The Canadian system in trouble

September 12, 2004

Advocates of a single payor system often point north to Canada. Many hold up the Canadian system as one we should emulate. Well, that system has cracks – Canada Looks for Ways to Fix Its Health Care System

Ms. Pacione, a retired bookkeeper, said she would like to be at the table when Prime Minister Paul Martin meets with the provincial premiers on Monday for a three-day televised meeting to find ways to alleviate the lengthening waits for basic care in Canada.

“If you are not bleeding all over the place, you are put on the back burner,” Ms. Pacione said, “unless of course you have money or know somebody.”

The publicly financed health insurance system remains a prideful jewel for most Canadians, who see it as an expression of communal caring for the less fortunate and a striking contrast to an American health care system that leaves 45 million people uninsured. But polls indicate that public confidence in the system is eroding, although politicians remain reticent to urge increasing privatization of services.

During the recent closely fought election campaign, Mr. Martin promised to fix Canada’s health care system “for a generation,” focusing on trimming waiting times for diagnostic tests, cancer treatment and elective surgery like hip replacements. He is eager to use this televised gathering, billed as a health care summit meeting, to reverse the current view among many Canadians that his government is vacillating and may well fall next year.

But medical professionals and local officials say a major reason it may not be easy to address the problem of slow access to treatment is because doctors who do preliminary diagnostic work, refer patients to specialists and monitor the care of chronically ill people are less and less available – especially in small towns and rural areas.

Health care costs are increasing everywhere because we can do so much more than we could 10 years ago. Our diagnostic tests have improved – but at increased cost. Our pharmaceutical choices are improving both quality and quantity of life – but at increased cost. We extend life for many diseases (e.g., diabetes, CHF, CAD, COPD) and the extra months and years cost money.

All of these advancements increase the need for routine medical care. We have not produced enough excellent generalists. We need physicians to care for the chronically ill. We need physicians to provide preventive care. But we (and the Canadians) are apparently not willing to pay.

While Canadian family physicians make a decent salary, they (like their US counterparts) do not have enough time to see each patient.

So I urge us to all understand the changing dynamics of health care. We must understand how the stresses of generalist care have changed. Solutions cannot be as simple as developing a single payor system. We must rethink the value of generalist care at all levels – not just here in the US, but in Canada, Great Britain and everywhere else.

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