I invite people to look back and read the clear claim that you made and then decide if your post above still makes any sense.
The fact that the USA healthcare system is different to Australia is not in doubt and not contested, certainly not by me (that is sort of the premise on which this thread is built)
However, I’ve made no direct comparison between The USA and Aus systems. You have (and threw in a claim about the NHS as well), and I merely ask you to provide the evidence for the claim you made.
You appear to be confusing my request for information as a counterclaim.
If you can’t back up your position with anything more than anecdotal family members and “Yes Minister” then it seems a fairly weak position.
They’re admitted in droves in Medical School, and the wide majority of them are flushed out during the first two years of Med School. So, it’s in a way quite similar to the US situation, except that it happens in the Med School itself, not in a preparatory general school.
with the difference that in the North American system, if you do your two years of pre-med and don’t get accepted into medical school, no-one ever needs to know.
In the French system, that mark of failure is on the notes from the institution, n’est-ce pas? Potentially follows you forever.
It is wasteful, but as I said that how the University system works in France. It’s particularly blatant for Medical studies (and I hear it’s even worst for veterinary schools), but the failure rate is in general massive, in particular in scientific fields (with the difference that in this case, there isn’t a specific number of openings, so you just have to do well enough to be admited in second year, third year, etc…). Most students are well above their head with the material, and there’s not much in the way of support for those who can’t manage by themselves (and there even used to be none at all when I was in my 20s…nowadays they pay at least some minimal attention to the transition between high school and uni).
But in France, selection for joining university is considered anathema. Anybody with a high school diploma is supposed to be able to join. So the selection is done by “natural selection of the most fit”, mostly during the first year. Swim or sink system. High school is differentiated in France, with many different sections, some including much more scholarly (as opposed to technical) material, some much more orientated towards sciences or towards humanities, etc… But nobody is preventing you from joining a mathematics/physics uni when you’ve mostly studied music and philosophy or accountancy in high school. You’ll just join and fail.
On top of which, there’s no equivalent to the college years where you begin by studying a variety of disciplines in France. If you join as a sciences student, you’ll do hard sciences and maths plus some hard sciences and maths, and then a little of hard sciences and maths. None of that major/minor bullshit. You’re there to become a phycisist or die trying (more likely). If you’re interested in anything else, you can do it on your own time. I’m exagerating a bit : when I was there we had one hour of english and one hour of computer science/ week. So it was only 95% sciences and maths ;).
Note that the more prestigious “grandes écoles” (which aren’t universities) have a drastic selection process in place, on the other hand. As a result, however, they have an even stronger bent towards “social reproduction”, with students coming mostly for an upper social background (and it’s becoming worst rather than improving : they used to the place where the son of a schoolteacher, himself the son of a farmer or blue collar, would reach the top. Not really anymore).
Failing in a field and switching to another is so common that it isn’t really a blackmark. Especially true for medical students, since it’s so notorious that only very few of them will manage. Any other uni or school you’ll subsenquently try to join will understand that failing in Medicine doesn’t mean that you’re a bad student. Three of my nephew/nieces started in Med school. One succeeded. The others two switched to history and law without a problem.
The main issue is the resulting waste of time, energy and money.
Drugs are free if administered in hospital or certain clinics.
Otherwise you pay out of pocket, but then again, the rates are dictated by province, and some provinces have mandated drug insurance policies too, with a cap on payments per year.
It’s not underfunding as much as it is administrative.
Across the country bureaucrats have come up with many plans to try and get doctors in the same place as patients. It’s just that patients have a very different idea about where they want to receive medical care than bureaucrats will accept.
Fr’instance, Quebec’s PREM system is a way to get doctors to work in rural areas and limit the number of doctors in the metropolis.
This means, of course, that every citizen knows the best doctors work in Montreal.
And so patients decide they won’t see a doctor 5 minutes from home, but instead travel to the city to see a better doctor, no matter their problem.
Those same patients then complain about wait times that would not exist if they stayed closer to home.
I’d like to address this point.
In my experience, delays in care happen because patients are uninformed about what type of care is performed where.
In the US, the result is people who have heartburn making appointments to see a cardiologist.
In Canada, it’s people going to the wrong hospital for their problem.
People in Canada have this idea that a hospital is a hospital is a hospital – which is actually not the case.
This week I’ve seen people on social media complaining about going to Montreal’s newest hospital ER because they fell and broke their wrist and being turned away. That is because this hospital does not treat broken bones. That’s done at a different hospital in the network which has the facilities for orthopedic surgery, if necessary.
But people don’t know this.
It’s a massive educational failing which could be corrected with a simple PR campaign.
Maybe, but when the wait times in Toronto, and (From what I’ve heard) Sault Ste Marie, and Fort MacMurray, and Winnipeg - are all in the “can’t find a doctor” range, it’s not because of regional disparity. It’s because doctors everywhere are overloaded.
Ontario, for instance, automatically covers prescription drugs for seniors. There is a $100 annual deductible – one of the rare cases where the patient actually has to pay something out of pocket – but even that is waived for those with low income. Since most people are either working and covered by one of the ubiquitous employer supplemental plans, or retired and covered by the public drug plan, relatively few people actually have to pay for drugs out of pocket.
That may be, but UltraVires is arguing from the standpoint of ideology, where “free market” principles are supposedly effective in addressing health care issues. But as I and many others are constantly having to point out, as I most recently did in post #110, the objectives of universal health care and its essential nature as a basic human right are fundamentally at odds with free market principles, so it’s hardly a surprise that it has never worked well in the US and never will, until the government becomes closely involved either in its strict regulation as a universal community-rated system or its direct administration, as it does in all other civilized countries.
