The Independent Newsweekly
Issue Date: June 18, 2004
Canadian confidence in health system falters
By ARTHUR JONES
Canada, once the industrialized worlds health care poster child, is today more like a surly teenager.
Canadians remain healthier than Americans, and it doesnt cost them as much to stay that way. Total per capita Canadian health spending is only $3,000 a year in U.S. dollars, compared to $5,000-plus in the United States.
Even so, Canadians arent deliriously happy with the health care they receive.
Hubert Gauthier, president and CEO of St. Boniface Hospital in St. Boniface, Manitoba, said patients in the United States worry about how theyll pay for treatments like a new hip. In Canada theyre worrying about how long theyll have to wait to get one. It could be six months or more.
Consequently Canada has recently been through a prolonged national dialogue related to the Romanov Report on its health care systems condition and its future shape.
Ask Gauthier how his country created Health Care Canada, its national health care service, and he cuts straight to its origins: Go back a bit and it was the religious orders, they were the driving force. They were owners of the facilities, they were the public health system before we had a public health system. And they were in the forefront of the public push for health care for all.
Understandably, when government is the source of funding, government wants to run the entire operation. In a 1990s restructuring of the hospital systems nationwide, many institutions were closed or combined to avoid duplication. The Catholic presence has shrunk dramatically -- though only in the same proportion as that of other religion-based or charitable providers.
The Catholic Health Association of Canada, meeting here in early May, was fine-focusing its goals. First among them is to influence public policy at the federal level.
That said, what 32 million Canadians get for their money is that everyone is covered.
Statistics tell the tale
Take care of the poor, the elderly and the marginalized and the national health, per se, improves. Studies by the World Health Organization, Organization for European Cooperation and Development, United Nations and private foundations all tell succinct tales.
And the United States comes out looking like a mean-spirited anti-health ogre, because it has the greatest income disparity in the industrialized world and the highest poverty rates. More than 22 percent of U.S. children live in poverty compared 15.5 percent in Canada. Americans have the lowest level of national health care coverage and the highest levels of drug abuse.
Most industrialized nations provide 100 percent health care coverage. Other countries, such as Germany, Belgium, Spain, Switzerland, France and Austria cover more than 92 to 99 percent of their populations. The industrialized laggards are Holland (around 75 percent), and the United States, where 40 percent of the population comes under programs such as Medicare and Medicaid.
While Americans throw more money at health care per capita than any other country in the world, their general health isnt as good. Canadian men and women outlive American men and women by two or three years, Americans are fatter than everyone in the industrialized world but the Swiss, and Americans access to essential routine health care is abysmal. Millions of Americans simply cant afford to go to a doctor.
Case in point: A recent Diabetes Care analysis that compares diabetes case management in the United States and Canada shows that Americans have a greater chance of not receiving care than Canadians, due primarily to lack of access to a physician.
There isnt a single measure in which the U.S. excels in the health arena, Stephen Bezrucha of the University of Washingtons School of Public Health told the Los Angeles Times recently. Nothing determines the health of a population more than the gap between rich and poor.
Canadian infant and maternal mortality rates are lower than in the United States. Far more Canadians than Americans suffering from severe mental disorders receive required mental health care. According to a 2003 Commonwealth Fund survey of five industrialized nations, Canadians have a far better chance of surviving liver and kidney transplants, childhood leukemia and colorectal cancer than Americans, but on a percentage basis more Americans survive heart attacks, breast cancer and cervical cancer.
Canadas woes include evidence of a U.S.-style private-payee system nibbling at the edges of its national health system. In some government run hospitals, private contracts can be made that offer after hours health procedures -- an illustration of wealth finding a way around waiting lists. Current Canadian Conservative Prime Minister Paul Martin scoffs at what he calls checkbook medicare, and in early May attacked those who advocate for-profit health care.
Constitutionally in Canada, explained Richard Haughian, president of the Catholic Health Association of Canada, health care is both a federal and provincial responsibility. Delivery is provincial; the federal government provides the funds and develops the standards. Influencing those standards is a key issue for the Catholic Health Association (see below).
Canada has other problems -- based more on lack of trust than lack of money.
CEO Gauthier warned of big accountability issues. The 2002 Romanov Report (officially, the report of the Commission on the Future of Health Care in Canada) showed Canadians have high expectations of their system but less confidence in the governments ability to deliver it effectively.
Canadians worry about the governments ability to track where the money is going or keep a watchful eye on health care taxes and budgets earmarked for health care expenditures.
Even so, said Gauthier, look at what Canadians get: They dont have to pay premiums, or co-pays, or fight with insurers. They dont know how much their care costs; they dont even see the bill.
Perhaps, he said, they should.
Added Catholic Health Care president Haughian, [Prime Minister] Martin will guarantee the provinces more money for the next 10 years, so theyve got security, but Martin is saying, Part of the [post-Romanov] bargain is well work together in a new way but theres going to be a new accountability.
Whether hell be able to achieve this, said Haughian, is a good question. But its a response to the popular mood.
Arthur Jones is NCR editor at large. His e-mail address is firstname.lastname@example.org.
National Catholic Reporter, June 18, 2004
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