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Author Topic: Ideal Health Care policy - How does the Canadian model rate?
Alienrocker
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Babbler # 2026

posted 18 November 2003 05:01 PM      Profile for Alienrocker        Edit/Delete Post
We are interested in learning more about the Canadian health care system.

Is it working well? What are the best things about your system, and also, what can be improved.

If something needs to be improved, how should it be done?

Thanks for the info


From: visiting central CT, USA from Rigel IV, Quadrant 9 | Registered: Jan 2002  |  IP: Logged
skdadl
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posted 18 November 2003 05:52 PM      Profile for skdadl     Send New Private Message      Edit/Delete Post
Because I am caught up in the system right now, I am filled with cranky complaints and criticisms about it. But I value the system none the less, as all our polls tell us the overwhelming majority of Canadians do.

I just happened to be reminded of the comparative stats in this a.m.'s paper: although Canadians spend only two-thirds of what USians do on health care, we live longer. I think that's the broad outcome that matters.

For younger and healthy Canadians, the great thing about the system is that everyone is entitled to an annual check-up, basic tests -- preventative medicine, for instance, which can mean a lot. Every young Canadian woman, eg, can have an annual Pap smear, an easy way to eliminate cervical cancer altogether -- whereas millions of USian women with no health insurance risk waiting till the disease is present -- and by then, usually lethal.

Of late, undeniably, everyone who has had to use the system has noted that all our institutions are understaffed and showing their underfunding in other ways. Many of our health-care workers are overworked, underpaid, and accorded low status -- since many of them are also recent immigrants, that is a significant social problem in my view, and not just for them. No one likes to leave a loved one in the care of workers who are frazzled and/or resentful.

In parts of Canada public-health systems are primitive and confused, as we saw during the SARS crisis last winter. We desperately need decent home-care. And so on.

You might try Googling for some good articles on last year's Romanow Report, a fairly good assessment of the whole system -- and a report that often seems to have been buried ever since.


From: gone | Registered: May 2001  |  IP: Logged
HeywoodFloyd
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Babbler # 4226

posted 18 November 2003 05:56 PM      Profile for HeywoodFloyd     Send New Private Message      Edit/Delete Post
My mom is in the system right now for breast cancer. She had a mastectomy and is at this very moment getting her first chemo treatment.

Dad was in a few years ago for a brain tumor.

In both cases, I have nothing but good things to say about the BC system. They got the treatment they needed quickly, the staff are excellent, the support networks are great.

We could do better but we are doing well.


From: Edmonton: This place sucks | Registered: Jun 2003  |  IP: Logged
mighty brutus
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posted 18 November 2003 06:08 PM      Profile for mighty brutus     Send New Private Message      Edit/Delete Post
I'm with HF on this. Yes, there is room for improvement, but at least we don't have to worry about HMO's chiselling us out of what we are entitled to. In the states, there are 40-60 million people with NO medical coverage whatsoever.
From: Beautiful Burnaby, British Columbia | Registered: Oct 2002  |  IP: Logged
skdadl
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posted 18 November 2003 06:17 PM      Profile for skdadl     Send New Private Message      Edit/Delete Post
Fingers crossed for your mum, Heywood.
From: gone | Registered: May 2001  |  IP: Logged
Smith
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posted 18 November 2003 06:18 PM      Profile for Smith     Send New Private Message      Edit/Delete Post
I would rather have everyone get adequate services than some people get superb services and others get substandard care, or nothing at all.

I'm young and fairly healthy and have no complaints about the system. I've always been able to get what I needed from it.

But it's underfunded and understaffed, which leads to travesties like private MRI clinics running out of hospitals because the hospitals aren't hiring enough staff to run the MRI machines full-time. People seem less tolerant of rising health care costs when they come in the form of tax hikes.

My grandmother just moved into a private retirement home, and they have facilities there that few Canadian hospitals would dream of. But they have those facilities because they only accept people in fairly good health who can afford to pay the fees. Treating the very ill is expensive; treating people who can't afford to pay is unprofitable. The market will not provide, so I'm glad the state does, or at least tries to.


From: Muddy York | Registered: Oct 2002  |  IP: Logged
'lance
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posted 18 November 2003 06:23 PM      Profile for 'lance     Send New Private Message      Edit/Delete Post
I think the fee-for-service model, which practically forces people like GPs to cram as many patient visits into a day as possible, could be seriously overhauled.

This might require more doctors, and nurses and technicians for that matter. But then, there are thousands of immigrant professionals who aren't allowed to practice in their fields because of restrictive qualification requirements (and not just medical people, of course, but engineers and so on). I can only suppose that the professional associations want to restrict the number of professionals who can actually practice, in order to keep salaries from dropping.


