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Health

Canada remains poor performer among countries with universal health care

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From the Fraser Institute

By Mackenzie Moir and Bacchus Barua

Canada reported far fewer physicians (ranking 28th of 30) and hospital beds (23rd of 29) per 1,000 people in 2021. And ranked low for the availability of MRI machines (25th of 29) and CT scanners (26thof 30) per million people in 2019

Earlier this year, the Trudeau government announced it will increase health-care spending to provinces and territories by $196.1 billion over the next decade. But patients hoping for improved access will likely be disappointed. In reality, Canada’s health-care system already ranks as one of the most expensive systems in the world, but only has mediocre results to show for it. In other words, the problem isn’t the amount of money we spend, it’s the poor value we get for our health-care dollars.

A new study compared the spending and performance of Canada’s system with 29 other universal health-care systems worldwide. According to the study (after adjusting for population age in each country), Canada was the highest spender on health care as a share of the economy (at 12.6 per cent) and ninth-highest on a per person basis in 2021, the latest year of available data.

And yet, compared to other universal countries, Canada reported far fewer physicians (ranking 28th of 30) and hospital beds (23rd of 29) per 1,000 people in 2021. And ranked low for the availability of MRI machines (25th of 29) and CT scanners (26thof 30) per million people in 2019 (the latest year of available data).

Unsurprisingly, scarce health-care resources are accompanied by long wait times. Using data collected in 2020 by the Commonwealth Fund, the study found that only 38 per cent of Canadians reported waiting less than four weeks for a specialist appointment—a much smaller percentage than countries such as Switzerland (68 per cent) and Germany (67 per cent). On this indicator, Canada ranked 10th out of 10 countries. Canada also ranked dead last (10th) on timely access to elective surgery—with 62 per cent of Canadians reporting waiting less than four months—compared to 99 per cent of Germans and 94 per cent of Swiss.

While these results were disappointing, Canada reported mixed results in other areas of performance. For example, although Canada performed poorly on safety indicators such as obstetric trauma during birth (23rd of 23 countries), it performed above the OECD average on other indicators including heart attack survival rates (9th of 25 countries). But while the Canadian system has in some areas performed in line with its high spending levels, overall it’s struggled to meet many of its basic obligations—especially timely access to care.

With its latest increase in health-care spending, the Trudeau government again ignores the fact that Canada already has one of the most expensive universal health-care systems in the world. And although some of this new spending is predicated on provinces tracking progress and demonstrating improvement on certain indicators, international data reveal a simple truth—Canadians do not receive commensurate value for their health-care dollars. Without fundamental reform, it’s unlikely the new spending promised by the Trudeau government will produce improved performance for Canadian patients and their families.

Health

UK to ban puberty blockers for minors indefinitely

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From LifeSiteNews

By Andreas Wailzer

UK Health Secretary Wes Streeting announced Wednesday that he will indefinitely extend a ban on puberty blockers for minors under the age of 18. The only exception is for clinical trials.

Puberty blockers will be banned indefinitely in the U.K. for under 18-year-olds, except for clinical trials.

In May of this year, the then-government of Rishi Sunak used emergency legislation to temporarily ban puberty blockers for minors. Health Secretary Wes Streeting announced on Wednesday that he will indefinitely extend the ban on the supply and sale of puberty blockers.

The Department of Health cited the Commission on Human Medicines’ (CHM) expert advice that said there was “currently an unacceptable safety risk in the continued prescription of puberty blockers to children.”

The U.K.’s National Health Service (NHS) already halted the prescription of puberty blockers to children in March. In May, the then-Conservative government introduced a ban, preventing the prescription of puberty blockers by European or private prescribers and legally restricting the NHS’s use of the drugs to clinical trials.

The ban was upheld in July by the High Court after pro-LGBT activists brought a challenge to the ruling because they “were concerned for the safety and welfare of young trans people in the UK.”

The prohibition of prescribing harmful puberty blockers for children was prompted by the Cass Review, an extensive report by pediatrician Dr. Hilary Cass that pointed out the significant risks of the medication and the lack of evidence regarding the alleged benefits of puberty blockers.

Health Secretary Streeting said that he would “always put the safety of children first” and added that his approach would “continue to be informed by Dr [Hilary] Cass’s review, which found there was insufficient evidence to show puberty blockers were safe for under-18s.”

Earlier on the same day that the nationwide ban was announced, the Parliament of Northern Ireland had voted unanimously to permanently ban puberty blockers in order to prevent the province from becoming a “back door” for the distribution of the drugs in the U.K.

“This marks a significant step in safeguarding children, preventing Northern Ireland from becoming a ‘back door’ for these unregulated treatments – a concern highlighted by Susie Green’s earlier attempts to circumvent mainland restrictions,” he said.

Susie Green is a transgender activist who set up a clinic in Northern Ireland in an attempt to circumvent the restrictions in mainland Britain.

“However, we must remain vigilant, as the demand for these drugs may drive young people to unregulated, dangerous sources,” Jordan stressed, urging lawmakers to prioritize safeguarding children.

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Health

The People Cheering Brian Thompson’s Murder Can’t Have the Medical Utopia That They Want

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Whether private or public, third-party payment for health care is a huge problem.

Evoking a collective scream of despair from socialists and anti-corporate types, police in Pennsylvania arrested Luigi Mangione, a suspect in the murder of UnitedHealthcare CEO Brian Thompson. Thompson, they insist, stood in the way of the sort of health care they think they deserve and shooting him down on the street was some sort of bloody-minded strike for justice.

