dmccread at MACH1.WLU.CA
Tue Sep 12 01:44:58 MDT 1995
> For the record, I have described the system in Ontario like a giant HMO.
> Since everyone participates you are free to choose any doctor, any
> hospital etc. Dr. DJ chimed in with an example of our government denied
> chemotherapy to a liver cancer patient, then prohibiting that patient
> from paying for that care themselves. I condemned the restriction on the
> patients freedom but maintained that a single payer system can cut costs
> and thus include more people in the system.
The system actually provides more services per patient than the
US system but the reimbursement is about 50% of what the US system
reimbursement is. Moreover, the choice of doctors in the US system is
sometimes an illusion when one is with an HMO (at least with certain
ones) and managed care does reduce the freedom a patient has. I am not
uncritical of the US system - but I am just as critical of the Canadian
system - I am giving a paper criticizing both systems and the British in
Virginia next month.
> We have also gone past the overuser/hypochondriac problem that we have
> with a system that does not incorporate a user fee. We have tried to
> address this with walk in clinics for normal maladies. I could also add
> the old argument that by encouraging preventative care we save lots by early
> prevention of chronic conditions, but I am not sure that this can be
> clearly supported by the statistical evidence.
Will, we have not gone beyond the hypochondriac problem. Indeed,
there is evidence that elderly people in Winnipeg use as many as four
primary care physicians in one day (none fo the uses major) so it must be
like a social outing for them.
Also, if we wished ot provide preventitive care we would do much
in the way of putting naturopathy and chiropractic into the system and we
would have nutritionists and others involved - as some HMOs have done in
the US. I am quite sure the price system used in the US discourages both
the hypochondriac and ensures a greater degree of prevention (as
evidenced by the fact we get about 125% of services per patient as US
The savings in the Canadian system are poor pay for physicians
(you are right the average is about $120,000 per primary care physician)
which you must remember is gross. There is also a different mix - we have
about only 10% of the specialists as the US - which means much of our
care is of a lesser level of sophistication and is cheaper.
> Paul suggested that we could not compare the two systems so I'll pass the
> buck over to you Paul.
I am not Paul - is what I have written helpful to this debate - I
have been away so this might be late getting to you.
> > I would also reiterate Will's comment that our system also is not perfect
> > but at least it places a greater emphasis on consumer wants and needs rather
> > than what the gov't wants.
I think we can all agree on this - although lately the insurance
companies have been playing the role governments play here - I have only
begun to realize that as I research the topic. I never could understand
why there was not the feeling of pleasure at having such a great system
as the US system until I realized the insurance compnaies could be
perverse. Still if your employer permits choice which some do then you
get to choose which we do not.
> Likewise, our system is imperfect but when you have a private insurance
> carrier motivated by lowers costs they have an incentive to lower cost by
> restricting the quantity and quality of coverage, ie new moms being pushed
> out of hospitals early, or my father-in-law initially denied Nupegen(?) by
> his insurance carrier to combat the effects of his chemotherapy.
Whether it is the insurance company or the government the effect
is the same - just you have in the US more chance of changing it by
changing insurance carriers whereas here the government does not change
the system even when an election brings in another set of politicians.
> I hope this brings you up to date, I have tried to give you an unbiased
> synopsis of the discussion to date, but since I aspire to publish in the the
> NY Times :) perhaps others will note my biases and disagree.
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