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| ]'s ] government, Canada's health care was expanded through the Medical Care Act, or ], to provide near universal coverage to all Canadians 'according to their need for such services and irrespective of their ability to pay'.<ref>http://www.civilization.ca/cmc/exhibitions/hist/medicare/medic-5h23e.shtml</ref>]] | |||
| '''Health care in Canada''' is delivered through a ] system, which is mostly free at the point of use and has most services provided by private entities.<ref name="CBC">Public vs. private health care ''CBC'', December 1, 2006.</ref> It is guided by the provisions of the ] of 1984.<ref name="Canada Health Act">{{cite web |url=http://www.hc-sc.gc.ca/hcs-sss/medi-assur/cha-lcs/overview-apercu-eng.php |title=Overview of the Canada Health Act |work= |accessdate=}}</ref> The government assures the quality of care through federal standards. The government does not participate in day-to-day care or collect any information about an individual's health, which remains confidential between a person and his or her physician.<ref name="theglobeandmail.com">http://www.theglobeandmail.com/globe-debate/five-things-canadians-get-wrong-about-the-health-system/article20360452/</ref> Canada's provincially based Medicare systems are cost-effective partly because of their administrative simplicity. In each province, each doctor handles the insurance claim against the provincial insurer. There is no need for the person who accesses health care to be involved in billing and reclaim. Private health expenditure accounts for 30% of health care financing.<ref>{{cite web|title=Exploring the 70/30 Split: How Canada's Health Care System Is Financed|url=https://secure.cihi.ca/free_products/FundRep_EN.pdf|publisher=The Canadian Institute for Health Information|accessdate=11 April 2013}}</ref> The Canada Health Act does not cover prescription drugs, home care or long-term care, prescription glasses or dental care, which means most Canadians pay out-of-pocket for these services or rely on private insurance.<ref name="theglobeandmail.com"/> Provinces provide partial coverage for some of these items for vulnerable populations (children, those living in poverty and seniors).<ref name="theglobeandmail.com"/> | |||
| Competitive practices such as advertising are kept to a minimum, thus maximizing the percentage of revenues that go directly towards care. In general, costs are paid through funding from income taxes. In British Columbia, taxation-based funding is supplemented by a fixed monthly premium which is waived or reduced for those on low incomes.<ref>http://www.health.gov.bc.ca/msp/infoben/premium.html#monthly</ref> There are no deductibles on basic health care and co-pays are extremely low or non-existent (supplemental insurance such as Fair Pharmacare may have deductibles, depending on income). In general, user fees are not permitted by the Canada Health Act, though some physicans get around this by charging annual fees for services which include non-essential health options, or items which are not covered by the public plan, such as doctors notes, prescription refills over the phone.<ref name="theglobeandmail.com"/> | |||
| A health card is issued by the Provincial Ministry of Health to each individual who enrolls for the program and everyone receives the same level of care.<ref>{{cite web |url=http://www.hc-sc.gc.ca/hcs-sss/delivery-prestation/ptrole/index-eng.php |title=Provincial/Territorial Role in Health |work= |accessdate=}}</ref> There is no need for a variety of plans because virtually all essential basic care is covered, including maternity. ] costs are not covered fully in any province other than Quebec, though they are now partially covered in some other provinces.<ref>http://business.financialpost.com/2013/09/28/does-your-province-cover-the-cost-of-infertility-treatments/</ref> In some provinces, private supplemental plans are available for those who desire private rooms if they are hospitalized. Cosmetic surgery and some forms of elective surgery are not considered essential care and are generally not covered. These can be paid out-of-pocket or through private insurers. Health coverage is not affected by loss or change of jobs, health care cannot be denied due to unpaid premiums (in BC), and there are no lifetime limits or exclusions for pre-existing conditions. The Canada Health Act deems that essential physician and hospital care be covered by the publicly funded system, but each province has some license to determine what is considered essential, and where, how and who should provide the services. The result is that there is a wide variance in what is covered across the country by the public health system, particularly in more controversial areas, such as midwifery or autism treatments.<ref name="theglobeandmail.com"/> | |||
| Canada is the only country with a universal healthcare system that does not include coverage of prescription medication.<ref>http://umanitoba.ca/outreach/evidencenetwork/archives/11837</ref><ref>http://www.thestar.com/opinion/editorialopinion/2012/10/09/why_in_a_sea_of_pink_are_so_many_cancer_patients_in_the_red.html</ref> Pharmaceutical medications are covered by public funds in some provinces for the elderly or indigent,<ref>CIHI p.91</ref> or through employment-based private insurance or paid for out-of-pocket. Most drug prices are negotiated with suppliers by each provincial government to control costs but more recently, the ] announced an initiative for select provinces to work together to create a larger buying block for more leverage to control costs.<ref>http://www.conseildelafederation.ca/en/initiatives/358-pan-canadian-pricing-alliance</ref> More than 60 percent of prescription medications are paid for privately in Canada.<ref name="theglobeandmail.com"/> ]s (often known as general practitioners or GPs in Canada) are chosen by individuals. If a patient wishes to see a specialist or is counseled to see a specialist, a referral can be made by a GP. Preventive care and early detection are considered important and yearly checkups are encouraged. | |||
| 2012 saw a record year for number of doctors with 75,142. The ] average salary was ]328,000.<ref>{{cite news|url=http://www.cbc.ca/news/health/canadian-doctor-total-at-record-high-1.1869346|title= | |||
| Canadian doctor total at record high | |||
| |publisher=]|accessdate=2013-09-28}}</ref> Recent reports indicate that Canada may be heading toward an excess of doctors,<ref>http://fullcomment.nationalpost.com/2013/10/08/barer-evans-what-doctor-shortage/</ref> though communities in rural, remote and northern regions, and some specialities, may still experience a shortage.<ref>http://umanitoba.ca/outreach/evidencenetwork/archives/15205</ref><ref>http://fullcomment.nationalpost.com/2013/02/22/maria-mathews-calling-all-country-doctors/</ref> | |||
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| ==Public opinion== | |||
| Canadians strongly support the health system's public rather than for-profit private basis, and a 2009 poll by Nanos Research found 86.2% of Canadians surveyed supported or strongly supported "public solutions to make our public health care stronger."<ref>{{cite web|url=http://www.healthzone.ca/health/article/679824 |title=Public health care scores big in poll as MDs study privatization |publisher=Healthzone.ca |date=2009-08-12 |accessdate=2011-02-10}}</ref><ref>{{cite web|url=http://www.nupge.ca/node/2486 |title=Canada overwhelmingly supports public health care |publisher=Nupge.ca |date=2009-08-13 |accessdate=2011-02-10}}</ref> A Strategic Counsel survey found 91% of Canadians prefer their healthcare system instead of a U.S. style system.<ref name="http">{{cite web|url=http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20080629/poll_us_canada_080629/20080629?hub=Politics |title=Canadians prefer Obama over own leaders: poll - CTV News |publisher=CTV.ca |date=2008-06-29 |accessdate=2011-02-10}}</ref><ref name="blogs.chicagotribune.com">{{cite news| url=http://blogs.chicagotribune.com/news_columnists_ezorn/2009/08/never-mind-the-anecdotes-do-canadians-like-their-health-care-system.html | work=Chicago Tribune | date=2009-08-06 | title=Never mind the anecdotes: Do Canadians like their health-care system?}}</ref> | |||
