I read a couple of recent articles regarding the free emergency medical care available in Canada.
In one, the author’s husband waited five hours to be evaluated for excruciating chest pain and was later diagnosed as having pulmonary emboli. The author stated that her husband’s challenge was to “survive the bureaucratic barriers long enough to benefit from this care.”
In the other, the author noted that so many hospitals were going on “bypass” (where they could divert patients coming to the hospital by ambulance) that ambulances were having difficulty finding a hospital available to take patients. The Canadian government “banned” the ability of hospitals to go on bypass, regardless of the number of patients in the emergency department. Now “critical congestion within ERs has become the norm.”
The author notes that “The problem is not the hospitals – the problem is the system.”
I think we’re kidding ourselves if we believe our emergency medical system will somehow become “better” if health care is nationalized.
On the other hand, we don’t run into the problems I read about on some ED blogs where the front line physician scrambles, lies, cajoles, etc. to get treatment for a patient with a thin wallet.
You take the bad with the good, I guess, and I doubt there are many Canadians who would give up our system for anything else.
Um… Marc… there is this little law called EMTALA here. You walk through the door, and you get to the specialist, if you need one, regardless of ability to pay. and if there is a specialist on call, because fewer specialists are taking ER call. So we all have specialist access, or none of us have access.
Canada’s system is great if you believe in health of the herd over heath of the individual. When I see Canadian patients, it is fun to watch their expression when you order a CT scan. Disbelief, mostly. They usually ask if they will be in our country long enough or should they wait the 3 months at home. Almost all Canadians seem to travel with private supplemental coverage, so they rarely ask about the bill.
Perhaps the Canadians love their system so much because they don’t know any other system. (ie your ankle fracture will be fixed in the Orthopedist’s office tomorrow in his surgicenter instead of a 2 day wait in a cot in the ER waiting for the OR to open — real case)
(Hey WC … is it Operating Room or Operating Department … nurse K made me ask
Operating Suite.
If you abbreviate it, maybe it is an orifice, or a Macintosh. Probably best not to abbreviate.
Anyone who follows the blogosphere, even a Canadian MS2 like me, definitely has heard about EMTALA… but usually not in the positive way igloodoc is describing. It gives free reign for every mom with a kid with the sniffles to come to the ER for a $500 workup instead of a quick, cheap visit to the family doctor. It just perpetuates the overwhelming cost of the American health care system. It’s why we spend $3326 per capita on health care, and you spend $6697, yet we still outpace Americans in nearly every major health category including life expectancy and infant mortality. And you tell me, just how easy is it to get that specialist to come into see the uninsured (or poorly insured) patient at 3 in the morning under EMTALA. With our system it might take a few hours longer, but at least they’re coming.
I love working in my health care system because I know that no matter what, everyone who walks in the door of my hospital is going to get excellent care, and I won’t have to fight with any insurance company, specialist, or government to get paid (when I eventually DO get paid for doing this stuff).
Yes, we do fail to get fast enough care for some things. Access to MRI and orthopedic surgery are probably our biggest woes right now, but what industrialized country doesn’t have some complaints about their health care system. We wait longer, but everyone ultimately gets the treatment they need, and I think the stats show that even though it’s not perfect, it’s better.
“everyone who walks in the door of my hospital is going to get excellent care”
“Access to MRI and orthopedic surgery are probably our biggest woes”
LOL yeah everyone gets excellent care if they can survive the wait and if they get their ration.
“And you tell me, just how easy is it to get that specialist to come into see the uninsured (or poorly insured) patient at 3 in the morning under EMTALA”
Ummmm well generally we page them, they call back, and if we need them to come in they come.
5 whole hours? That would NEVER happen here in the states.
Oh, wait–what’s that you say? Five hour waits are commonplace?
The last part sounds like what people say about us. I agree it would be scary for me not to have CT access but we have our own issues with congestion, crowding, and diversion. I feel like it’s impossible to get objective info about nationalized health care systems–it’s always reported through the prism of either liberal or conservative bias.
“Hey WC … is it Operating Room or Operating Department … nurse K made me ask”
Heh.
It’s not free. Those are tax dollars at work.
It’s interesting that “ED congestion being the norm” is often brought up as a criticism of Canada’s socialized health care, yet much of the work on emergency department gridlock has come out of US centres which are as bad or worse. Emergency department congestion is a problem of global proportions, and we see it on both sides of the border.
