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Despite being number two in spending per GDP Canada's health are system delivers mediocre results.


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This echoes what you can find yourself fairly easily by googling spending by country and then various studies of wait times and health care outcomes. Canada pays as much as many European nations which provide much better health care than we do.

The Fraser Institute’s latest comparison of international health-care systems reminds Canadians what we’ll return to when the pandemic ends. The study compares Canada’s health-care spending and performance to 28 universal health-care systems (on an age-adjusted basis in 2018). Despite being the second-highest spender (11.3% as a percentage of GDP), Canada’s health-care system routinely delivered mixed to poor performance compared to our international peers.

Of specific concern, Canada has remarkably few medical resources per capita. For example, we ranked second-last for acute care beds (25 out of 26), with 2.1 beds per thousand people. By comparison, South Korea has nearly four times as many beds available (8.1 per thousand) while Japan (5.8 per thousand) and Germany (5.5 per thousand) have almost three times as many.

Ontario’s overcrowded hospitals — again, despite few COVID-19 patients — suddenly make a lot of sense. We also rank near the bottom of the pack for the number of physicians available (26 out of 28) with only 2.8 physicians per thousand population, far behind countries such as Austria (5.2 per thousand).

https://torontosun.com/opinion/columnists/opinion-comparing-canadian-health-care-to-other-countries

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I fell a little nauseous about having to defend our admittedly broken sick care system, but in this case, I need to comment.   Our costs in comparison with almost every other more successful G7 state are distorted all to hell because we live where we live.  Our economy, our culture and our business links to the WORST sick care system on Earth are so close, we get to practice little of the good and almost ALL of the bad in our efforts to keep Canadians alive.   To begin with (IMHO of course, but I think I am on pretty good ground with this) health care and sick care (they are different things) are, or at least really SHOULD be recognized as a social service.   South of the 49th, it is a business partly funded by social services (medicare, medicaid, GI and government employees) backed by three big, greedy pigs on its back:  lawyers, insurers and big pharma.   Because of the fuzzy border between us and US, we tend to do a lot of things in the same way, pay insurance for instance, based on US ideas of liability, wages to keep med pros in, do a little prophylactic medicine (they do a LOT to avoid potential liability claims) and so on.  We get the public insurance part fairly right, but totally screw up the interface between private and monopolized public delivery.  And, as suggested, we also underfund and understaff but a lot of that is due to the overcost of geography - both our location relative to the US and the very large area and small populations we must serve.   It is not appropriate to compare SK to SK for instance:

"South Korea is approximately 99,720 sq km, while Canada is approximately 9,984,670 sq km, making Canada 9,913% larger than South Korea. Meanwhile, the population of South Korea is ~51.8 million people (14.1 million fewer people live in Canada)."  Add to that SK never sees SK's -40C temperatures, and SKorea is a much more productive culture (survives - actually prospers - on very high level of value added vs. our resource extraction model with little value added) and economy, not saddled with costs such as ridiculous immigration, aboriginal and stagnant region dependency costs.  Also, I suspect our dependence on both recreational and US-style prescribed addiction to drugs-for-profit is a major factor.

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28 minutes ago, cannuck said:

I fell a little nauseous about having to defend our admittedly broken sick care system, but in this case, I need to comment.   Our costs in comparison with almost every other more successful G7 state are distorted all to hell because we live where we live.  Our economy, our culture and our business links to the WORST sick care system on Earth are so close, we get to practice little of the good and almost ALL of the bad in our efforts to keep Canadians alive.  

 

Well, that didn't take long.   As usual, any discussion about health care costs and deficiencies in Canada are defended by pointing "south of the border".   It is the go-to, reflexive response no matter what the context.   It is the Canadian way.

 

 

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11 minutes ago, bush_cheney2004 said:

Well, that didn't take long.   As usual, any discussion about health care costs and deficiencies in Canada are defended by pointing "south of the border".   It is the go-to, reflexive response no matter what the context.   It is the Canadian way.