| A 2009 Harris/Decima poll found 82% of Canadians preferred their healthcare system to the one in the United States,<ref>{{cite news|url=http://blogs.chicagotribune.com/news_columnists_ezorn/2009/08/never-mind-the-anecdotes-do-canadians-like-their-health-care-system.html |title=Never mind the anecdotes: Do Canadians like their health-care system? |publisher=Chicago Tribune |date=2009-08-06 |accessdate=2011-02-10}}</ref> while a Strategic Counsel survey in 2008 found 91% of Canadians preferring their healthcare system to that of the U.S.<ref name="http"/><ref name="blogs.chicagotribune.com"/> | |||
| A 2003 Gallup poll found 25% of Americans are either "very" or "somewhat" satisfied with "the availability of affordable healthcare in the nation", versus 50% of those in the UK and 57% of Canadians. Those "very dissatisfied" made up 44% of Americans, 25% of respondents of Britons, and 17% of Canadians. Regarding quality, 48% of Americans, 52% of Canadians, and 42% of Britons say they are satisfied.<ref name="Gallup.com">{{cite web|url=http://www.gallup.com/poll/8056/healthcare-system-ratings-us-great-britain-canada.aspx |title=Healthcare System Ratings: U.S., Great Britain, Canada |publisher=Gallup.com |accessdate=2011-02-10}}</ref> | |||
| ==Economics== | |||
| Canada has a publicly funded ] system, with most services provided by the private sector. Each province may opt out, though none currently do. Canada's system is known as a ], where basic services are provided by private doctors (since 2002 they have been allowed to incorporate), with the entire fee paid for by the government at the same rate. Most government funding (94%) comes from the provincial level.<ref name="CIHI p.xiv"/> Most family doctors receive a fee per visit. These rates are negotiated between the provincial governments and the province's medical associations, usually on an annual basis. Pharmaceutical costs are set at a global median by government ]s. | |||
| ] | |||
| ] | |||
| Hospital care is delivered by publicly funded hospitals in Canada. Most of the public hospitals, each of which are independent institutions incorporated under provincial Corporations Acts, are required by law to operate within their budget.<ref></ref> Amalgamation of hospitals in the 1990s has reduced competition between hospitals. As the cost of patient care has increased, hospitals have been forced to cut costs or reduce services. Applying ] to analyze cost reduction, it has been shown that savings made by individual hospitals result in actual cost increases to the Provinces.<ref>MacInnes JK, McAlister VC. Myopia of healthcare reform using business models. Ann R Coll Physicians Surg Can 2001; 34: 20-2. Available at </ref> | |||
| In 2009, the government funded about 70% of Canadians' health care costs. This is slightly below the OECD average of public health spending.<ref name="CIHI p.xiii">CIHI p.xiii</ref> This covered most hospital and physician cost while the dental and pharmaceutical costs were primarily paid for by individuals.<ref name="CIHI p.xiii"/> Half of private health expenditure comes from private insurance and the remaining half is supplied by out-of-pocket payments. Under the terms of the ], public funding is required to pay for medically necessary care, but only if it is delivered in hospitals or by physicians. There is considerable variation across the provinces/territories as to the extent to which such costs as out of hospital prescription medications, physical therapy, long-term care, dental care and ] are covered.<ref>{{cite web |url=http://www.health.gov.on.ca/english/public/pub/ohip/amb.html |title=Ontario Ministry of Health and Long-Term Care - Public Information - Ontario Health Insurance Plan - Ohip Facts - Ambulance Services Billing |work= |accessdate=}}</ref> | |||
| Health care spending in Canada (in 1997 dollars) has increased each year between 1975 and 2009, from $39.7 billion to $137.3 billion, or per capita spending from $1,715 to $4089.<ref>CIHI pg. 119</ref> In 2012, total health care spending in Canada is expected to reach $207 billion, averaging $5,948 per person. Figures in National Health Expenditure Trends, 1975 to 2012, show that the pace of growth is slowing. Modest economic growth and budgetary deficits are having a moderating effect. For the third straight year, growth in health care spending will be less than that in the overall economy. The proportion of Canada’s gross domestic product (GDP) spent on health care will reach 11.6% this year—down from 11.7% in 2011 and the all-time high of 11.9% in 2010.<ref>. Canadian Institute for Health Information (CIHI). Retrieved: 28 May 2013.</ref> Total spending in 2007 was equivalent to 10.1% of the gross domestic product which was slightly above the average for ], and below the 16.0% of GDP spent on health care in the United States.<ref>CIHI p.55</ref> | |||
| In 2009, the greatest proportion of this money went to ] ($51B), followed by ] ($30B), and ] ($26B).<ref name=CBC2009>{{cite news |url=http://www.cbc.ca/health/story/2009/11/19/health-care-spending-canada.html |title=Canadian health-care spending to top $180B|work= CBC News|accessdate= | date=2009-11-19 |deadurl=yes}} {{Dead link|date=April 2014|bot=RjwilmsiBot}}</ref> The proportion spent on hospitals and physicians has declined between 1975 and 2009 while the amount spent on pharmaceuticals has increased.<ref>CIHI p.20</ref> Of the three biggest health care expenses, the amount spent on pharmaceuticals has increased the most. In 1997 the total price of drugs surpassed that of doctors. In 1975 the three biggest health costs were hospitals ($5.5B/44.7%), physicians ($1.8B/15.1% ), and medications ($1.1B/8.8% ) while in 2007 the three biggest costs were hospitals ($45.4B/28.2% ), medications ($26.5B/16.5% ), and physicians ($21.5B/13.4% ).<ref>CIHI p.112-113</ref> | |||
| Health care costs per capita vary across Canada with Quebec ($4,891) and British Columbia ($5,254) at the lowest level and Alberta ($6,072) and Newfoundland ($5,970) at the highest.<ref name="CIHI p.xiv"/> It is also the greatest at the extremes of age at a cost of $17,469 per capita in those older than 80 and $8,239 for those less than 1 year old in comparison to $3,809 for those between 1 and 64 years old in 2007.<ref name="CIHI p.xiv"/> | |||
| According to Lightman, “In-kind delivery in Canada is superior to the American market approach in its efficiency of delivery.” In the USA, 13.6 per cent of ] is used on medical care. By contrast, in Canada, only 9.5 per cent of GNP is used on the medicare system, “in part because there is no profit incentive for private insurers.” Lightman also notes that the in-kind delivery system eliminates much of the advertising that is prominent in the USA, and the low overall administrative costs in the in-kind delivery system. Since there are no means tests and no bad-debt problems for doctors under the ] in-kind system, doctors billing and collection costs are reduced to almost zero.<ref>Ernie Lightman, 2003 Social policy in Canada Toronto:Oxford University Press pg 130-131 | |||
| </ref> | |||
| ==History== | |||
| ===18th century=== | |||
| ] were initially places which cared for the poor; others were cared for at home. In ] (formerly known as ] and then as ]), a series of charitable institutions, many set up by Catholic religious orders, provided such care.<ref>{{cite book|last=Shah|first=Chandrakant P|year=2003|title=Public health and preventive medicine in Canada|edition=5th|publisher=Elsevier Canada|location=Toronto}}</ref> As the country grew, hospitals grew with them. They tended to be not-for-profit, and were run by municipal governments, charitable organizations, and religious denominations (both Catholic and Protestant).<ref>.</ref> These organizations tended to be at arm's length from government; they received subsidies from provincial governments to admit and treat all patients, regardless of their ability to pay. Dr. David Parker of the Maritimes was the first to operate using anesthetic. One of the first "modern" operations, the removal of a tumour, was performed by ] in ]. | |||
| ===19th century=== | |||
