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Free drinks at a banquet is a nice analogy, but have Canadians in fact seen their doctors largely for frivolous reasons? Do you know of any studies supporting that because I am sure there would be.

I am not sure about doctors fleeing south, that is a statistic that is real and factual or it isnt, but I am sure that if the salaries are 4-5 times as much there would be some of that. There is a serious shortage of primary care physicians in the US, they must be among the specialties?

That's fascinating because, as usual, while the poor get blamed for fraud it's the rich that are plundering the Medicaid coffers

As Canada's Slow-Motion Public Health System Falters, Private Medical Care Is Surging

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By CLIFFORD KRAUSS
Published: February 26, 2006

VANCOUVER, British Columbia, Feb. 23 — The Cambie Surgery Center, Canada's most prominent private hospital, may be considered a rogue enterprise.

Accepting money from patients for operations they would otherwise receive free of charge in a public hospital is technically prohibited in this country, even in cases where patients would wait months or even years in discomfort before receiving treatment.

But no one is about to arrest Dr. Brian Day, who is president and medical director of the center, or any of the 120 doctors who work there. Public hospitals are sending him growing numbers of patients they are too busy to treat, and his center is advertising that patients do not have to wait to replace their aching knees.

The country's publicly financed health insurance system — frequently described as the third rail of its political system and a core value of its national identity — is gradually breaking down. Private clinics are opening around the country by an estimated one a week, and private insurance companies are about to find a gold mine.

Dr. Day, for instance, is planning to open more private hospitals, first in Toronto and Ottawa, then in Montreal, Calgary and Edmonton. Ontario provincial officials are already threatening stiff fines. Dr. Day says he is eager to see them in court.

"We've taken the position that the law is illegal," Dr. Day, 59, says. "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years."

Dr. Day may be a rebel (he keeps a photograph of himself with Fidel Castro behind his desk), but he appears to be on top of a new wave in Canada's health care future. He is poised to become the president of the Canadian Medical Association next year, and his profitable Vancouver hospital is serving as a model for medical entrepreneurs in several provinces.

Canada remains the only industrialized country that outlaws privately financed purchases of core medical services. Prime Minister Stephen Harper and other politicians remain reluctant to openly propose sweeping changes even though costs for the national and provincial governments are exploding and some cancer patients are waiting months for diagnostic tests and treatment.

But a Supreme Court ruling last June — it found that a Quebec provincial ban on private health insurance was unconstitutional when patients were suffering and even dying on waiting lists — appears to have become a turning point for the entire country.

"The prohibition on obtaining private health insurance is not constitutional where the public system fails to deliver reasonable services," the court ruled.

In response, the Quebec premier, Jean Charest, proposed this month to allow private hospitals to subcontract hip, knee and cataract surgery to private clinics when patients are unable to be treated quickly enough under the public system. The premiers of British Columbia and Alberta have suggested they will go much further to encourage private health services and insurance in legislation they plan to propose in the next few months.

Private doctors across the country are not waiting for changes in the law, figuring provincial governments will not try to stop them only to face more test cases in the Supreme Court.

One Vancouver-based company launched a large for-profit family medical clinic specializing in screening and preventive medicine here last November. It is planning to set up three similar clinics — in Toronto, Ottawa and London, Ontario — next summer and nine more in several other cities by the end of 2007. Private diagnostic clinics offering MRI tests are opening around the country.

Canadian leaders continue to reject the largely market-driven American system, with its powerful private insurance companies and 40 million people left uninsured, as they look to European mixed public-private health insurance and delivery systems

flyonthewall, thanks for the citations but lack of primary care doctors but that problem exists in the US as well and what you brought up about Canadian doctors going to practice in the US you have discussed elsewhere, but it is a non sequiteur.

You were trying to make a case for the services having no value because they are perceived as free, hence the system is swamped with frivolous visits, which is why I gave the analogy I did.

Ontario emergency room waits fatal, health officials say

April 18, 2005 -- Emergency room waiting times at some Ontario hospitals are prompting seriously ill people to walk away, sometimes with fatal results, health officials say.

