Canada is one of the few countries in the world that does not have a private healthcare system. We have a socialized system that is funded fully by the government. The funding comes from general revenues obtained through taxation. Each Province determines what percentage is paid through healthcare premiums.
The Canada Health Act forms the guidelines for provision of healthcare and has 5 basic tenants. The first tenant is Public Administration, which means that the provincial government determines which medical services are insured and how they are funded. The second tenant is Accessibility, which means that Canadians must have reasonable access to insured services without paying user fees. The question is what is reasonable access. How long should patients wait to see a specialist, get an MRI scan or get their operation. The third tenant is Comprehensiveness which means that provincial health insurance programs must include all medically necessary services for the purpose of maintaining health, preventing disease, for diagnosing or treating an injury, illness or disability. Most provinces do not include coverage for physiotherapy, massage therapy, chiropractic treatment or prescription medication. The forth tenant is Universality which means that all hospital and physician care are covered and that Canadians do not have to pay insurance premiums to receive coverage through the provincial health insurance. The fifth and final tenant is Portability, which means that provincial insurance plans cover medical care delivered in other provinces.
Each province determines what they pay their doctors and their nurses. This can create competition between provinces for the limited number of healthcare providers available. Most doctors are paid through a fee for service system. The government sets a price for physician services that include consults, procedures and surgery. Provincial medical associations negotiate with the government to determine what each medical specialty will get paid for the service that they provide. For example, a family doctor gets paid $84.45 for an office visit. Neurosurgeons gets paid $172.86 for the initial consult and $47.16 for follow-up office visits. For surgery neurosurgeons get paid $670.84 for doing a lumbar discectomy and $1071.89 for removing a brain tumor. Every specialist in the province gets paid the same amount for each service based on the negotiated fee schedule.
Governments provide annual funding to hospitals, which determine which services and how many they can deliver during the fiscal year based on the cost of each service and the amount in their budget. For example, a hospital determines how much money they can spend on MRI’s, which determines how many scans they can do in a year. They also determine how many operations can be performed, how many in-patient beds, how many nurses they can hire, etc. All of these factors result in long wait lists for services that are considered essential.
Doctors are private practitioners meaning that they are self-employed small businesses with approximately 30% overhead costs for office rent, paying staff, paying license fees, etc. Surgeons are provided access to operating rooms by the hospital, which determines how much operating time a surgeon is allowed which is ultimately determined by their hospital budget. Most surgeons, like myself, are given on average one operating day per week that extends from 8 am until 3:15. For neurosurgery this usually equates to 1 – 3 operations per day (per week). Generally I would book 3 or 4 operations for each office day that I have in a week. On average I have 4 office days and one operating day per week which means that I schedule between 12 and 16 operations per week but only get to do between 1 and 3 operations per week resulting in an ever growing wait list for surgery. The only way to decrease wait lists is to stop seeing patients in the office. That is why many specialists have periods of time where they do not accept any new referrals from the family physicians.
Doctors are required to participate in a continuing medical education program that requires that they do 400 hours of study during every 5 year cycle. Part of this requires attending medical conferences while some can be achieved by reading medical journals. It is the doctor’s responsibility to pay for these educational requirements.
Canada has the longest wait lists in the world for specialist consults, diagnostic imaging tests (CT, Ultrasound and MRI), and for surgery.
Canada is often compared to the United States, which has one of the least efficient and most expensive healthcare systems in the world. Most other countries have a blend of publicly administered and private healthcare. The private systems can be for-profit meaning that the owners share the revenue after paying expensed or not-for-profit meaning that the profits are used to buy new equipment or to fund other social programs. Countries like Australia, France, Germany, Switzerland and the Netherlands have a blended system of private and public healthcare.
Private includes private insurers who pay for heathcare usually as a supplement to the public system. It also includes private clinics or hospitals that are funded through the private insurance companies or out of pocket payments by the patients. In most countries the public system contracts to the public hospitals to provide some of the publicly funded services.
In most countries the public hospitals fund the critical services such as emergency room care, intensive care and urgent or emergent surgery. Most private hospitals are smaller and provide elective, shorter stay procedures like joint replacements.
As the Canadian population ages, the burden on the social healthcare system is going to increase which will result in longer wait lists for services. It is time for Canada to make drastic changes to the way it delivers healthcare. It is time to create a system in which public and privately administered care can work together to provide better healthcare for Canadians. There is no need to have long wait lists for medically necessary services.
Canadians have been brainwashed to think that we have the best healthcare system in the world. If you have a critical illness that requires urgent treatment then our system is pretty good. If you have a chronic disease or a non-life threatening illness then we probably have one of the worst healthcare systems in the world.
The Fraser Institute consists of analysts who research and write articles on a number of topics including healthcare. I have included a number of these articles some of which are short and others are quite lengthy. They are all worth reading to get a better appreciation of how our healthcare system works and how it compares to other countries who spend a similar or lesser amount of income tax on healthcare.