From: gld@cunixb.cc.columbia.edu (Gary L Dare)
Subject: Re: The Canadian Health System: Better
Followup-To: na
Reply-To: gld@cunixb.cc.columbia.edu (Gary L Dare)
Organization: Curious Goods (formerly Louis Vendredi Antiques)
Date: Fri, 21 Aug 1992 04:29:50 GMT

In article <1992Aug19.082947.1@uwovax.uwo.ca> singer@uwovax.uwo.ca writes:

>Canadian system is described as somewhere between that of Sweden and
>the U.S., in fact it is to the "left" of Sweden's system (for a good
>description of the latter see H. Bergstrom, "Pressures Behind the
>Swedish Health Reforms, Swedish Information Service or c/o Dagens
>Nyheter (Newspaper), Stockholm.) I believe the "socialized" Canadian
>health system is one of the reasons why Canada was rated by a UN
>survey as the best country in which to live.

Actually, as a Canadian with medical friends back home in private
practice, they would be very surprised to hear that our system is
"socialized" ... usually, this kind of talk comes from American
ideologues who want to negatively present our system as being more
Sovietic than any reality and never mind any distinctions ... a lot 
of myths have been debunked down here (never mind what our own press
says, folks can't even buy it down here) by CNN's recent focus series
on Canadian medicine in early June, but there are still occasional
murmurs from the "don't you all live in igloos?"  crowd ...

The rest of this article is a summary I post around USENET explaining
what the real Canadian health care system is like.  This dispels spins
by both the American right and "left" on what our system does ... it is
a hybrid public/private system like in richer European countries.  The
follow-ups are being sent out of this newsgroup to an appropriate place.

Also, the Summer 1992 edition of France magazine (available from most
college French departments and branches of the Alliance Francaise)
describes their system, which is very very very similiar to Canada's
(and may have been the basic model we chose; I don't know the history
here ...).

[One further note, the information used by critics about "dying in line"
come from a study by Vancouver's conservative Fraser Institute (and thus
the cited references to British Columbia) commissioned more than a decade
ago, when even Americans waited 6 months for bypass operations (which is
said to be overdone in the States anyways).  A follow-up Fraser study in
response to how their American cousins used their old numbers exists but
has been conveniently ignored by people who "can't get at it" although it
has been available for almost a year.  Current queue times are ~3 months,
and only so because emergencies get bumped to the front ...

CNN had a hard time finding convincing evidence of the mythical massive
queues for their focus serieson Canadian medicine in early June, 1992.]



Canada has a public health insurance system ("PHI" in Americanese)
funding private doctors, and public and private hospitals.  They are
paid on a per-procedure basis according to a fee shedule as per any
insurance plan in America.  Doctors' guilds in each province negotiate
the fee schedule, and their offices run the standard billing software
(97% are billed to the provincial plan).  Each province is in effect
an HMO, with every resident having access to choosing their own doctor
and hospital in that province (outsourcing to bigger, richer provinces
upon approval of the insurer/HMO).  France and Germany also have PHI;
all three are known as fiduciary in legalese (i.e., not an arm of the
government to pound on particular people, a fave American paranoia;
it's just a passive pool that pays bills from earmarked tax funds).

The fee schedule is for the provincial HMO, but doctors in some
provinces can charge higher rates in cash, too, and let the patient
get the reimbursement.  No doctor is obligated to bill the provincial
HMO, but if you're in Canada it'd be stupid not too ... you'll find
the odd loner who is bogged down by ideology and goes the cash-only
route.  Since our doctors run private practices with billing software
(97% of the database entries are to the provincial health fund) they
can take cash.  In fact, a couple of my medical friends have said that
they'll only take cash from Americans (and let them sort things out
with their insurance) because they have been weasled by American
private health insurers when presenting bills for their clients.

Oh yeah, there is also private insurance in Canada for stuff that is
not basic medical (bandages to brain surgery).  This gives you perks
like one would get in a premium U.S. hospital like private room, a
cellular telephone, etc.  Private insurers are happy that it's all
they have to sell to individuals and for corporate bennies, and if the
Tories or Liberals ever dared to "go American" the political moneymen
at London Life, etc. will raise holy hell (friends in insurance tell
me that, anyways) before flashing their political donation money.

On the other hand, Great Britain runs a National Health Service (NHS)tm
which is closer to what Americans call "socialized medicine".  Doctors
are salaried out of the public purse and a bureaucrat oversees the use
of services (gee, doesn't this sound familiar? (-;).  NHS is not PHI.

While I cheer the U.S. for being a leader in creating free markets
around the world (trade harassment of imports aside), the medical
coverage issue is ideologically polarized, too overly simplified (see
paragraph #2), and what we call "not invented here" in engineering ...
Canada, France and Germany are not valid labs to gain experience from
although their doctors and hospitals are (or can be, in the latter
case) private.  The terrorist Georges Habash was treated at a private
hospital in France last spring, but its regular customers pay it out
of their public health.  However, I am aware that the US public and
government have a more hostile relationship than we know in the rest
of the West ...  I'm not proposing any solutions for you guys, just
trying to set the record straight.

[My own prediction is that the U.S. will go to a system where basic
coverage is covered by a public pool, but brokered by private firms
who will offer what we call "private supplementary" up north on top of
it all (basically, filling out what their current policies are).  The
same class differentiations in the U.S. and Canada will remain due to
the presence of "private supplementary" and those who can pay for it.]

gld
--
~~~~~~~~~~~~~~~~~~~~~~~~ Je me souviens ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Gary L. Dare				Elections 1992-93:
> gld@cunixB.cc.columbia.EDU		* Jean Chretien (Canada)
> gld@cunixc.BITNET			* Perot^H^H^H^H^H Elvis! (USA)