Contrasting Canada and the US: What Did They Get Right and Wrong About Healthcare?

[David Baxter PhD]

Contrasting Canada and the United States: What Did They Get Right and Wrong About Healthcare?
by Jock Murray, MD, The Medscape Journal of Medicine
11/07/2008

Every country is struggling with its healthcare system, and each has solved some problems and incurred others. Remember, no country can afford everything for everyone right now, so pick two. Canada gives everything to everyone, but in some instances, not right now. The USA gives everything right now, but not to everyone.^[1-3]

Canada got some things right:

• Five fundamental values
• A National system
• Noncompetition
• Cost controls
• Macromanagement
• A Royal College concept over medical and surgical specialty training, program evaluation, and examination
• Residency training only in university programs.

Canada got some things wrong:

• Inadequate research support
• Global cuts without much planning
• Poor planning of physician, nurse numbers
• Waiting lists.

The USA got some things right:

• Opportunities for the individual
• Innovation and creativity
• Research support
• Benefits for risk takers
• Expertise in specialty care.

The USA got some things wrong:

• 45 million uninsured and an equal number underinsured
• No coherent system
• No overriding principles
• Expensive, complex administration
• Excessive controls on physicians
• Excessive physician paperwork
• Micromanagement
• Powerful competing forces that can resist change
• Expensive specialty care
• Inadequate and complex concept of primary care
• No plan for when profit goes out of the system
• Excessive malpractice.

Some things neither country got right:

• Physician distribution
• Long-term planning
• Patient advocacy
• Support for academic centers
• Big Pharma influence
• Public health support
• Population health perspective
• A rational approach to rationing
• Balance of income for cognitive and proceduralist physicians
• Drug costs.

The different ways Canada and the USA have addressed healthcare is reflected in their history, their feelings about government involvement, and views on individuals vs the group. It is reflected in their mottos. For the USA it is Life, Liberty, and the Pursuit of Happiness; and Canada it is Peace, Order, and Good Governance.

Link to video