# Canada ranks second last in health care



## Rusty O'Toole (Feb 1, 2012)

Latest health care rankings of 11 rich countries









Canada's health system ranked second last among 11 countries: report


A new report has ranked Canada's health system second last, ahead of the United States, when comparing 11 high-income countries.




www.ctvnews.ca


----------



## sags (May 15, 2010)

So socialized healthcare took all the top spots on the list, with the US privatized system coming last.

I don't find that a surprise and I agree with the report that we need to increase financial support for people without benefit packages that include dental care, prescriptions, glasses etc.


----------



## sags (May 15, 2010)

The bottom line though is money. It is always about money.

The time has come to seriously discuss increasing government revenues to pay for what we want to achieve. That means higher taxes, and not just on the wealthy because that won't be enough.

Taxes have to rise for everyone because that is the operational mathematics.

More people pay a little each to create a bigger increase in revenues.

Reducing or freezing spending isn't an option anymore. There is too much that needs to be done.


----------



## Rusty O'Toole (Feb 1, 2012)

sags said:


> The bottom line though is money. It is always about money.
> 
> The time has come to seriously discuss increasing government revenues to pay for what we want to achieve. That means higher taxes, and not just on the wealthy because that won't be enough.
> 
> ...


You go first


----------



## MrMatt (Dec 21, 2011)

Rusty O'Toole said:


> Latest health care rankings of 11 rich countries
> 
> 
> 
> ...


It's really important to note that in Canada we separate out much of health care from "health care".

Dental is arguably the most common.
I look at how good my dental care is, access, price etc.
Physiotherapy, all sorts of things that aren't covered.

I think it's crazy you can book surgery for your pet in days, but for yourself it's months or years.


----------



## afulldeck (Mar 28, 2012)

sags said:


> The bottom line though is money. It is always about money.
> The time has come to seriously discuss increasing government revenues to pay for what we want to achieve. That means higher taxes, and not just on the wealthy because that won't be enough.
> Taxes have to rise for everyone because that is the operational mathematics.
> More people pay a little each to create a bigger increase in revenues.
> Reducing or freezing spending isn't an option anymore. There is too much that needs to be done.


I think those who want more from government, ought to pay more. I want less, less services, less intrusion and I am willing to pay less. It's time to drastically reduce spending. Nothing more needs to be done other than to get better money managers.....


----------



## afulldeck (Mar 28, 2012)

MrMatt said:


> It's really important to note that in Canada we separate out much of health care from "health care".
> 
> Dental is arguably the most common.
> I look at how good my dental care is, access, price etc.
> ...


Its not crazy...its a travesty.


----------



## Jimmy (May 19, 2017)

Interesting. The best systems in the report for outcomes are Switzerland and Austria which are a combo of public / private services. Completely pubic systems are awful for outcomes like wait times and lower mortality rates etc like in Canada


----------



## damian13ster (Apr 19, 2021)

sags said:


> The bottom line though is money. It is always about money.
> 
> The time has come to seriously discuss increasing government revenues to pay for what we want to achieve. That means higher taxes, and not just on the wealthy because that won't be enough.
> 
> ...


The U.S. continues to outspend other nations on health care, devoting nearly twice as much of its GDP as the average OECD country. U.S. health spending reached nearly 17 percent of GDP in 2019, far above the 10 other countries compared in this report. Moreover, high U.S. out-of-pocket health spending per person, the second-highest in the OECD, makes it difficult for many Americans to access needed care. 

US spends twice as much on healthcare as the 2nd closest country. It isn't about the money. 










There is actually negative correlation of health care quality to spending. 
Countries spending more have worse performance.
It is simple. Smart system is efficient, and therefore it is cheaper.
Canada is led by unintelligent people, and that's why despite higher spending than New Zealand, Australia, Netherlands, Norway, UK, Sweden, and comparable to Switzerland and Germany,
Canada ranks significantly worse in quality of health care.
It isn't about the money. If it was, we would be performing better than those countries.
It is about the efficiency. Smart system will result in better and most efficient performance, which will lead to decrease in costs of the system


----------



## Ukrainiandude (Aug 25, 2020)

MrMatt said:


> I think it's crazy you can book surgery for your pet in days, but for yourself it's months or years.


Veterinary services are provided on payment basis by private sector vs health care is provided by private sector but funded by the government via taxes.
Cut the middle man (government) out and you will get the same speed and lower taxes.


----------



## MrMatt (Dec 21, 2011)

damian13ster said:


> The U.S. continues to outspend other nations on health care, devoting nearly twice as much of its GDP as the average OECD country. U.S. health spending reached nearly 17 percent of GDP in 2019, far above the 10 other countries compared in this report. Moreover, high U.S. out-of-pocket health spending per person, the second-highest in the OECD, makes it difficult for many Americans to access needed care.
> 
> US spends twice as much on healthcare as the 2nd closest country. It isn't about the money.
> 
> ...


The reason Canada ranks worse is because we don't have any private care options.
If there are shortfalls in the public system, too bad. 

The reason the US does poorly is because they confuse 2 (3) different populations.

The people who can afford the absolute best care in the world, and the incredibly well funded medical researchers.
The people who can't afford care.
Then of course there are the people in the middle with insurance who have decent levels of care.


----------



## sags (May 15, 2010)

The countries doing better than Canada not only have socialized healthcare, but are very small countries with large populations.

Canada is larger in size than all of those countries put together, and has a small fraction of the population spread out across the breadth of the country.

It costs a lot more to provide services when people are so spread out and sparsely populated.

To a large extent the costs are a matter of density. Privatization isn't going to change that.

In fact, there would be no healthcare in sparsely populated areas at all if it was privatized.


----------



## sags (May 15, 2010)

Ukrainiandude said:


> Veterinary services are provided on payment basis by private sector vs health care is provided by private sector but funded by the government via taxes.
> Cut the middle man (government) out and you will get the same speed and lower taxes.


Only the extremely wealthy could afford the full cost of major surgery and hospital stays.

