Waiting times in the UK have gone up and down over the decades. It’s a variable picture, not just about hospital or primary care facilities, but also dependent on the state of general social care (which is organised and paid for by a different route) for the increasing numbers of frail elderly people, who can end up in hospital far longer than is medically necessary, because there aren’t adequate arrangements at home, or some alternative form of home. But that’s compounded by the way the number of hospital beds available has declined as budgets have been squeezed. Most of the waiting problems of the early 1990s disappeared when the Blair government poured a lot of money in and expenditure went up to EU average levels as a % of GDP. Since then the finances have been squeezed again and the % of GDP has dropped to nearer 9%; and there are howls of protest (I simplify) about staff shortages and rising waiting times.
It’s the problem of long lead times for training, as against constantly rising demand as people live longer and with more complex conditions, and ever newer and more expensive bits of kit become essential (I simplify). It’s reckoned (I don’t know on what basis) that there’s a need for an annual 2% real terms increase in expenditure to keep on an even keel. That, and recruiting staff from overseas.
Third-country doctors I know that have worked in the Canadian and Aus system think that the Aus system works better than the Canadian one.
Interestingly, although the American HEALTH system is notoriously broken, the allocation of resources inside the medical system (for those on the inside…) is often better than governement systems – as you would expect: capitalism does better resource allocation than state systems. So theatre utilisation is better, technical inovation is better etc. (All this within a system where health outcomes are worse and costs are higher…).
I’ve heard that Belgium has the best health system, better than Aus.
I would be interested to know more specifically what you think capitalism does better “inside the medical system”. Certainly some of those claims are false or are red herrings. Technical innovation, for example, is strong in the US across practically the whole spectrum of technology, not just medicine, simply because it’s a large rich developed country in which a lot of big corporations do R&D and the government generously funds organizations like the National Institutes of Health and other medical research. This has nothing to do with the particular form of health care funding, and indeed private health insurance companies have basically nothing whatsoever to do with medical innovation and medical research, but are essentially self-serving leeches in the system that add no value whatsoever. One can imagine federally funded universal single-payer health care with no changes at all in the underlying R&D infrastructure – in fact, there would be more money available to pay for it, because hundreds of billions would be saved by eliminating insurance bureaucracy.
I don’t know what you mean by “theatre utilization”, but I can tell you for a fact that resource utilization is frequently much worse in the US than in Canada. Patients may brag about being able to get an outpatient MRI or CAT scan the next day while in Canada as an elective outpatient you may have to wait. But think about what this means and how it comes about. The only way to get almost instant access to these million-dollar machines manned by highly paid staff is to have these facilities sitting around idle much of the time, just in case someone needs them. The cost of doing this is enormous, yet it’s still profitable because when that [del]sucker[/del] patient comes along, they can charge pretty much whatever they like. Whereas when usage is based on a triage-prioritized queue, it’s operationally efficient yet everyone is seen in accordance with their medical priority – and in-hospital patients never have to wait at all. So a diagnostic imaging process that costs $400 in Canada might cost $5000 or more in the US. Which represents more efficient resource utilization? What efficient capitalist company would tolerate having a very costly manufacturing facility that spends 90% of its time doing nothing?
To be clear, we have ambulance, fire, and police services and hospital ERs on standby all the time – that’s because they’re emergency services, and that’s as it should be. And surgical queues and imaging queues are bumped all the time by medical emergencies. That’s all as it should be. But that’s no way to run the routine vast majority of the health care system.
ETA: Posted before I saw this. Yeah, totally agree.
That is a skewed sample, of course. Doctors who have worked in Canada and Australia, but choose Australia, can be presumed to prefer the Australian system - because they chose it.
Just as doctors who worked in both systems, but chose the Canadian system, can be assumed to prefer the Canadian system - because they chose it.
It would be interesting to have a comprehensive statistically sound study on this point, but just relying on the say-so of the doctors who personally prefer the Australian system is not statistically sound.
I think it’s hard to describe the Canadian system as conscription. Doctors are not public employees. That was one of the key points that came out of the doctors’ strike in Saskatchewan: the rejection of that aspect of NHS. Rather, doctors are independent physicians, who run their own clinics and put in claims to the medicare commissions to be paid.