| The first medical schools were established in Lower Canada in the 1820s. These included the ], which is the faculty of medicine at ] today; in the mid-1870s, Sir ] changed the face of medical school instruction throughout the West with the introduction of the hands-on approach. The College of Physicians and Surgeons of Upper Canada was established in 1839 and in 1869 was permanently incorporated. In 1834, William Kelly, a surgeon with the ], introduced the idea of preventing the spread of disease via sanitation measures following epidemics of ]. In 1871, female physicians ] and ] won the right for women to be admitted to medical schools and granted licenses from the ]. In 1883, Emily Stowe led the creation of the ], affiliated with the ]. In 1892, Dr. ] wrote the landmark text '']'', which dominated medical instruction in the West for the next 40 years. Around this time, a movement began that called for the improved health care for the poor, focusing mainly on sanitation and hygiene. This period saw important advances including the provision of safe drinking water to most of the population, public baths and beaches, and municipal garbage services to remove waste from the city. During this period, medical care was severely lacking for the poor and minorities such as ]<ref>{{cite journal|url=http://www.cmaj.ca/cgi/content/full/179/7/728 |doi=10.1503/cmaj.081290 |accessdate=2011-02-10|title=Physician advocacy essential for Canada's First Nations|year=2008|last1=Warren|first1=P.|journal=Canadian Medical Association Journal|volume=179|issue=7|page=728|pmid=18809906|pmc=2535741}}</ref> | |||
| ===20th century=== | |||
| The twentieth century saw the discovery of insulin by ] and his colleagues, ], ], and ]<ref>The Discovery of Insulin, 25th Anniversary Edition, by Michael Bliss, Chicago, ISBN 978-0-226-05899-3</ref> in 1922. For this, ] and ] of the ] won the 1923 ].<ref>{{cite web|url=http://nobelprize.org/nobel_prizes/medicine/laureates/1923/ |title=The Nobel Prize in Physiology or Medicine 1923 |publisher=Nobelprize.org |accessdate=2011-02-10}}</ref> Dr. ], who discovered a successful surgical treatment for epilepsy called the "]", founded the ] in 1934. | |||
| The early 20th century saw the first widespread calls for increased government involvement and the idea of a national health insurance system had considerable popularity. During the ] calls for a public health system were widespread. Doctors who had long feared such an idea reconsidered hoping a government system could provide some stability as the depression had badly affected the medical community. However, governments had little money to enact the idea. In 1935, the ] passed a bill creating a provincial insurance program, but they lost office later that year and the Social Credit Party scrapped the plan due to the financial situation in the province. The next year a health insurance bill passed in ], but its implementation was halted over objections from doctors. ] promised to introduce such a scheme, but while he created the ] he failed to introduce a national program. | |||
| ===The beginning of coverage=== | |||
| ] | |||
| It was not until 1946 that the first Canadian province introduced near universal health coverage. ] had long suffered a shortage of doctors, leading to the creation of ] programs in the early twentieth century in which a town would subsidize a doctor to practice there. Soon after, groups of communities joined to open ]s under a similar model. There had thus been a long history of government involvement in Saskatchewan health care, and a significant section of it was already controlled and paid for by the government. In 1946, the ] government in ] passed the '']'', which guaranteed free hospital care for much of the population. ] had hoped to provide ], but the province did not have the money. | |||
| In 1950, Alberta's ] also introduced a public health care plan. Alberta, however, created Medical Services (Alberta) Incorporated (MS(A)I) in 1948 to provide prepaid health services. This scheme eventually provided medical coverage to over 90% of the population.<ref>{{cite web|url=http://www.albertadoctors.org/bcm/ama/ama-website.nsf/0/72D6C5EEBCA2CA9787256E1C0056E7A8?OpenDocument |title=History |publisher=] |accessdate=2011-02-10}}</ref> | |||
| In 1957, the majority ] government under Louis St. Laurent passed the ]<ref>{{cite journal |pmc=1829926 |title=The Hospital Insurance and Diagnostic Services Act: Its Impact on Hospital Administration |year=1958 |volume=78 |issue=10 |pmid=13523526 |last1=Turner |first1=JG |pages=768–70 |journal=Canadian Medical Association journal}}</ref> to fund 50% of the cost of such programs for any provincial government that adopted them. The HIDS Act outlined five conditions: public administration, comprehensiveness, universality, portability, and accessibility. These remain the pillars of the '']''. | |||
| By 1961, all ten provinces had agreed to start HIDS Act programs. In Saskatchewan, the act meant that half of their current program would now be paid for by the federal government. Premier ] decided to use this freed money to extend the health coverage to also include physicians. Despite the sharp disagreement of the ], Lloyd introduced the law in 1962 after defeating the ] in July. | |||
| ===Medical Care Act=== | |||
| The programs in Saskatchewan and Alberta proved a success and the federal government of ] introduced the ] in 1966 that extended the HIDS Act cost-sharing to allow each province to establish a universal health care plan -an initiative that was drafted and initiated by the ] and supported by the ] (NDP). It also set up the ] system. In 1984, the ] was passed under a majority Liberal government, which prohibited ]s and extra billing by doctors. In 1999, ] ] and most premiers reaffirmed in the ] that they are committed to health care that has "comprehensiveness, universality, portability, public administration and accessibility."<ref>Government of Canada, Social Union, News Release, "." Retrieved 20 December 2006.</ref> | |||
| ==Government involvement== | |||
| The various levels of government pay for about 70% of Canadians' health care, although this number has decreased somewhat in recent years.<ref>CIHI</ref> The ] (formerly called the British North America Act, 1867, and still known informally as the BNA Act) did not give either the federal or provincial governments responsibility for health care, as it was then a minor concern. The Act did give the provinces responsibility for regulating hospitals, and the provinces claimed that their general responsibility for local and private matters encompassed health care. The federal government felt that the health of the population fell under the ] part of its responsibilities. This led to several decades of debate over jurisdiction that were not resolved until the 1930s. Eventually the Judicial Committee of the Privy Council ] decided that the administration and delivery of health care was a provincial concern, but that the federal government also had the responsibility of protecting the health and well-being of the population. | |||
| By far the largest government health program is ], which is actually ten provincial programs, such as ] in ], that are required to meet the general guidelines laid out in the federal ]. Almost all government health spending goes through ], but there are several smaller programs. The federal government directly administers health to groups such as the military, and inmates of federal prisons. They also provide some care to the ] and veterans, but these groups mostly use the public system. Prior to 1966, ] had a large health care network, but this was merged into the general system with the creation of ]. The largest group the federal government is directly responsible for is ]. Native peoples are a federal responsibility and the federal government guarantees complete coverage of their health needs. For the last 20 years and despite health care being a guaranteed right for First Nations due to the many treaties the government of Canada signed for access to First Nations lands and resources, the amount of coverage provided by the Federal government's ] program has diminished drastically for optometry, dentistry, and medicines. Status First Nations individuals qualify for a set amount of visits to the optometrist and dentist, with a limited amount of coverage for glasses, eye exams, fillings, root canals, etc. For the most part First Nations people use the normal hospitals and the federal government then fully compensates the provincial government for the expense. The federal government also covers any user fees the province charges. The federal government maintains a network of clinics and health centres on ]. At the provincial level, there are also several much smaller health programs alongside ]. The largest of these is the health care costs paid by the ] system. Regardless of federal efforts, healthcare for ] has generally not been considered effective.