Dr. Sean Gartner says 11 per cent of the people who came to the emergency room at his hospital in Guelph last month ended up leaving without receiving treatment.

A few months earlier, Gartner said an elderly man who left after he became tired of waiting was later found dead.

In February, Patricia Vepari, a 21-year-old engineering student, arrived at a Kitchener hospital emergency room with a fever, sore throat and nausea.

Facing an eight-hour wait, she decided to go home, where she died of an infection.

Tom Closson, president of Toronto's University Health Network, said the outbreak of severe acute respiratory syndrome at several health-care facilities two years ago seems to have discouraged many people from going to emergency rooms with minor problems.

This means people who walk away are more likely to have a serious ailment, he said. "It's a serious, serious problem."

Closson said while the provincial government is spending a lot of money and effort to reduce waiting times for cardiac treatment and hip replacements, emergency facilities are not getting the same attention.

"I think there's much more suffering that occurs in my waiting room than occurs with people with osteoarthritis," said Gartner.

Toronto Patients Die Waiting for Emergency Care

February 9, 2008 --
There was a furor among Toronto paramedics as three Emergency Medical Service (EMS) patients died in the waiting room or on a stretcher waiting for emergency care between Monday and Tuesday.

According to the paramedics union of Toronto, the emergency room conditions in Toronto city is depressive.

The emergency department of Etobicoke General Hospital witnessed the painful deaths of two women and one man between Monday and Tuesday.They were waiting on a stretcher or in the waiting room due to "offload delay" said Glenn Fontaine, unit ambulance chairman for Toronto Paramedic Local 416.

Offload delay refers to paramedics at hospital with a patient waiting for a bed.

Glenn Fontaine said one patient died while waiting with paramedics for a bed and another had a heart attack after a painful wait for three hours in the waiting room.

The Toronto Emergency Medical Service Deputy Chief Norm Lambert admitted that paramedics citywide are feeling stressed out by crowded emergency rooms, which result ed in patients waiting for hours but denied the allegations of the paramedics.

B.C. senior's hospital death being investigated

Apr. 25 2006 -- why it took seven hours on a normal day for an emergency room doctor to see an elderly Nanaimo, B.C. man who died waiting for care.

"They did nothing," Cheryle Cook said Tuesday of the final hours of her father George Cook's life.

She pushed for the investigation.

On April 13, the 88-year-old Cook was taken from his senior's home to Nanaimo Regional General Hospital suffering from pneumonia.

When Cheryle arrived, she found him laying on a cot in a hallway near a door.

So let me see a citation that Canadians use health services frivolously en masse.

US health care systems
Steven Lewis, Danielle A. Southern, Colleen J. Maxwell, James R. Dunn, Tom W. Noseworthy, William A. Ghali
ABSTRACT

Background: There are no reported head-to-head comparative assessments of health care in any two countries by people who have experienced both. We sought to report the experiences and views of Americans living in Canada who have used both health care systems as adults.

Methods: We surveyed a sample of Americans living in Canada. We used 5 communication strategies to obtain the sample and asked respondents to provide experience-based ratings of various dimensions of health system quality.

Results: The survey was completed by 310 people who met the inclusion criteria. This group was highly educated (58% with a master's degree or higher) and prosperous (51% of households had a yearly income > $100,000). Seventy-four percent rated the overall quality of US health care as excellent or good, compared with 50% who gave this rating to Canadian health care. Most preferred the American system for emergency, specialist, hospital and diagnostic services. Respondents rated the Canadian system more highly for access to drug therapy and expressed similar views of the two systems with respect to care from a family physician. The features of the US system rated most positively were timeliness and quality; those rated most highly in the Canadian system were equity and cost-efficiency. The most negatively viewed features of the US system were cost/inefficiency and inequity; those of the Canadian system were wait times and personnel shortages. Although respondents generally rated the components of the US system more favourably than Canada's, when asked which system they preferred overall, 45% chose the US system and 40% chose Canada's.

Conclusion: Americans living in Canada generally rated the US health care system as being better than the Canadian system. However, they acknowledged the inefficiency and inequity of the US system, and nearly half preferred the Canadian system despite its perceived problems.

