Canadian model of healthcare ails

Canada's provincial leaders pledged C$1 billion (US$640 million) to purchase high-tech equipment starting this year. But any shortening of the typical two-month wait for patients to receive MRI tests and CAT scans isn't likely soon.

"It will take a decade to get speed of access and modern healthcare back in Canada," says Michael Decter, chair of the national board of the Canadian Institute for Health Information, and former deputy minister of health in Ontario.

Although Mr. Decter agrees that the system is shaken, he still says that modernized public healthcare is the solution.

"We do well on life expectancy and immunization of children compared to the US," he says, noting that the US spends about 40 percent more on healthcare in total than Canada. "But we see the drug ads on US television and worry that we're not as shiny and new as the Americans."

Fixing the deficiencies of the healthcare system is now the mandate of a royal commission, headed by former Saskatchewan premier Roy Romanow. Over the next few months, Mr. Romanow will head to London, Paris, and Washington to gather insights that could help remedy Canada's ailing system.

Solutions would likely include greater home care, user fees for patients who can afford them, and private or semiprivate hospitals, all of which top-ranked countries such as France, Sweden, and Australia feature.

The strains on the system are already forcing local shifts to alternative models. Some communities are allowing nurses to treat minor cases without referring patients to a doctor. Seventy-seven percent of nurses and 60 percent of doctors support this approach.

One of the CMA's recommendations is setting national standards for wait times.

"Canadians are divided over the establishment of user fees," says CMA president Dana Hanson. Although Dr. Hanson believes in a publicly funded system, he doesn't discount private-public partnerships. Some provinces already hire private labs, he points out.

Should Romanow's commission fail to deliver a workable solution, Canada's 10 provinces might be forced to take matters into their own hands.

"Some provinces could independently impose user fees or copayments," suggests Walker. Ontario and Alberta are the two provinces who, he says, might be able to give up federal Medicare aid in favor of a provincially run system. Both provinces are wealthier and less dependent on federal outlays to balance their medical costs.

But Mr. Reinhardt says introducing some features of the US healthcare system might be fraught with difficulties. "[The US] system has left 40 million people uninsured," he says, "and medical bills have become the second leading cause of personal bankruptcy in the US."

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