Canada: The Great One

So we looked at Australia and New Zealand yesterday.  It’s time to talk about Canada, since our northern neighbor has had some unkind things spoken about it in the comments section.  Which Canadian Medicare system is the real one?  The horrific one of inappropriate care, no hip replacements and maddening wait times that’s popped up in the comments?  A single-payer paradise?  Or something in between?

Well, let’s get most of the good stuff out of the way at the top.  (Or, if you prefer, you can peruse some of the specific numbers on Health Care Economist’s “Health Care System Grudge Match:  Canada vs. U.S.”).  They beat us at life expectancy, infant mortality, obesity, and spend less than half of what we do per capita on health care.  It’s a little bit like matching up the 1985 Edmonton Oilers and the NY Rangers.  Oh, and let’s not forget the 2003 NEJM study that shows that administration costs account for 31% of health care expenditures in the U.S., but only 16.7% in Canada.

Still, Canadian health care isn’t perfect.  It has its problems.  The three most prominent are an emerging physician shortage, the long-standing problem of wait times, particularly for elective or specialist treatment, and an oft-cited shortage of some specialized equipment like MRI machines.  So let’s tackle them – how badly do these impact the quality of care in Canada?

Well, when it comes to a physicians’ shortage, we don’t have a lot to brag about.  According to the WHO stats, we’re about even in physicians per 1,000 people – 2.4 for us, 2.2 for them.  Skeptics of health care reform often talk about lack of compensation compared to docs in the U.S.  But a family doctor in Canada makes an average of $202,000 (about $161,000 American).  That’s actually a little more than a family practice doctor in the U.S.  The real difference is that salaries don’t diverge as broadly between specialists and primary care in Canada.  As a direct result, the U.S. is bordering on a primary care crisis, while Canada is experiencing a more general shortage.  In any case, I’m not sure we have much to crow about.

No question, we have MRI machines up the wazoo here – more than 4 times per 1,000 people what Canada has.  We are King of All Da Toyz, no question.  But as much as people love to tell us about Canadian citizens crossing the border to get an MRI in the U.S. and jump the queue back home, the absence of MRIs hasn’t seemed to affect their quality of care that much.  Canada has about as many MRI machines per capita as Australia, Belgium, Germany, New Zealand, the U.K., and France.  That’s like a “who’s who” of who delivers better care for less money than we do.  It might be worth questioning whether we get as much bang for our buck from having as many MRIs as we think we do...

Jumping to the wait times – yeah, they’re not great.  So much so that the Canadian government has begun semi-obsessively tracking them on the provincial level.  They vary tremendously from province to province.  If you’re in Ontario and looking to use the emergency room, you’ll actually be in a fair amount of luck – the average time you’ll spend there, including seeing the doctor and everything, will be about 4 hours.  That’s actually about the same as us.  You’ll find some very busy emergency rooms in inner-city Toronto, but that’s true of any major U.S. city as well.  Rural areas up north have worse waiting times, but the U.S.’s regional differences are similarly all over the map.  Check out the rankings from the American College of Emergency Physicians, ranking emergency care, state by state.  Pennsylvania, home to Philadelphia and Pittsburg, gets a C+.  Arkansas gets a D-.  Plus we’ve got some unique American traditions that impact on the amount of time it’ll take for you to get your care.  Like, “diversions” – where the ambulance is actually waved away because the emergency room is so slammed.  Or crowded emergency rooms with uninsured patients receiving care for treatable ailments.  Hard to see that we have them beat at this.

But let’s get to the wait times for specialist care.  An NEJM study that gets frequently cited is this one from 1994, which looked at the time it took for orthopedic consultations and knee replacement surgery for a group of patients in the U.S. and Canada.  And yes, there was a difference.  As reported in the abstract:

The median waiting time for an initial orthopedic consultation was two weeks in the United States and four weeks in Ontario. The median waiting time for knee replacement after the operation had been planned was three weeks in the United States and eight weeks in Canada.

Yup, no sugar-coating that.  Well, how dissatisfied were they with this intolerable delay?

85.1% were satisfied with their wait time in Canada.  That compares to 95% of patients in the U.S., to be sure, but 85.1% is nothing to sneeze at.  When it came to satisfaction with their care for the surgery as a whole, there was practically no difference – 85.3% in the U.S., 83.5% for Canada.

And that’s the thing you just can’t escape about the Canadian system.  Everybody bitches about dealing with doctors or hospitals, whether you’re patient or impatient, the second it becomes inconvenient (I don’t like waiting a month for a referral appointment here in New York, either).  When people tell the old horror stories, you’d think the Canadians who need medical care would be on their last nerve.

But overall, they love it.  They ran the tv show “The Greatest Canadian” with viewers voting by E-mail, Web, telephone, and letter.  The winner wasn’t a prime minister, a Nobel Prize-winner or even a hockey player.  It was Tommy Douglas – the politician who ushered in Canadian Medicare.  That doesn’t make the Canadian system of health care sound like a burden.  It makes it sound like a Great One.

(Photo credit of Wayne Gretzky:  kk+ on Flickr.)