My comment above about the Ontario seniors’ drug plan is just one small example of this. It’s a sensible program because seniors are far more likely to need costly medication, and may need it long term, so they need the most help. But what insurance company in its right mind, applying “free market” principles, would insure only the highest-risk and most expensive demographic? They’d go after young people who aren’t likely to need medication but from whom they could collect premiums and profit handsomely. It’s government, as always, that actually looks after the public interest.
We have a variant of that in the UK, but rather in the policy/planning end of the scale rather than the individual user side of it, in that you can only access hospital specialists through your GP or a hospital A&E (=ER), and everyone knows that. But people will resist to the death any proposals to re-organise local hospitals and services to redistribute services so that, e.g., major traumas requiring highly specialist treatment can be concentrated in fewer, better-resourced locations, while their local hospital A&E is “downgraded” to lesser injuries and “urgent care”.
There’s a constant process of re-arrangement and delegation of responsibilities and capabilities from hospital specialists out to community and GP services, and from doctors to specialised nurses and paramedics - because that’s how medicine develops. At one level, people understand that; at another they don’t like the idea of the ambulance having to go an extra 20 miles, even if everyone tells them there’d be a better chance of surviving that stroke or car crash.
(PS: Of course there needs to be regulation in marketised medicine: what else is the process of licensing doctors, nurses, drugs and medical devices? How can the consumer possibly be acting at the same level of capability and competence of judgement as the provider?)
To be fair, in most of Canada, a hospital is a hospital, is a hospital. Mostly only in large metropolitan areas, and medical hubs, are efficiencies realized by separating urgent care from emergent care, etc. But that’s the exception, not the norm.
Exactly. Other than, say, “Women’s Hospital” or “Hospital for Sick Children” which may or may not still specialize, all hospitals I’ve every heard of treat whoever comes in for whatever.
The problem with ER’s in hospitals, and (I presume) also in the USA, is that what both health systems really need is more walk-in clinics. You can’t just drop in on the local doctor and get treated - they close up at 5PM, and they are usually booked all day. So the ER substitutes for a walk-in clinic for probably 80% of the patients, rather than doing its job of treating real emergencies and possible hospital admission cases.
YMMV, but here in Regina, the doctors’ clinics work by appointment and by walk-in. If I want to see my own doc, I make an appointment - usually a couple of days, but the last one I made was the next day at 9.30.
But if you want to go as a walk-in, it’s same day service, perhaps after a 30-60 minute wait.
ETA: and most of them stay open in the evening, usually to 8 or so, accepting last patient at 7.15 or 7.30.
In other words, I don’t think you can make a general statement about clinic times and walk-ins that’s good across Canada. Clinics are private businesses, not under gov’t direction, and each one sets their own hours and appointment/walk-in policies.
Only if you define “most” geographically.
I’m just checking quickly, but it seems that any region with more than 250,000 people has specialized hospitals.
Adding up, that means more than half of Canadians live in a region where there is more than just THE hospital in town – and so people should know the appropriate place to seek treatment.
Intuitively, this seems an exceptionally peculiar claim.
The US system is notoriously expensive with inefficiency considered a bit part of the reason. It costs about 10 000 per American per year to run. Meanwhile the NHS is known to be very efficient in terms of cost per results. It costs a bit under 3000 per head of population per year. Generally getting better results and covering the whole population.
Mathematically, it seems exceedingly improbable that the NHS has anywhere near that inefficiency. There would simply not be enough money left for it to do much actual work, and its results indicate that a lot of actual work is being done.
It is not correct to say that capitalism discourages inefficient use of resources. In reality as we can observe it, market-based healthcare leads to exceptionally inefficient use of resources. This is also in accordance with orthodox economic theory, which indicates that health care is highly unsuited for market-based delivery much like contract arbitration and national defence.
What is true is that operating theatres in the US sees more use. This is due to what is normally called “ineffective use of resources” as the difference is more than made up by the US tendency to overprovision.
Further, when stating “and notoriously in the NHS, surgical theatres are built and left empty, unused, for years” I think I need to see some cites on that claim. I’ve heard that a hospital was not immediately put to use in the 70s and that the case was lampooned in “Yes, minister” However, “Yes Minister” is not a documentary, and basing opinions about NHS efficiency on it is rather like if I were to base opinions on US nuclear safety on what I’ve seen of Homer Simpson.
If wards standing empty for years is indeed “notorious”, you should have no difficulty finding proper sources for it. If not peer-reviewed then at least not the Daily Heil or Express.
That’s a myth, actually. The US spends more money on research per person, but like every other area of healthcare, results are not proportional. Innovation is still good but per person it is not noticeably better than in the state run UK. In general, US innovation is more about commercializing and improving breakthroughs and discoveries rather than making the big eurekas, but that is a fair enough area of specialization.
“Inefficiences” in medical services must be a very tricky concept: one bean-counter’s “productivity” gain is a patient’s inconvenience or even misery as the nurses haven’t the time to stop and help them drink, or hold their hand when they’re frightened or dying. It’s the difference between “efficient” and “effective”: is a reduced number of beds (or even empty wards) a measure of understaffing or of better care outside hospital?
As ministers in charge of the NHS are currently (and once again) finding, you need some redundancy to cope with the unexpected, and if you squeeze the number of beds per measure of population, sooner or later you can’t cope when there’s some epidemic, or when winter pressures, or the number of frail elderly with reduced social care support at home, increase demand on the hospitals. It wouldn’t be surprising that a market-based system might have greater apparent redundancy to allow for the ability to treat people with minimal delays - but as to whether that’s inefficient or ineffective depends on your priorities and your choice of measures.