Canada: Health care spending to reach record $171B: report

[Murrican]

http://www.cbc.ca/health/story/2008/11/13/health-spending.html

Worth noting that all Canadians have free health care at a per person average cost of $5,170 and yet per person costs remain highest in the US at $6,714. Canadian healthcare covers all but most esoteric elective surgery, excluding, for example, vanity surgery, but including just about everything, except private room coverage, unless only private rooms are available (and then it's fully covered, otherwise the difference would be payable). Government-issued health cards take care of everything. Health is delivered by provinces and each finances it slightly differently; in Ontario there's a nominal health fee of about $7 per month for those working, but in most others there's no fee at all. Ontario spends about $30 billion a year for health care for its 13 million residents; including financing hospitals, air ambulances for the remote north, clinics, private doctors, etc. Doctors are paid set rates for procedures and appointments with the pay schedule negotiated every few years.

Despite what you may have heard, it works well. I've seen a specialist 6 times this year, had three involved hospital procedures and one overnight stay, and one emergency vist. My cost: $0. My wait? None.

The US needs a model to deliver health care more effectively and efficiently. The Canadian model works. The trick is the transition and what individuals want, need and want their governments to provide. Now that every other financial fundamental is being re-considered, it's time to take on health care, too.

Or, not? Your opinion?

Health care spending to reach record $171B: report

Thursday, November 13, 2008

CBC News

Health care spending in Canada is expected to outpace inflation to reach $171.9 billion in 2008, up more $10.3 billion from last year's estimate, according to a report released Thursday.

The spending works out to $5,170 per person, with expenditures reaching a record 10.7 per cent of the gross domestic product, the Canadian Institute for Health Information said in its report, National Health Expenditure Trends, 1975 to 2008.

This rate has climbed gradually since 2002, from 10.0 per cent that year.

"Health care spending is expected to grow faster than Canada's economy, outpacing inflation and population growth," said Glenda Yeates, the president and CEO of the institute.

"In the context of recent changes in the economy, it is important to keep monitoring these trends in order to better understand how our dollars are being spent and how we compare to other countries."

Canada was in the top fifth of countries in the Organization for Economic Co-operation and Development in terms of per person spending on health in 2006, spending $3,678 US per person — a similar amount to France, Germany, the Netherlands and Austria.

Spending per person on health care remained highest in the United States at $6,714 US, followed by Norway ($4,520 US), Switzerland ($4,311 US) and Luxembourg ($4,303 US).

[lions1mew]

I've been all for universal health care for ages. I was hired at my present job in April '01, promised a raise and health insurance within 6 months. Didn't get a raise for 18 months and then only 50 cents an hour and to top it off, didn't get health insurance until one year ago.

I haven't used anything except the vision to get stronger glasses. Haven't seen a doctor in over 10 years. I'm healthy and don't really see the need. I realize I need to get a well check-up because I'm not as young as my brain seems to think I am *smirks* so I'd like to see one soon just to get looked over.

I pay $86 every two weeks and that's on top of my boss contributing $100 a month. If I could put that into a universal health care fund and not have to worry about co-pays or deductibles, I'd be thrilled beyond words.

[Murrican]

In contrast, I pay $7 a month when employed on an hourly basis (employer pays the same amount per employee per month, I believe). Due to the nature of my current employment, I pay $0 per month/year. And I've used the health system more this year than in any year since 1988 (in the meantime both parents had lengthy hospital stays before passing away, and there were no costs).

The US system really needs reform...

[ConnieB]

In contrast, I pay $7 a month when employed on an hourly basis (employer pays the same amount per employee per month, I believe). Due to the nature of my current employment, I pay $0 per month/year. And I've used the health system more this year than in any year since 1988 (in the meantime both parents had lengthy hospital stays before passing away, and there were costs).

The US system really needs reform...What about the cost of your taxes?????

There is a guy in my nursing clinicals who moved here from Windsor and he said the taxes in Canada are very high, plus he moved here because we do have better medical. His wife had to wait 3 to 4 months for her test, then 5 more months for her surgery. To me that is NOT good health care. If this had happened to my dad, he would most likely have died from cancer. It was the fast action that caught it in time. He had ALL his test done within one week and the results the day after those test were done. I do not feel he would get that type of care with universal health care in the US.

First, our nation WILL NOT be able to supply health care to everyone without getting the money from some place, and where do you think that place will be?????? the American people. So actually health care WILL NOT be free. Nothing is ever free!!!!!!!!!!!!!!!!! even through the government.

Second, I've been to Medicaid clinics and the waits are long because they over book their patients just to get more money from the government. WHY? because doctors will not be able to charge the government their normal fees, so they have to make it up some how.

