Don’t Envy Me Because I’m Canadian

by Dave Schuler on June 15, 2014

A couple of Canadian researchers caution Americans about being too ready to admire the Canadian system. A big problem—wait times:

These wait times are not simply “minor inconveniences.” Patients experience physical pain and suffering, mental anguish, and lost economic productivity while waiting for treatment. One recent estimate (2013) found that the value of time lost due to medical wait times in Canada amounted to approximately $1,200 per patient.

There is also considerable evidence indicating that excessive wait times lead to poorer health outcomes and in some cases, death. Dr. Brian Day, former head of the Canadian Medical Association recently noted that “[d]elayed care often transforms an acute and potentially reversible illness or injury into a chronic, irreversible condition that involves permanent disability.”

New research also suggests that wait times for medically necessary procedures may be associated with increased mortality. A recent report concluded that between 25,456 and 63,090 Canadian women may have died as a result of increased wait times between 1993 and 2009. Large as this number is, it doesn’t even begin to quantify the possibility of increased disability, poorer quality of life, and mental stress as a result of protracted wait times.

I think it’s also worth mentioning that Canadians who can afford it always have the U. S. healthcare system as a recourse. IMO any analysis of the Canadian system should take that into account.

While I think that the Canadian system overall is a good comparison for the U. S. system IMO there are a couple of things we should keep in mind. First, the Canadian system didn’t start off as a federal system and still isn’t a federal system. It’s a provincial system. Second, as a JAMA study I’ve mentioned from time to time points out, administrative costs in the Canadian system aren’t as low as some Americans seem to think they are. About 15% IIRC. That’s better than here but it doesn’t provide the savings it would take to cover everybody under a single-payer system without paying a considerable amount more than we do now.

{ 6 comments… read them below or add one }

steve June 15, 2014 at 2:19 pm

Yes, Canada has bad wait times. If you want good wait times you copy systems like Japan’s or the UK. Anyway, two things. First, I think I have probably read most of those wait time studies at one time or another. They are mostly a bit suspect IMO, especially when they use cancer statistics. Where Canada has really bad wait times is in their elective care. We do very well in those times. However, if you look at wait times to get care when you are sick, our times are not that good, even if we do beat Canada That said, if you want to believe those wait times and believe that they are harmful then you need to average in the wait times for people in our system who have no insurance.

On Canadians coming to the US, they have that alternative but it is rarely taken. I have never seen one.

Overall, they still spend less than we do and they insure everyone.


Dave Schuler June 15, 2014 at 5:06 pm

If you want good wait times you copy systems like Japan’s or the UK.

I think that Japan’s system would only work in Japan. Lots and lots of automation; a predisposition not to use the healthcare system.

steve June 15, 2014 at 6:02 pm

It is more complicated that that. They have about 3 times as many CT scanners as we have and about 1/3 more MRI machines. They are about twice as likely to be on dialysis. They are certainly predisposed to many kinds of care. They have low rates of transplants for example, though the absolute number of transplants is much lower than dialysis patients. Japan’s would not work here because they have a much higher level of govt involvement in setting prices.

In terms of doctor visits, drugs, etc. there is this.

“THE Japanese spend half as much on health care as do Americans, but still they live longer. Many give credit to their cheap and universal health insurance system, called kaihoken, which celebrates its 50th anniversary this year. Its virtues are legion. Japanese people see doctors twice as often as Europeans and take more life-prolonging and life-enhancing drugs. Rather than being pushed roughly out of hospital beds, they stay three times as long as the rich-world average. Life expectancy has risen from 52 in 1945 to 83 today. The country boasts one of the lowest infant-mortality rates in the world. Yet Japanese health-care costs are a mere 8.5% of GDP.”


Guarneri June 15, 2014 at 7:25 pm

Its anecdotal, but I have a significant number of business relationships with Canadian firms. A social relationship with some as well. Nobody likes it, but they have no choice but to opt to the US if they can.

On a somber note, my sister has had a cancer recurrence. It took Vanderbilt two days to get her in and start the workup. Two days.

Sometimes I think steve just makes this stuff up to fit his worldview.

jan June 15, 2014 at 8:41 pm

So sorry to hear about your sister, Drew. Hope her treatment turns out well for her.

steve June 15, 2014 at 8:54 pm

Whenever possible I cite the data. In the case of Canada, that data is actually pretty solid. In the case of wait times, that is extremely well studied. I am sure that my personal experience is not the same as others. I am also not given to the habit of whining and don’t tolerate it real well in others, though I try.

Best of luck to your sister. Recurrence is one of those truly ugly words when you have cancer. My wife is now in her maintenance phase and we hope to never have to face that.


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