WhiteCoat

More On Comparing Health Care Systems

I’m trying not to make this blog like a broken record, but I have several “Google Alerts” for medical-related articles and I keep receiving abstracts describing the difficulties other countries are having with their health care systems.

I know that I keep using Canadian health care as an example of what could happen if a socialized system is implemented in the US, but Canada isn’t the only country having difficulty keeping its health care system sustainable.

This in-depth article from the McKinsey Quarterly (free registration required to read the entire article – definitely worth doing so) [hat tip to Head. S p a c e] notes that Japan’s health care system “has come under severe stress” and that its “sustainability is in question.” Demand for health care in Japan is increasing and Japan is having difficulty allocating available medical resources. As a result, patients are finding it more difficult to “get the care they need, when and where they need it.”
Japan’s emergency rooms turn away tens of thousands of people every year who need care – something which is beginning to happen in this country.
There is also an “ER [cringe] crisis” in Japan – because too few specialists are available for ED consultation.
Hospital reimbursements are low.
There is no incentive to modernize treatments.
Many poorly thought out cost-control measures Japan implemented have actually cost the system more money. Hmmmm. Where have I heard of that happening before?

When we switch to socialized medicine, we must be very careful not to replicate formulas for a failing system. Giving people unlimited access to free care seems to be a common denominator in more than one floundering national health care plan.

OK … as long as I mentioned Canada, I’ll throw in the latest article.

This article in the Calgary Herald describes how median wait times for available hospital beds are now 16.6 hours. In other words, half of Calgary patients wait more than 16 hours to get a bed. There is a shortage of nursing homes, sick elderly patients get sent to hospitals, and there are little if any “funded” beds available.
One story described an elderly patient who was experiencing a stroke and had to wait 24 hours to see a physician – by that time, the damage would have been long irreversible.
As with many health care articles, I think you can learn a lot about the underlying issues by reading the comments section. Comments to this article painted a vivid and familiar picture.
Many Canadians complained that nonurgent cases contributed to wait times and made statements such as “The emergency room [cringe] is for emergencies.”
Other commenters blamed the state of affairs on elected political parties. Sound familiar?
One of the ways that the hospital systems are apparently recouping some of the costs of care is by charging patients for parking at their facilities. Several commenters expressed their disgust with “paying for parking.”
The comment that made the biggest impression on me was one that claimed the Canadian government is “cutting costs/services, and making it look like it is in the red by underfunding it, only to make a greater case for PRIVATIZATION.”

I’m not sure if we should be telling Canadians to be careful what they ask for or if they should be making that statement to us.

3 Responses to “More On Comparing Health Care Systems”

  1. Carey says:

    Thank you for the insightful post comparing health care systems. So much of this informs and calls into question some of the solutions we have attempted to generate like universal healthcare; comparative effectiveness research; electronic medical records and empowered patients. Aside from the question of what exactly is the issue we are trying to address or “solve” with such initiatives your post reminds me of an article/interview by KevinMD in USA Today talking about the difficulty of actually thinking any sort of reform through. That is, how will we actually achieve a new system in practice? Just mentioning the term “universal” demands a tremendous amount of generating and filling positions, educating professionals, fair pay, responsible collaboration, effective decision making and so on that seems to often get overlooked…Thanks again, I enjoy reading your thoughts about the life of an emergency departments in particular and healthcare in general…

  2. Sarah says:

    Please keep in mind that the Canadian health care system is different in different provinces. Alberta has been ‘oil rich’ for many years with a growing population but the government there has chosen not to invest in health care infrastructure. This is now biting them in the ass (one of the ways that we Canadians keep our politicians in line – especially on health care – is via the media spotlight so often the picture painted in the media is pretty doom and gloom).

    In Ontario, wait times became an issue a while back so now the government runs a website http://www.health.gov.on.ca/transformation/length_of_stay/index.html
    You can look up how well your local hospital is doing in comparison to the provincial targets and averages. The hospital that I work at manages to get 9 out of 10 “Minor or uncomplicated conditions/requiring less time for diagnosis, treatment or observation” seen and out the door in 5.3 hours or less – which means we’re not meeting the provincial average and target. We’re working on this – we’ve proposed new strategies to the ministry of health and received additional funding to implement them. For “Complex conditions/requiring more time for diagnosis, treatment or hospital bed admission” we’re also not meeting the average or target, and again, we’re working on it. Apparently we’re doing better than Calgary though: our ‘total time’* for 9 out of 10 patients is 14.3 hours.

    I suppose any health care system is only as good as it’s weakest link – I just don’t want the assumption to be that the entire Canadian health care system is a mess. Or that we’re not trying to get any better.

    Sarah, Your lowly ward pharmacist, fine purveyor of quality drug information, medication counsellings, med histories, and renal dosing calculations. Also known as the antibiotic over-treatment dragon-lady.

    *“Total Time Spent in the ER” is the maximum amount of time 9 out of 10 patients spend in an ER receiving care or waiting for admission to a hospital bed. It begins when a patient registers until the patient is discharged or is admitted to a hospital bed.

  3. Sarah says:

    Please keep in mind that the Canadian health care system is different in different provinces. Alberta has been ‘oil rich’ for many years with a growing population but the government there has chosen not to invest in health care infrastructure. This is now biting them in the ass (one of the ways that we Canadians keep our politicians in line – especially on health care – is via the media spotlight so often the picture painted in the media is pretty doom and gloom).

    In Ontario, wait times became an issue a while back so now the government runs a website http://www.health.gov.on.ca/transformation/length_of_stay/index.html
    You can look up how well your local hospital is doing in comparison to the provincial targets and averages. The hospital that I work at manages to get 9 out of 10 “Minor or uncomplicated conditions/requiring less time for diagnosis, treatment or observation” seen and out the door in 5.3 hours or less – which means we’re not meeting the provincial average and target. We’re working on this – we’ve proposed new strategies to the ministry of health and received additional funding to implement them. For “Complex conditions/requiring more time for diagnosis, treatment or hospital bed admission” we’re also not meeting the average or target, and again, we’re working on it. Apparently we’re doing better than Calgary though: our ‘total time’* for 9 out of 10 patients is 14.3 hours.

    I suppose any health care system is only as good as it’s weakest link – I just don’t want the assumption to be that the entire Canadian health care system is a mess. Or that we’re not trying to get any better.

    Sarah, Your lowly ward pharmacist, fine purveyor of quality drug information, medication counsellings, med histories, and renal dosing calculations. Also known as the antibiotic over-treatment dragon-lady.

    *“Total Time Spent in the ER” is the maximum amount of time 9 out of 10 patients spend in an ER receiving care or waiting for admission to a hospital bed. It begins when a patient registers until the patient is discharged or is admitted to a hospital bed.
    BTW I love your blog!

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