No, it's not just a reflex, it is reality.  Now that the Little Tur...uh, TRUdeau has a kissin' cousin commie on the other side, things will get continue to get worse for both sides of the border.  Of course, that could all change if both were to take on the genuine problems that cause this particular problem.  Dumping the LLL (Legal Liability Lottery) as a core component of business could not only let sick care go to the SS side, but let things such as the hog tied genav industry go back to world domination.

To add to this discussion: HEALTH care (actually preventing illness) is something Canada does a lot better since we to some extent trust government, whereas the lardass profile of much of yankee doodle population is a direct result of not listening to same advice and guidance - i.e. what little of it is offered by government.

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2 minutes ago, cannuck said:

No, it's not just a reflex, it is reality.  Now that the Little Tur...uh, TRUdeau has a kissin' cousin commie on the other side, things will get continue to get worse for both sides of the border. 

 

Sorry, two different nations with different priorities.  Single payer, universal coverage for all already failed in the U.S., even with Obama-Biden's ACA.   A majority of Americans would not tolerate the long wait listing seen for basic testing and procedures in Canada.

It is Canada's health care "system", with principal responsibility at the provincial level that varies widely.   The U.S. deflection is just Canada's favourite excuse for not doing any better.

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3 minutes ago, bush_cheney2004 said:

 

Sorry, two different nations with different priorities.  Single payer, universal coverage for all already failed in the U.S., even with Obama-Biden's ACA.   A majority of Americans would not tolerate the long wait listing seen for basic testing and procedures in Canada.

It is Canada's health care "system", with principal responsibility at the provincial level that varies widely.   The U.S. deflection is just Canada's favourite excuse for not doing any better.

You hit the nail on the head: different prioirities.  The US "system" panders to the big pharma, big legal, Wall Street and Big Med lobbies to sustain an unsustainable business, whereas Canada virtue signals to the far left but without the foresight and courage to turn away from the "business/gov't" model it has developed stuck between the left and the right.   Reality is: if EITHER country made the #1 priority to take care of the health and sickness of it's citizens they would both look pretty much the same - and NOT include most of what drives the most of the US and much of Canada's fumbling exploitation of sick care as a "business".

 

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15 minutes ago, cannuck said:

You hit the nail on the head: different prioirities.  The US "system" panders to the big pharma, big legal, Wall Street and Big Med lobbies to sustain an unsustainable business, whereas Canada virtue signals to the far left but without the foresight and courage to turn away from the "business/gov't" model it has developed stuck between the left and the right. 

 

That's for Canada to sort out, and is not the responsibility or duty of the American or any other foreign health care system.   Obviously Canada was able to shift to a universal health insurance system without regard to what happens in the U.S., so that excuse rings hollow.  Canada's system is under-capitalized because of a political and cultural refusal to allow more private insurance partnerships as seen in other OECD nations with far better access and results.   

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 Reality is: if EITHER country made the #1 priority to take care of the health and sickness of it's citizens they would both look pretty much the same - and NOT include most of what drives the most of the US and much of Canada's fumbling exploitation of sick care as a "business".

 

Don't try to change the health care system is another country in the mistaken belief it will help your own troubles....it won't.   The U.S. is not Canada by design, and it will likely stay that way.

 

 

 

 

 

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12 minutes ago, bush_cheney2004 said:

Don't try to change the health care system is another country in the mistaken belief it will help your own troubles....it won't.   The U.S. is not Canada by design, and it will likely stay that way.

I am a Canadian citizen, but 80% of my corporate presence is US domiciled.   So it IS "mine" to change as the status of sick care directly impacts our employees and how we conduct business (and how much money we can make).  The advanced state of decay of the US economy, the over-regulation and risks and costs of the LLL and incredible risk of serious illness bankrupting employees, employers and small companies means our strategy these days is to move production to safer countries (that include Canada).  When opening a business outside of the US, sick care protection for workers is a minor consideration - as extending the care to cover travel and other items is a minor benefit in compensation packages.

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5 minutes ago, cannuck said:

I am a Canadian citizen, but 80% of my corporate presence is US domiciled.   So it IS "mine" to change as the status of sick care directly impacts our employees and how we conduct business (and how much money we can make). 