<ref>{{cite journal|last=Silversides|first=Ann|date=October 23, 2007|title=The North "like Darfur"|journal=Canadian Medical Association Journal|volume=9|issue=177|url=http://www.cmaj.ca/cgi/content/full/177/9/1013|doi=10.1503/cmaj.071359 |pmid=17954876 |pmc=2025628|pages=1013–4}}</ref><ref>{{cite journal|last=Gao|first=Song|author2=et al. |date=November 4, 2008|title=Access to health care among status Aboriginal people with chronic kidney disease|journal=Canadian Medical Association Journal|volume=10|issue=179|url=http://www.cmaj.ca/cgi/content/full/179/10/1007|doi= 10.1503/cmaj.080063|pmid=18981441|pmc=2572655|pages=1007–12}}</ref><ref>{{cite journal|last=Peiris|first=David|coauthors=Alex Brown, BMed MPH and Alan Cass, MBBS PhD|date=November 4, 2008|title=Addressing inequities in access to quality health care for indigenous people|journal=Canadian Medical Association Journal|volume=10|issue=179|url=http://www.cmaj.ca/cgi/content/full/179/10/985|doi=10.1503/cmaj.081445|pmid=18981431|pmc=2572646|pages=985–6}}</ref> | |||
| Despite being a provincial responsibility, the large health costs have long been partially funded by the federal government. The cost sharing agreement created by the HIDS Act and extended by the Medical Care Act was discontinued in 1977 and replaced by ]. This gave a bloc transfer to the provinces, giving them more flexibility but also reducing federal influence on the health system. In 1996, when faced with a large budget shortfall, the Liberal federal government merged the health transfers with the transfers for other social programs into the ], and overall funding levels were cut. This placed considerable pressure on the provinces, and combined with ] and the generally high rate of ] in health costs, has caused problems with the system. | |||
| ==Private sector== | |||
| About 27.6% of Canadians' health care is paid for through the private sector. This mostly goes towards services not covered or partially covered by Medicare, such as ]s, ] and ]. Some 75% of Canadians have some form of supplementary private health insurance; many of them receive it through their employers.<ref> OECD Health Project, 2004. Retrieved January 21, 2008.</ref> | |||
| The Canadian system is for the most part publicly funded, yet most of the services are provided by private enterprises. Most doctors do not receive an annual salary, but receive a fee per visit or service.<ref name="CBC"/> According to Dr. Albert Schumacher, former president of the ], an estimated 75 percent of Canadian health care services are delivered privately, but funded publicly. | |||
| <blockquote>"Frontline practitioners whether they're GPs or specialists by and large are not salaried. They're small hardware stores. Same thing with labs and radiology clinics ...The situation we are seeing now are more services around not being funded publicly but people having to pay for them, or their insurance companies. We have sort of a passive privatization."<ref name="CBC"/></blockquote> | |||
| "Although there are laws prohibiting or curtailing private health care in some provinces, they can be changed", according to a report in the ''New England Journal of Medicine''.<ref>{{cite web|url=http://content.nejm.org/cgi/content/full/354/16/1661 |title=Private Health Care in Canada, Robert Steinbrook, N Engl J Med, 354:1661-1664, April 20, 2006 |publisher=Content.nejm.org |date=1970-01-01 |accessdate=2011-02-10}}</ref><ref name="NYTimes">{{cite news |first=Clifford |last=Kraus |title=As Canada's Slow-Motion Public Health System Falters, Private Medical Care Is Surging |url=http://www.nytimes.com/2006/02/26/international/americas/26canada.html?ex=1184644800&en=44cca772dc339429&ei=5070 |work=New York Times |date=2006-02-26 |accessdate=2007-07-16}}</ref> In June 2005, the ] ruled in '']'' that Quebec's prohibition against private health insurance for medically necessary services laws violated the ], potentially opening the door to much more private sector participation in the health system. Justices ], Jack Major, ] and ] found for the majority. "Access to a waiting list is not access to health care", wrote Chief Justice Beverly McLachlin. | |||
| The Quebec and federal governments asked the high court to suspend its ruling for 18 months. Less than two months after its initial ruling, the court agreed to suspend its decision for 12 months, retroactive to June 9, 2005.<ref>{{cite news| url=http://www.cbc.ca/news/background/healthcare/2005scc035decision.html | work=CBC News | title=CBC News Indepth: Health Care | deadurl=yes}} {{Dead link|date=April 2014|bot=RjwilmsiBot}}</ref> | |||
| ==Physicians and medical organization== | |||
| Canada, like its North American neighbour the United States, has a ratio of practicing physicians to population that is below the OECD average <ref>{{cite web|url=http://titania.sourceoecd.org/vl=4012838/cl=17/nw=1/rpsv/health2007/g4-2-01.htm |title=OECD data. Number of practising physicians |publisher=Titania.sourceoecd.org |accessdate=2011-02-10}}</ref> but a level of practicing nurses that is higher than either the U.S. or the OECD average.<ref>{{cite web|url=http://titania.sourceoecd.org/vl=4012838/cl=17/nw=1/rpsv/health2007/g4-3-01.htm |title=SourceOECD: OECD Health 2007 |publisher=Titania.sourceoecd.org |accessdate=2011-02-10}}</ref> | |||
| Family physicians in Canada make an average of $202,000 a year (2006, before expenses).<ref name="CTV.ca">{{cite web|url=http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20061221/quebec_doctors_061221?s_name=&no_ads= |title=Que. doctors lagging in fee-for-service payments |publisher=Ctv.ca |date=2006-12-21 |accessdate=2011-02-10}}</ref> ] has the highest average salary of around $230,000, while ] has the lowest average annual salary at $165,000, arguably creating interprovincial competition for doctors and contributing to local shortages.<ref name="CTV.ca"/> | |||
| In 1991, the Ontario Medical Association agreed to become a province-wide ], making the OMA union a monopoly. Critics argue that this measure has restricted the supply of doctors to guarantee its members' incomes.<ref>{{cite web|url=http://www.cofp.com/documents/2004Nov9NPCorcoranArticleDoctorsSoldOutAgain.pdf |archiveurl=http://web.archive.org/web/20060531053501/http://www.cofp.com/documents/2004Nov9NPCorcoranArticleDoctorsSoldOutAgain.pdf |archivedate=2006-05-31 |title=ONTARIO DOCTORS SOLD OUT AGAIN |date=November 6 | work=National Post | author=Terence Corcoran |accessdate=2011-02-10}}</ref> | |||
| In September 2008, the ] and the ] agreed to a new four-year contract that will see doctors receive a 12.25% pay raise. The new agreement is expected to cost Ontarians an extra ]1 billion. Referring to the agreement, Ontario ] ] said, "One of the things that we've got to do, of course, is ensure that we're competitive ... to attract and keep doctors here in Ontario...".<ref>{{cite news|url=http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20080915/doctors_wage_080915/20080915?hub=Health|title=Ont. doctors get 12.25 per cent wage hike|accessdate=2008-09-15}}</ref> | |||
| In December 2008, the ] reported a critical shortage of ] and ]. The report stated that 1,370 obstetricians were practicing in Canada and that number is expected to fall by at least one-third within five years. The society is asking the government to increase the number of ] spots for obstetrics and gynecologists by 30 per cent a year for three years and also recommended rotating placements of doctors into smaller communities to encourage them to take up residence there.<ref>{{cite news|url=http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20081205/ob_shortage_081205/20081205?hub=Health|title=Obstetrician shortage endangers moms, babies: report says|date=2008-12-05|publisher=]}}</ref> | |||
| Each province regulates its medical profession through a self-governing College of Physicians and Surgeons, which is responsible for licensing physicians, setting practice standards, and investigating and disciplining its members. | |||