It can cost $200,000 US. for heart surgery in the US, plus the cost of rehabilitation and drugs.


----------



## Ukrainiandude (Aug 25, 2020)

sags said:


> Only the extremely wealthy could afford the full cost of major surgery and hospital stays.
> 
> It can cost $200,000 for heart surgery in the US, plus the cost of rehabilitation.


Did you know that 91% of Americans have health insurance and everyone over 65 years old gets it for free?
For a single worker in 2019, the average premium was $7,188. Of that, workers paid $1,242 or 17.2%.
Annually, the rest was picked up by employers.


----------



## sags (May 15, 2010)

They only recently have Obamacare, which is a government program.

Medicade and Medicare are government programs and are underfunded.

Most of the employer provided health care insurance in the US is useless.

They have high co-pay amounts and very limited coverage. It is like cheap travel insurance.

The US healthcare system is only less of a mess now than it was before Obama.

But it is still a huge mess.


----------



## sags (May 15, 2010)

If Canadians want better healthcare they have to be willing to pay for it.


----------



## ian (Jun 18, 2016)

Good reason to stay healthy and take care of yourself.


----------



## sags (May 15, 2010)

Yup......cause if you get really sick all the money in the world won't save you.


----------



## Jimmy (May 19, 2017)

So the best systems for outcomes are a private/public combo.


----------



## sags (May 15, 2010)

There aren't enough patients willing or able to pay the full cost of private healthcare.

As long as private healthcare providers receive no public funding, I have no objection.

But, I don't think that is what they have in mind.

They want government money to guarantee their business will be profitable.

They want the government to direct patients to their private clinics......and pay them.

Otherwise they would sitting around waiting for a wealthy patient to show up.

Anything that siphons money away from the public system is a non-starter for most Canadians.


----------



## bgc_fan (Apr 5, 2009)

Not that the Canadian Health care system is perfect, but it's worth looking at where the improvements can be made rather than making a blanket statement that it's a private/public combo that is superior. Also, it's also worth noting that the spending is being measured as percentage of the GDP, and not spending per capita. Based on 2019 spending, but I imagine it doesn't change much.




















The top three are Norway, Netherlands, and Australia, but from what I can tell, Norway and Australia are primarily public, while Netherlands is privatized, but non-profit.

So, the biggest deficiencies are Access to Care, Administrative Efficiency, Equity, and Health Care Outcomes.

Access to Care: Netherlands is the winner on that one. They have an interesting network of 24/7 acute primary care centers, so people aren't going to emergency for after-hours treatment for non-emergency issues.

Administrative Efficiency: Interesting note related to access to care, as it is pointed out that Canadians use the emergency department for non-emergency issues instead of seeing a regular doctor which is the cheaper option.

Equity: Kind of related to access to care again, but it seems that it is more of the spread between high and low income patients reporting issues with getting health care. So while Australia comes out as number 1 as there is less of a spread, it should be noted that they have a higher issue with access to care due to costs (19 and 24% for high and low income) vs 7 and 21% for Canada.

Health Care Outcomes: They use three measures, and only one is actually directly related to health treatment: condition-specific health care outcomes. The other two are population health outcomes (which seem to be more lifestyle related), and mortality amenable to health care (which is seems more to be related to the access to care).

It should be noted the 4 features that the top performing countries have:

_1. They provide for universal coverage and remove cost barriers so people can get care when they need it and in a manner that works for them.
2. They invest in primary care systems to ensure that high-value services are equitably available locally in all communities to all people, reducing the risk of discrimination and unequal treatment.
3. They reduce the administrative burdens on patients and clinicians that cost them time and effort and can discourage access to care, especially for marginalized groups.
4. They invest in social services that increase equitable access to nutrition, education, child care, community safety, housing, transportation, and worker benefits that lead to a healthier population and fewer avoidable demands on health care._


----------



## ian (Jun 18, 2016)

Years ago I did business with a hospital in Vancouver. They had a much needed state of the art MRI machine sitting in a storage room for nine months. Why....the Province provided the funds for the MRI but not the capital required to do the necessary renovations to the area OR pay for the extra staffing.

We have private MRI clinics that operate 18 hrs a day. Sometimes longer. Yet to access them we have to pay. They cost of operating them is much less that the hospital cost if only because of the real estate. We have not integrated them into our public health care system where we now live. Union issues, political issues, BS issues.

The system is broken. There are some health care services that can be delivered far more efficiently, at less cost, and as safely and as competently as those provided in a hospital setting.


----------



## Jimmy (May 19, 2017)

The funding can be public. *But the services should be private or public whichever is better value.* Here anything private is looked at distastefully by left wing govts who just want more state control and don't care what is best for the patient.

The countries w the best outcomes again , Austria and Switzerland have a combo of public /private services. Most systems are a combo for the services provided.


----------



## damian13ster (Apr 19, 2021)

ian said:


> Years ago I did business with a hospital in Vancouver. They had a much needed state of the art MRI machine sitting in a storage room for nine months. Why....the Province provided the funds for the MRI but not the capital required to do the necessary renovations to the area OR pay for the extra staffing.
> 
> We have private MRI clinics that operate 18 hrs a day. Sometimes longer. Yet to access them we have to pay. They cost of operating them is much less that the hospital cost if only because of the real estate. We have not integrated them into our public health care system where we now live. Union issues, political issues, BS issues.
> 
> The system is broken. There are some health care services that can be delivered far more efficiently, at less cost, and as safely and as competently as those provided in a hospital setting.


Exactly. Giving morons that run the current system more money will only result in more wastage.
It is time to reform the system, decrease administrative cost, cut the fat, and increase efficiency.
It will ultimately decrease spending on health care and increase the quality of it. Both are great things!
Simply throwing more money at broken system led by unintelligent people is equivalent of lighting the money on fire.
Reform is needed, an incentive for efficiency is needed. There is zero incentive for improvements now, simply because it is all socialized and the popular answer will always be 'throw more money in' rather than 'let's fix the problems and improve the system'


----------



## sags (May 15, 2010)

The need is to expand access throughout the entire system, from diagnostics to treatment.