From: that enchanted place on the top of the Forest | Registered: Jul 2001  |  IP: Logged
Mr. Magoo
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posted 18 November 2003 06:27 PM      Profile for Mr. Magoo   Author's Homepage     Send New Private Message      Edit/Delete Post
quote:
which practically forces people like GPs to cram as many patient visits into a day as possible

... or they'll never pay off a boat and a cottage!


From: ø¤°`°¤ø,¸_¸,ø¤°`°¤ø,¸_¸,ø¤°°¤ø,¸_¸,ø¤°°¤ø, | Registered: Dec 2002  |  IP: Logged
skdadl
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posted 18 November 2003 06:29 PM      Profile for skdadl     Send New Private Message      Edit/Delete Post
quote:
But they have those facilities because they only accept people in fairly good health who can afford to pay the fees. Treating the very ill is expensive; treating people who can't afford to pay is unprofitable.

From experience, I know this to be super-true.

Private nursing homes claim to be able to cope with dementia/Alzheimer's patients, eg, but in fact they cannot cope with the severe anxiety and agitation that eventually most people with dementia go through. Their main ways of coping are (1) heavier drugs and (2) pressing families to pay for extra "dedicated" workers.

However posh the private homes look, and some (not all) do, it is such a relief -- I cannot tell you -- to go from one of them, where a seriously ill person is treated as a pariah, to a public home where every symptom is recognized and coped with compassionately. (Still not cleverly enough, in my view, but ...)

Many of the homes in our "public" system are in fact privately owned. We have public-public, public-private, and private. In my experience: go for the public-public. Values, you know. When people are sick, values matter.


From: gone | Registered: May 2001  |  IP: Logged
HeywoodFloyd
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posted 18 November 2003 06:34 PM      Profile for HeywoodFloyd     Send New Private Message      Edit/Delete Post
Thanks for the thoughts SK

I tell you, when my parents were diagnosed, I would have sold everything I owned if it meant they could have gotten better treatments. Not that they had bad treatments or care. Like I said, it was excellent.

Still, nothing is too good for family.

What does this mean? If I had to pay for an MRI scan to ensure that a family member got fast treatment then I would. If I had to pay for surgery because the public queue was backed up past the life expectancy of the family member needing treatment then I would.

I don't claim to be an expert on health care delivery. All I know is if I had to pay, I would. I don't think I should have to pay for all of it.


From: Edmonton: This place sucks | Registered: Jun 2003  |  IP: Logged
Rufus Polson
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posted 18 November 2003 06:40 PM      Profile for Rufus Polson     Send New Private Message      Edit/Delete Post
This is a classic case where much of what's wrong with the system *could* be solved by throwing money at it.
Which is not to say that there aren't plenty of improvements that could be made, some of which (e.g. in the field of prescription drugs) would save money. But a lot of the acute stuff, the "system seeming to fall apart at the seams" stuff, basically just needs some more cash to fund some more beds and some more nurses and some more equipment. Places where emergency is being abused because there aren't enough long-term care beds, you put in more long-term beds. Places where there's months-long waits for MRIs, you buy a couple of MRI machines and/or fund a couple more technicians to run the ones you have. Places where there's ages long waits for surgery, you hire a couple more surgeons and fund a couple more operating theaters. Problem solved. Many elements of the difficulty with health care are way simpler than they're made out to be.

Once that's done, it puts us in a better position to look at moving things forward. Ultimately, I'd love to see a system where you had hospital districts controlled in a more democratic way by the staff and doctors together, and where you had ongoing monitoring of life expectancies and quality of health in all the districts, and the health staff in each district given bonuses based on improvements in those things over time. That'd help get everyone pulling together. Within that, let them decide where they want to devote their efforts in terms of preventive medicine versus acute care, diet intervention, home care or community centers versus central hospital funding and so on and on. Maintain standards of access, but define them such that you're not mandating models. Decentralized little clinics, house-call based models, mid-size integrated community centres and big honking hospitals may all meet the standard that any sick Canadian should be able to see a qualified health care professional and get care when they need it.

To make sure they've got the information they need about what will work, maintain national and provincial centers for education and study of different kinds of health intervention, and encourage/make it easy for doctors, nurses, and everyone else down to cleaning staff to continue their education and keep their ideas current. Perhaps tie income to skills; every certification you get, even if your JD involves processing trash, gets you some extra $$. I don't know whether they're still doing it, but my understanding is that the Canadian Armed Forces used to do that and it worked very well.

And drastically restrict drug company advertising to health care personnel. Their propaganda is seriously skewing prescription patterns.