 

So it is OK for you to pursue profits in a foreign country but you want to influence how others pursue profit in their own nation ?   How others sell their intellectual property and services ?  

No, it is not "yours" to change, and you will not be able to do so.   This topic is about the sorry state of health care in Canada, remember ?

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10 minutes ago, bush_cheney2004 said:

 

So it is OK for you to pursue profits in a foreign country but you want to influence how others pursue profit in their own nation ?   How others sell their intellectual property and services ?  

No, it is not "yours" to change, and you will not be able to do so.   This topic is about the sorry state of health care in Canada, remember ?

And any such discussion is impossible to have without considering the contributing factors - the largest one of which is our shared border, economies, services and culture.

Since I have a responsibility to shareholders and employees wherever we do business, it is indeed my responsibility to promote any change for the better.  There is one hell of a difference between speculating on what someone else does managing the equities underlying your 401k might do vs. having to be directly responsible for a company and all of its component parts.

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1 minute ago, cannuck said:

And any such discussion is impossible to have without considering the contributing factors - the largest one of which is our shared border, economies, services and culture.

 

And yet, such discussions and decisions are routinely made without regard to such things.   Again....two different nations and sets of priorities.    Canada has purposely and specifically made a point of not adopting "American style" in many areas, so don't expect joint discussions or decisions.

 

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Since I have a responsibility to shareholders and employees wherever we do business, it is indeed my responsibility to promote any change for the better.  There is one hell of a difference from speculating on what your 401k might do vs. having to be directly responsible for a company and all of its component parts.

 

So do American health care providers, medical workers, insurance companies, device manufacturers, pharma, and many other contributors to what is nearly 20% of the U.S. economy.    You seem more concerned with a foreign nation's health care system than fixing your own.

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17 hours ago, Moonlight Graham said:

My experience with my province's healthcare system is routine disappointment.  Not funding a public system adequately is a kind of human rights abuse.

And yet, we're number two in funding....

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6 hours ago, cannuck said:

"South Korea is approximately 99,720 sq km, while Canada is approximately 9,984,670 sq km, making Canada 9,913% larger than South Korea. Meanwhile, the population of South Korea is ~51.8 million people (14.1 million fewer people live in Canada)."

It's not clear to me why this should matter. Ninety percent of our population lives in large urban centers within 100km of the US border on 4% of our territory. Much of our territory is almost completely uninhabited. When you're counting the square km up there you're including millions of kms of frozen tundra. And I don't think that costs much to health care. It's also not clear to me why a small hospital in semi-rural Sk or AB  or even ON costs that much more than one in Toronto. The costs of everything there is cheaper, including labour, which should help counter the cost of shipping drugs and supplies in.

6 hours ago, cannuck said:

Add to that SK never sees SK's -40C temperatures,

Perhaps, but they do see it in Sweden and Finland and Norway and Denmark. This is, after all, a comparison with 28 other systems, not just SK.

 

 

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I'd love to see what we're spending money on as compared to other health care systems. I suspect that having a dozen different health departments is part of the reason. But I doubt it's the only reason. There is no central system and the others often seem to be a disorganized mess. Something which has been shown to be especially problematic in trying to address the covid virus.

From the actual report:

Canada spends more on health care than the majority of high-income OECD countries with universal health-care systems. After adjustment for “age”, the percentage of the population over 65, it ranks second highest for expenditure on health care as a percentage of GDP and seventh highest for health-care expenditure per capita.

Out of 28 countries, Canada ranks 26th for physicians, 17th for nurses, 25th for curative (acute) care beds (out of 26), and 22nd for psychiatric care beds per thousand population (table A2, p. 43) and 9th for long-term care beds (out of 25). As can be seen in table 3, after adjustment for age, Canada ranks 26th for physicians (figure 3a), 14th for nurses (figure 3b), 25th for curative (acute) care beds (out of 26) (figure 3c), 24th for psychiatric care beds per thousand popu-lation, ranked 7th (out of 25) for long-term care beds per thousand population (65 and over). Except for above average availability of long-term care, and middling nursing density, Canada clearly has many fewer human and capital medical resources per capita when compared to other high-income OECD countries with universal health care.