There is no benefit to getting earlier diagnosis if there is no timely treatment available.

The solutions are already known. Governments just don't want to spend the money necessary.

The health tax in Ontario was a good intial start but is not nearly enough.

We either want healthcare and will pay for it........or we don't.


----------



## Ukrainiandude (Aug 25, 2020)

sags said:


> They only recently have Obamacare, which is a government program.
> 
> Medicade and Medicare are government programs and are underfunded.
> 
> ...


Do you know anyone who moved out of the USA (returned to Canada) because health care was inadequate?


----------



## sags (May 15, 2010)

Umm......everyone who rushed back to Canada and didn't want to get stuck in the USA with a huge medical bill if they got covid ?

Unfortunately for them, some Canadians didn't make it back in time, and are facing a $300,000 US. bill.









Nova Scotia snowbirds face huge medical bill after contracting COVID-19 in Florida | SaltWire


A Kings County couple are facing hefty medical bills after they both became ill with COVID-19 while in Florida. Debbie Mailman of Aylesford says she and ...




www.saltwire.com


----------



## Ukrainiandude (Aug 25, 2020)

I am talking moved permanently, settled down, then returned.


----------



## sags (May 15, 2010)

Ukrainiandude said:


> I am talking moved permanently, settled down, then returned.


You left out......met a girl, got married, bought a house, had babies, climbed the corporate ladder.........and then returned to Canada.

In that case, yea.........I can't say as I know any, but likely that is as many people as you know stayed in the US because they loved the healthcare.


----------



## ian (Jun 18, 2016)

It is not just money Sags. They have to work smart, work efficiently. More integration of the private system with the public system. Some Provinces are doing this by moving some urgent care into publicly funded physicians clinics which are sometimes in very close proximity to hospital emerg. Alberta is starting to do something similar.

It is about wringing the best out of both sectors. If it was up to me all not emerg MRI's would be done outside the hospital environment by private clinics running 18 hours or more per day to squeeze the most patient time out of the capital resource. Same for some other services that could easily be offloaded from the expensive hospital environment.


----------



## sags (May 15, 2010)

Who would pay for the extra MRI machines, technicians, building costs ?

I don't disagree if the patients pay the full cost, but if the government pays they might as well expand the pubilc system.

Private or public.......if you expand services you also expand costs and somebody has to pay for it.


----------



## sags (May 15, 2010)

Wouldn't private MRI clinics just create longer waiting lists for public services ?

They would tell patients.......you have a problem and need surgery.......and then what ?

The patients would go on a long waiting list like everyone else. I don't think diagnostics is the problem.

The bottleneck is in the treatment for the diagnosis.


----------



## MrMatt (Dec 21, 2011)

Ukrainiandude said:


> I am talking moved permanently, settled down, then returned.


Not a single person, to be fair they all had above average incomes.

But once you're in the US with decent health insurance, the care is better.

I actually know a pair of Windsor area professionals, who live in Canada, but work in the US, and keep up US heath coverage, because it is much better.


----------



## james4beach (Nov 15, 2012)

sags said:


> You left out......met a girl, got married, bought a house, had babies, climbed the corporate ladder.........and then returned to Canada.
> 
> In that case, yea.........I can't say as I know any, but likely that is as many people as you know stayed in the US because they loved the healthcare.


I had a great career in the US. But I left the US partly because of the healthcare situation.

More broadly, it's because life in Canada is better, the society is better, there's much less crime. But healthcare was one consideration.

If I was self employed in the US, or doing freelance work, I would have to buy my own health insurance. Even in my early 30s and in perfect health, this was already costing me something like $800 a month at a rate subsidized by my ex employer. That rate was going to go well over $1000/mo and if I ever had health problems, it was only going higher ... if I had a family, it probably could hit several thousand $ per month.

On top of that, what most people (even Americans!) don't understand is that health insurance of this type doesn't even cover all their health expenses! So you'll pay $2000/month or whatever, but certain hospital procedures or surgeries will not be covered, or your insurance will only cover 80% and you pay the remaining 20%.

These costs were just insane for me. Absolutely no way I was going to run my own business in the US and pay those kinds of healthcare costs.


----------



## kcowan (Jul 1, 2010)

james4beach said:


> ...
> On top of that, what most people (even Americans!) don't understand is that health insurance of this type doesn't even cover all their health expenses! So you'll pay $2000/month or whatever, but certain hospital procedures or surgeries will not be covered, or your insurance will only cover 80% and you pay the remaining 20%.
> 
> These costs were just insane for me. Absolutely no way I was going to run my own business in the US and pay those kinds of healthcare costs.


Yes most people only feel the pinch when they make a claim. And if it happens while you are travelling, the ambulance will not take you to an in-network facility.

Our experience with this kind of coverage is 6 months in Mexico where they quote a rate that includes $1000 US deductible. We have never had a claim that cost more than $1000 US in Mexico.


----------



## Rusty O'Toole (Feb 1, 2012)

New MRI machines cost $225,000 to $1.2 million. You can get an MRI at a private clinic in Los Angeles for $225 and up. In Spain the same thing is under $200. Machines in Ontario hospitals typically are only used for 6 to 8 hours a day to save paying a technician. There is no reason they could not be used more, bringing down the unit cost. In other words the ones we have could be used more efficiently and if more were needed they are not as expensive as they used to be.


----------



## sags (May 15, 2010)

Our hospitals perform diagnositic testing 24 hours a day, but the private clinics do only operate on "business hours". Some are only open some days due to lack of doctors. Generally, you have to find out which ones are open if you are looking to go to one.

We already have private clinics for lab work like blood tests and xrays. The doctor gives us an authorization and we present it at the private facility. They also take our OHIP number. They seem to work out well.

Private clinics do offer more opportunity, but they depend on government money. They also only stay open when they are fully booked and profitable.

When Ontario privatized a new maximum security prison in Lindsey, Ontario there were so many problems they ended the contact and went back public.

