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July 07, 2006

Canada's Public System Out-performs U.S.

Canada outperforms U.S. in public health care
Our system could be much worse

After a day of giving checkups, prescribing drugs and hearing about symptoms, one New Brunswick family physician wasn't surprised to read a Harvard Medical School study released this month, stating Canada's public healthcare system outperformed its U.S. counterpart in economic efficiency and patient well being.

The study, published in the American Journal of Public Health July issue, found U.S. residents spend twice as much per capita on health care, yet they're 19 per cent more likely to face unmet health needs.

"There's no question a universal health care system is the best one," said Dr. Eva Eros, a Moncton based family physician practicing in New Brunswick for more than 20 years.

"I don't see how the market system can be called efficient when more than 40 million Americans are uninsured," said Dr. Eros.

More than seven times as many U.S. residents reported going without needed care due to cost as Canadians (7.0 per cent of U.S. respondents vs. 0.8 per cent of Canadians). Uninsured U.S. residents were particularly vulnerable; 30.4 per cent reported having an unmet health need due to cost, according to the study.

Harvard's study analyzes the Joint Canada-U.S.

Survey of Health, the first-ever cross national health survey carried out by the two nations' official statistics agencies involving 3,505 Canadians and 5,183 Americans interviewed between November 2002 and March 2003.

Dr. Eros thinks higher rates of chronic illness south of the border are symptoms of culture, along with economics and public policy. "...one of the things they (the report's authors) say is that the U.S.

has higher rates of chronic disease, which doesn't necessarily mean worse treatment. Longer work hours, fast-food, obesity, spending all that time in the car, there are social factors at play beyond the health care system itself," she said.

According to the study, U.S. residents had: more high blood pressure (18 per cent of U.S. residents versus only 14 per cent for Canadians) and higher obesity rates (21 per cent of U.S. respondents reporting obesity versus 15 per cent of Canadians).

Canadians were 7 per cent more likely to have a regular doctor.

"These findings raise serious questions about what we're getting for the $2.1 trillion we're spending on health care this year," said Dr. David Himmelstein, Associate Professor of Medicine at Harvard and study co-author.

"We pay almost twice what Canada does for care, more than $6,000 for every American, yet Canadians are healthier, and live two to three years longer." Even with the private for-profit insurance driven health model so thoroughly rebuked by top medical institutions (the New England Journal of Medicine published a study in 2003 showing the U.S. model was less efficient and had greater administrative costs) privateers still lurk in the shadows of policy.

With an aging population, sick people in this country could be very profitable.

The great game of who controls New Brunswick's health care is still in full swing, although it's probably never been so cynical, so overtly linked to polling numbers not principle. Stephen Harper devoted a good part of his political life to undermining the public system, he led the National Citizens Coalition, a group created in 1967 specifically to oppose public health care.

But Mr. Harper has changed his tone, consistently supporting the Canada Health Act, key legislation protecting universal public care. He even rebuked his pal Alberta Primer Ralph Klien back in April, when old king Ralph tried implement his 'third way' health model.

Alberta's shelved legislation would have: created a new insurance scheme for those willing to pay for quicker access to joint replacements and other procedures and allowed doctors to practice in both the private and public systems at the same time.

Bernard Lord's 2003 musings of privately managed hospitals met the same fate as Ralph's palliative pipe dream and haven't re-emerged.

Harper and others who morally believe in private health care are more politicians desiring power than wonks wanting policy. They've read the polls and they know privatization is deeply unpopular.

Harper won't be privatizing health services soon, although it's hard to believe he won't try to the moment he's given the political space.

Like many New Brunswickers, Dr.

Eros isn't without some nasty anecdotes from current Canadian health policy, "I have a patient now who has been waiting six months for hip surgery and she'll probably have to wait another three, she's in chronic pain so this isn't an ideal situation." But rather than letting the rich jump the queue on essentials services, Dr. Eros thinks, "we need to train more specialists to address the long delays for surgery and more family physicians to address the needs of patients who don't have a primary care physician even in this country." She thinks primary care teams including nurse practitioners and public health nurses can do a great deal to improve access to health care.

"Primary care helps provide early diagnoses which can fix ailments before they get more expensive and difficult to treat. Hospital admission can be avoided," she said.

The health-care situation in New Brunswick isn't perfect but, according to Dr. Eva Eros and Harvard Medical School, it could be a whole lot worse.


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