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Healthcare in Canada

25/12/2013 Leave a comment

Over the break I’ve finally had time to (get close to) finishing Jeffrey Simpson’s newish book, Chronic Condition. Basically, Canada’s healthcare system is headed for crisis, but it’s a “political third rail”, a reference to the rail carrying power for electric trains – touch it, even with the best of intentions, and you die. The book is a brilliant look at how medicare happened, how it works in Canada and other countries, how it’s broken, and how to fix it.

What it boils down to is that between 1975 and 2006, we see:

  • 75.4% growth in GDP per capita
  • 51% growth in expenditures on hospitals
  • 98% growth in expenditures on physicians
  • 338% growth in expenditures on drugs outside of hospitals

(All figures adjusted for inflation)

This might be okay if our outcomes were enough to justify our spending, but by OECD standards they are decidedly mediocre. Moreover, this spending will likely continue to grow faster than the economy. Eventually, there will be a crunch on government budgets since taxes can’t rise indefinitely. In Simpson’s words:

The first and most important lesson about health care is that simple solutions to complicated problems are invariably wrong or deeply suspect… The decade ahead will feature slower economic growth in Canada and the rest of the Western world… Choices will be inescapable and hard.

Some of his proposed solutions:

  • constrain wage growth of healthcare professionals – doctors’ salaries alone represent 14% of healthcare spending (hospitals and drugs make up 29% and 16% respectively). “Unless physicians and nurses show more flexibility in how they work, and unless they accept that their remuneration cannot continue to outstrip governments’ revenue growth, it will be very hard to improve medicare’s challenges of quality, access, and cost.”
  • “dehospitalize” medicare by emphasizing home care, long-term care sites, nursing homes, and family and specialist clinics
  • institute regional health authorities where they don’t already exist and give them control over budgets
  • make physicians and nurses accountable to these regional authorities instead of the provincial government
  • encourage private delivery of publicly-paid services where costs are lower for equivalent services
  • encourage delivery of services by lower-cost providers, such as nurse-practitioners
  • allow hospitals to use operating rooms for privately-paid surgeries when not in use for other procedures
  • allot hospital budgets according to some base amount plus an additional sum for each patient treated instead of lump sums – make patients sources of revenue and not costs
  • lower drug costs through a national drug scheme
  • institute user fees to discourage overuse and offset or waive them for lower-income people
  • reduce social inequality – statistically, poor people have more health problems

Ironically, inequality is the most likely of these challenges to be addressed. Healthcare reform is politically unfeasible, hence Simpson’s ‘third rail’ moniker.

What makes healthcare the ‘third rail’ of Canadian politics? As Canadians, we have built our national identity around our healthcare system. Needed reforms threaten the interests of people working in healthcare – and these powerful groups know that by raising the scary spectre of private, Americanized healthcare, they can elicit a knee-jerk emotional reaction from the public that will prevent any changes.

Healthcare is part of a larger complex of social problems that really frustrates me. Regarding healthcare specifically, my generation is going to be on the hook for a host of cost increases and it’s going to be the quality of our healthcare that suffers as a result. Another example is the environment – the boomer and post-boomer generations are receiving all of the job and wage benefits but will not live to see the costs.

And we have to put up with all of this while the traditional media and the rest of the population tell us that we’re lazy, entitled, ungrateful, and socially dysfunctional. Right.

More “Old  Economy Steve” memes here.

LOL,

Tim

PS – Also, this: