Last year, the Missoulian State Bureau began examining factors behind these costs, as well as looking at alternatives to our current health-care system.
The series' third installment begins today, with a look at Canada's publicly funded health-care system, which provides basic medical care for all citizens.
“He has a set of specialists, we have a family doctor, a diabetic specialist, a dietitian and a social worker that all work on his team,” she says. “And every two months he sees at least one of that group, if not all of them.”
For these services, the health care bill for Capper and her son is zero. Like every Canadian citizen, they have free access to taxpayer-funded health care.
“Every time I have to go and get supplies for him, I thank my lucky stars that we have universal health care coverage,” Capper says. “I couldn't imagine not having our Canadian system.”
Capper is hardly unique in her endorsement of her country's “single-payer” system, which has government-funded health insurance for all.
From physicians to business people to regular citizens, support for a publicly funded system runs deep. Canadians practically consider free health care a “birthright,” as one health care official put it, and the man seen as the father of the system, former Saskatchewan Premier Tommy Douglas, is a national hero.
Yet while the Canadian health-care system is popular with its citizens, it's not without its problems and challenges.
For starters, it faces a nationwide shortage of physicians, nurses and other health care workers, brought on by health budget cuts in the 1990s and other factors.
Here in Calgary, a booming city of 1 million people, the shortage is particularly severe.
As many as 20 percent of the city's population has no regular family doctor; health officials say 300 additional physicians are needed to serve the city.
The Calgary Health Region also is scrambling to build hospitals and other facilities to keep pace with its growing population.
The “wait list” also is a staple of the Canadian system, as citizens sometimes must wait long periods for non-critical surgeries or other procedures. The average wait in Alberta for a knee replacement that's not considered an emergency is 14 weeks; a non-emergency MRI test is 11 weeks.
“Our trauma care, our stroke care, our cardiac care are at a level that is probably world class,” says Dr. Rob Abernethy, the medical director for emergency services in the Calgary region. “It's the care that needs to be done but can wait, (that) can wait at a cost, and the cost is usually pain and suffering for patients.”
And, finally, Canadians openly fret about how the taxpayer-funded system can be sustained and still provide the same level of care to all, in the face of rising health care costs and an aging population.
“My major concern is, can the citizens of this province continue to afford the health care that we are enjoying now?” says Sandy Larson, the mayor of Swift Current, Saskatchewan. “How do we continue to pay for the escalating cost of health care the way they are? Where do the dollars come from?”
For the past 40-plus years, dollars for the Canadian health care system have come mostly from taxpayers, through national, provincial and local governments.
Each province (the Canadian equivalent of a state) acts as a publicly funded health insurance company for its citizens, paying private physicians and other health-care providers for their work. The provinces also own and staff most of the nation's hospitals.
The provincial health ministry, in consultation with the provincial legislature, designs and manages publicly funded health-care offerings each year, based on principles set by the national government.
Alberta, with a population of nearly 3.5 million people, has an annual health care budget this year of $12 billion, including $3.5 billion in federal funds. The money pays for a huge array of services, from physician fees to cancer research to mental health treatment.
The provincial share of the spending comes from the province's general budget, which is financed primarily by income taxes and mineral taxes and royalties.
Alberta also charges most citizens a monthly health care premium: $44 per person or $88 for a family. Those 65 or older pay nothing and poor people also may have their premiums subsidized or eliminated. Some provinces, like Saskatchewan, charge their citizens no premium.
Like an insurance company, the province decides which health care services are covered for all citizens. The coverage generally includes all basic medical care, such as most surgeries, hospital care, emergency visits, prescription drugs while you're in the hospital, and physical therapy, to name a few.
Services not covered include cosmetic surgery, most dental care, vision care and eyeglasses and prescription drugs outside a medical facility. For these services, Canadians often have health insurance, which can be offered through your employer - much as it is in the United States.
Blue Cross of Alberta has 1.4 million customers, selling health insurance that “picks up where the publicly funded system leaves off,” says Susan Brand, a company spokeswoman in Edmonton.
Yet for basic medical care, there's no need for insurance - or, in most cases, money in your pocket. Any Canadian citizen can go to a hospital, clinic or private doctor's office and get the care they need, free of charge.