| The national doctors association is called the ];<ref>{{cite web|url=http://www.cma.ca/index.cfm/ci_id/121/la_id/1.htm |title=Canadian Medical Association |publisher=Cma.ca |accessdate=2011-02-10}}</ref> it describes its mission as "To serve and unite the physicians of Canada and be the national advocate, in partnership with the people of Canada, for the highest standards of health and health care. "<ref>{{cite web|url=http://www.cma.ca/index.cfm/ci_id/44413/la_id/1.htm |title=About CMA |publisher=Cma.ca |date=2010-03-24 |accessdate=2011-02-10}}</ref> Because health care is deemed to be under provincial/territorial jurisdiction, negotiations on behalf of physicians are conducted by provincial associations such as the ]. The views of Canadian doctors have been mixed, particularly in their support for allowing parallel private financing. The history of Canadian physicians in the development of Medicare has been described by C. ].<ref>{{cite book|last=Naylor|first=C David|year=1986|title=Private Practice, Public Payment: Canadian Medicine and the Politics of Health Insurance 1911-1966|publisher=McGill-Queen's University Press|location=Kingston, Ontario}}</ref> Since the passage of the 1984 ], the CMA itself has been a strong advocate of maintaining a strong publicly funded system, including lobbying the federal government to increase funding, and being a founding member of (and active participant in) the Health Action Lobby (HEAL).<ref>{{cite web|url=http://www.physiotherapy.ca/HEAL/english/index.htm |title=HEAL home page |publisher=Physiotherapy.ca |accessdate=2011-02-10}}</ref> | |||
| However, there are internal disputes. In particular, some provincial medical associations have argued for permitting a larger private role. To some extent, this has been a reaction to strong cost control; CIHI estimates that 99% of physician expenditures in Canada come from public sector sources, and physicians—particularly those providing elective procedures who have been squeezed for operating room time—have accordingly looked for alternative revenue sources. | |||
| One indication of this internal dispute came when Dr. ] of B.C. was elected CMA president in August 2007. Day is the owner of the largest private hospital in Canada and a vocal supporter of increasing private health care in Canada. The CMA presidency rotates among the provinces, with the provincial association electing a candidate who is customarily ratified by the CMA general meeting. Day's selection was sufficiently controversial that he was challenged—albeit unsuccessfully—by another physician. The newspaper story went on to note that "Day said he has never supported the privatization of health care in Canada, and accused his detractors of deliberately distorting his position." <ref>{{cite news|url=http://www.cbc.ca/canada/prince-edward-island/story/2006/08/22/day-cma-president.html |title=CBC Private health-care advocate wins CMA presidency |publisher=CBC.ca |date=2006-08-22 |accessdate=2011-02-10 |deadurl=yes}} {{Dead link|date=April 2014|bot=RjwilmsiBot}}</ref> | |||
| ==Criticisms== | |||
| ===Wait times=== | |||
| ], a ], publishes a series of surveys of the health care system in Canada based on Canadians' first-hand experiences of the health care system.<ref name=Canadastat>{{cite web|url=http://www.healthcoalition.ca/index-eng.pdf|title =Healthy Canadians: Canadian government report on comparable health care indicators}}</ref> | |||
| Although life-threatening cases are dealt with immediately, some services needed are non-urgent and patients are seen at the next-available appointment in their local chosen facility. | |||
| The median wait time in Canada to see a special physician is a little over four weeks with 89.5% waiting fewer than 90 days.<ref name=Canadastat /> | |||
| The median wait time for diagnostic services such as MRI and CAT scans <ref>Diagnostic tests defined as the following: non-emergency magnetic resonance imaging (MRI) devices; computed tomography (CT or CAT) scans; and angiographies that use X-rays to examine the inner opening of blood-filled structures such as veins and arteries.</ref> is two weeks with 86.4% waiting fewer than 90 days.<ref name=Canadastat /> | |||
| The median wait time for elective or non-urgent surgery is four weeks with 82.2% waiting fewer than 90 days.<ref name=Canadastat /> | |||
| Another study by the ] found that 57% of Canadians reported waiting 30 days (4 weeks) or more to see a specialist,{{page needed|date=July 2013}} broadly in line with the current official statistics. A quarter (24%) of all Canadians waited 4 hours or more in the emergency room.<ref>Commonwealth Fund, "Mirror, Mirror on the Wall: An International update on the comparative performance of American health care", Karen Davis et al., May 15, 2007.</ref>{{page needed|date=July 2013}} | |||
| Dr. Brian Day was once quoted as saying "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two-to-three years."<ref>{{cite news| url=http://www.nytimes.com/2006/02/28/international/americas/28canada.html?ei=5090&en=ad12dcee61e8b584&ex=1298782800&partner=rssuserland&emc=rss&pagewanted=print | work=The New York Times | title=Canada's Private Clinics Surge as Public System Falters | first=Clifford | last=Krauss | date=2006-02-28 | accessdate=2010-05-04}}</ref> Day gave no source for his two to three years claim. The Canadian Health Coalition has responded succinctly to Day's claims, pointing out that "access to veterinary care for animals is based on ability to pay. Dogs are put down if their owners can’t pay. Access to care should not be based on ability to pay." <ref>{{dead link|date=February 2011}}</ref> Regional administrations of Medicare across Canada publish their own wait time data on the internet. For instance, in British Columbia the wait time for an elective hip replacement is currently a little under ten weeks.<ref>{{dead link|date=February 2011}}</ref> The CHC is one of many groups across Canada calling for increased provincial and federal funding for medicare and an end to provincial funding cuts as solutions to unacceptable wait times.<ref>{{cite web|url=http://www.web.net/ohc/index.html |title=Ontario Health Coalition - Home |publisher=Web.net |accessdate=2011-02-10}}</ref> | |||
| Since 2002, the Canadian government has invested $5.5 billion to decrease wait times.<ref>, CBC News: In Depth: Health Care, November 29, 2006. Retrieved November 19, 2007.</ref> In April 2007, Prime Minister ] announced that all ten provinces and three territories would establish patient wait times guarantees by 2010. Canadians will be guaranteed timely access to health care in at least one of the following priority areas, prioritized by each province: cancer care, hip and knee replacement, cardiac care, diagnostic imaging, cataract surgeries or primary care.<ref>Media release , Office of the Prime Minister, April 4, 2007. Retrieved November 19, 2007.</ref> | |||
| In a 2007 episode of ]'s '']'' titled "Sick in America", host ] cited numerous examples of Canadians who did not get the health care that they needed.<ref>, ABC News, 2007</ref> The ] found that treatment time from initial referral by a GP through consultation with a specialist to final treatment, across all specialties and all procedures (emergency, non-urgent, and elective), averaged 17.7 weeks in 2005,<ref>{{cite web|url=http://www.independent.org/newsroom/article.asp?id=1292 |title=Hidden costs of Canada's Health Care System |publisher=Independent.org |date=2004-04-23 |accessdate=2011-02-10}}</ref> contradicting the Canadian government's 2007 report regarding itself.<ref>{{cite web|url=http://www.cihi.ca/cihiweb/en/downloads/aib_provincial_wait_times_e.pdf |title=Wait Times Tables A Comparison by Province 2007 |format=PDF |accessdate=2011-02-10}}</ref> | |||
| ====Counter-criticism: Some longer wait times can benefit patients==== | |||