Third, I have not heard anything good about Canada's health care system and my husband works with many canadians. They actually carry insurance from my husband's company so they can get health care in MI. Why would they do this if Canada's health care is soooooo good?

[Murrican]

What about the cost of your taxes?????

Reasonable, and dropping. Our Conservative government has been slashing all kinds of taxes.

There is a guy in my nursing clinicals who moved here from Windsor and he said the taxes in Canada are very high, plus he moved here because we do have better medical. His wife had to wait 3 to 4 months for her test, then 5 more months for her surgery. To me that is NOT good health care. If this had happened to my dad, he would most likely have died from cancer. It was the fast action that caught it in time. He had ALL his test done within one week and the results the day after those test were done. I do not feel he would get that type of care with universal health care in the US.

I disagree with the guy from Windsor. Care here responds to the need, not the chequebook. No credit card needed at the emergency department, or for admission. I have had all kinds of tests done at the same time, can schedule whatever appointments with my doctor I want. No charges for specialists. Zilch. There's alsways some anecdotal example that tries to reinforce a stereotype.

Seven miles from where I live the provincial government built a brand-new hospital just a few years ago. It cost nothing for local people and replaced two older hospitals. The hospital foundation raised money locally for equipment not fully funded by the government. This keeps the community involved in community care. Here's the website: http://www.nhh.ca/about.asp

First, our nation WILL NOT be able to supply health care to everyone without getting the money from some place, and where do you think that place will be?????? the American people. So actually health care WILL NOT be free. Nothing is ever free!!!!!!!!!!!!!!!!! even through the government.

Free and freedom is relative. If you are a slave to future catastrophic health costs which will either hammer your savings now or later, or render you bankrupt and destitute, I question how much political/social freedom you really have. If I were to do it, the money would come from re-assigning priorities: all medicare and medicaid funds would go to universal healthcare -- that's "13% of the entire federal budget" in 2003 for Medicare -- which has premiums -- (see: http://en.wikipedia.org/wiki/Medicare_(United_States) ) and about $295 billion for Medicaid (see: http://en.wikipedia.org/wiki/Medicaid ). I'd eliminate all current premiums, and all private insurance premiums would disappear, too, except for premium hospital treatment (i.e. single room instead of double room or ward -- I've never paid extra but have been in all three and didn't care which I had). Each person could pay $250 a year for healthcare (maybe less) and nothing for those not working, poor, or elderly (over 65). And premiums would be tax-deductible. It would be universal, portable to any state, and state-administered, which means current bureaucracies could be re-purposed, as Medicaid already costs 22% of each state's budget ( http://en.wikipedia.org/wiki/Medicaid ) so the government administrative expertise exists already.

Canadian health care costs $172 billion, our population is about 33 million. US population is about 305 million, so at the same rate Canadian health care costs, the US cost would be $1,576,850,000,000 per year ($1.6 trillion). Annual premiums of $500 per person equals $1.5 trillion. Those required premiums would be covered by a chunk of the money from existing budgets, a modest tax assessment per week per employee (totalling not more than $300 per year -- $25 a month). Hospital owners would receive appropriate rentals, doctors would receive money on a schedule. And there would be a provision so those wishing to pay directly, could so so, with a surcharge on those costs to go to supporting the public system...

cont'd

[Murrican]

continued... from previous post.. which said a moderator had to review it...?

Our drug costs are not paid for by medicare, unless you're admitted to hospital, but our drug costs are legislated to a much lower price than in the US. Which is why Americans cross the border to buy prescription drugs here...

Second, I've been to Medicaid clinics and the waits are long because they over book their patients just to get more money from the government. WHY? because doctors will not be able to charge the government their normal fees, so they have to make it up some how.

Not allowed in Canada, so not a problem. And it does not happen here. Doctors make a lot here. I have doctor friends who make much more than they can spend or invest...

Third, I have not heard anything good about Canada's health care system and my husband works with many canadians. They actually carry insurance from my husband's company so they can get health care in MI. Why would they do this if Canada's health care is soooooo good?

Well, you've heard it from me. So you have heard it. I can buy Blue Cross health insurance so I don't worry about catastrophic health care when travelling in the US, but I don't. Snowbirds who go to Arizona or Florida often buy health care for down there. That's why most people buy it. Either that or they've been spooked by the media, your husband is familiar only with what he's been told, or it's not a representative sample. Probably all three. Every operation -- including sex-change operations in Ontario -- are covered 100%. All tests are covered 100%. Hospital beds are covered 100%. Emergency room visits and clinic and doctor appointments are covered 100%. If your husband sells health care insurance to Canadians, he's only talking to ones who want it, possibly ones who are truck drivers or otherwise work part-time in the US, but I know no one who has supplementary health care.

