Friday, August 21, 2009

Cafferty on Canadians

Jack Cafferty points to* this article in the Detroit Free Press which describes how some Detroit hospitals have made deals with the Ontario Ministry of Health and Long-Term Care to provide certain medical procedures that are hard to come by in Canada. He implies that this is a failure of the Canadian health care system.

My pithy reply was: "The Canadian citizen is guaranteed to get treatment, and his government is taking steps to provide it at the lowest cost. The problem here is … what?" Many commenters, I was happy to see, agreed. The point is that the ministry finds an efficient way to meet their citizens' needs and they meet those needs. It sounds like a good thing.

So what does it mean that some Canadians come to the US? Mainly, it means that Canadian hospitals aren't filled to the brim with every medical technology there is in the world. It also stems from the fact that Canada suffers a shortage of specialists; while there is easy access to general practitioners, when you're referred to a specialist there may be more of a delay (not because of any particular bureaucratic inefficiency, but just because those doctors already have full schedules and non-emergency patients get shunted to the back of the queue). Canada could certainly invest more money in its own hospitals**, but with most Canadians living within easy proximity to the US, it's arguably a wise saving of taxpayer money to make use of Detroit hospitals as they do.

The fact that hospitals are jumping on these contracts also indicates that there is an overcapacity in US medical facilities. Apparently we have more doctors and more hospital machines than we can keep busy with the number of patients who have the a) need and the b) means to pay for treatment. One suspects that (b) is no trivial factor.

Some of the commenters want to believe that the Canadian government is failing to provide doctors. This is a confusion that I see popping up all the time: mixing up health care delivery with health care payment. The Canadian government doesn't actually run health care; the hospitals are private and Canadians can still purchase private health insurance. Any hospital can purchase the equipment for these procedures if they have the financial incentive to do so and obviously Ontario is willing to make it worth someone's while to do it. So it's hard - or ought to be hard - to read this article and conclude that government has screwed up medical care.

* Actually, he mentions it, but doesn't provide a link. C'mon, CNN, you can do better than that!

** It's worth pointing out that there's a limited and specific list of tests and procedures that Ontario is contracting for; it's not like they have 19th Century hospitals.


James Hanley said...

Umm, and why does Canada have a shortage of specialists?

So far I don't like the rhetoric on either side of this debate. No one's being honest with the facts and careful in their analysis.

Scott Hanley said...

Most likely there's just more money to be made for the physician in the US. My Canadian librarian colleagues keep telling me there's a rather severe brain drain out of Canada these days, as they have more skilled people than they can employ.