Disbelief at getting a CT? Heh. We have a couple of CTs running 24/7 where I work here in the Great White North. If it’s warranted, it gets done: right then and there. Now, if you’re looking for a CT tonight for something that can probably wait until morning, or if you’ve had ongoing problems for months… you can probably safely wait, and so you will. You’re not going to use a CT as a surrogate for a proper physical examination. You’re not going to be scanning people for minor issues that can be ruled out on clinical grounds. If a CT is being ordered in my ED, and I have good evidence-based reasons to do so, fantastic… put ‘em in the doughnut.
MRI? If I need it, it gets done. If I’m ordering it for a spinal cord compression… no questions asked. If I’ve got someone with shoulder pain for 3-4 months, well, they can wait. It’s probably not going to change their acute management anyway.
It’s also interesting that WhiteCoat has elected to base his opinion of the entire Canadian health care system on two editorial pieces talking about emergency departments in a single province — one clearly written by the angry family member of a patient. No bias there, eh?
Ontario’s biggest system issue at the moment is the occupation of acute care beds by elderly patients who cannot go home, yet there are insufficient long-term care and rehab spots available at the present time. They block acute care beds, so patients end up waiting boarded in the ED waiting, so the ED gets congested and the wait times go up. Different hospitals deal with this in different ways, made difficult by the limited budget in place from the province to fund more beds.
If you’re well, the Canadian system does a good job of helping to keep you that way. If you’re very ill, the Canadian system is very good at mobilizing the resources you need. It’s the wide grey middle zone where you start hearing stories about prolonged wait times and difficulty accessing timely care — depending on your definition of timely. Given the return for the amount of money expended, it’s not bad.
I live about ten miles (by crow or boat) from Canada. I’ve heard mixed reviews with the Canadian system. People love it when they hear about individuals with $10K bills, and hate it when they have to wait for an MRI (or cannot get one).
I know many people who live in Ontario who are very unhappy. I heard there was a plan to close the ER (or sorry…ED!) in both Niagara Falls, ans Fort Erie, Ontario, and expand the St Catherines facility. Three ED’s in a 20 Mile Area. There was a lot of anger/worry about that. However, The NYS DOH came in and asked that the Buffalo/ Niagara Falls area close half of our hospitals. They told us we had “too many” beds. They are still working it out…
HOWEVER! It was funny…that one of the worst hospitals were asked to close…and the “chain” did a huge marketing blitz. So…yes it is still open!
Having been both an employee and a user of both the US and CAD health care systems, I feel that I have a good understanding of both systems. Before anyone jumps all over me, I said “good”, but by no means “complete”.
I think it boils down to access, wait times and cost. In both systems, all people have access to health care (thanks to EMTALA in the US, but that only relates to EMERGENCY care). In CAD, we wait longer for non-urgent/less urgent outpatient tests/procedures. Though we don’t like the wait, we’ve become used to it. Would Americans tolerate waiting? No way. And why should they? They’ve never had to, so it would be difficult to get used to.
However, please don’t mistake EMERGENCY access to mean access to all types of health care. Just because all Americans can receive ER care doesn’t mean they are covered for preventative or specialized care. How many MDs no longer accept Medicare? More than we like to admit. Which forces those pts to overuse the ER. Which in turn causes more problems. Wait times in the US are long too, and access to inpatient beds can be just as difficult.
Many Americans seem to misunderstand access to Emergency Care in Canada. It’s actually a big pet peeve of mine. “They come to the US to get treatment that they couldn’t get in their own country’s ERs” (as I read recently). Some have said that CAD come to the US and are “shocked” to get a CT scan in the same day. When was the last time someone looked at a CAD ER? I work in a “smallish” ER in a midsized Ontario town. We have both CT and MRI access and our ER patients get their scan on the same day, if the need is there. IF THE NEED IS THERE. CAD docs tend to practice less “CYA” medicine than their US counterparts (lawsuits are capped at a much lower monetary value in CAD than they are in the US).
The big difference is cost. And Canadians are cheap. Sorry folks, but we are. How many of us can fathom paying $3000 for an MRI or $400 for a fiberglass cast??? But that is EXACTLY what I paid for both of those things when I was living/working in the US. And that is WITH insurance. Yes, I got the MRI within a month….but it came at a steep cost (at least I thought so, but then, I’m a cheap CAD). So, you take the good with the bad. We wait longer for certain things, but we also don’t pay a premium for having everything at our fingertips the moment we want it.