On a sunny October morning, Linda Scott of Calgary has driven herself to the South Calgary Urgent Care Centre, where she is treated for a sprained ankle.
Scott hurt herself the previous night, stepping oddly after she'd helped out at the polls for municipal elections. An X-ray shows that her ankle is not broken; she gets it wrapped before she leaves on crutches, which cost her $22.
There are no insurance forms to fill out, no medical bills to pay - she just shows her Alberta Personal Health Card, which is issued to each citizen.
“It's nice to have (the system) when you need it,” says Scott, who runs an oilfield maintenance firm in northern Alberta.
The clinic is owned by the Calgary Health Region, a division of the government health care bureaucracy. Alberta has nine health care regions, each of which has a local governing board appointed by the provincial health minister.
The clinic employs five full-time and two part-time physicians and a full nursing staff. Private doctors also work stints at the clinic to bone up on their emergency skills, says Dr. Wikus Venter, the clinic director.
All told, the Calgary Health Region employs 29,000 people, including thousands of nurses, other hospital and clinic staffers, medical technicians, administrators and its own consumer complaint department, known as the Office of Patient Concerns.
The clinic is in a leased building remodeled in 2004, part of a multibillion-dollar health facility building boom in the Calgary Region. A construction crane can be seen at every major hospital in the city, an entirely new hospital is being built, and a new $90 million government-owned clinic is going up downtown and will open in April.
The health region has $2.5 billion worth of construction projects under way, approved by the Alberta Legislative Assembly and drawn up according to a plan that is updated each year, in consultation with local physicians and other medical professionals.
Bob Holmes, the region's senior vice president for planning and capital development, says building plans are helping carry out a “strategic health plan” produced by the region in 2001.
The burgeoning city had overcrowded hospitals and medical facilities, and wanted to keep its facilities safe and modern, he says.
Included in the building boom is the new $253 million Alberta Children's Hospital, completed earlier this year in northwest Calgary. Children even helped design the state-of-the-art facility, where the facade resembles a Lego castle.
The 125-bed hospital has free day care for kids whose parents are visiting sick siblings, color-coded floors, an art-therapy room where patients can draw and produce skits, a movie theater, seven playgrounds or playrooms both inside and outside the hospital, a chapel with a special area for Native American sweetgrass-burning ceremonies, and a pet room where children in the hospital can visit with their pets from home.
At the physical therapy rooms, physiotherapist Caroline Turner is taking 5-year-old Alex Kusche through exercises to stretch his leg muscles. Alex has cerebral palsy, and the therapy is meant to prevent deformity as he grows.
“That's our long-term goal,” Turner says. “He sees me weekly. We're (also) trying to meet the needs of the family as well as we can, with home exercise programs.”
Alex's family pays nothing for his therapy visits to the hospital.
With oil and other revenues pouring into the province, Alberta and the Calgary Region have the money now to embark on their ambitious building program. But then comes the hard part: finding enough people to staff the facilities.
At least 25,000 people will be needed to staff expanded hospitals, new clinics and other Calgary Region facilities and replace people who retire or quit in the next four years. Nurses and other health care professionals, such as physical therapists, speech pathologists and social workers top the list.
Medical schools and colleges in Canada have been increasing slots for physicians and nurses, but the region is preparing its own programs to train skilled workers and others needed to fill the void.
The shortage of hospital beds and staff in Calgary got some international publicity this summer, when Calgary resident Karen Jepp had to be sent to Great Falls to give birth to quadruplets.
The Jepp quadruplet daughters required four “Level 3” intensive-care neonatal beds, and there weren't enough beds together at one site in Calgary, with the necessary one-to-one nurse staffing.
Region officials looked elsewhere in western Canada, but couldn't find four Level 3 beds available together, so they sent Jepp and her husband J.P. to Benefis Hospital in Great Falls.
Don Stewart, spokesman for the Calgary Health Region, says physicians and regional officials thought Great Falls was the best option for the family, since it's fairly close to Calgary.
“This is all part of making sure expectant mothers and newborns get the care they need, when they need it,” he says.
