Health care the tie that binds

Canadian Medical Association Journal 1996; 155: 274
As we read the article "Visions of our medicare future: status quo has become a dirty word in Canadian health care" (CMAJ 1996; 154: 693-696) [full text / résumé], by Charlotte Gray, we were unclear about which country was being described. Gray referred to a Canada in which public-opinion polls have revealed "an acute shift of opinion" on "how sacred health care really is." But in the Canada we are familiar with, the health care system remains the most popular government program ever and the single strongest thread binding the nation together.[1] A survey found that satisfaction with the health care system was higher in Canada than in nine other nations, including the United Kingdom and the United States.[2] A more recent survey published in CMAJ reported that more than 90% of Canadians support the five principles of the Canada Health Act: universality, accessibility, portability, public administration and comprehensiveness.[3]

We were also perplexed by Gray's claim that the efficiency and effectiveness of the health care system could be improved by the introduction of greater market forces and an increase in the number of payers. It is this multiplicity of payers that currently burdens the system in the United States. Woolhandler and associates[4] showed that administrative costs in the US health care system are more than double those in the Canadian system. Managed-care contracts do not lower these costs.

Our health care system represents an investment in the productivity and the future of Canada. Health insurance adds $500 to the cost of a car produced in the United States, compared with the cost of such a car in Canada,[5] whereas the safety and security offered by our health care system prevent families from facing tough choices between, for example, university education for their children and nursing care for their parents. Most people increase spending on valuable investments, but government spending on health care has remained relatively stable during the last decade. The increase in total spending is more the result of increased private-sector participation. Drifting away from a single-payer, universal system will only shift costs to the private sector and increase overall spending. Emphasizing evidence-based medicine, broad determinants of health and a close relationship among our hospitals, schools for training health care professionals, and the communities they serve is the best way to make the health care system more effective and the only way to make it more efficient.

Adalsteinn D. Brown
Department of Epidemiology and Biostatistics
University of Western Ontario
London, Ont.
Department of Public Health and Primary Care
University of Oxford
Oxford, England

Robert Y. McMurtry, MD, FRCSC
Dean
Faculty of Medicine
University of Western Ontario
London, Ont.

References

  1. Dwyer V: In search of unity. MacLean's 1994; 107 (27): 16-9.
  2. Blendon RJ, Leitman R, Morrison I, Donelan K. Satisfaction with health care in ten nations. Health Aff 1990; 9: 185-92.
  3. Most Canadians think all medicare principles should be protected, survey reveals [newsbrief]. CMAJ 1992; 146: 989.
  4. Woolhandler S, Himmelstein DU, Lewontin JP. Administrative costs in US hospitals. N Engl J Med 1993; 329: 400-3.
  5. Korcok M. Medicare system gives Canadian industries competitive advantage, observers say. CMAJ 1993; 146: 1011-3.
| CMAJ August 1, 1996 (vol 155, no 3) |