When they privatized the driver registration offices, the lineups were long and people complained. The private operators finally hired more staff, but the government has moved more of it to online now.

Privatization of LTA homes has not worked out well. They had the worst outcomes during the pandemic.

Basically, the experience with privatization is less than stellar. Maybe it could be improved if the government set down some mandates they have to operate under.

But, I think governments that want to privatize don't want nothing further to do with it, so little attention is paid to audits and inspections.


----------



## sags (May 15, 2010)

I am not opposed to more private clinics, but I think we should know the details before jumping into it in a big way.

Our son has the same doctor as we do, but he also has an "online" access line to doctors that is provided through the construction union.

He called them last night after his baby daughter was stung by a bee and her foot became red and bruised. 

The doctor called him back and they did a video examination where he determined the sting was on a vein so it made it look worse.

That is a lot better than spending 8 hours at the kids ER in the hospital.


----------



## Chrysaphius (Jun 16, 2021)

Jimmy said:


> So the best systems for outcomes are a private/public combo.


I agree with you completely. My last visit to emergency was a disgrace. You have to wait in long lines to see a triage nurse and I almost blacked out waiting in line. I finally saw the triage nurse and asked if I could pay 5k to see a doctor ASAP and they said no they can't do that. Usually they make you wait in the waiting room after triage assessment and then they call you in after waiting a while. However, this time, the triage nurse saw that I was in such bad shape that she told the other triage nurse that she was talking me into the back hospital room area right away- again because she saw in such bad shape I was in.

Some of the nurses are great, but some of the nurses are screaming and laughing with each other while patients are around in bed - some of them dying. This is unacceptable and these nurses should be fired. There are also nurses and even some doctors who are on social media on their phone (while not on break or lunch) instead of doing their f**** job. This is also unacceptable and they should be reprimanded or fired.

I was suffering so badly the last time in, I needed diazepam/valium, and after waiting in one of the chairs where they start you with the IV drip this moronic nurse kept going on and on about the 800k dollar house she bought in some rural area, and was showing pictures to another worker. She wasn't being quiet either, and an elderly gentleman in an IV drip in a chair next to me looked like he died. I had to keep asking if I could get diazepam. 15 minutes later the nurse said "ok I have to take care of "Diazepam Guy' which is dehumanizing and unprofessional.

Thankfully, on that occasion, the second nurse was wonderful and really took care of me.

This is just one of the many horror stories I can tell. I have many more about my own experiences and those of my elderly father when he had kidney stones and was in such terrible agony it was the first time in my 39 years of life that I can remember seeing him tremble and tear up due to the pain and the length of time it took for the doctor to give him pain medication. My father is 80 years old, he was 77 at the time and my sister was with him, and she told me all of this. Had I been there I would not have put up with that callous disregard to my father shown by those moronic nurses. There would have been hell to pay. We almost had to take him to Buffalo, NY, where he could have gotten surgery that day. (And yes I know this option isn't financially viable for all people, but that's not my problem.)

The hospital I am referring to specifically is Markham-Stouffville Hospital. Markham is a wealthy/affluent suburb in Ontario so I don't know how this behaviour/lack of treatment/ or treatment, is able to continue unaddressed. 

A mix of private / public healthcare is probably the best way to go. We are also losing a lot of our top doctors who go to the US where they can make a lot more money, and I don't blame them at all.

People think Canadian healthcare is free, it isn't free, it's paid for through taxes. However, it is socialized medicine, and that's what happens. 

It is sickening.

Sorry for the lengthy post, but the OP's post reminded me of how enraged I get when I think of healthcare and patient care in Ontario - especially Markham Stouffville Hospital.


----------



## kcowan (Jul 1, 2010)

Speaking from experience in BC, I think the emergency admitting procedure is at the mercy of the triage nurses. So your experience rings true. I used to go to the M-S Hospital and the pandemic or cost cuts must be having an impact. Sorry for your bad experience.

We used to have a handy clinic but now emergency is our only choice!


----------



## Rusty O'Toole (Feb 1, 2012)

Here in small towns the license offices were all privately owned and most were friendly and gave good service. I only recall one exception and they did not last long. The government was going to nationalize them but changed their minds thank goodness.


----------



## sags (May 15, 2010)

They were terrible here. Long lineups and a couple of tellers. It would be a good 40 minute wait and there were only about 4 chairs to sit.

All the car dealers had to line up to get plates and that created a lot of people at any given time.

My son got his license in Alberta when he was working there. I believe they were private and much better run.

We sat at a table and they came and took the papers and brought back the license.


----------



## damian13ster (Apr 19, 2021)

sags said:


> The need is to expand access throughout the entire system, from diagnostics to treatment.
> 
> There is no benefit to getting earlier diagnosis if there is no timely treatment available.
> 
> ...


Then how do you explain all the countries that pay less and get better service?
And don't give me the population density crap as Australia is among them.

As you can see from that report, there is negative correlation between amount being spent and quality of health care.
The trend shows that higher healthcare spending = worse healthcare outcomes.

The explanation is really simple: good healthcare systems are efficient and therefore cheap.
Our healthcare system is inefficient, wasteful, and therefore has poor quality and is expensive.
The way to address it is not to throw even more money away.

The way to address it is to make the system more efficient, less wasteful, so ultimately we will be spending less on healthcare.

Giving more money to our healthcare system now is equivalent of covering all living expenses of a 40-year old that does nothing productive but plays video-games in the basement.
Of course he is happy, but ultimately it is counter-productive


----------



## sags (May 15, 2010)

Canada's per capita spending on healthcare is considerably lower than it was from 2010 to 2014, under the Harper conservatives.

Canada is 13th in the world for per capita spending. The US spends twice as much as Canada.

If we want to improve health care, we will have to boost spending on it.





__





Canada Healthcare Spending 2000-2022


Current expenditures on health per capita in current US dollars. Estimates of current health expenditures include healthcare goods and services consumed during each year.




www.macrotrends.net


----------



## Jimmy (May 19, 2017)

That is the liberal answer to anything -throw more $ at it. And it doesn't work 

They need to get better results for the $ spent. The US shows throwing $ around isn't the answer.