From: Caithnard College | Registered: Nov 2002  |  IP: Logged
'lance
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posted 18 November 2003 06:57 PM      Profile for 'lance     Send New Private Message      Edit/Delete Post
quote:
... or they'll never pay off a boat and a cottage!

Yeah, but I don't believe it's GPs who pull down the mega-bucks -- particularly when you factor in the hours some of them have to work, at least in rural areas. Another detail is that the they typically have staffs to pay.

It's specialists who really make serious coin. One reason it's apparently getting harder and harder to get medical students to choose family practice as a field of study.


From: that enchanted place on the top of the Forest | Registered: Jul 2001  |  IP: Logged
arborman
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posted 18 November 2003 07:08 PM      Profile for arborman     Send New Private Message      Edit/Delete Post
The debate in recent years about a health care system 'in crisis' has mostly been in the media. There have been unique cases of people waiting overlong for treatment, and they have been blown out of proportion.

The health system 'crisis' is mostly a phantasm. Most people referring to it in such a way will, when pressed, admit they have had pretty good service when they needed it, but they have 'heard' about bad cases etc.

Another media driven frenzy in a teapot, basically. The underlying system is strong, but we do need to pay our doctors and nurses enough, as well as ensure their working lives etc. are livable (ie not 60 hrs/week).

I can give an interesting comparison, having needed the exact same surgical procedure in 2 different provinces inside of the same year. It's minor/day surgery, and not a life threatening condition (unless left for years). I lived in Ottawa for a year.

Shortly after I arrived in Ottawa, the symptoms appeared. Having experienced them before, I went to a doctor and asked for a referral to a specialist (ENT). I got an appointment about 4 months in the future (this already knowing what was needed). When I finally saw the specialist, his hospital did not have the capacity to do this (very minor) surgery, so he referred me to another specialist, whom I could not see for another 4 months. By the time I finally saw the second specialist, my throat had progressed to the point that I had no voice (my friends called me whispers). He was able to squeeze me in (for a 5 minute surgery, mind you..) 3 months later, which was to be 2 weeks before I left to move back to BC. I finally had the surgery.

When I arrived back in BC, I found (through a reoccurence of the symptoms) that it had progressed so far while I was waiting for surgery in Ontario that another round would be required. I went to see my old doctor and start the whole routine over again. He referred me to a specialist (ENT), which took exactly 12 minutes. The specialist was able to find a space for me the following Monday.

So in Ontario, after a few years of Harris and the gang, it took almost a full year to access a needed, though admittedly not life and death, surgery. While my life was never in danger, my ability to work and function was significantly affected by not having a voice (try it sometime).

In BC, where the devil had only just begun to have his way, it took a week. It also happened quickly enough that I haven't had to go back, and probably never will.

Case study of the effects of an underfunded right wing damaged health care system. I fear the long term effects if Campbell and co. continue wreaking their havoc here over the long-term. We might get to be as bad as Ontario, which would be a tragedy.


From: I'm a solipsist - isn't everyone? | Registered: Aug 2003  |  IP: Logged
Smith
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posted 18 November 2003 07:15 PM      Profile for Smith     Send New Private Message      Edit/Delete Post
quote:
Private nursing homes claim to be able to cope with dementia/Alzheimer's patients, eg, but in fact they cannot cope with the severe anxiety and agitation that eventually most people with dementia go through. Their main ways of coping are (1) heavier drugs and (2) pressing families to pay for extra "dedicated" workers.

The retirement home my grandmother is in does not even claim to be able to cope with such patients, which is fair enough. It's more like a rather luxurious dormitory than a hospital or nursing home, which is fine, because my grandmother doesn't need a nursing home or a hospital. If she were seriously ill, we'd be back on the public system.


From: Muddy York | Registered: Oct 2002  |  IP: Logged
Nam
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posted 21 November 2003 11:24 PM      Profile for Nam     Send New Private Message      Edit/Delete Post
I believe one of our greatest assets in regards to our health system is our (tattered) social safety net. The single largest determinant of one's health is how rich one is. Recently in Calgary, Dennis Raphael from York University spoke to a large group of us, and it boggles the mind why our health care providers aren't more up front about the benefits of reducing poverty on the health of our nation. Instead of "healthy lifestyles" campaigns based on eat your fruits and veggies, they should be doing work on getting rid of poverty, and seeing the lowering of costs to our health systems. Raphael has a very funny, and very pointed, slide in his presentation that describes how to ensure a healthy life. The first point is "Don't be poor. If you are, stop it. If you can't stop, be poor for as short as time as possible". The second point is "Ensure you are born to rich parents". Anyways, just a reminder that healthcare is about so much more than doctors, nurses, hospitals etc.
From: Calgary-Land of corporate towers | Registered: Dec 2002  |  IP: Logged

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