The tale of two cities
Geoffrey Simpson documents the failures of Canada’s often-praised health care system. The following is a personal illustration of its inefficiencies. It has nothing to do with the medical expertise of the various professionals who deliver the services, but results from the organization of the system itself, which politicians and officials fail to recognise. Delivery of health care in Bangkok, Thailand is more efficient than that in Ottawa. It is cheaper for the government, private insurers and for the individual who pays for this by a combination of taxes, premiums to private insurers and cash, to say nothing of the benefits accruing to the patient….myself in this case.
Delivery of medical services involves reporting of symptoms, diagnosis and treatment. The shorter the time period for the delivery of treatment, the sooner the remedy is likely to occur, the lower the overall costs, and not least the less discomfort to the patient. Delivery in Bangkok is faster and cheaper than in Ottawa for the following reasons.
The symptoms involved two sore shoulders. In Bangkok, an appointment with a hospital-based shoulder sports medicine doctor at 8.30am Tuesday morning lead to a MRI scan at 2pm on the same day, with the results reported two days later. The initial diagnosis suggested that a cortisone injection or an operation might be required if the rotator cuff muscle was damaged. An operation is generally recommended, but because of my age, it was unlikely to be successful. Cortisone would relieve the pain but would make a future operation not possible. A decision would be made once the MRI results were interpreted.
In Ottawa, a decision was reached by a circuitous and inefficient route. The symptoms were reported to a GP six months earlier who ordered physio treatment for the shoulders. This had limited effect and was followed by a doctor ordering an x-ray, followed by a meeting with the doctor followed by further physio, followed by a doctor ordering an ultrasound, followed by further physio. The ultrasound showed a full tear in the right rotator cuff muscle. It was suggested that a MRI would provide the most definitive information but was (for some reason, probably cost) not recommended.
The Ontario process lead to several visits to the doctor paid for by the government, treatment applied before a full diagnosis was made. X-ray and ultrasound were paid for by the government. The X-ray was done immediately, while there was a three week wait time for the ultrasound. The physio was paid for by a combination of private insurance and cash.
In contrast, the Bangkok process involved one visit to a sports medicine doctor and the MRI being done the same day so that treatment could begin at once based on correct diagnostic information. Payment for this was a combination of cash, Ontario and private insurance. A doctor’s report and a CD of the MRI scans was received three days after the initial appointment. Treatment could then begin at once based on complete information.
It is hard to praise the Canadian system which prolongs the stages of diagnosis to six months from 48 hours elsewhere, and involves intermediate treatment based on incomplete information. The patient, myself in this case, feels the difference.