----------



## andrewf (Mar 1, 2010)

Canada already is a public/private combo system. We need to completely ignore the US as an example. They have a completely dysfunctional system that is very wasteful and ineffective.


----------



## newfoundlander61 (Feb 6, 2011)

In Canada Newfoundland is having a tough time, of the 33 residents who completed the family-medicine program from Memorial University’s school of medicine, 20 are now practising in Newfoundland and Labrador. However, *only one of the 20 doctors has expressed plans to open a family practice*. The other 19 plan to serve as locums — which means they’ll fill in for other doctors, but won’t take patients of their own. Approx 90,000 people in Nfld do not have a family doctor.


----------



## gibor365 (Apr 1, 2011)

sags said:


> Canada's per capita spending on healthcare is considerably lower than it was from 2010 to 2014, under the Harper conservatives.
> 
> Canada is 13th in the world for per capita spending. The US spends twice as much as Canada.
> 
> ...


Israel spends more than twice less than Canada and ranked higher (from our own experience Israeli system is much better). Israel has public/private combo, but public services are highly competitive. Israelis have Freedom of choice and change between 4, non-profit Health Funds (HF). HF gets money from government, so more patients HF has, more money they get.


https://www.jhsph.edu/research/centers-and-institutes/health-services-outcomes-research/_images/Materials/The_Israeli_Healthcare_System_Accomplishments_and_challenges_facing_the_system.pdf


----------



## Mortgage u/w (Feb 6, 2014)

get rid of unions in the public sector.


----------



## gibor365 (Apr 1, 2011)

Mortgage u/w said:


> get rid of unions in the public sector.


Unions are the big problem (and IMHO) should be banned, but this is not a major problem with Canadian healthcare. Different sources give different number of Unions per country, but Canada has less Unions than countries that have much better healthcare.
IMHO, the major problem is monopoly


----------



## bgc_fan (Apr 5, 2009)

newfoundlander61 said:


> In Canada Newfoundland is having a tough time, of the 33 residents who completed the family-medicine program from Memorial University’s school of medicine, 20 are now practising in Newfoundland and Labrador. However, *only one of the 20 doctors has expressed plans to open a family practice*. The other 19 plan to serve as locums — which means they’ll fill in for other doctors, but won’t take patients of their own. Approx 90,000 people in Nfld do not have a family doctor.


This is the point that is getting lost in all this public/private model. Public/private model is a nice academic argument in large population centers where you have sufficient medical services, and access to primary care physicians. But it's the underserved areas that is the problem for lack of affordable access. It goes without saying that Canada has one of the lowest per capita of doctors (2.7 per 1000), while Norway has 4.8. Somehow, I don't think spending less is the fix, nor is the correlation between high spending and low quality of health care a causation linkage. Of course, the US is the outlier, based on the fact that 34% of the health care costs is due to administration, vs 17% for Canada.

Other countries may have lower administration costs, but there are always factors to keep in mind. The main one is population density as it's easier to provide health care with less resources if everyone is localized. We're 38th at 81.6%, Norway is actually ahead of us at 35th with 83%. The other top 2 are Netherlands at 92.2% (13th), and Australia at 86.2% (30th). So instead of just throwing a blanket statement of "public funding model doesn't work", maybe start looking at some of the factors to explain the differences.


----------



## Jimmy (May 19, 2017)

gibor365 said:


> Unions are the big problem (and IMHO) should be banned, but this is not a major problem with Canadian healthcare. Different sources give different number of Unions per country, but Canada has less Unions than countries that have much better healthcare.
> IMHO, the major problem is monopoly


Well it is sort of a problem considering our hospitals are all union rackets and as essential services they can extort govt for as much gravy wage hikes and benefits as they like.

Drs, Nurses and admin workers in ON all make obscene wages w gravy pensions for life. It could be much better


----------



## damian13ster (Apr 19, 2021)

Jimmy said:


> Well it is sort of a problem comsidering our hospitals are all union rackets that extort govt and as essential services they get to rip off taxpayers as much as they like.Drs, Nurses and admin workers in ON all make obscene wages w gravy pensions for life


I don't think unions can be made illegal. Freedom of association.
However, making unions mandatory for employees if they want to enter certain workplace, profession, etc. should be absolutely off limit. It is literal monopoly.
Unions are inherently inefficient and definitely one of the many problems within Canadian healthcare


----------



## Jimmy (May 19, 2017)

damian13ster said:


> I don't think unions can be made illegal. Freedom of association.
> However, making unions mandatory for employees if they want to enter certain workplace, profession, etc. should be absolutely off limit. It is literal monopoly.
> Unions are inherently inefficient and definitely one of the many problems within Canadian healthcare


They violate that same right which is the right to not associate. We should have right to work like 1/2 the US states.


----------



## damian13ster (Apr 19, 2021)

Jimmy said:


> They violate that same right which is the right to not associate. We should have right to work like 1/2 the US states.


Agree. That's why you can't really outlaw unions, but you can outlaw a workplace to be fully unionized (as in if employee wants to work and employer wants to hire, one doesn't have to sign up for union, and also union doesn't offer protection from firing)


----------



## gibor365 (Apr 1, 2011)

damian13ster said:


> I don't think unions can be made illegal. Freedom of association.


When I worked in very big Canadian private financial company, there was a clause in contract that creating union is not allowed and you will be fired


----------



## andrewf (Mar 1, 2010)

gibor365 said:


> When I worked in very big Canadian private financial company, there was a clause in contract that creating union is not allowed and you will be fired


Many things can be put into contracts. It doesn't mean that they are enforceable. 

Have you ever read hilarious lease agreements? Landlords put all kind of unenforceable nonsense into them.