Health status and health care utilization. Respondents were healthy: 83% self-rated their health status as excellent or very good in the 2 years before moving to Canada, as compared with 73% of Canadians in the top income quintile who give their health this rating. Eighty percent rated the health status of their partner or spouse and 85% rated that of other household members as excellent or very good. Thirty-one percent reported that, since moving to Canada, at least one member of their household had experienced a chronic illness; 21% of respondents had had surgery in a hospital requiring an overnight stay; and 25% had had day surgery procedures. The typical household had made 5 visits to a family doctor, 2 to a specialist, and 1 to an emergency department and had filled 4 drug prescriptions annually. Thirty percent had received health care of any type in the United States in the previous year, and 11% had travelled to the United States expressly for that purpose.

Insurance coverage and out-of-pocket costs. Not surprisingly, given their income and education, 98% of respondents had health insurance before their arrival in Canada, mostly through employer-paid, for-profit insurance plans. Ninety-one percent had health insurance supplementary to the main plan. These data are significant: the study respondents by and large experienced the best of the US health care system, which very likely influenced their expectations and assessment of the Canadian system. Seventy-two percent were very or somewhat satisfied with their US health insurance overall, whereas 19% were somewhat or very dissatisfied.

Interestingly, given their socioeconomic status, 32% reported that health care coverage had exerted quite a lot or a great deal of influence on where they looked for a job in the United States, and 29% reported that this consideration influenced decisions about whether to stay in or leave a job. In addition, 24% reported paying out-of-pocket health care costs in the United States that created significant financial hardship, compared with 5% who reported a similar experience in Canada.

Expectations of Canadian health care before arrival. Two-thirds of respondents had formed an opinion of Canadian health care before their arrival. Of these, 35% had anticipated that the system would be worse than what they were used to in the United States, 29% had thought it would be better, and 37% had thought it would be the same. One-quarter indicated that their opinion had some influence on their decision to move to Canada, and 95% of these said it had been a positive motivator.

Comparative assessment of experiences in the two systems. Figure 1 reports respondents' assessments of the timeliness and quality of Canadian and US health care services, based on their own experiences. By considerable margins, respondents rated the US system as better than the Canadian system in all categories except the cost of drugs and administrative complexity. The gaps were larger for timeliness than for quality-of-care items. Notably, 41% rated the United States as providing greater freedom to choose health care providers, compared with 27% who rated Canada higher in this regard.

Comparative assessment of the merits of the two systems. Figure 1 also reports ratings of a number of structural aspects of the two systems. By and large, these reflect the ratings of the care itself, although the views on the system as a whole are somewhat more generous toward Canada. Respondents were particularly critical of the timeliness and availability of specialized services in Canada. Canada was rated considerably better only with respect to out-of-pocket costs, and somewhat better on the question of cost relative to quality. Overall, 50% rated the Canadian system as good or excellent, compared with 74% who gave this rating to the US system.

Similarly, we asked respondents to indicate where they would prefer to obtain treatment if they or a household member became seriously ill. Figure 2 shows that most preferred US care in 4 of 6 categories and Canadian care in 1 category (prescription drugs); preference for care provided by a family physician was distributed equally between the two countries.

We asked respondents to list the 3 most positive and negative aspects of both health care systems. Table 2 lists the most commonly mentioned responses. Quality, comprehensiveness and accessibility of care appeared in roughly equal numbers as perceived "positives" and "negatives" in the Canadian system. Equity/universality of coverage was considered a major positive in Canada and a major weakness in the United States. Cost/efficiency was considered a major positive in Canada and a major negative in the United States, whereas wait times were perceived as the principal Canadian negative and their absence a major US positive.

Differences in opinion attributable to length of time in Canada and place of residence in Canada. Our study included roughly equal numbers of Americans who had moved to Canada in 2000 or later, or before 2000. Ratings and opinions generally did not vary according to how long respondents had lived in Canada. However, 39% of the earlier arrivals had anticipated that health care would be better in Canada than in the United States, as compared with 26% of more recent arrivals (p = 0.02). Among the later arrivals, only 15% rated the quality of care provided by Canadian family physicians as better than in the United States, whereas 41% rated it worse; among earlier arrivals 29% rated family medicine as better and 24% rated it as worse (p < 0.01).

