stream of strong pro-public health care (as in the current system is the only way) studies to the press.
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Post by Glocksman »

Are there any impartial studies of the Canadian system?
I'm interested because while I favor universal healthcare for the US, I'm not sure exactly what kind of model (or mix of models) we should adopt.
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Post by Darth Wong »

The complaints about long wait times are fairly recent, and related mostly to specialists. I'm old enough to remember a time when this was not a concern, and the tipping point was some drastic cutbacks in health-care funding at the federal level. Those cutbacks were driven in large part by a real Canadian bankruptcy scare more than a decade ago, in which Canada's debt situation seemed to be out of control. But after getting the budget under control, it is time to commit to funding the system properly again.

The problem now as I see it is that the conservative mindset assumes these recent problems are due to the public nature of the system rather than recent underfunding. If Canadian health-care spending rose to anywhere near American current levels, all of these problems would evapourate. So certain people keep pushing for more private health-care options rather than more funding for the public system.
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"Viagra commercials appear to save lives" - tharkûn on US health care.

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Post by Imperial Overlord »

President Sharky wrote: What history of manipulating evidence?
Let's start with Tax Freedom Day

page 15
This misuse of statistics is so egregious that
naturally the Institute is aware of it. However, in
its press release on tax freedom day, it makes no
mention of this dubious use of statistics. It simply
reports the average family’s cash income as
implicitly being its sole income. In Tax Facts 3,
the Institute gives this feeble explanation for using
the average family’s cash income instead of
its total income: “If we told people that taxes are
3% of their total income before tax, they would
have a large task ahead of them to estimate all
the types of income that must be included to arrive
at this measure of income...Cash income is a
useful tool in describing the tax burden because
it does not force people to go through arithmetic
gymnastics to arrive at their total income before
tax to get an idea of how large the total tax burden
is.” (pp. 37-38)
This is ridiculous. The Institute implies that it
is sparing people from complicated calculations,
but it has already done the calculations for them.
It has already arrived at a figure for “total income
before taxes” — an amount clearly identified in its
table as $90,458 — so no arithmetic gymnastics
are required.
Or how about their bulletin?
In addition to the inadequate explanation or justification of key methodological choices, the presentation of findings (however interesting they may sometimes be) is sometimes inaccurate, vague or misleading.
Or cozing up to the tobacco industry junk scientists?

foreward
At best, working hand-in-hand with the tobacco manufacturers on issues of junk science call in to question the ethics and judgment of the Fraser Institute. But getting into bed with the international masters of the use of 'junk science' and disinformation to block public health reform is cavalier and irresoponsible.
A little latter, page 7
The tobacco industry published the proceedings of the conference and distributed the 389 page
text to media and libraries in Canada and around the world. Although the papers were not
peer-reviewed, they ended up being cited as industry evidence as if the McGill Conference had
been some kind of “significant scientific assembly” (Rob Cunningham in Smoke & Mirrors: The
Canadian Tobacco War).
As we expected, the Fraser Institute plans to publish the proceedings of the Ottawa
conferences. Distribution to the industry disinformation system will inevitably follow. The
Ottawa conferences will follow the pattern for the McGill Conference, Imperial College
Conference, and conferences in Lisbon, Hanover, Budapest and Milan.
And, just as Canadian health groups experienced following the McGill Conference, government
bureaucrats and health officials from around the world will telephone health officials in Canada
and ask for background on the Ottawa conferences and their supposed “findings”. Thanks to
the Fraser Institute, the disinformation campaign will grind on.
So go fuck yourself.
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Post by Darth Wong »

Frankly, any "Institute" which engages in tobacco apologism can be automatically assumed to be full of shit, even without detailed examination. The level of dishonesty required in order to be a tobacco apologist is breathtaking. There are really only two types of person who become tobacco apologists:

1) Fucking idiots.
2) Fucking liars.
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"Viagra commercials appear to save lives" - tharkûn on US health care.

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Post by Enigma »

Darth Wong wrote:The complaints about long wait times are fairly recent, and related mostly to specialists. I'm old enough to remember a time when this was not a concern, and the tipping point was some drastic cutbacks in health-care funding at the federal level. Those cutbacks were driven in large part by a real Canadian bankruptcy scare more than a decade ago, in which Canada's debt situation seemed to be out of control. But after getting the budget under control, it is time to commit to funding the system properly again.

The problem now as I see it is that the conservative mindset assumes these recent problems are due to the public nature of the system rather than recent underfunding. If Canadian health-care spending rose to anywhere near American current levels, all of these problems would evapourate. So certain people keep pushing for more private health-care options rather than more funding for the public system.
True. But the money would have to be used intelligently instead of just throwing cash around.

First there should be a sliding scale pay rate for doctor's who have their own practice. Currently as it is, a brand spanking new doctor gets the same amount of money per patient visit as a doctor that has been practising for over thirty years. Kind of hard to keep doctors if their costs are rising but the commision barely budges. The provinces (at least in Ontario) should give more consideration for doctors that have their own practise than those who work from the hospitals.

Also, accelerate the recertification of foreign trained\experienced doctors so that it doesn't take years for those doctors to be able to start their practise. Do we really need them to start over? If they've got the education and the experience then maybe a series of tests\exams they could take before they can work. This way we won't have long wait times at the ER. (The ER in itself is another story).

I know all of this falls on the provinces but if the feds really open up their purse strings then they should have strings attached to the money like what I mentioned above.

Plus, I'd like to see the unions in the healthcare industry be knee capped so that several medical services can be used beyond the "9 to 5" work hours. (i.e. Cat scans and MRIs)
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