----------



## Chrysaphius (Jun 16, 2021)

kcowan said:


> Speaking from experience in BC, I think the emergency admitting procedure is at the mercy of the triage nurses. So your experience rings true. I used to go to the M-S Hospital and the pandemic or cost cuts must be having an impact. Sorry for your bad experience.
> 
> We used to have a handy clinic but now emergency is our only choice!





gibor365 said:


> Unions are the big problem (and IMHO) should be banned, but this is not a major problem with Canadian healthcare. Different sources give different number of Unions per country, but Canada has less Unions than countries that have much better healthcare.
> IMHO, the major problem is monopoly


I agree with you 1000000000%.


----------



## sags (May 15, 2010)

There is already a shortage of doctors, nurses, PSWs, and other health care staff. Lowering wages by eliminating unions will only lead to greater shortages.

We know that in Ontario there is a huge shortage of PSWs and there is talk of raising their wages permanently.

In competition with other jobs, who wants to do the kind of work that PSWs are hired to do ?

It is funny that in our society many people who do the worst jobs earn far less than people with much nicer jobs.

A PSW earns near the minimum wage to look after the elderly, while a bank executive gets paid 6 figures for going to meetings.

Our priorities are mixed up.


----------



## gibor365 (Apr 1, 2011)

andrewf said:


> Many things can be put into contracts. It doesn't mean that they are enforceable.
> 
> Have you ever read hilarious lease agreements? Landlords put all kind of unenforceable nonsense into them.


Recalling my past working experience, this clause (no unions allowed) was when our company got sold to the biggest US bank and we needed to sign new contract. Then I thought, WTF, is it legal at all?! Probably yes, it is


----------



## andrewf (Mar 1, 2010)

Might be some language about not using company resources to organize.


----------



## Tostig (Nov 18, 2020)

Rusty O'Toole said:


> Latest health care rankings of 11 rich countries
> 
> 
> 
> ...


Is anybody really surprised since there are so many Canadians as represented in this forum who don't want to spend the money to make any improvements. Although our frontline workers are considered to be heros, our society does not think we should pay them what they are valued.


----------



## damian13ster (Apr 19, 2021)

Tostig said:


> Is anybody really surprised since there are so many Canadians as represented in this forum who don't want to spend the money to make any improvements. Although our frontline workers are considered to be heros, our society does not think we should pay them what they are valued.


First check out just how big of a percentage of health care spending goes to front line workers.
Then reconsider your comment.
We want to make the system efficient. We want to cut the fat. So far all that politicians are proposing is increasing the fat and throwing away more money.


----------



## bgc_fan (Apr 5, 2009)

Tostig said:


> Is anybody really surprised since there are so many Canadians as represented in this forum who don't want to spend the money to make any improvements. Although our frontline workers are considered to be heros, our society does not think we should pay them what they are valued.


Nope, because the government can't do anything right and waste money (being sarcastic). Now, no one will actually provide concrete proof (say financials or anything), but just say that the system wastes money on administrative costs and actually ignore the 2nd order consequences. For example, lets get rid of that $40k clerk and save $40k a year, but now you have the nurses doing all that paperwork. So in reality you're spending more on nurse time than you would save by having that cleric do the paperwork. Or they actually gloss over the fact that other countries actually spend more per capita and get better health care, but use the US as the example where it doesn't work.

I don't think the issue is pay, although that is a consideration, the real issue is the number of health care workers. Basically, we're forcing people to burn out and that was evident in the past year. On top of that, you have a provincial government actually cutting nurses' pay, and somehow that's the fault of the unions.


----------



## Jimmy (May 19, 2017)

sags said:


> There is already a shortage of doctors, nurses, PSWs, and other health care staff. Lowering wages by eliminating unions will only lead to greater shortages.
> 
> We know that in Ontario there is a huge shortage of PSWs and there is talk of raising their wages permanently.


You have it all backwards. Unions artificially inflate wages which leads to more unemployment Eco 101. Lower wages means more jobs.


----------



## damian13ster (Apr 19, 2021)

bgc_fan said:


> Nope, because the government can't do anything right and waste money (being sarcastic). Now, no one will actually provide concrete proof (say financials or anything), but just say that the system wastes money on administrative costs and actually ignore the 2nd order consequences. For example, lets get rid of that $40k clerk and save $40k a year, but now you have the nurses doing all that paperwork. So in reality you're spending more on nurse time than you would save by having that cleric do the paperwork. Or they actually gloss over the fact that other countries actually spend more per capita and get better health care, but use the US as the example where it doesn't work.
> 
> I don't think the issue is pay, although that is a consideration, the real issue is the number of health care workers. Basically, we're forcing people to burn out and that was evident in the past year. On top of that, you have a provincial government actually cutting nurses' pay, and somehow that's the fault of the unions.


Then how do you explain the fact that we are spending more money than majority of developed nations and get worse results? Literally the study posted in this thread says that, so yes, there is concrete proof.


----------



## bgc_fan (Apr 5, 2009)

damian13ster said:


> Then how do you explain the fact that we are spending more money than majority of developed nations and get worse results? Literally the study posted in this thread says that, so yes, there is concrete proof.


That's your interpretation, the study is saying that as a percentage of GDP we are spending more. It doesn't mean we're spending more in actual dollars, or per capita. Personally, I don't think percentage of GDP spending means a whole lot when comparing countries. I've already pointed out that when it comes to per capita health spending, Canada is not near the top.

But please, show where this waste is coming from. I'm sure as someone who prides himself in analytics must have data to show how the money is being wasted. Your agenda is that government wastes money, but you don't actually base that on anything. For example, did it occur to you that there could be other factors for increased cost? For example, average registered nurse salary in Canada is $71,399/yr, while in Norway it is 442,889 kr/yr or approx $62,253.14 Cad/yr. Same for family physician, Canada $150,130 vs 1,300,000 kr or approx $182,734.50 Cad. So nurses get paid more in Canada, but family physicians get paid more in Norway. The point being is that there are other factors, and it's lazy to just say, it's waste with no actual proof, aside from a few anecdotes.

Edit: Thought I might as well post the spending comparison after all from the report... Canada comes mid-way as % GDP not 2nd most after US.