For almost all measures, province of residence in Canada did not influence perceptions. Albertans were moderately more positive about the quality of care than their counterparts in other provinces, and Albertans and Ontarians rated the efficiency of their provinces' services somewhat higher.

Qualitative comments on overall system comparisons. Respondents rated the Canadian system as a whole more highly than its component parts. They often tempered their praise for the US system with caveats such as, "If you're rich, you can get state-of-the-art care," or, "All positive features are contingent on having good private health insurance." They also identified equity or universality as a major strength in Canada, even though they had not been personally disadvantaged in the less equitable American system.

These reservations are reflected in the responses to the question, "All things considered, which system do you prefer?" Here the margin was narrow: 45% chose the US system, and 40% chose Canada's.

Conclusions

Highly educated, prosperous American émigrés to Canada are comparatively unimpressed with many elements of the Canadian health care system, but are more generously disposed toward its fairness and efficiency. Respondents' opinions of the quality and timeliness of care in Canada are similar to those of Canadians in general. In this sense, the study findings challenge two prevailing ideas: that Canadians idolize their universal-coverage medicare program to the point of being wilfully blind to its flaws, and that Americans who are accustomed to the best of US health care would be categorically harsh critics of the Canadian system and unsympathetic to its egalitarian ethos. These findings may be of interest to policy-makers not only in Canada and the United States but also internationally as all countries struggle to improve quality, contain costs, and allocate resources among competing interests.


http://www.openmedicine.ca/article/view/39/43

Respondents were particularly critical of the timeliness and availability of specialized services in Canada. Canada was rated considerably better only with respect to out-of-pocket costs, and somewhat better on the question of cost relative to quality. Overall, 50% rated the Canadian system as good or excellent, compared with 74% who gave this rating to the US system.

By considerable margins, respondents rated the US system as better than the Canadian system in all categories except the cost of drugs and administrative complexity. The gaps were larger for timeliness than for quality-of-care items. Notably, 41% rated the United States as providing greater freedom to choose health care providers, compared with 27% who rated Canada higher in this regard.

We asked respondents to indicate where they would prefer to obtain treatment if they or a household member became seriously ill. Figure 2 shows that most preferred US care in 4 of 6 categories and Canadian care in 1 category (prescription drugs); preference for care provided by a family physician was distributed equally between the two countries.

Among the later arrivals, only 15% rated the quality of care provided by Canadian family physicians as better than in the United States, whereas 41% rated it worse; among earlier arrivals 29% rated family medicine as better and 24% rated it as worse.

I think hospitals should require birth certs before allowing anyone into er thanks to our federal government pushing the north american union, then turn right around and sue the feds for failure to enforce existing immigration laws. When people start dying in the streets then it might get their attention.

I hope everyone on the border states write their reps and demand compensation.

Just imagine if this were being fed from the federal trough via the universal health agenda effectively removing the states power to do anything about it?
.

LOL, what a survey. Only half of Americans living in Canada rate the Canadian medical system as good or better, compared to 74 percent for the US system.

Insurance coverage and out-of-pocket costs. Not surprisingly, given their income and education, 98% of respondents had health insurance before their arrival in Canada, mostly through employer-paid, for-profit insurance plans. Ninety-one percent had health insurance supplementary to the main plan. These data are significant: the study respondents by and large experienced the best of the US health care system, which very likely influenced their expectations and assessment of the Canadian system. Seventy-two percent were very or somewhat satisfied with their US health insurance overall, whereas 19% were somewhat or very dissatisfied.

Interestingly, given their socioeconomic status, 32% reported that health care coverage had exerted quite a lot or a great deal of influence on where they looked for a job in the United States, and 29% reported that this consideration influenced decisions about whether to stay in or leave a job. In addition, 24% reported paying out-of-pocket health care costs in the United States that created significant financial hardship, compared with 5% who reported a similar experience in Canada.