Access to Healthcare in Canada and the U.S. — Cont’d

Wait Times

According to Dr. Zvi Margaliot, another factor that affects accessibility to healthcare is wait times. Depending on specialty and illness severity, wait times in the U.S. can vary from immediate assistance to a waiting period of a few weeks. Recent statistics suggest that funding typically plays a significant role in treatment plans, and patients with excellent insurance coverage are more likely to receive immediate care and have access to more physicians and hospitals. Similarly, Individuals on Medicaid or Medicare may have difficulty finding a provider in their area, and if they do, appointments may not be available for some time, and their choice of treatments may be limited based on coverage. Even patients with private insurance may find that they must travel long distances, even out of state, or wait several weeks to access medical specialists or clinics that are approved by their insurer, especially in underserved areas.

In Canada, access to urgent medical care for seriously injured or ill patients generally is very good. However, wait times for non-urgent care are, for the most part, much longer than in the U.S. and are dictated by availability of physicians, healthcare resources and illness severity. According to the most recent Commonwealth Fund Report on healthcare, Canada ranked dead last of OECD (Organization for Economic Cooperation and Development) member countries in having the longest wait times for access to medical specialists and for surgery. The Canadian system is also the second most expensive healthcare system in the world, second only to the U.S. These are very sobering statistics.

Why is that the case?

Like the US, Canada has finite resources. Tax revenues fund the healthcare system, but also all other government spending on things like education, security, social services, law enforcement, environment etc… The Ontario Government already spends 55 cents of every tax dollar on healthcare, and the top income tax bracket in Canada is already more than 50% for high earners — that’s a heavy tax bill. There’s no more room for additional spending, yet the population keeps aging, and requires more and more medical care. The government then has to choose which services they can afford to continue to fund, and which they cannot, and they can also choose how many healthcare services (such as operations) they will pay for every year. Physicians in Canada don’t work for the Government. Most are self-employed contractors, who submit monthly invoices to the Government Insurance Plan for the services they provide, on a fee-for-service basis, and receive monthly payments from the Government. Almost all major treatment takes place in public hospitals or affiliated facilities. The Government then indirectly control the number of services provided by capping physicians’ payments, and restricting the money provided to the public hospitals every year, and more and more frequently, reducing annual hospital budgets. Increasing the waiting list for elective surgery is a form of rationing spending, and a way to defer dealing with the problem in any substantial way to the future, when it will become someone else’s (another politician’s) problem. Cynical but true.

The ugly truth is that the waiting list in some Canadian cities for hip and knee replacement is over 6 months, non-urgent spine surgery, jaw surgery and foot and ankle surgery as much as 2 years or more. Waiting lists for MRI are several months. At the same time, most Canadian operating rooms sit idle 16 hours every day, since hospitals only have funds to run the operating rooms for one, 8 hour shift, 5 days a week. Many hospitals also shut down elective (non-emergency) surgery a few weeks a year (6 weeks a year is not unusual) while most hospitals in the U.S. only shut down for a few days (Christman, New Year and Easter holidays). Because of limited funding and resources, there are newly-graduated, fully-trained, highly-capable surgeons in Canada who have nowhere to perform surgery and cannot provide their services to the patients who need them.

The Canadian system also offers restricted choice in healthcare services to insured Canadians. Since the Government controls what services are insured, and the hospitals cannot afford to pay for very expensive treatment or products out of their fixed (decreasing) budgets, Canadians simply don’t have access to very new or expensive treatment options. It is true that the Government will usually cover all necessary treatments, sometimes at a basic level, but some patients may want higher-tier and better treatment. These patients must travel outside of Canada where they can pay out-of-pocket for such treatment.

What is the “Solution“?

Not surprisingly, neither the American nor the Canadian healthcare systems are ideal — far from it. From a social-justice, societal-benefit perspective, the non-for-profit Canadian system seems better, offering universal access to all at a reasonable level of care.

However, from an individual patient’s point view, the waiting lists are too long, and there is limited access to cutting-edge products and technology, especially when compared to the for-profit U.S. system.

The solution then must lie somewhere between these two systems. Fortunately, such systems already exist and have been very successful in many other countries, where healthcare is delivered using a mix of private and public providers. Many countries in Europe, including the U.K., Germany, France and Sweden, use a combination of government and private insurance, and provide services both at public and private clinics and hospitals, such that all residence have universal access to care, and those that have the means also have a choice of where to receive their care. These hybrid systems cost less than either the U.S. or the Canadian systems, and, it is well-documented, provide better outcomes and longer life-spans. This is most likely to be the only way forward for the Canadian system.

U.S. vs. Canada

In the U.S., a hybrid system already exists, but without price and outcomes transparency. Medicare and Medicaid need to be boosted so that they provide more than bare-bones services, and cost controls, in the form of volume contracts, discounts and transparency will make the system more sustainable.

Some patients have already figured some of this out on their own, and take advantage of cross-border medical tourism:

Many Canadian patients may elect to cross the border into the U.S. to have procedures done that may not be readily available in Canada, either because of unreasonable wait times or availability; however, for individuals willing to put in the effort, most costs are out of pocket.

Alternatively, many American patients choose to cross over to Canada to fill their prescription medications. Even with private insurance, some individuals have found that purchasing medicine on this side of the border, or from online from Canadian pharmacies, saves them a significant amount of money in the long-run.

Dr. Zvi Margaliot is Board certified from the Royal College of Canada and has been practicing for over 20 years. Specializing in hand and wrist surgery, he is well respected in both Canada and the United States.