Michael Moore's sheer fantasy: Canada's "world-class" health-care systemWhen Michael Moore's Sicko is widely released later this month, calls for universal health care will likely increase. And, no doubt, Canada's health system will be among those lauded as an ideal model. It certainly is a system to which Mr. Moore is partial—along with those of France and Cuba—but it's far from ideal. Universal health care is a worthy aim, but government–funded universal health care has severe drawbacks, the most serious of which relate to patients receiving timely care.
Medical Progress Today
June 22, 2007
It may be surprising to many Americans that Moore’s Great White panacea comes with a hefty price tag. In 2006, Canada spent 10.3% of its GDP on health care, or about $148 billion Cdn, an amount that is larger than that spent in almost every other developed nation save Iceland and the United States on an age–adjusted basis, and which is growing at a faster rate than inflation and population growth. Since Canadians arguably value equality above almost anything else, especially when it comes to health care, all of this spending should produce one of the best health–care systems in the world. It doesn't.
In the World Health Organization's World Health Report 2000, Canada ranked 30th of 191 countries, ahead of both the United States (ranked 37) and Cuba (39), but far behind the top two performers—France and Italy, respectively—which, unlike Canada, incorporate cost–sharing, private providers and private insurance into their medical systems. In fact, Canada is the only OECD country without a private parallel insurance system, i.e. private insurers are only permitted to cover items not offered by the government plan.
And that's where the problems start. According to the Fraser Institute, a Canadian think tank that has been compiling data on waiting lists for 16 years, waiting for health care is a routine experience for millions of Canadian patients. According to the institute's survey of medical specialists, the wait from referral by a general practitioner (GP) and consultation with a specialist was 8.8 weeks in 2006, while the wait for treatment after consultation was nine weeks in 2006.
Overall, the total wait, from GP to treatment, for the 10 provinces and 12 specialties surveyed, was 17.8 weeks last year. However, among the provinces, there was much variation, from Ontario’s low of 14.9 weeks to New Brunswick's high of 31.9 weeks. Among specialties, the median total waiting time ranged from 4.9 weeks for oncology to 40.3 weeks for orthopedic surgery.
The pervasiveness of the waiting list problem, and a Supreme Court decision (Chaoulli v. Quebec (Attorney General), 2005) that the province of Quebec's ban on private health insurance for necessary medical services violated the right to "life, liberty and security" found in the Canadian Charter of Rights, has motivated the federal and provincial governments to commit to a reduction of wait times in five areas—cancer, heart, diagnostic imaging, joint replacement and sight restoration services—as well as to implement patient wait time guarantees.
How well is the government doing in reducing wait times? The Canadian Institute for Health Information (CIHI) now compiles data on the waits for these priority areas and monitors how the provinces are gathering the information. Varied reporting methods make regional comparisons extremely difficult, but CIHI reports a few findings from the two analyses it has conducted to date.
First, substantial numbers of patients still face extremely long wait times. Of the 2.8 million Canadian adults who visited a specialist in 2005, 20% waited three months or longer. Regarding cardiac surgery, of new heart attack patients who had angioplasty or bypass surgery within a year, half waited four days or less for angioplasty and 2.5 weeks or less for bypass surgery—however, notes CIHI, "the 10% of patients who waited the longest had waits that were six or more times longer than those of typical patients." Half of all knee and hip replacement patients underwent surgery within seven months and 4.5 months, respectively, but 10% of knee patients waited 21 months or more and 10% of hip patients waited 15 months or more.
Canadians also wait for diagnostic tests, anywhere from two to 79 days for a CT scan and seven to 177 days for an MRI, depending on urgency and province, according to CIHI. (Fraser Institute survey data show median waits of 4.3 weeks for a CT, 10.3 weeks for an MRI and 3.8 weeks for an ultrasound.)
Doctors are also very concerned about the effects that delayed access to care has on their patients. In a 2006 Fraser Institute survey, out of 116 categories, actual waiting times exceeded what specialists thought was reasonable in 77% of the comparisons.
As for patients, a 2005 Statistics Canada survey found that most respondents were accepting of their waits. However, many were not: 29% felt the waits for specialist visits for a new condition/illness were unacceptable, 24% had unacceptable waits for selected diagnostic tests (non–emergency MRIs, CTs, angiographies) and 17% for non–emergency surgery other than dental surgery.
Other independent studies confirm that Canada's promise of equitable health care is more mythology than reality. Cardiovascular surgery queues have been jumped by the famous or well–connected, rural residents encounter more barriers to access than urbanites, low–income Canadians are less likely to visit medical specialists and use diagnostic imaging, and lower–income Canadians have been shown to have lower cardiac and cancer survival rates than higher–income Canadians.
Canada is one of the biggest spenders on health care in the world, yet has comparatively fewer practising physicians and diagnostic technologies, and its hospitals often operate at occupancy rates of higher than 90%. Canada doesn’t fare particularly well against other industrialized countries with respect to healthy life expectancy, infant mortality rates and potential years of life lost due to preventable diseases, falling into the mid—or lower–range of OECD rankings.
Rhetoric aside, Canada doesn't live up to its promise of equal access to care, which is its main claim to fame in the U.S. In this aspect, the Canadian universal health–care system may have something in common with Mr. Moore—his films may be called documentaries, but they’re more fiction than fact.
Cynthia Ramsay is an independent health economist and businesswoman living in Vancouver, B.C.