----------



## Mortgage u/w (Feb 6, 2014)

sags said:


> There is already a shortage of doctors, nurses, PSWs, and other health care staff. Lowering wages by eliminating unions will only lead to greater shortages.
> 
> We know that in Ontario there is a huge shortage of PSWs and there is talk of raising their wages permanently.
> 
> ...


I don't necessarily agree that eliminating unions would lower wages. I think their wages would actually increase. For starters, the union fees get eliminated. I would think there will be more incentives.....management would be able to recognize and compensate good workers, preventing them from going elsewhere. 

All unions do is put employees on a production belt....they all get treated equally and receive perks in order of seniority, not competence. In turn, the employees treat their employer in the same manner. Might have been a great idea many years ago.....but not by today's standards. There are labor laws that exist and enforced provincially......don't see why you'd need a union rep to act as an interpreter.


----------



## damian13ster (Apr 19, 2021)

bgc_fan said:


> That's your interpretation, the study is saying that as a percentage of GDP we are spending more. It doesn't mean we're spending more in actual dollars, or per capita. Personally, I don't think percentage of GDP spending means a whole lot when comparing countries. I've already pointed out that when it comes to per capita health spending, Canada is not near the top.
> 
> But please, show where this waste is coming from. I'm sure as someone who prides himself in analytics must have data to show how the money is being wasted. Your agenda is that government wastes money, but you don't actually base that on anything. For example, did it occur to you that there could be other factors for increased cost? For example, average registered nurse salary in Canada is $71,399/yr, while in Norway it is 442,889 kr/yr or approx $62,253.14 Cad/yr. Same for family physician, Canada $150,130 vs 1,300,000 kr or approx $182,734.50 Cad. So nurses get paid more in Canada, but family physicians get paid more in Norway. The point being is that there are other factors, and it's lazy to just say, it's waste with no actual proof, aside from a few anecdotes.
> 
> ...


Don't care about the issue enough to break it down piece by piece - simple as that.
If you see nothing wrong with spending more or as much as other countries and getting worse results, that's all good.
Health care in Canada other than emergency care is straight atrocious. 
If you want to see the waste, don't have to look very far. Look at the sunshine lists in respective states.
I am yet to see superior metric to spending/GDP as it adjusts for the size of the economy.


----------



## sags (May 15, 2010)

Mortgage u/w said:


> I don't necessarily agree that eliminating unions would lower wages. I think their wages would actually increase. For starters, the union fees get eliminated. I would think there will be more incentives.....management would be able to recognize and compensate good workers, preventing them from going elsewhere.
> 
> All unions do is put employees on a production belt....they all get treated equally and receive perks in order of seniority, not competence. In turn, the employees treat their employer in the same manner. Might have been a great idea many years ago.....but not by today's standards. There are labor laws that exist and enforced provincially......don't see why you'd need a union rep to act as an interpreter.


Without union contracts setting the terms and conditions of work, the hospitals and other employers would have to compete with each other for staff.

With the current supply and demand issues, people would gravitate to the employer who offers the highest wages and benefits.

Removing unions would drive up the labor costs and increase the shortages of workers.


----------



## bgc_fan (Apr 5, 2009)

damian13ster said:


> Don't care about the issue enough to break it down piece by piece - simple as that.


So you got nothing, thanks.



damian13ster said:


> I am yet to see superior metric to spending/GDP as it adjusts for the size of the economy.


Fine so USA, FRA, SWE, GER, and SWITZ spend more than CAN. Other than NZ and AUS, the others are within fractions of a percentage.

As for worse results, you can take a look at what the report actually recommends. Instead of looking at improvements to health care, you're taking the opposite track of reducing health care spending which isn't going to help. Or the fact that the inefficiency of the Canadian system is that people are over-using the emergency departments.

Here are some characteristics of the top performing countries from the report:

_Prioritizing maternal health is critical for reducing maternal mortality. Top-performing countries have had success in preventing maternal deaths through the removal of cost sharing for maternal care. They invest in primary care models that ensure continuity of care from conception through the postpartum period, including midwife-led models. They offer social support benefits, including parental leave.
Several additional causes of avoidable mortality are linked to mental health. Higher rates of suicide in the U.S. — rates that have increased every year since 2000 — could be addressed by expanding the capacity of primary care to diagnose comorbid mental health conditions and provide early intervention and treatment as well as promote social connectedness and suicide prevention. Compared to other countries, the U.S. has a comparatively smaller workforce dedicated to meeting mental health needs. Countries like the Netherlands, Sweden, and Australia more frequently include mental health providers on primary care teams._

Basically, investing in primary care and social support would end up increasing the health care outcomes and increase efficiency as people stop using the emergency departments. Norway probably has the best model to follow for that:

_Top-ranking countries like the Netherlands and Norway ensure timely availability to care by phone on nights and weekends (with in-person follow-up at home as needed). In the Netherlands, cooperative “GP posts” are staffed by general practitioners (primary care physicians), who are obligated to provide at least 50 hours of after-hours care (between 5:00 pm and 8:00 am) annually in order to maintain their professional licensure. In Norway, the Patients’ Rights Act specifies a right to receive care within specific timeframes and with maximum wait times applying to covered services, including general practitioner visits, hospital care, mental health care, and substance use treatment._


----------



## damian13ster (Apr 19, 2021)

I never said either of those things.
I said system needs to be made more efficient, which ultimately will lead to lower spending.
Not to simply cut spending.

And I didn't say Canadians are over-using the emergency departments. I said that emergency care is only decent part of our health care system.

Good luck introducing mandatory overtime in Canada 
The suggestions made imho are very good. They are relatively cheap to implement too. And the fact we don't have them is the very reason why our system is inefficient and wasteful. 
We don't have smart people at the helm. There is no incentive to improve efficiency to the system, as people making those decisions are the very people responsible and benefiting for the fat in the system. Those are two root causes of the problems.


