2003 October 19 Sunday
Canada Suffering Medical Brain Drain To United States

Tyler Cowen has linked to an interesting piece in the New York Times on the sorry state of Canadian medicine.

"It's not about the money," said Dr. Sriharan, a 38-year-old immigrant from Sri Lanka. "We can't do our job properly with operating room time so extremely limited here."

Forced to compete for operating room time with other surgeons, he said that he and his colleague could complete only one or two operations on some days, meaning that patients whose cases were not emergencies could go months or even years before completing necessary treatment.

Of course people are going to say that a decision of this sort to move to the US to practice medicine is not about their own income even though prospects of much higher incomes would play a major role in most people's decision-making. However, poor facilities and all sorts of resource limitations have got to seem like the insult added to injury for someone who spent many years training only to be faced with limits on how well they can apply what they know.

Can the last neurosurgeon who leaves please turn off the lights in the last neurosurgery clinic? If it gets bad enough the Canadian government will be forced to raise salaries for high priced specialties and to make some more money available to allow them to carry out their work.

There was a net migration of 49 neurosurgeons from Canada from 1996 to 2002, according to the Canadian Institute for Health Information, a large loss given that there are only 241 neurosurgeons in the country.

While the NY Times story is mostly anecdotal there are more statistically based arguments that suggest that you are a lot better off getting sick with a serious illness in the United States than in Canada.

Update: Sally Pipes, president of the Pacific Research Institute, has a 4 part series at Tech Central Station about Canadian health care. Canada is lacking in modern diagnostic equipment.

According to the Organization of Economic Cooperation and Development, Canada has about half the number of MRI units and CAT scanners as the average for other industrial nations, ranking it in the lower third of the 30 nations for such vital diagnostic tools. It gets lumped in among the former nations of the communist block. Canada is even farther behind in other technology. In 2001, Canada had only two functioning PET (positron emission tomography) scanners for its 31 million people, or one for every 15 million residents versus 250 such machines in the United States, or one for every 1.1 million residents. Such scanners are particularly vital to women suffering from breast cancer as they are 80 percent accurate (and even better than MRIs) in determining whether the disease will recur.

Pipes' second article in the series describes how hospitals try to cut back on the amount of various procedures they perform.

Canada's primary care physicians don't face a lot of hassle from the government in dealing with their patients. But they also aren't given many of the tools American doctors have to heal their patients or save lives. Price controls through global budgets, wherein hospitals are given a lump sum of money each year, make patients liabilities to be avoided. "[I]n Canada, the patient is a source of expense. So it's to the hospitals benefit to reduce costs [by] doing the least amount of operations as possible," Dr. Alfons Pomp, a Canadian laparoscopic surgeon told one writer.

Coupled with government purchasing controls, the arrangement virtually guarantees the unavailability of high-tech diagnostic equipment, modern medical procedures and new and better pharmaceuticals, all because they are considered too expensive.

Canada's system discourages the use of drugs to lower costs.

Also imported would most likely be the waits for new drugs. The median time for drug approvals in Canada is nearly half a year longer than in the United States. Under formulary rules, a new drug place in a category cannot increase the cost of drug treatment for a disease -- even if it reduces the other medical costs associated with the treatment. More effective drugs thus can be kept off the market or made more costly to buy for Canadians for years.

By contrast, in America's freer market health care companies and physicians embrace drug use in order to lower total costs and improve health.

Science writer Ronald Bailey in Reason magazine reported how Humana Hospitals cut the death rate for congestive heart patients from 25 percent to 10 percent through a year-long disease management program. The program increased the use of pharmaceuticals, raising costs for its pharmacy by 60 percent. But hospital costs dropped 78 percent, saving Humana $10 million net. Drug therapy thus was both life saving and cost saving.

In a kind of unintended reverse experiment, proving the same thing, the New Hampshire Medicaid program in 2000 limited the number of prescriptions it would pay in order to save some money. They did for drug costs -- but not for nursing homes. The rate of admission to them doubled.

Indeed, according to research by Columbia University professor Frank Lichtenberg, every $1 of increased spending on new pharmaceuticals reduces other health care expenditures by an average of $7.17.

The Canadian health care single payer system and price controls are things we should avoid like a plague in the United States.

Share |      By Randall Parker at 2003 October 19 07:43 PM  Socialism, Capitalism


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