Canada: The Health of Health Care

Nice to read conclusions through a British study released in Health Affairs that credits Canada's health care system with "excellent value for the money". We like to think so. We want to believe that's the case. And, when we do have reason to use our health care system most Canadians generally seem to come away with an appreciation of our system, and seem also to feel that they've received their expectations' worth.

This particular study looked at our health care system from the perspective of "amenable mortality", which is to say deaths that would not have occurred if responsively-effective health care had been administered. The investigators brought into consideration the occurrences of deaths pre-age 75 resulting from a range of causes including heart disease, stroke, cancers, diabetes some bacterial-type infections and common surgical-procedure complications.

Canada had latterly ranked fairly high in an earlier report dating from 1997-98 figures from among some 19 countries whose original purpose was to compare the status of the U.S. health delivery system with those of 14 western European nations as well as Canada, Australia, New Zealand and Japan. The newer study, looking at figures from 2002-03 sought to track whether gaps had become narrower or wider.

In the interim, Canada appears to have moved up a notch from its 7th place ranking to 6th place at the later time-frame-figures examined. Placing Canada after France, Japan, Australia, Spain and Italy. Canada's health care system appears to have performed up to our expectations, in effectively preventing a greater number of people from dying prematurely as a result of treatable conditions.

And, it would appear, we're steadily improving. Since the comparison was between the United States and all those other countries, it's somewhat amazing that the U.S. ranked last, despite the fact that their health care system is far more costly to the economy. Ours might perhaps be considered to be somewhat less profit-based than that in the American free-market economy where costs are levied based on what it is thought the market can bear.

Needless to say, what the market is thought to be able to absorb doesn't quite take into consideration that vast lower-earning demographic that stands outside that particular grid, that is under-served and, as a result, prone to fewer needed medical interventions resulting in a fragile health situation for a startling number of health-uninsured and health-neglected Americans.

Still, we needn't be too proud of ourselves in Canada. For the simple fact is we too are suffering from mismanagement of a vital system meant to serve all Canadians to the best of its abilities. We have a clearly insufficient number of doctors to serve the needs of the population, with a doctor-patient ratio of 2.3 per one thousand population. Leaving us at 24th on a list of 28 industrialized countries.

The grim reality that one and a half million Canadians are unable to procure the services of a family doctor shouldn't make us feel too complacent about things. The Canada Health Act, which guarantees Canadians universality of health and medical availability, also led to the drain of doctors from Canada into the United States, faced with such barriers to free enterprise as denial of user fees, private clinics and hospitals and doctors' balanced billings.

Add to that the fact that governments in their wisdom felt that diminishing the supply of doctors would have the salubrious effect of lessening the numbers of tests, surgeries and treatments and thus effectively lowering costs to government health budgets. Medical schools obligingly lowered their cohorts of medical graduates. That brilliant strategy led to the shortage Canadians face today in the availability of doctor-services.

And then there's an additional situation where a country like Canada, so dependent on immigration, fails to take full advantage of highly educated, foreign-certified and trained medical professionals who emigrate to Canada with the intention of practising here, but are unable to because hurdles are placed in the way of certifying them for practise in this country. Our medical professionals aren't fond of what they perceive as competition of their monopoly.

There's a double whammy for us; Canadian-trained doctors whose education has been paid for partially with tax dollars streaming southward to the United States where the profit motive is handsomely rewarded. And foreign-born and -trained medical professionals, finding themselves locked out of practise in Canada, heading south as well, where they receive much warmer welcomes.

Another good news front - although it doesn't solve the practical problems facing families without adequate medical oversight - is the pace at which Canada's innovation, competitiveness and productivity in medical research appears to be paying off. Canada appears to be performing very well in the area of innovative health products and services.

Health care technologies which include tissue engineering for stem cell research, targeted drug delivery and genetically-directed health care look to promise great potential in the coming years within Canada. Our current score of well in excess of one hundred medical "world firsts" through Canada's research hospitals and resulting spin-off companies employing thousands of Canadians are all to the good.

It would be awfully nice, though, if we really got our acts together and tackled the issue of primary care, offering the comfort and stability to all Canadians of the services of a general practitioner. We urgently need more experienced nurses in virtually all of our hospitals. And we've got to get back to where we once were, in ensuring that hospital support staff, including cleaning custodians directly employed by individual hospitals make a come-back.

We can't coast on our successes, because we haven't yet reached the point where all Canadians are effectively served. But we're doing all right; just need to re-orient a bit here and there - and rather urgently at that.