The Jepps' travel and medical costs for the births in the United States were paid by the Alberta government, and staff has since been added in the region to increase the available number of Level 3 incubators, he added.
Glenn Comm, an anesthesiologist and president of the Calgary Area Physicians Association, says he felt sending the Jepps to the United States was “an embarrassment” for the system.
However, if the government properly funds and staffs the new expanded facilities in Calgary, “we'd probably be in pretty good shape,” Comm says.
The shortage of medical personnel, which exists in other countries as well, including the United States, was exacerbated in Canada by cutbacks in the public health-care system in the 1990s.
Alberta, like many provinces, faced large public debts and chose to scale back a health system that was “over-capacity” on facilities and personnel. In the Calgary Region, one hospital was demolished and two others were sold to private operators.
Medical personnel in Alberta are roundly critical of the cuts, saying the provincial government went too far in its zeal to reduce public spending.
“Many people in health care were left without jobs, so many left the country to go work in the United States,” says Comm. “We lost (a lot) of workers.
“It was a product of political ideology. We were going into debt, and they wanted to get out. It was tunnel-vision, thinking of nothing else but getting out of debt, and not looking at the overall picture.”
Comm also says some physicians may leave Canada because they feel they're not adequately paid - particularly family physicians. The government and the AMA negotiate doctors' fees, but the fees don't always cover things like rising rents or other costs of running a practice, he says.
The Alberta Medical Association says the average gross pay for a family physician in the province in the 2005-06 fiscal year was nearly $208,000. Yet anywhere from 40 percent to 50 percent of that pay goes to cover the physician's costs of operating his or her private practice, the AMA estimates.
The average income for an anesthesiologist in Alberta is probably just under $300,000 a year, Comm says.
Comparable physician income figures for Montana aren't available. National studies for 2005 say income for family physicians in the United States ranges from $140,000 to $190,000; the range for anesthesiologists was $285,000 to $450,000 a year.
Comm is among those who say the publicly funded system can't continue to provide “everything for everyone when it is needed” without changes that somehow would make patients more personally and financially responsible for their health decisions.
Yet while Comm sees problems with the system, he's still a fan of publicly funded care for all. The Alberta native attended medical school in Loma Linda, Calif., and practiced for two years in Reno, Nev., but returned to Alberta in 1984 and has been here ever since.
“When I came back from the States, I was really happy that I didn't have to think of the financially devastating consequences of the treatment for someone,” he says. “The whole idea of not being wiped out by an illness certainly makes me a supporter of a public system of some sort.”
In fact, regardless of where Canadians come down on the future of their health care system, one constant seems to exist: They want to preserve the publicly funded system, guaranteeing equal access to basic medical care.
“We have to have at least the basic system for everybody,” says Abernethy, the emergency care director. “When I go to work, I don't worry about whether people can pay or not, which I think is a nice way to work a medical system.”
Canadian system's big flaw: Dreaded ‘wait list'
CALGARY, Alberta - If you're a Canadian citizen and you need cataract surgery, a new knee or hip, or an MRI and it's not deemed an emergency, be prepared to wait.
“In the U.S., you have a sore hip, you see your orthopedic surgeon and he suggests you get a new hip, and you have a real good health insurance plan, you say, ‘Tomorrow or next week?' ” says Dr. Rob Abernethy, director of emergency care for the Calgary Health Region.
“We might say, ‘Next year? A year and a half from now?' ”
For this system, which provides publicly funded health care to all citizens, the “wait list” is the Achilles heel - the whipping boy that attracts the most criticism, both from within and outside the system.
Wait lists are the system's means of rationing care not needed to cure an acute disease, treat an injury or save someone's life.
Wait lists also led to a 2005 Canadian Supreme Court decision that could influence the future of the country's publicly funded health system, recharging a lively debate over how to attack wait times.
“When you're not in critical care, how long are you disabled until you finally get the treatment you need?” says Dr. Darryl LaBuick, a family doctor and president of the Alberta Medical Association. “That's where our system is hurting. That's going to get worse as our population ages.”
The association, whose trademarked motto is “Patients First,” has suggested establishing something called a “care guarantee,” which could be a maximum wait time for a certain procedure.