| It has been speculated and supported in data that the complete elimination of all waiting times is not ideal. When waiting lists arise through a prioritization process based on physician-determined medical urgency and the procedure's risk, (in contrast to patient's ability to pay or profitability for the physician), waiting lists can possibly help patients. It's been postulated that a system of immediate care can be detrimental for optimal patient outcomes, as unnecessary or unproven surgery might not be easily avoided if all patients are granted instant care. An example is the Canadian province of ], where, according to surgeon Dr. Lawrence Burr, 15 heart patients died in 1990 while on a waiting list for heart surgery. According to Robin Hutchinson, senior medical consultant to the Health Ministry's heart program, had the waiting list not existed and all patients given instant access to the surgery, the expected number of fatalities would have been 22 due to the operation mortality rate at that time. Hutchison noted that the ]'s media campaign did not make reference to these comparative statistics and focused on deaths during waiting for surgery. Since, ideally, waiting lists prioritize higher-risk patients to receive surgery ahead of those with lower risks, this helps reduce overall patient mortality. Consequently, a wealthy or highly insured patient in a system based on profit or ability to pay (as in the U.S.) may be pushed into surgery or other procedures more quickly, with a result in higher ] or mortality risk. This is in addition to the better-understood phenomenon in which lower-income, uninsured, or under-insured patients have their care denied or delayed, also resulting in worse health care.<ref name="bare_url">{{Cite news | |||
| | last=Schmitz | |||
| | first=Anthony | |||
| | title=Health Assurance | |||
| | newspaper=In Health | |||
| | volume=5 | |||
| | issue=1 | |||
| | pages=39–47 | |||
| | url=http://www.healthadvocates.info/HealthAssurance.pdf | |||
| | date=January–February 1991 }}</ref> | |||
| ===Restrictions on privately funded health care=== | |||
| {{Main| Canada Health Act}} | |||
| The ], which sets the conditions with which provincial/territorial health insurance plans must comply if they wish to receive their full transfer payments from the federal government, does not allow charges to insured persons for insured services (defined as medically necessary care provided in hospitals or by physicians). Most provinces have responded through various prohibitions on such payments. This does not constitute a ban on privately funded care; indeed, about 30% of Canadian health expenditures come from private sources, both insurance and out-of-pocket payments.<ref>{{Cite book |author=] | date=September 27, 2005 | title=CIHI exploring the 70-30 split| publisher= Canadian Institute for Health Information| url=http://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=AR_1282_E | isbn=1-55392-655-2 | accessdate=2007-12-21 |location=Ottawa, Ont.}}</ref> The Canada Health Act does not address delivery. Private clinics are therefore permitted, albeit subject to provincial/territorial regulations, but they cannot charge above the agreed-upon fee schedule unless they are treating non-insured persons (which may include those eligible under automobile insurance or worker's compensation, in addition to those who are not Canadian residents), or providing non-insured services. This provision has been controversial among those seeking a greater role for private funding. | |||
| In 2006, the Government of British Columbia threatened to shut down one private clinic because it was planning to start accepting private payments from patients.<ref>{{cite news |first=Miro |last=Cernetig |title=B.C. gov't gets tough with private clinic |url=http://www.canada.com/topics/news/story.html?id=16141a15-58d5-4e05-a1d2-78eaaeae207a&k=29315 |work=Vancouver Sun |publisher=CanWest News Service |date=2006-12-01 |accessdate=2008-01-09 }}</ref> | |||
| Governments have responded through wait time strategies, discussed above, which attempt to ensure that patients will receive high-quality, necessary services in a timely manner. Nonetheless, the debate continues. | |||
| ===Cross-border health care=== | |||
| {{cleanup|section|date=January 2008}} | |||
| The border between Canada and the United States represents a boundary line for ], in which a country's residents travel elsewhere to seek health care that is more available or affordable. | |||
| ====Canadians visiting the US to receive health care==== | |||
| Some residents of Canada travel to the United States for care. A study by Barer, et al., indicates that the majority of Canadians who seek health care in the U.S. are already there for other reasons, including business travel or vacations. A smaller proportion seek care in the U.S. for reasons of confidentiality, including abortions, mental illness, substance abuse, and other problems that they may not wish to divulge to their local physician, family, or employer. | |||
| * Canadians offered free care in the US paid by the Canadian government have sometimes declined it. In 1990 the British Columbia Medical Association ran radio ads asking, "What's the longest you'd wait in line at a bank before getting really annoyed? Five minutes? Ten minutes? What if you needed a heart operation?" Following this, the government responded, as summarized by Robin Hutchinson, senior medical consultant for the health ministry's heart program. Despite the medically questionable nature of heart bypass for milder cases of chest pain and follow-up studies showing heart bypass recipients were 25-40% more likely to be relieved of chest pain than people who stay on heart medicine, the "public outcry" following the ads led the government to take action: | |||
| <blockquote>"'We did a deal with the University of Washington at Seattle' said Hutchinson.. to take 50 bypass cases at $18,000 per head, almost $3,000 higher than the cost in Vancouver, with all the money the province..In theory, the Seattle operations promised to take the heat off the Ministry of Health until a fourth heart surgery unit opened in the Vancouver suburb of New Westminster. If the first batch of Seattle bypasses went smoothly..then the government planned to buy three or four more 50-head blocks. But four weeks after announcing the plan, health administrators had to admit they were stumped. 'As of now..we've have nine people sign up. The opposition party, the press, everybody's making a big stink about our waiting lists. And we've got nine people signed up! The surgeons ask their patients and they say, "I'd rather wait", We thought we could get maybe two hundred and fifty done down in Seattle..but if nobody wants to go to Seattle, we're stuck,'".<ref name="bare_url" /></blockquote> | |||
| * In a Canadian National Population Health Survey of 17,276 Canadian residents, it was reported that 0.5% sought medical care in the US in the previous year. Of these, less than a quarter had traveled to the U.S. expressly to get that care.<ref> Canadian National Population Health Survey study</ref> | |||
| * A 2002 study by Katz, Cardiff, et al., reported the number of Canadians using U.S. services to be "barely detectible relative to the use of care by Canadians at home" and that the results "do not support the widespread perception that Canadian residents seek care extensively in the United States."<ref>{{cite journal|url=http://content.healthaffairs.org/cgi/content/full/21/3/19 |doi=10.1377/hlthaff.21.3.19|title=Phantoms in the Snow: Canadians' Use of Health Care Services in the United States|year=2002|last1=Katz|first1=S. J.|last2=Cardiff|first2=K.|last3=Pascali|first3=M.|last4=Barer|first4=M. L.|last5=Evans|first5=R. G.|journal=Health Affairs|volume=21|issue=3|pages=19–31|pmid=12025983}}</ref> | |||
| * According to a September 14, 2007, article from ], Canadian Liberal MP ] went to the United States for breast cancer surgery in June 2007. Stronach's spokesperson Greg MacEachern was quoted in the article saying that the US was the best place to have this type of surgery done. Stronach paid for the surgery out of her own pocket.<ref>{{cite web|url=http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20070914/belinda_Stronach_070914/20070914?hub=TopStories |title=Stronach went to U.S. for cancer treatment: report |publisher=CTV.ca |date=2007-09-14 |accessdate=2011-02-10}}</ref> Prior to this incident, Stronach had stated in an interview that she was against ].<ref>{{cite news| url=http://www.cbc.ca/sunday/coverstory_stronach.html | title=CBC News: Sunday - Belinda Stronach Interview | deadurl=yes}} {{Dead link|date=August 2010|bot=RjwilmsiBot}}</ref> | |||
