Medical Device Daily Canadian Correspondent

The state of the nation north of the U.S. is strong. Tops among G7 nations in job growth. A world leader in education. A housing market and a retail sector that continue to show strength as others falter.

Canada, just about everyone agrees, is in pretty good shape, a consensus all the more remarkable for comparisons made with the U.S. and the widely shared view that America is on the brink of — if not already in — the trough of recession. And for the moment, that old dictum which says when the U.S. sneezes Canada catches a cold seems to have been put to rest.

However, the health of Canada’s healthcare system may be feeling a bit ill, paralleling symptoms in the U.S.

The Canadian Medical Association (CMA) last month released a study showing that in 2007 Canadian patients waiting for healthcare services in only four clinical areas cost Canada’s economy $14.8 billion in lost productivity and health expenses. Meantime, a study released by the European Health Consumer Index ranked Canada’s healthcare system 23rd among those of 29 European countries, and dead last in terms of value for money spent.

All of this is consistent, Brian Day, MD, president of CMA, told Medical Device Daily, citing the fact “that six or seven” of these European nations “spend the same or less than Canada does on healthcare.

“We’re with countries like Romania and Hungary, while countries like Norway and France, Austria, France, Switzerland and Germany that have universal healthcare are at the top,” Day said. “And what’s different is [Canada] is spending billions and billions of dollars to keep people waiting for healthcare. That’s how silly the system is.”

Day lays much of the problem at the feet of Canadian healthcare policymakers who long ago chose block funding as the primary method for financing public hospitals. When hospital administrators receive a lump sum payment at the beginning of each fiscal year, they spend the remainder of the year preserving that budget by rationing services to patients.

As a result, says Day, many patients wait – often up to a year or more – for medical treatment that the Canadian Health Act says they are legally entitled to.

Another result is that hospitals are slower to release patients from their care because this would make room for other patients in need of more immediate, more acute, more expensive medical care.

“In other words,” he says, “the consumer is at the bottom of the pyramid.”

He says that a better alternative to this “reverse incentive” would be to allow patients to pay for each procedure using their Medicare card. In this way, hospitals would be forced to compete with one another, generating revenues by providing patients with better, faster service.

Others are more skeptical about this new “patient-centered” approach to healthcare, viewing the term — and others such as “sustainable” healthcare — as code for up-ending a system they say is already working relatively well.

Among them, is Roy Romanow, author of a report on healthcare that recommended a stronger federal and provincial commitment to Canadian healthcare.

“There is very little evidence that [the current healthcare system] is unsustainable,” Romanow told Medical Device Daily. “It is argued that the percentage of provincial healthcare budgets increase. That is correct but, overall, provincial budgets increase as well and proportionately they remain the same.”

“Well he’s absolutely wrong,” counters Day.

“Between 1984 and 2005 the population in Canada rose 25% while healthcare costs rose 400%. If you look at GDP we were spending 6% in the 60s on healthcare, 7% in the 70s, 8% in the 90s and now we’re at 10.5 %.”

Day says it’s no conspiracy that every finance minister in the country says the status quo in healthcare is unsustainable. Canada, he points out, now has the highest percentage of people over the age of 65 in its history, along with the lowest percentage of those under 15 years of age.

Who, he asks, is going to provide the funding as the baby boomers age?

“If you’re 90, it costs the system $20,000 a year. If you’re 20, the system costs are $1,000 a year. So with an aging population and a shrinking pool of tax paying workers, this is unsustainable and every finance minister in the country believes that.”

Those who support the current system and those seeking radical reform are no closer on other issues. The CMA wants Ottawa to develop a strategic plan to address the shortage of health professionals across the country.

The Health Council of Canada, however, says the problem is not so severe, citing a recent survey in which the vast majority of Canadians (96%) report having either a regular medical doctor or regular place to go for primary healthcare. Where Day endorses the use of private clinics to take the pressure off publicly operated hospitals and clinics (he runs his own facility, the Cambie Surgery Center, in Vancouver) others argue that the solution is to do a better job in the public system rather than using more private health clinics.

Don Juzwishin, MD, Health Council CEO, told Medical Device Daily, “In terms of facilitating efficiency and effectiveness within the public system,” the solution isn’t necessarily to “fall back on to the private argument as a complementary way of solving that problem. All that does is simply allow people to jump the queue for healthcare services.”

If there is agreement anywhere it is for physicians to become better organized by availing themselves more readily of new technology.

Juzwishin says, for example, that many physicians maintain an “antediluvian” attitude towards electronic health records, technology that would increase coordination of the system by facilitating communications among healthcare providers.

But even here Day takes issue. Physicians and hospitals, he says, don’t invest in new technology — or make full use of existing technology — because there is no incentive to do so under the current funding formula.

“When you have a global budget, what is the incentive to run your MRIs in the evening when patients are using up your money? If the system was focussed on the consumer and the patient, there would be an incentive to be more productive, efficient and effective.”