From: gld@cunixb.cc.columbia.edu (Gary L Dare)
Subject: Re: Canadian healthcare system
Followup-To: talk.politics.medicine
Organization: Deep Space Nine (DS9)
Date: Tue, 26 Jan 1993 21:14:07 GMT

clarke@watson.ibm.com (Ed Clarke) writes:
>
>My understanding is that some "standard" things (MRI, CAT) require 
>very high priced equiptment.  Canadian doctors don't have the hardware 
>available because their government won't pay for it.  Here, everybody 
>and his brother buys the hardware and then looks for patients to keep 
>it busy.

Unfortunately, what they don't tell you down here is that our doctors
are private and only the basic insurance is "public".  The government
doesn't take part in providing the health care (thank goodness) but
only as a vehicle for routing insurance dollars.  In relative terms,
an HMO is much more overbearing and intrusive (a la true socialized
medicine) than what we Canadians know, using unbridled real insurance,
even though it is public -- culturally, basic medical needs are not
viewed by most Canadians or Europeans as a commodity such as owning
a VCR; that aspect is non-market, while non-medical stuff including
the kind of hospital room you can afford, etc. is still market.

Private insurance is available individually or as corporate benefits
for non-basic medical amenities.  You can probably get a copy of what
IBM Canada offers your colleagues in the way of benefits like private
or semi-private hospital rooms, tv, telephone, private ambulance
transport, etc.

Canadian doctors are as welcome to buy hardware as are public or
non-profit private hospitals*, especially since their take-home pay is
well equivalent to their American cousins ...  the difference in gross
pay is almost entire accounted for by the near-absence of malpractice,
making that insurance an order of magnitude lower.  However, there are
cultural factors involved (one of my friends, now a doctor, is trying
to organize an entry for the next America's Cup, so that means no
funds for an MRI at his office).

[France and Germany have practically the same system as Canada, but
with aggressive private for-profit hospitals in the French case.  A
small population, unevenly distributed, works against this for Canada.
Please refer to an atlas showing population distributions to see this.]

Doctors in Canada must licence and capitalize their own practices.
Pay rent.  Hire office staff and nurses.  Group together into firms
just like lawyers.  Nobody tells them how to do those things within
the law.  Patients come in, doctors expect to get paid.  They bill
insurance for whatever was done.  No insurance? -- then it's cash
(e.g., some tourist emergency, or American tourist with private
insurance plan that has stiffed their practice in the past).

I've not seen any differences at this level in either Manitoba,
Alberta, Ontario, Quebec or New Jersey (my girlfriend gets what is
arguably some of the best health insurance from her father, a research
exec with a major Euro-American drug firm, had a back condition and
from seeing her go through the rounds in New Jersey, that reminded me
almost exactly of what I saw back home in Winnipeg -- I'm the one who
usually gets stuck driving a friend or relative to the doctor ...
hey, maybe I'm that good?  (-;).

gld
--
~~~~~~~~~~~~~~~~~~~~~~~~ Je me souviens ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Gary L. Dare
> gld@columbia.EDU 			GO  Winnipeg Jets  GO!!!
> gld@cunixc.BITNET			Selanne + Domi ==> Stanley