| * When ], the premier of Quebec, needed cancer treatment, he went to the US to get it.<ref> The Independent Institute, February 1, 1994</ref> | |||
| * In 2007, it was reported that Canada sent scores of pregnant women to the US to give birth.<ref>{{cite web|url=http://www.komotv.com/news/10216201.html |title=Some Canadian mothers forced to give birth in U.S. | KOMO-TV - Seattle, Washington | News |publisher=Komo-Tv |date=2010-04-01 |accessdate=2011-02-10}}</ref> In 2007 a woman from ] who was pregnant with quadruplets was sent to ] to give birth. An article on this incident states there were no Canadian hospitals with enough neo-natal intensive beds to accommodate the extremely rare quadruple birth.<ref>{{cite web|last=Calgary |first=The |url=http://www.canada.com/calgaryherald/story.html?id=41ccae74-8325-449a-b89f-e68957ca25ae&k=79546 |title=Calgary's quads: Born in the U.S.A |publisher=Canada.com |date=2007-08-17 |accessdate=2011-02-10}}</ref> | |||
| * A January 19, 2008, article in '']'' states, "More than 150 critically ill Canadians – many with life-threatening ] – have been rushed to the United States since the spring of 2006 because they could not obtain intensive-care beds here. Before patients with bleeding in or outside the brain have been whisked through U.S. operating-room doors, some have languished for as long as eight hours in Canadian emergency wards while health-care workers scrambled to locate care." <ref>{{cite news|author=Canada |url=http://www.theglobeandmail.com/servlet/story/RTGAM.20080119.neuro191/BNStory/specialScienceandHealth/home |title=Health |publisher=Globe and Mail |date= 2008-01-19|accessdate=2011-02-10 |location=Toronto}}</ref><sup></sup>{{citation needed|date=August 2012}} | |||
| *In 2010, Newfoundland and Labrador Premier ] traveled to the US for heart surgery.<ref>, CBC News, February 2, 2010</ref> | |||
| In 2005 ] of ], traveled to the ] after deciding she couldn't afford to wait for appointments with specialists through the Ontario health care system.<ref name=TorStar2007-09-06> | |||
| {{cite news | |||
| | url=http://www.thestar.com/News/article/253664 | |||
| | title=Patients suing province over wait times: Man, woman who couldn't get quick treatment travelled to U.S. to get brain tumours removed | |||
| | quote=Lindsay McCreith, 66, of Newmarket and Shona Holmes, 43, of Waterdown filed a joint statement of claim yesterday against the province of Ontario. Both say their health suffered because they are denied the right to access care outside of Ontario's "government-run monopolistic" health-care system. They want to be able to buy private health insurance. | |||
| | date=2007-09-06 | |||
| | author=Tanya Talaga | |||
| | work=] | |||
| | accessdate=2009-07-27 | |||
| | archiveurl=http://www.webcitation.org/query?url=http%3A%2F%2Fwww.thestar.com%2FNews%2Farticle%2F253664&date=2009-08-07 | |||
| | archivedate=2009-08-07 | |||
| }}</ref><ref name=Nrfm2007-09-30> | |||
| {{cite news | |||
| | url=http://www.nationalreviewofmedicine.com/issue/2007/09_30/4_policy_politics02_16.html | |||
| | title=New lawsuit threatens Ontario private care ban: "Ontario Chaoulli" case seeks to catalyze healthcare reform | |||
| | date=2007-09-30 | |||
| | author=Sam Solomon | |||
| | volume=4 | |||
| | issue=16 | |||
| | work=] | |||
| | accessdate=2009-07-27 | |||
| | archiveurl=http://www.webcitation.org/query?url=http%3A%2F%2Fwww.nationalreviewofmedicine.com%2Fissue%2F2007%2F09_30%2F4_policy_politics02_16.html&date=2009-08-07 | |||
| | archivedate=2009-08-07 | |||
| }}</ref> She has characterized her condition as an emergency, said she was losing her sight, and portrayed her condition as life-threatening brain cancer. OHIP did not reimburse her for her medical expenses. In 2007 she joined a lawsuit to force the Ontario government to reimburse patients who feel they had to travel outside of Canada for timely, life-saving medical treatment. In July 2009 Holmes agreed to appear in television ads broadcast in the United States warning Americans of the dangers of adopting a Canadian style health care system. After her ad appeared critics pointed out discrepancies in her story, including that ], the condition she was treated for, was not a form of cancer, and was not life-threatening.<ref name=CbcShonaExaggeration> | |||
| {{cite news | |||
| | url=http://www.cbc.ca/health/story/2009/07/31/medicare-ad-exaggeration523.html | |||
| | title=Anti-medicare ad an exaggeration: experts | |||
| | date=2009-07-31 | |||
| | author= | |||
| | publisher=] | |||
| | archiveurl=http://www.webcitation.org/query?url=http%3A%2F%2Fwww.cbc.ca%2Fhealth%2Fstory%2F2009%2F07%2F31%2Fmedicare-ad-exaggeration523.html&date=2009-08-07 | |||
| | archivedate=2009-08-07 | |||
| | accessdate=2009-08-07 | |||
| }}</ref><ref name=HuffingtonPost> | |||
| {{cite news | |||
| | url=http://www.huffingtonpost.com/ian-welsh/americans-lives-vs-insura_b_241703.html | |||
| | title=Americans Lives vs. Insurance Company Profits: The Real Battle in Health Care Reform | |||
| | date=2009-07-21 | |||
| | author=] | |||
| | publisher=Huffington Post | |||
| | accessdate=2009-07-21 | |||
| | archivedate=2009-08-07 | |||
| | archiveurl=http://www.webcitation.org/query?url=http%3A%2F%2Fwww.huffingtonpost.com%2Fian-welsh%2Famericans-lives-vs-insura_b_241703.html&date=2009-08-07 | |||
| }}</ref> In fact, the mortality rate for patients with a Rathke's cleft cyst is zero percent. | |||
| <ref name=emedicine> | |||
| {{Cite journal | |||
| | url=http://emedicine.medscape.com/article/343629-overview | |||
| | title=Rathke Cleft Cyst | |||
| | date=2008-03-27 | |||
| | author= Omar Islam, MD, FRCP(C) | |||
| | publisher= Medscape | |||
| | accessdate=2009-11-22 | |||
| | postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}} | |||
| }}</ref> | |||
| ====US citizens visiting Canada to receive health care==== | |||
| Some US citizens travel to Canada for health-care related reasons: | |||
| *Many US citizens purchase prescription drugs from Canada, either over the Internet or by traveling there to buy them in person, because prescription drug prices in Canada are substantially lower than ]; this cross-border purchasing has been estimated at $1 billion annually.<ref>{{cite journal |coauthors=Morgan, Steven and Hurley, Jeremiah |date=2004-03-16 |title=Internet pharmacy: prices on the up-and-up |journal=CMAJ |volume=170 |issue=6 |pages=945–946 |pmid=15023915 |doi=10.1503/cmaj.104001 |url=http://www.cmaj.ca/cgi/content/full/170/6/945?etoc |accessdate= 2007-07-11 |author=Morgan, S. |pmc=359422}}</ref> | |||
| *Buying prescription drugs from even the most well respected internet pharmacies in Canada often results in a prescription filled from drugs sourced not from Canada but rather Caribbean nations or from eastern Europe. The Canadian online pharmacy that sells the drugs offers a Canadian price but buys at a still cheaper rate from third parties overseas. This has led to problems with prescriptions being filled with counterfeit drugs, which sometimes have no activity whatsoever. Some pharmacists have exited this business because of the ethical problems involved, and some less established internet sites may be knowingly selling fake drugs. In 2014, the largest online Canada drug retailer was forbidden by Health Canada from selling wholesale drug. Of the three primary entrepreneurs of online Canadian drugs sold to the United States, one is in jail, one exited the industry entirely, and the third is under investigation for criminal wrongdoing.<ref>http://www.winnipegfreepress.com/opinion/fyi/waking-the-giants-201736111.html</ref><ref>http://www.winnipegfreepress.com/business/Health-Canada-suspends-Winnipeg-based-online-pharmacys-licence-262399141.html</ref><ref>http://www.winnipegfreepress.com/opinion/fyi/generation-rx-200693481.html</ref> | |||
| * Because ] is legal in Canada but illegal in most of the US, many US citizens suffering from ], ], ], and ] have traveled to Canada for medical treatment. One of those is ], the ]'s 1998 candidate for governor of ], who is suffering from ].<ref> ] July 20, 2002</ref> Recent legal changes such as ] may decrease this type of medical tourism from California only. | |||
| ==Comparison to other countries== | |||
| {{Main|Comparison of Canadian and American health care systems}} | |||
