Medical Malpractice by Canadian Governments

The Canadian medical system is much admired outside of the country. Patients receiving its services have mixed views, some strongly critical. To me, the problems appear systemic. While there are excellent facilities and well trained doctors, nurses and administrators, the parts are not integrated in a way which delivers treatment satisfactorily. The problem rests with government financing and its interaction with those providing medical services.

Emergency problems are dealt with promptly and efficiently. Non-emergencies can result in unacceptable delays. Two examples: I thought the delay I experienced to see an orthopedic surgeon for an ankle injury was excessive – it was projected at nine to twelve months from referral by a GP. I am sitting by my phone at the eight month mark. A friend with a spinal disc problem requiring surgery was told the wait would be four years. Even if the first is marginally acceptable, the latter is not. It does not represent the satisfactory working of a medical system. Rather than fulminate further, I will try to outline what seems to be the problem. (Yes I am old and it may not matter, but young people experience similar delays.)

Operating rooms in hospitals are available. In many, they are used less than 24 hours a day (Jeffrey Simpson documented this in his book, Chronic Condition, reviewed at https://cmaule.wordpress.com/category/book-reviews/ April 22, 2013). Surgeons are available. What seems to be missing is the support staff to allow the available surgeons to work in the available theatres. Why? Hospitals do not have the funds to pay the non-medical staff to allow a team to provide the services. I hope this is the reason. If not, it means crushing incompetence on the part of those administering hospitals.

The solution lies primarily in the hands of the government in making its budgeting decisions. Maybe there are other factors of which I am unaware, but to an economist when you have unused high cost facilities and unused high cost specialists, then there must be some further factors causing friction in the system, which prevents delivery of the services accounting for a major share of the provincial government’s budget. The parts are not working smoothly together and the engine is not producing full power. A racing car manufacturer would never allow the system to wreck the car’s performance.

What Ontario experiences may be different to that in other provincial jurisdictions. I have read that Vancouver operating theatres are more intensively used with surgeons operating on private patients during nighttime hours. This signals a combination of public and private medical services in BC. The same is true elsewhere in Canada where only certain medical services are covered by the government, and individuals either pay cash for non-covered services or buy private medical coverage, as one does when travelling abroad. It is estimated that in Canada the government pays for 70% of medical services and the remainder is privately financed.

The medical system, like the educational and defense systems which are publicly funded, take time to change, sometimes too long. Technology may expedite change. In other sectors information technology has caused seismic eruptions. Think of communications, music, films, television, radio, newspapers, books, and now education with online courses, and defense with missiles and drones. Similar changes are coming to medicine with real time monitoring devices, for example, which do not require as many visits of patients with doctors. The inefficiencies associated with travel time for patients and office time for doctors can be reduced. A doctor’s productivity may be increased by being able to monitor and treat more patients in a given time period. One example is provided by https://www.youtube.com/embed/r13uYs7jglg

 

In sum, the Canadian medical system has excellent elements but is seriously malfunctioning. Unless there is public criticism which makes politicians take notice and act, Ontarians are doomed to receiving poor health services for their tax dollar, or go elsewhere in Canada or abroad and pay for necessary treatment. Note that this already happens with education, whereby about five percent of the school age population is educated privately, while their parents get no relief from the taxes used to provide public education.

 

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