Neither system is perfect and both need over-hauling. We may be neighbouring countries, but our healthcare needs are vastly different. We should learn from each other about what works and what doesn’t, from sources other than the radio, news and inflammatory commentaries. But we shouldn’t expect to mimic each other’s systems because they are both far from perfect.
http://www.cnn.com/2009/HEALTH/02/27/healthcare.budget/index.html
I feel the most sorry for these people. Stories like this are emerging more frequently since the downturn in the economy. And Canada’s healthcare system is looking more and more appealing, at least to me. At least she wouldn’t be broke there.
Can’t have it both ways. As WC has said you can’t have your health care cheap,fast, and good all together.
Which should we have? I vote for good and cheap (unless you have a “real” emergency that is).
BTW, don’t they call the OR “Theatre” up there?
The First Law of Thermodynamics -
You can’t get more than what you pay for.
The story I always tell is of a Canadian nursing student in my class who always left the classroom in protest when some socialist crayzee was talking to us about how great the Canadian system was.
It may be that our very access to high-tech (not necessarily high-quality) care is exactly what’s driving down our outcomes. CT scans increase overall cancer rates, catheterizations increase kidney failure, aggressive anticoagulation triggers bleeds–all therapies have a risk and the higher impact they are, the higher risk. Everyone wants ‘full tilt’ care for their aunt with chest pain until she bleeds into her head from the heparin.
A lot of community hospitals do cath way more than academic centers, for example. I just had the conversation the other night while working at children’s that a patient I was seeing who got obs and a plain film before a CT scan would’ve been scanned on coming in the door in a community hospital.
In EM, though, the pendulum is shifting back; many recent podcasts from UCLA re-affirm the importance of, gasp, history and physical instead of triple-rule-out CT (to get PE, ACS, and aortic dissection) in the management of intermediate risk chest pain.
The US leads the way in flashy interventions like MRI, CT, and helicopter medicine. The key now is to judiciously apply those resources. We’ve had helicopter crashes because three show up for one car accident because of re-imbursement. The local ambulance company advertises on TV for people to call them directly. People come in demanding an MRI. It’s time for us to say, ‘no’. You don’t need an MRI, you don’t need a CT, you need a doc who will listen, and when I say, ‘go home, but watch for x, y, and z, follow up with your PMD, and come back’–I’m asking you, patient, to take responsibility for your own health.
We can’t deliver what people want anyway–to know for sure, via MRI or CT, that they will never get what they are afraid of. Time to stop trying. The biggest obstacle to that isn’t the government, but lawsuits.
Well… we could build more hospitals so we have more EDs.
I am losing my faith in our government and I never felt that way before. I hope I am wrong.
“We can’t deliver what people want anyway–to know for sure, via MRI or CT, that they will never get what they are afraid of. Time to stop trying. The biggest obstacle to that isn’t the government, but lawsuits.”
Yeah, the miniscule number of lawsuits filed per number of patients seen is the root of the healthcare problem. Not the government that basically funds over 50% of all healthcare, dictates types of care, reimbursement rates, etc. Or the health insurers that do the same. Excellent diagnosis!
[...] « Emergency Medical Care in Canada [...]
cheap, fast, good Pick any 2.
What planet are some of you American doctors on ? I’ve had er treatment in France, Canada, and the US all comparable in my estimation. In fact the best hands on care was in France.
US doctors lose more money thru bad financial investments than lawsuits. In the US too many MDs put $$$ before medicine with disastorous results.
My girlfriend who is studying in Edmonton recently had “sudden sensoneural hearing loss.” Right away I found on WebMD that this was one of the few emergencies in otology and that she needed to be seen immediately and begin taking oral steroids. The emergency room doctor decided to refer her to an ENT. Not being from Canada neither she nor I initially realized this meant she wouldn’t see anyone for months. I pleaded her case with the emergency room without success and called every ENT in Edmonton. Finally I flew her to Vancouver to see a private ENT. He told her she should have called him immediately and he gave her the steroids. She now has an extra airplane ticket in her purse for the next time she needs to see a doctor right away.