When Bill Clinton attempted to reform US healthcare in 1994, his administration often touted Canada's publicly funded, universal access system as a model to be emulated. As it turns out, the Canadian system may be crumbling under its own weight.

Despite spending nearly C$100 billion (US$64 billion) per year on healthcare – the most per capita among countries that run a similar system – a study released last week by the Fraser Institute, a public-policy think tank in Vancouver, shows that Canada ranks only slightly higher than Hungary, Poland, and Turkey in the quality of service its citizens receive.

Canada is the last industrialized nation to rely solely on government funds for its core healthcare system. There's an emerging view that it, too, may abandon a system that has long been a symbol of its national identity.

"We are no longer the model," says Michael Walker, executive director of the Fraser Institute. "When you consider that equal access in a country as spread out as Canada would require a greater number of physicians and diagnostic equipment, we're clearly headed in the wrong direction."

Two issues in particular plague the Canadian system, which forbids any form of user payment or private care for core services: the number of doctors and access to high technology.

Canada fields 1.8 doctors per 1,000 inhabitants, which places it 17th on a list of 20 countries with universal access (the list does not include the US). To leap into first place, Canada would need to add 48,000 doctors to its current roster of 57,000.

Canada lags even further behind in access to high-tech equipment, including machines used for magnetic resonance imaging (MRI) and computed axial tomography (CAT) scans. This shortage affects wait time for diagnostic assessments, which in provinces such as Saskatchewan can run well over three months.

According to Dr. Walker, hospitals absorb 55 percent of the total annual healthcare budget. The Fraser study found that nonmedical staff – including painters, electricians, and cooks – tend to be paid 50 percent higher than their counterparts in nonmedical industries. "We are not controlling our costs," he says.

Exacerbating Canada's poor performance among industrialized countries is its proximity to the US, notes Princeton University health economist Uwe Reinhardt. "Since Canada is part of the American job market, Canadian nurses and doctors must be compensated at levels that compete against US jobs," he says. "That means that even with the same level of care, Canadians will pay more than Europeans for core services."

Another survey, released last week by the Canadian Medical Association (CMA), shows growing dissatisfaction with the current system. The findings reveal that six in 10 Canadians expect the quality of healthcare to worsen over the next five years. And with 58 percent of respondents acknowledging that their confidence in the system is falling, versus 51 percent in 2000, Canadians are seriously contemplating a user-pay system. While 56 percent of survey respondents say they would pay more in taxes to maintain current service levels, 49 percent say they would welcome an approach that blends public and private care.

Page: 1 | 2