NRL News
Page 6
April 2009
Volume 36
Issue 5

Inadequately Funded Universal Health Care Leads to Rationing:
Part 1—Canada
By Roger Stenson with Jennifer Popik, J.D.

NRLC has long argued that the cost of health care does not require rationing lifesaving treatment. See http://www.nrlc.org/MedEthics/AmericaCanAfford.html  As Congress prepares to pass health care reform intended to have universal coverage, it is critically important to include a means of sustainable, adequate funding for it (see www.nrlc.org/MedEthics/SaveNotRation.html), so as to lessen the real danger of rationing. We have too many examples of what can go wrong in the rationed health care systems elsewhere that rely on general fund revenues.

Canada has a “single payer” system. Basic services are provided by private doctors paid for by the government at an annually “negotiated” rate. It is funded by Canada’s 10 provinces and two territories, with the aid of federal block grants comprising about 16% of the cost. Provinces rely primarily on income taxes, supplemented by sales taxes and lottery proceeds.

Dr. David Gratzer reports that “[a] survey in 2000 involving 1,500 people suggested that a full eight out of ten Canadians consider their health-care system to be ‘in crisis.’” Dr. Gratzer writes, “On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute. Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care. I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic—with a three-year wait list; or the woman needing a sleep study to diagnose what seemed like sleep apnea, who faced a two-year delay; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks.”

The Fraser Institute counts the number of Canadians on waiting lists for medical procedures at 827,429; the median wait time for an MRI is 10.1 weeks. (The U.S. has five times as many MRI machines per capita.) In 2007, the Canadian Broadcasting Corporation reported that the waiting period between referral from a family doctor and surgery averaged 18.3 weeks across the provinces, with a high of more than half a year (27.2 weeks) in Saskatchewan, which pioneered Canada’s health care system.

A study in the Canadian Medical Association Journal found that at least 50 patients in Ontario alone have died while on the waiting list for cardiac catheterization. When Carri Ash of British Columbia noticed her water break prematurely at home, she was told there was no room, not even a single bed, for her high-risk delivery in all of Western Canada. Only seven months pregnant and obviously in danger, she had to be flown to Seattle.

Physicians are in short supply. Canada has roughly 2.1 practicing physicians per 1,000 people, far less than the world average—a ratio that has not grown since 1990. One community in Nova Scotia conducted a lottery for a spot to see a primary care physician.

 According to data from a joint survey conducted by Statistics Canada and the National Center for Health Statistics, long wait times, physician shortages, and poor health outcomes have meant that “thirty-three percent of Canadians say they have an unmet medical need.”

This has led to the creation of a new industry—health care brokers who assist, for a fee, patients who cannot get timely treatment. While Canadians may not legally pay for private health insurance (other than those who live in the Province of Quebec),  they may pay brokers to arrange medical care they need. Patients otherwise wait to arrange treatment outside of Canada, typically in the U.S. Apart from the brokers, one out of three Canadian doctors send a patient to the U.S. each year. At least seven of the provinces send cancer patients to the United States for radiation therapy.

Meanwhile, one facility in Houston, the M.D. Anderson Cancer Center, spends more money on medical research than all of Canada.

Reports on rationing in other countries will be in future editions of NRL News.