If a Toronto hospital can't handle a burn victim -- for example -- they fly them to a US hospital in Buffalo or elsewhere and the government pays the full tab. We have health care service speed guarantees.

I talked recently to a veteran emergency room nurse. She says Americans are surprised when they come into emergency after a car accident and aren't immediately asked for a credit card before they get care. Hey, we'll bill ya later. But if there were universal health care in Canada and the US it would be possible to have reciprocal coverage on both sides of the border...

[DoubleEdgeSword]

Not allowed in Canada, so not a problem. And it does not happen here. Doctors make a lot here. I have doctor friends who make much more than they can spend or invest...




I work in an ER. My number one problem with Medicaid patients is getting them follow-up care. Many, many times they will come back to the ER because the pysicians we refer them to don't take thier insurance.

I just found this today:



Half of primary care doctors in survey would leave medicine

Physicians here have closed their practices to Medicare and Medicaid patients because of low reimbursemnts and overwhelming paperwork from the government. It is a problem.

Nearly half the respondents in a survey of U.S. primary care physicians said that they would seriously consider getting out of the medical business within the next three years if they had an alternative.

The survey, released this week by the Physicians' Foundation, which promotes better doctor-patient relationships, sought to find the reasons for an identified exodus among family doctors and internists, widely known as the backbone of the health industry.

A U.S. shortage of 35,000 to 40,000 primary care physicians by 2025 was predicted at last week's American Medical Association annual meeting.
In the survey, the foundation sent questionnaires to more than 150,000 doctors nationwide.

Of the 12,000 respondents, 49 percent said they'd consider leaving medicine. Many said they are overwhelmed with their practices, not because they have too many patients, but because there's too much red tape generated from insurance companies and government agencies.

To manage their daily work schedules, many survey respondents reported making changes. With lower reimbursement from insurance companies and the cost of malpractice insurance skyrocketing, these health professionals say it's not worth running a practice and are changing careers. Others say they're going into so-called boutique medicine, in which they charge patients a yearly fee up front and don't take insurance.

And some like Pocinki are limiting the type of insurance they'll take and the number of patients on Medicare and Medicaid. According to the foundation's report, over a third of those surveyed have closed their practices to Medicaid patients and 12 percent have closed their practices to Medicare patients That can leave a lot of patients looking for a doctor.

http://www.cnn.com/2008/HEALTH/11/17/primary.care.doctors.study/index.html

[DoubleEdgeSword]

In addition to problems with Medicaid and Medicare patients, we just don't have enough primary care physicians in our area. Waits for a new-patient visit can be up to six months. It's impossible to get a same-day sick visit. I know because these patients come to the ER for colds and other minor complaints telling us, "My doctor couldn't see me and told me to go to the ER."

I've had patients who have left their doctor's waiting rooms and come to the ER because they didn't feel like sitting for an hour or more to see their PCP. Granted, they ended up waiting a heck of a lot longer in the ER, but that just shows you the mindset of today's patient.

Mental health beds are sorely lacking in our community. So, it is not unusual for us to have two, sometimes three psychiatric holds in our ER for three days at time. That's two or three beds of our 22-bed ER. That puts sick patients on gurneys in the hallways.

And then there are the uninsured who have nowhere else to go. Waits at the County Health Dept. are weeks-long just to qualify and weeks more to be seen. They come to the ER. Those who don't qualify for the Health Dept. but can't afford to buy insurance? They come to the ER.

We are a for-profit hospital that was bleeding red from low reimbursements, staggering paperwork and non-paying uninsured. To make matters worse, the largest hospital in the area began triaging non-emergent patients and charging them $150 to be seen. They all flocked to us.

So, this year, we instituted the same policy. The doctors, mid-levels and nurses hate it. We're here to treat patients, insurance or no insurance. But, if the hospital goes under, nobody has a job. Nice catch-22, huh? So, we all spend a lot of time justifing, on paper, why we treated such-and-such patient instead of triaging them out the door.

The system is broken.

[tiger_rascal]

This might sound awful, but I take my nephew to the clinic now when he gets sick instead of his pediatrician. If we call his pediatrician for an appointment we have to wait at least a month. And then lets just say our appointment is at 2pm, we dont get seen till 4 pm one time it was a 3 hour wait!!! So now I only take him there once a year for his annual check up or unless the doctor at the clinic calls her and sets up a special appointment.

[DoubleEdgeSword]

This might sound awful, but I take my nephew to the clinic now when he gets sick instead of his pediatrician. If we call his pediatrician for an appointment we have to wait at least a month. And then lets just say our appointment is at 2pm, we dont get seen till 4 pm one time it was a 3 hour wait!!! So now I only take him there once a year for his annual check up or unless the doctor at the clinic calls her and sets up a special appointment.