Per million population, Canada ranks 23rd (out of 26) for MRI units, 24th(out of 27) for CT scanners, 18th (out of 23) for PET scanners, 2nd (out of 21) for Gamma cameras, and 12th (out of 20) for Mammographs (table A3, p. 44). After adjustment for age, Canada ranks 22nd (out of 26) for MRI units (figure 4a), 21st (out of 27) for CT scanners (figure 4b), 18th (out of 23) for PET scanners, 2nd (out of 21) for Gamma cameras, and 14th (out of 20) for Mammographs

As can be seen in table 7, Canada is tied for last place (out of 10) for the percentage of patients able to make a same-day appointment when sick (43%; figure 6a), and ranks 4th (out of 10) for the percentage of patients who report that it is very or somewhat easy to find care after hours (63%). Canada placed second last (with 62.8%) among the 16 countries for which data was available on the percentage of patients who reported waiting more than four weeks for an appointment with a specialist.

https://www.fraserinstitute.org/sites/default/files/comparing-performance-of-universal-health-care-countries-2020.pdf

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So they rated spending per GDP, which is a weird metric.  And they ranked us on things like acute-care beds...

I have 100% belief that the system could be better, and that we don't treat patients as well as we could and that we overspend.  I also belief that left-of-centre Canadians wrongly compare us to the US system and get religious about our system, to the point of downplaying the flaws.

But I think this report is dishonest.  Reform in Canada is tricky, and to engender trust you have to come to the table with clean hands.  

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1 hour ago, Michael Hardner said:

So they rated spending per GDP, which is a weird metric.  And they ranked us on things like acute-care beds...

Lots of spending is rated on a GDP level to account for what countries can afford. They also rated us on per capita spending.

What's wrong with ranking us on acute care beds? Isn't that a decent metric?

1 hour ago, Michael Hardner said:

But I think this report is dishonest.  Reform in Canada is tricky, and to engender trust you have to come to the table with clean hands.  

What is dishonest about it? They didn't make recommendations for what to change or suggest why our spending is high but what we get for it is low.

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1 hour ago, Michael Hardner said:

https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capitaj

 

We are 12th and 13th in per capita funding using these tables.

The report adjusted their ranks by allowing for aging. Ie, older populations require more spending. A country with an older population spending the same as a younger country will be behind them.

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37 minutes ago, Argus said:

What's wrong with ranking us on acute care beds? Isn't that a decent metric?

Sure, but one could decide beforehand that they want to put the situation in a bad light, then handpick stats that make you look bad.

https://www.cihi.ca/en/how-does-canadas-health-spending-compare

This has Canada as 5th place as % of GDP.

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"Better health care models, which routinely deliver superior performance for comparable cost, exist and we should work towards a “better normal” once the pandemic is over."

I think that sounds innocuous enough, but making change is difficult - especially in a fractious environment or one in which people have agendas.  

If they are looking for better value then we could set that as a goal, along with an agreement that we won't be cutting budgets right ?  If you save money you can allocate it to another area and expand that program.

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1 hour ago, Michael Hardner said:

Sure, but one could decide beforehand that they want to put the situation in a bad light, then handpick stats that make you look bad.

https://www.cihi.ca/en/how-does-canadas-health-spending-compare

This has Canada as 5th place as % of GDP.

Yeah, but they used damned near every metric you can think of, from acute care beds to long term care beds to wait times to see a doctor to wait times to see a specialist to number of doctors of various specialties to number of diagnostic machines and to health care outcomes. What did they miss?

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9 hours ago, Argus said:

Yeah, but they used damned near every metric you can think of, from acute care beds to long term care beds to wait times to see a doctor to wait times to see a specialist to number of doctors of various specialties to number of diagnostic machines and to health care outcomes. What did they miss?

The way to talk about management is to use dashboards.  That's what they use in business.  A newspaper story of a think-tank is an old way.  I didn't see some metrics I would expect but if they had a dashboard you could look up anything.

 

I think the only way to talk about this is to not be partisan and to acknowledge our common 'values' then drill down on what that means.  We all want 'fairness' 'value' 'efficiency'.  But how to measure and what does it mean ?

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