From: fulk@cs.rochester.edu (Mark Fulk)
Newsgroups: sci.med
Subject: Re: Physician's Incomes
Date: 17 Dec 92 18:43:10 GMT
Organization: University of Rochester

In article <BzEy3t.D7q@acsu.buffalo.edu> oispeggy@ubvmsd.cc.buffalo.edu (Peggy Brown) writes:
>Health insurance is a different issue entirely.  I do support 
>a minimum level of health insurance for everyone.  I am not at 
>all familiar with the Canadian system, but I would want to find
>out what problems they have, before saying "let's do what they
>do."
>
>- Peggy -

This issue has been thoroughly ventilated in the press over the last
few months.  The conclusions I've picked up on are as follows:

1) The Canadians spend very little on health care _administration_, as
compared to the US.  A lot of the difference is in the doctor's offices:
doctors don't have to employ staff that deal exclusively with insurance
claims.

2) In general, Canadians exhibit a high degree of satisfaction with their
system.  Public opinion of the health care system is much higher in
Canada than nearly anywhere else.

3) Canadian health care costs are well below the US amounts, 30% or more so.

4) On the other hand, Canadian health care costs are inflating well above
the general rate of inflation, although not as rapidly as in the US.
I don't remember the specific rates, but 6-7% for Canada (10-15% for the US)
sticks in my mind.

5) At least some parts of Canada don't have as easy access to hi-tech care
as is common in the US.

On the _other_ other hand...

4') I'm not sure that we should regard all relative rises in health care
costs as being inflationary.  Many of the goods we use are becoming a
great deal easier to make, in terms of labor, energy, or other resources.
Medicine is not experiencing such a cost reduction, and it is not clear
that such is possible.  Consequently, it should not come as a surprise
that a greater fraction of income is going to health care now than previously.
We also expect a great deal more of health care than we did in the past.
The percentage of citizens in the older years, who require more expensive
care than younger folks, is increasing.

5') Some complaints about, e.g., the distance to an MRI scanner, have
originated in such places as Winnipeg.  An awful lot of the Canadian
population is concentrated in southern Ontario (Toronto, Ottawa) and
southern Quebec (Montreal).  It is easy to forget how sparsely the
population is scattered in Manitoba and Saskatchewan.  Torontan friends
say that they have quite as fancy a level of care as say, Bostonians.

Ruth Croxford tells me that the rules about supplementary insurance and
extra fees have changed: doctors charging above the provincial insurance's
rate have to bill the patient, who cannot get even part of the bill back.
Supplementary insurance has been restricted to areas not covered by the
government.  This applies to Ontario, but she thinks that the other
provinces have similar rules.  I suspect that this is a response to the
inflation rate in health care, and it seems to me that the changes are
really unwarranted.

One difficulty with the Canadian system is that it is a _provincial_
system, not a federal system (until recently, when the federal government
started to pick up part of the tab).  I think that the mobility of the
American population militates strongly in favor of a national plan.  I, for
one, have changed states twice in eight years, and five times in my life.
-- 
Mark A. Fulk			University of Rochester
Computer Science Department	fulk@cs.rochester.edu