If the wait time exceeds the maximum, Canadian patients could get the care somewhere outside the system and still get reimbursed by the government.
Yet Canada currently forbids citizens to buy from a private source any health care that's offered in the publicly funded system - so that “somewhere outside the system” would have to be legalized, or possibly in another country, like the United States.
“We're still very strong supporters of the public system,” says LaBuick. “But we feel patients should have an opportunity to pursue private care where there is no offering from the public system. There should be a safety valve in the public system.”
The length of wait for a nonemergency surgery or treatment in Canada varies greatly, depending on the procedure, the province, where you live and the “urgency” of your health situation. It could be a week; it could be a year or longer.
Alberta Health and Wellness, the government ministry that manages health care in the province, lists nearly 50 procedures on its “wait list registry,” which is available on the Internet and lists wait times at individual hospitals and regions. http://www.ahw.gov.ab.ca/waitlist/CategoryOverview.jsp
The latest data say the average wait for a hip replacement in Alberta is about three months, although 28 percent of the 523 patients whose hips were replaced in the three months before Sept. 30 waited anywhere from four to 12 months. A few waited even longer.
The average wait for cataract surgery is 10 weeks; for a knee replacement, 14 weeks; an MRI test, nine weeks; a CT scan, 1.4 weeks.
A patient's individual surgeon decides where one sits on a wait list, based on the surgeon's judgment and a list of urgency “assessment tools” approved by the provincial health ministry.
Most Canadian provinces have embarked on efforts to reduce wait times, especially in the wake of the June 2005 Canadian Supreme Court decision that struck down Quebec's law prohibiting private health insurance.
The ruling came on a lawsuit filed by a 73-year-old man who had been waiting many months for a hip replacement. A 4-3 majority of the court said long waits for medical care violate Quebec's right to “security of person,” and that private health care could alleviate the waits.
The court majority went on to say that the government “cannot choose to do nothing” to alleviate wait times that are violating fundamental rights.
While the ruling applied only to Quebec's provincial laws, it added another element to the ongoing debate across Canada on how to manage waiting lists in the healthcare system.
Saskatchewan has taken several steps to reduce wait times, including special funding, new operating-room schedules, hiring surgical care coordinators for its two largest cities and a computerized surgical information system.
In a 2007 report, the Saskatchewan Health Ministry said the number of people waiting more than a year for surgery in this province of 1 million people had dropped 34 percent in the past two years, from 7,900 to 5,200.
The report also said the average wait time for a non-emergency MRI test had dropped from 300 days to 136 days.
Some have suggested Canada should allow people to avoid long wait lists by purchasing private care outside the publicly funded system.
They also note that some Canadians already have such access outside the public system, such as the Royal Canadian Mounted Police, professional athletes and workers compensation cases.
Yet while some say opening up the system to privately purchased care can help reduce wait lists, others argue the opposite.
Karen Craik, an emergency room nurse and secretary-treasurer of the United Nurses of Alberta, says the Calgary Region should buy back two of the hospitals it sold to private interests in the 1990s.
Adding more beds and operating rooms to the public system would ease wait lists, she says. The system also needs to recruit and/or hire more doctors and nurses, she adds.
“When they created (the private hospitals), they said it would reduce wait lists, but the evidence has shown that it doesn't, because it takes staff and resources out of the public health system,” Craik says. “They're still saying if you allow more privatization, it will reduce wait times. But I would think it would be just the opposite.”
Kobus Le Roux, a physician in Maple Creek, Saskatchewan, agrees. He says in his native South Africa 25 years ago, authorities created a private system for those who could pay and kept the public system for everyone else.
The result has been a deterioration of the public system, he says. “At the state facilities, the standard is going down and down; at the private hospitals, it's getting better and better.”
Craik says while all Canadians would like to cut down on wait times, the system still delivers timely care when it's urgent. Craik was diagnosed with ovarian cancer several years ago and says she got the care she needed quickly.
“There were no delays, no questions about the lab work,” she says. “I was just so glad I was in Canada. There was something that needed to get done, and it got done.”
|
 |
 |
Add your comment now! Write your comment in the form below.
(Email address is for verification only. If you'd like to email a story, look for the link above)