This is typical of what I'm seeing, Chad. And with most insurance companies charging a smaller deductible for an ER visit than a walk-in clinic will charge for a visit, they come to the ER. That's why you'll see so many ERs now with "Fast Track" areas for minor complaints.

[Murrican]

The first of my reply post to Connie appears to still be awaiting "moderation"...

Changing the US system would be a huge undertaking; it was for Canada in 1965-1967, when hospitals under various ownership (private, public, community, university, etc.) all became part of the universal healthcare system (somce call it "socialized" medicine as a perjorative, but if there's one thing you want to be "social" it's health care, I'd say). BUT it would be worth it.

Canada universalized health care following the report of the Royal Commission on Health Services in 1964. The Commission was set up by a Conservative Prime Minister and reported to a Liberal Prime Minister in a minority Parliament, but it triggered the political passage of Canadian Medicare in 1965. To actually hear from the Commission Chairman and see what was said, see: http://archives.cbc.ca/health/health_care_system/clips/447/ (BTW, the first implementation of universal health care in Canada was in 1962 in one province -- Saskatchewan -- by Premier Tommy Douglas, who is the grandfather of Kiefer Sutherland.) It was controversial, then. But its proponents stood firm. “Every person, regardless of geographic location or economic circumstances, has a right to a uniformly high quality of medical services.” -- ~ Saskatchewan Government Brief to the Royal Commission on Health Services January, 1962 - http://scaa.usask.ca/gallery/medicare/

Though there were many Medicare firsts in Saskatchewan, its development was part of wider social and historical trends in Canada and around the world. Czarist Russia attempted to implement a complete system of state medicine in rural areas in 1864. A comprehensive system of social insurance including health insurance was introduced in Germany in 1883. Though limited in scope, the British health service benefits plan for general practitioner care of workers was initiated in 1911. The Scandinavian countries, New Zealand, Austria, Chile, the Netherlands and Japan had forms of state supported health insurance before World War II.

In Canada the federal, provincial and municipal governments gradually assumed greater healthcare responsibilities. In the years following World War I, led by Saskatchewan, groups such as veterans and victims of certain illnesses such as cancer and tuberculosis were provided with state-sponsored programs. In 1948 the federal government implemented the National Health Program of Grants as a precursor to “a National Health Insurance Plan.” In 1949 British Columbia followed Saskatchewan in introducing a hospitalization plan. By 1961, all provinces had some sort of government-supported healthcare plan.
http://scaa.sk.ca/gallery/medicare/en_intro.php

[Murrican]

Back to the USA

Some US hospitals might be combined at the management level, older ones might close, new ones would be built. The system would be rationalized based on populations and need, not the populations of people able to pay. Think of it this way: you're somewhere far from home on an Interstate and are in an accident. You want top-quality care...

Right now there are a lot of hidden costs, such as the paper work DES alludes to, the paper work at the insurance company level, bureaucracies at Medicaid and Medicare, fraud apprehension systems, etc. I know someone (female) who was a lawyer in the US for a health insurance company and spent years challenging claims, including in court. The inhumanity of it drove her out of the health care industry (and lawyers are thick-skinned).

The re-allocation of the money currently expended for for health care in the US ($2,047,770,000,000 -- according to the CBC figures at the top of this thread -- 305 million people X $6714) would allow for a real transition period -- start by employee check-offs of $300 to $500 per year max., fold in all current Medicaid and Medicare funds, and even charge a premium for those who want to continue pay-as-you-go care (say, the super-rich). Hospitals would be paid for the amount of working floorspace, number of employees caring for employees as a percentage of total staff, volume of ER, per-clinic, etc. Staff would be paid as well or better than now. Insurance company profits would shrink...

My missing post got into financials, too, and I hope it re-appears because I didn't keep a copy...

We identify ourselves at a hospital as a Canadian resident (not just for citizens) with a health card. It seems the leading country in the world could do it even better...

[Murrican]

Universalized healthcare would help the US economy in a number of ways:


reduce employer health costs (making them lowerr-cost producers which helps fight imports and helps exports)

reduce competition between employers to provide private health care programs

increase health of workers

reduce family stress over a family member's health costs

let people live longer and more healthily

[tiger_rascal]

I wish I had a healthcare. :(

I really need to see a dr. about my left shoulder. I think Im losing mobility in my left arm. Sometimes my fingers on my left hand spasm and I cant stop them. I messed my left shoulder up a long time ago and never could see a dr. about it. Now Im afraid my left shoulder joint is messed up badly.