The assassin’s fans—and the legal system has yet to convict anybody for the crime—are moral degenerates. But they’re also dreaming, if they think insurance executives like Thompson are all that stands between them and their visions of a single-payer medical system that satisfies every desire. While there is a lot wrong with the main way health care is paid for and delivered in the U.S., what the haters want is probably not achievable, and the means many of them prefer would make things worse.

“Unlimited Care…Free of Charge”

“It is an old joke among health policy wonks that what the American people really want from health care reform is unlimited care, from the doctor of their choice, with no wait, free of charge,” Michael Tanner, then of the Cato Institute, quipped in 2017.

The problem, no matter how health care is delivered, is that it requires labor, time, and resources that are available in finite supply. Somebody must decide how to allocate medications, treatments, physicians, and hospital beds, and how to pay for it all. A common assumption in some circles is that Americans ration medicine by price, handing an advantage to the wealthy and sticking it to the poor.

“Today, as everyone knows, health care in the US can be prohibitively expensive even for people who have insurance,” Dylan Scott sniffed this week at Vox.

The alternative, supposedly, is one where health care is “universal,” with bills paid by government so everybody has access to care. Except, most Americans rely on somebody else to pay the bulk of their medical bills just like Canadians, Germans, and Britons. And while there are huge differences among the systems presented as alternatives to the one in the U.S., third-party payers—whether governments or insurance companies—do enormous damage to the provision of health care.

Third-Party Payers, Both Public and Private, Raise Costs

“Contrary to ‘conventional wisdom,’ health insurance—private or otherwise—does not make health care more affordable,” Jeffrey Singer, a surgeon and senior fellow with the Cato Institute, wrote in 2013. “The third party payment system is the principal force behind health care price inflation.”

In the U.S., the dominance of third-party payment, whether Thompson’s UnitedHealthcare, one of its competitors, Medicare, Medicaid, or something else, makes it difficult to know the price for procedures, medicines, and treatments—because there really isn’t one price when third-party payers are involved.

Several years ago, the first Trump administration required hospitals to publish prices for services. My local hospital offers an Excel spreadsheet with wildly varying prices for procedures and services, from different categories of self-pay, Medicare, Medicaid, and negotiated rates for competing insurance plans.

“A colonoscopy might cost you or your insurer a few hundred dollars—or several thousand, depending on which hospital or insurer you use,” NPR’s Julie Appleby pointed out in 2021.

That said, savvy patients paying their own bills can usually get a lower price than that paid by insurance.

“When government, lawyers, or third party insurance is responsible for paying the bills, consumers have no incentive to control costs,” Arthur Laffer, Donna Arduin, and Wayne Winegarden wrote in the 2009 paper, The Prognosis for National Health Insurance. After all, the premium or tax is already paid, right?

Other Countries Struggle With Similar Issues

Concerns about rising costs, demand, and finite resources apply just as much when the payer is the government.

“State health insurance patients are struggling to see their doctors towards the end of every quarter, while privately insured patients get easy access,” Germany’s Deutsche Welle reported in 2018. “The researchers traced the phenomenon to Germany’s ‘budget’ system, which means that state health insurance companies only reimburse the full cost of certain treatments up to a particular number of patients or a particular monetary value.” Budgeting is quarterly, and once it’s exhausted, that’s it.

Last year in the U.K., a Healthwatch report complained: “We’re seeing a two-tier system emerge, where healthcare is accessible only to those who can afford it, with one in seven people who responded to our poll advised to seek private care by NHS [National Health Service] staff.” Britain’s NHS remains popular, but it has long struggled with the demand and expense for cancer care and other expensive treatments.

And Canada’s single-payer system famously relies heavily on long wait times to ration care. “In 2023, physicians report a median wait time of 27.7 weeks between a referral from a general practitioner and receipt of treatment,” the Fraser Institute found last year. “This represents the longest delay in the survey’s history and is 198% longer than the 9.3 weeks Canadian patients could expect to wait in 1993.”

You have to wonder what those so furious at Brian Thompson that they would applaud his murder would say about the officials managing systems elsewhere. None of them deliver “unlimited care, from the doctor of their choice, with no wait, free of charge.” Some lack the minimal discipline imposed by what competition exists among insurers in the U.S.

We Need Less Government Involvement in Medicine

“Policymakers need to understand that the key to ‘affordable health care’ is not to increase the role of health insurance in peoples’ lives, but to diminish it,” Cato’s Singer concluded.

My family found that true when we contracted with a primary care practice that refuses insurance. We pay fixed annual fees, which includes exams, laboratory services, and some procedures. My doctor caught my atrial fibrillation when he walked me across his clinic hall on a hunch to run an EKG.

The Surgery Center of Oklahoma famously follows a similar model for much more than primary care. It publishes its prices, which don’t include the overhead and uncertainty of dealing with third-party payers.

Those examples point to a better health care system than what exists in the United States—or in most other countries, for that matter. They’re probably not the whole answer, because it’s unlikely that one approach will suit millions of people with different medical concerns, incomes, and preferences. But making people more, rather than less, responsible for their own health care, and getting government and other third-parties as far out of the matter as possible, is far better than cheering the murder of people who supposedly stand between us and an imaginary medical utopia.

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