----------



## sags (May 15, 2010)

Mortgage u/w said:


> I don't necessarily agree that eliminating unions would lower wages. I think their wages would actually increase. For starters, the union fees get eliminated. I would think there will be more incentives.....management would be able to recognize and compensate good workers, preventing them from going elsewhere.
> 
> All unions do is put employees on a production belt....they all get treated equally and receive perks in order of seniority, not competence. In turn, the employees treat their employer in the same manner. Might have been a great idea many years ago.....but not by today's standards. There are labor laws that exist and enforced provincially......don't see why you'd need a union rep to act as an interpreter.


This real world you speak of doesn't exist.......worker recognition etc.

Check out any industry and compare wages and benefits between union and non-union employees.

I have never met anyone who regrets being in a union. Those opposed to unions typically don't belong to one.


----------



## gibor365 (Apr 1, 2011)

Our OHIP is "amazing" LOL.... I got ear infection, went to clinic ..... Doctor is doing only consultations over the phone... Waiting for call... Curious how he will be able to check my ear over the phone....
But who cares?! Doctors are really enjoying "working from home" (even though we're in Phase 3 of reopening) ... they getting same money and doing practically nothing. What a healthcare we got LOL


----------



## bgc_fan (Apr 5, 2009)

damian13ster said:


> And I didn't say Canadians are over-using the emergency departments. I said that emergency care is only decent part of our health care system.


I didn't say that you said that. I said the report stated that, and that's a reason for some of the inefficiency. 



damian13ster said:


> Good luck introducing mandatory overtime in Canada


Nope, it's a staffing issue. Having people pull in overtime on a consistent basis means that you're understaffed. Hence, Norway is able to give more primary care and keep people from using the emergency departments. 



damian13ster said:


> The suggestions made imho are very good. They are relatively cheap to implement too. And the fact we don't have them is the very reason why our system is inefficient and wasteful.


So which suggestions do you agree with? 

Here's my proposed plan of action: dramatically increase the number of doctors, nurses and health support workers and set up 16/7 (maybe 24/7) primary care clinics in all communities and ensure that every Canadian is on one roster or another. This addresses accessibility and keeps people out of the emergency departments unless it is a true emergency. Now this can be done in partnership with private industry to provide the infrastructure. Appletree Medical Group does this sort of thing at a limited scale. My first thought is that Loblaws/Shoppers is pivoting into the health and wellness business, and working with them as a partner is a viable possibility. Add a nutritionist/fitness/lifestyle type staff member as well because one of the biggest issues identified in the study is general fitness and that reflects poorly on the health measures. However, that's really an individual responsibility, although the health care system should provide some guidance/support on that.

But, this sort of thing requires a large investment to start, and the personnel don't exist. There's going to be a significant lag to get people trained and ready. Very few people see the utility of planning this sort of initiative if there's no perceived gain if it takes 5-10 years to implement. 



damian13ster said:


> We don't have smart people at the helm. There is no incentive to improve efficiency to the system, as people making those decisions are the very people responsible and benefiting for the fat in the system. Those are two root causes of the problems.


You keep repeating this and offer nothing to support. It's a little hard to debate when all you do is just offer up personal opinions. It's this sort of thing that politicians like saying when they are running on a populist platform. But when they get elected, find out that there actually isn't much that can be cut.


----------



## Mortgage u/w (Feb 6, 2014)

sags said:


> Without union contracts setting the terms and conditions of work, the hospitals and other employers would have to compete with each other for staff.
> 
> With the current supply and demand issues, people would gravitate to the employer who offers the highest wages and benefits.
> 
> Removing unions would drive up the labor costs and increase the shortages of workers.


competition is good. and people should gravitate to the employer who offers the best for them. 

Not sure you have privately funded hospitals in your area, but I can attest that the service there is at a whole other level when compared to public hospitals.

I don't agree there are supply issues either. I would state that hospitals are overstaffed. But the fact they are unionized, it makes employees lazy and creates the illusion they are short staffed. (just my opinion on what I have personally observed)


----------



## gibor365 (Apr 1, 2011)

Mortgage u/w said:


> competition is good. and people should gravitate to the employer who offers the best for them.
> 
> *Not sure you have privately funded hospitals in your area, but I can attest that the service there is at a whole other level when compared to public hospitals*.
> 
> I don't agree there are supply issues either. I would state that hospitals are overstaffed. But the fact they are unionized, it makes employees lazy and creates the illusion they are short staffed. (just my opinion on what I have personally observed)


Service in private Medcan is a lot better than is any public clinic


----------



## Beaver101 (Nov 14, 2011)

^ Better be at $3K (? or more) per year membership fee. I think those who can well afford MedCan should either be off OHIP or pay proportionately more than $900 of annual premiums.


----------



## sags (May 15, 2010)

They aren't open 24/7 either and basically perform the function of a family doctor by referring patients to specialists in the public system......so on to the waiting list they go.

The bottleneck isn't in getting diagnosed. It is in getting treated by specialists. 

We need more operating rooms, surgeons and surgical teams, not people telling us to eat more fibre.


----------



## sags (May 15, 2010)

People advocate for private clinics when they have no idea what it would cost, and ignore the fact that most people couldn't afford to pay the cost.

Lets say for example..........you set up a surgery clinic. You build a building and buy all the necessary equipment.

I don't know how long the average surgical procedure is but my appendectomy took 5 hours and my heart ablation took 4 hours. The next door neighbor had triple bypass surgery and it was a 10 hour operation. I spent a couple of days in the hospital and she spent over a week.

So you hire surgeons of various disciplines........heart surgeons, orthopedic surgeons, eye surgeons, general surgeons etc. Then you hire surgical nurses and anathesiologists. You will also need secretaries and custodians.

Now you need people to clean up and sterilze the room and sterilize all the tools before and after each operation.

Then you need a recovery room with all the equipment and trained nurses. Then you need a regular room to house patients while they recover.....more staff required.

If the average operation takes 4 hours and there is 1 hour of cleanup time between operations........you could do about 5 operations in a 24 hour period.........maybe.

The cost of those operations would be enormous. It just isn't a practical solution unless rich people want to set it up for themselves.


----------