Instead of an NHS system, it’s an “in or out” system. If a doctor wants to take the benefit of getting paid by the provincial medicare system, no muss, no fuss, no squabbling over insurance coverage, no fear of cheques bouncing, then they get a billing number from the medicare system and away they go.
If a doctor wants a pure free-enterprise system, where the patient does all those shopping around things, haggles over the price, and the doctor has to do all their own debt collection, they can do so. That doctor just cannot get a billing number and participate in the medicare system. As well, if private insurers want to set up a completely private insurance system, the Supreme Court has held that they can do so, in certain cases. And if patients wanted to pay directly for their own care, or pay for their own comprehensive health care insurance, it is in theory possible to do so. We could in theory have a purely private medical health system, running alongside the public system.
But we don’t. Because, surprise surprise, patients and doctors prefer the publicly funded system and there is little to no interest by doctors to try to set up their own privately funded practices. Nor is there a pool of dissatisfied patients who want to pay out of their own pockets, either directly to the doctor, or to an insurance company.
And yes, the fact that they pay taxes which fund the public system does reduce the amount of surplus cash that they could use for private health care. But the key point, as md2000 and wolfpup have made, is that there is no political will to change the system. That is not just inertia: Canadians by and large like the system we have, and vigorously oppose even hints to creating a parallel private system, as exists in other countries.
I went to the link posted and read it all but I still don’t understand “charge bands”. Is it a monthly premium? If so, can you change which band you want any given month?
Or is it a fee you pay each time you see a dentist. For example, if you need a filling, you go to the dentist and pay £53.90 for one filling. If you need another filling next month, it’s £53.90 again.
I looked around a bit more on the InterWebz. I think I may understand it. Someone who knows please tell me if I’ve got it straight.
I think it works like this:
You go to a dentist for an exam and they figure out all the work that needs to be done in your entire mouth. This is your treatment plan. After looking at your plan you decide which level of service (or band) that you need. For example if you need 7 fillings you would choose Band 2 which covers fillings (along with similar and lesser treatments).
Then you need only pay the £53.90 Band 2 charge and that one payment will cover your entire treatment plan. If, however, you had needed 3 crowns as well as the 7 fillings, you would have selected Band 3 at £233.70 and that would have covered your total dental treatment including all the crowns, all the fillings, and whatever other things you need done (a cleaning, x-rays etc.).
Well, your dentist would have told you what was needed and which charge band that course of treatment fell in: you don’t have a choice of what the treatment costs, any more than you do in any other system. But yes, the charge bands relate to the nature, rather than quantity, of the work involved.
If every mechanic in town has every line engaged, will they remove someone else’s car to make room for yours? If a part they need to fix your car has to be made to order and shipped to the garage, will more money magically make it appear?
If you want to manage your medical care by private negotiation with a doctor, nobody’s going to stop you. But, as with any service in demand, you are somewhat in your private doctor’s hands as to when they can fit you in, however the system’s managed, just as you are if your car mechanic is in demand and has a queue of people waiting.
Nor does any NHS “bureaucrat” determine your need. Your GP carries out an initial diagnosis, and if necessary refers you to a hospital specialist. It’s the hospital specialist medical team that decides how urgent your need is for their treatment, just as they would if you were going to them privately - which you might well have an option to do (provided of course that you can afford it), since they are also free to spend a certain amount of time on private practice. The thing that’s different is that in the NHS you don’t have the financial implications to worry about, that’s between the doctors and the commissioning agencies.
Which confirms my suspicion that the waiting times/problems with finding a doctor who takes patients in Canada is probably an underfunded healthcare issue. If you have 33% less doctors than other comparable countries, there obviously going to be some problems.
Also means that if the USA switched to some public/free healthcare system, there would probably be also a shortage of doctors there, since the proportion of doctors is quite similar in both countries.
It just ensures the latter. Obviously, more doctors wouldn’t be an issue for the patients, but only for the doctors’ income.
Indeed, they’re the best at cramming crap in their mind. Which isn’t really a guarantee that they’re going to be the best doctors. And contrarily to other fields, they don’t need to simply put enough crap in their mind, they need to put more crap than the others in their mind, because of the NC.