| The Canadian health care system is often ] to the US system. The US system spends the most in the world ], and was ranked 37th in the world by the ] in 2000, while Canada's health system was ranked 30th. The relatively low Canadian WHO ranking has been criticized by some {{Who|date=November 2009}} for its choice of ranking criteria and statistical methods, and the WHO is currently revising its methodology and withholding new rankings until the topics are addressed.<ref>{{cite journal|author=Phyllida Brown |url=http://www.bmj.com/cgi/content/full/324/7331/190/b |title=WHO to revise its method for ranking health systems |doi=10.1136/bmj.324.7331.190b |date=2002-01-26 |accessdate=2011-02-10|journal=BMJ|volume=324|issue=7331|pages=190b}}</ref><ref>{{cite journal |last=Deber |first=Raisa |date=2004-03-15 |title=Why Did the World Health Organization Rate Canada's Health System as 30th? Some Thoughts on League Tables |journal=Longwoods Review |volume=2 |issue=1 |pages= |url=http://www.longwoods.com/product.php?productid=17238 |accessdate= 2008-01-09 |quote=The measure of "overall health system performance" derives from adjusting "goal attainment" for educational attainment. Although goal attainment is in theory based on five measures (level and distribution of health, level and distribution of "responsiveness" and "fairness of financial contribution"), the actual values assigned to most countries, including Canada, were never directly measured. The scores do not incorporate any information about the actual workings of the system, other than as reflected in life expectancy. The primary reason for Canada's low standing rests on the high educational level of its population, particularly as compared to France, rather than on any features of its health system. }}</ref> | |||
| Canada spent approximately 10.0% of GDP on health care in 2006, more than one percentage point higher than the average of 8.9% in ] countries.<ref name="OECD 2008">, ], July 2007. Retrieved February 2, 2009.</ref> According to the ], spending is expected to reach $160 billion, or 10.6% of GDP, in 2007.<ref>Media release, , Canadian Institute for Health Information, November 13, 2007. Retrieved November 19, 2007.</ref> This translates to $4,867 per person. | |||
| Most health statistics in Canada are at or above the G8 average.<ref>{{cite news|url=http://v1.theglobeandmail.com/special/romanow/stories/numbers.html |title="Health Care: The Romanow Report - By the Numbers" (Saturday, Feb. 4, 2006) globeandmail.com - Canada's best source for news continuously updated from The Globe and Mail |publisher=] |date=2006-02-04 |accessdate=2011-02-10 |location=Toronto}}</ref> Direct comparisons of health statistics across nations is complex. The ] collects comparative statistics, and has published brief country profiles.<ref>{{cite web |author=] | title=OECD Health Data 2008: How Does Canada Compare| url=http://www.oecd.org/dataoecd/46/33/38979719.pdf| format=PDF| accessdate=2009-01-09}}</ref><ref>{{cite web|url=http://www.oecd.org/document/46/0,3343,en_2649_34631_34971438_1_1_1_1,00.html |title=Updated statistics from a 2009 report |publisher=Organization for Economic Co-Operation and Development |date=2010-09-28 |accessdate=2011-02-10}}</ref><ref>{{cite web|url=http://www.oecd.org/document/16/0,3343,en_2649_34631_2085200_1_1_1_1,00.html |title=OECD Health Data 2009 - Frequently Requested Data |publisher=Organization for Economic Co-Operation and Development |date=2010-09-28 |accessdate=2011-02-10}}</ref> | |||
| {| class="wikitable sortable" | |||
| |- | |||
| !Country | |||
| !<small>]</small> | |||
| !<small>] rate</small> | |||
| !<small>]s per 1000 people</small> | |||
| !<small>] per 1000 people</small> | |||
| !<small>Per capita expenditure on health (USD)</small> | |||
| !<small>Healthcare costs as a percent of ]</small> | |||
| !<small>% of government revenue spent on health</small> | |||
| !<small>% of health costs paid by government</small> | |||
| |- | |||
| |] | |||
| |81.4 | |||
| |4.2 | |||
| |2.8 | |||
| |9.7 | |||
| |3,137 | |||
| |8.7 | |||
| |17.7 | |||
| |67.7 | |||
| |- | |||
| |'''Canada''' | |||
| |'''81.3''' | |||
| |'''4.5''' | |||
| |'''2.2''' | |||
| |'''9.0''' | |||
| |'''3,895''' | |||
| |'''10.1''' | |||
| |'''16.7''' | |||
| |'''69.8''' | |||
| |- | |||
| |] | |||
| |81.0 | |||
| |4.0 | |||
| |3.4 | |||
| |7.7 | |||
| |3,601 | |||
| |11.0 | |||
| |14.2 | |||
| |79.0 | |||
| |- | |||
| |] | |||
| |79.8 | |||
| |3.8 | |||
| |3.5 | |||
| |9.9 | |||
| |3,588 | |||
| |10.4 | |||
| |17.6 | |||
| |76.9 | |||
| |- | |||
| |] | |||
| |82.6 | |||
| |2.6 | |||
| |2.1 | |||
| |9.4 | |||
| |2,581 | |||
| |8.1 | |||
| |16.8 | |||
| |81.3 | |||
| |- | |||
| |] | |||
| |81.0 | |||
| |2.5 | |||
| |3.6 | |||
| |10.8 | |||
| |3,323 | |||
| |9.1 | |||
| |13.6 | |||
| |81.7 | |||
| |- | |||
| |] | |||
| |81 | |||
| |4.8 | |||
| |2.5 | |||
| |10.0 | |||
| |2,992 | |||
| |8.4 | |||
| |15.8 | |||
| |81.7 | |||
| |- | |||
| |] | |||
| |78.1 | |||
| |6.9 | |||
| |2.4 | |||
| |10.6 | |||
| |7,290 | |||
| |16.0 | |||
| |18.5 | |||
| |45.4 | |||
| |} | |||
| ==See also== | |||
| {{Portal|Canada}} | |||
| {{Misplaced Pages books|Canada}} | |||
| *] | |||
| *] | |||
| *] | |||
| *] | |||
| *] | |||
| *] | |||
| *] - tabular comparisons of the US, Canada, and other countries not shown above. | |||
| *] Evidence Network of Canadian Health Policy | |||
| *] | |||
| *] | |||
| *] | |||
| *] | |||
| ==References== | |||
| {{Reflist|2}} | |||
| ;Bibliography | |||
| {{Refbegin}} | |||
| *CIHI 2009 {{cite web|url=http://secure.cihi.ca/cihiweb/products/National_health_expenditure_trends_1975_to_2009_en.pdf|title=secure.cihi.ca |format=pdf |work=Canadian Institute for Health Information|accessdate=}} | |||
| {{Refend}} | |||
| ==Further reading== | |||
| *{{cite book|url=http://books.google.ca/books?id=_q0O2RjAO84C&lpg=PA37&dq=Canada%20Health%20Act&pg=PP1#v=onepage&q&f=true|title=Health care reform & the law in Canada: meeting the challenge|first1= Timothy A|last1= Caulfield|first2= Barbara |last2=Von Tigerstrom|publisher= University of Alberta Press|year= 2002|isbn=0-88864-366-7}} | |||
| *{{cite book|author= Fierlbeck, Katherine|title=Health Care in Canada: A Citizen's Guide to Policy and Politics|url=http://books.google.com/books?id=K-cvzH07VCUC&pg=PP1|year=2011|publisher=University of Toronto Press|isbn=978-1-4426-0983-9}} | |||
| *{{cite book|url=http://books.google.ca/books?id=gk6PhLacH3wC&lpg=PA19&dq=Health%20care%20in%20Canada&pg=PP1#v=onepage&q&f=true|title=Cost Containment and Efficiency in National Health Systems : A Global Comparison|first1=Philip |last1=Jacobs|first2= Egon |last2=Jonsson|first3= John |last3=Rapoport|publisher=Wiley-VCH|year= 2008|isbn=978-3-527-32110-0}} | |||
| *{{cite book|url=http://books.google.ca/books?id=8KvGkTvjH1oC&lpg=PR1&dq=Health%20care%20in%20Canada&pg=PR1#v=onepage&q&f=true|first=John Deutsch |last=Institute|title=Study of Economic Policy Health Services Restructuring in Canada Conference|publisher=Economic Policy, Queen's University|year=2006|isbn=978-1-55339-075-6}} | |||
| *{{cite book|url=http://books.google.ca/books?id=mGGcyOSrESEC&lpg=PP1&dq=Health%20care%20in%20Canada&pg=PP1#v=onepage&q&f=true|title=Health systems in transition : Canada|first= Gregory P|last= Marchildon|publisher= University of Toronto Press|year= 2006|isbn= 978-0-8020-9400-1}} | |||
| * {{Cite book |last = Raphael |first =Dennis |year =2007 |title =Poverty and Policy in Canada: Implications for Health and Quality of Life |url =http://books.google.ca/books?id=P15Ye7AcS34C&lpg=PA288&dq=Gun%20policies%20in%20Canada&pg=PP1#v=onepage&q&f=true |publisher=Canadian Scholars' Press |isbn=978-1-55130-323-9 |accessdate = |postscript = <!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}} }} | |||
| *{{cite book|url=http://books.google.ca/books?id=MUItoTour5oC&pg=PA559&dq=Canada+Health+Act#v=onepage&q&f=true|pages=559–562|title=Encyclopedia of health services research|first=Ross M|last= Mullner|publisher=SAGE|year=2009|isbn=978-1-4129-7194-2}} | |||
| ==External links== | |||
| * | |||
| * | |||
| * | |||
| * Data from the ] | |||
| ** | |||
| ** | |||
| ** | |||
| {{Canada topics}} | |||
| {{North America topic|Health in}} | |||
| {{DEFAULTSORT:Health Care In Canada}} | |||
| ] | |||
Revision as of 23:16, 19 December 2014
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