Not sure what edge knowing the names of all both in the feet or whatever is going to give them in engineering.
And besides, if it’s a good idea, is there a good reason why we shouldn’t apply the same system to other disciplines? Why shouldn’t lawyers, or plumbers, benefit from a numerus clausus system to keep their income higher?
If food and hair cuts were tax-funded public services and death/pain/incapacitation were caused by lack of access to them…yes, that is the whole point of universal healthcare. Access is open to all but it is governed by medical need not ability to pay.
If there is a slot for a knee replacement tomorrow and it is a choice between me, needing it to allow me to continue to ski, or a teenager ravaged by arthritis and unable to walk…bump me down the list. I can wait.
Patients get assigned, the doctor doesn’t choose. When someone moves to a new area, they’re supposed to go to the nearest public healthcare center and ask for their history to be reassigned there; the admin person handling it will ask if you have any specific preference for your generalist/family doctor, if you don’t they’ll ask do you prefer mornings or afternoons, and they’ll assign you one according to your preferences. The admins know what’s the workload each doctor has and generally try to spread the workload around.
When you are sent to a specialist, it’s just by roll call. If you’re going to be seeing that particular type of doctor regularly then you’ll see the same one (unless they happen to be on vacation or something like that, in which case and if triage allows for it you’ll be given the choice to reschedule or see someone else). If your specialist visits are irregular then you may get assigned a different doctor each time you go for that specialty (my own mammograms get checked by a different doc every time, but I only go to the obgyn for wellness checks).
A doctor can recuse himself if there is a conflict of interest: for example, when my mother had surgery last year, one of the internists recused himself from the case as he’s also her neighbor. Given how often the two of them and his parents are in and out of each other’s house, he preferred to be able to stay in a role as “friend of the patient” and not be the one rooting around in her intestines. Understandable.
Yes, you should wait longer in a restaurant if there is someone there who is starving and may die if they don’t get food right away, while you’re simply hungry.
Yes, you should wait longer in the barber shop if someone comes in with a scalp condition that requires immediate attention or else they may suffer permanent disfigurement, while you just have long hair that needs attention.
Of course, neither of those is likely to happen with a restaurant or a barber shop, while that sort of thing does happen with regularity in the medical system. So really, your analogies are simply silly. Argument by analogy only works if the situations are equivalent.
Two points: it’s not some bureaucrat who determines how badly I need a particular treatment: it’s the medical professionals.
First: if I’m in the ER because I’ve sprained my ankle, and they bring in someone having a heart attack, I don’t get to say “Heart attack guy has to wait his turn. I was here first.” And if the situation is reversed, heart attack guy was there first and I come in with a sprained ankle, I don’t get to pull out my wallet and say, “I’ll pay cash right now with a premium to jump the queue ahead of heart attack guy.” In both cases, the ER doctors and nurses would just say: “Heart attack is a medical emergency and takes priority over a sprained ankle.”
Second: every time US folks bring up the “bureaucrat” argument against a government run operated health care system, they seem to conveniently forget that in the US system of private insurance, bureaucrats in health insurance companies are making those health care decisions all the time, and the basis they make them on is to save money for the insurance companies. Take a look at Broomstick’s thread, where her husband has cancer and she can’t get the insurance company to authorize a PET scan.
That fight is not over whether a PET scan is medically needed: the doctor and oncology nurse are both convinced it is.
But a bureaucrat in the insurance company is disputing their medical assessments, so the PET scan has not occurred, last time I checked that thread. That’s heart-breaking: your doctor and oncology professionals are convinced this procedure is needed, for a life-threatening condition, but the private insurance bureaucrat is stopping it from going ahead.
Getting back to the question asked in the OP, it’s examples like that that make Canadians determined to keep our system, and not abolish UHC. Our system is based on medical assessments of need, not on the bottom line of private health care insurance companies. And, in our system, if there are problems, there are clear political accountabilities, where people can put pressure directly on the politicians, to improve the system. That type of political pressure simply is not possible when the system is run by private insurance companies who are motivated by the need to make a profit for shareholders.
So, I don’t see any chance that Canada will abolish our universal health care system.