2008 July 05 Saturday
Knee And Hip Replacement Rationing In Canada

Socialist rationing of medical care in Canada:

Los Angeles, London, New Delhi, Singapore (June 19, 2008) Health-care system constraints combined with a lack of a uniform referral process are leaving Ontario physicians brokering which patients are in greatest need of hip and knee replacement, a study led by a St. Michael's Hospital researcher funded by the Canadian Institutes of Health Research has revealed. The variability in this process means not everyone who needs this surgery will actually get surgery.

Rather than rationing by price Canada effectively rations based on all sorts of factors. The advantage? American socialists can ignore this rationing and point at the Canadian system as morally superior.

"Findings from our study suggest several system factors are shifting the onus to physicians and surgeons to prioritize which candidates will receive hip and knee replacement," said lead author Pamela Hudak, a researcher in the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital. "Physicians appear to adjust their criteria, often on a case-by-case basis, to identify which patients will be referred for or, in the case of surgeons, offered surgery. Ultimately this results in a varied approach in determining the best candidates, leaving many eligible and suitable candidates on waiting lists or to manage their problems as best they can with conservative approaches like medications."

The study, conducted by a team of researchers from across the University of Toronto and published last week in the journal Medical Decision Making, published by SAGE, examined the impact of patient characteristics, including age, weight/obesity, comorbidity and perioperative risk, and gender and caretaker roles in the decision-making process of 18 family physicians, 15 rheumatologists and 17 orthopedic surgeons from across Ontario.

"Although we expected these characteristics to affect candidates chosen for surgery, we did not expect the significant impact system constraints, such as lack of home care and postoperative support, waiting lists and access to operating rooms, would have on the decision-making process," Hudak explained. "Waiting lists prompted some physicians to refer patients earlier than normal while the lack of available home care and postoperative support, crucial for hip and knee replacement patients, prevented other physicians from referring patients. Beyond these limitations, surgeons also said they would take on more cases if more operating room time was available. These limiting factors can then affect how surgeons and physicians prioritize their patients, especially without common guidelines."

You can see why more affluent Canadians drive south over the border to pay for treatment in the United States.

Update: Ned brings my attention to this video on how the Canadian health care system makes people with deadly diseases wait when their lives are at great risk:

Share |      By Randall Parker at 2008 July 05 10:50 AM  Economics Health

averros said at July 5, 2008 1:05 PM:

> Physicians appear to adjust their criteria, often on a case-by-case basis, to identify which patients
> will be referred for or, in the case of surgeons, offered surgery.

Well, to anyone who has a half clue about socialism the meaning of that is very simple: physicans take bribes. Or work the network of favors, something called "blaht" in Russian.

As always, when equality is enforced, some people get to be more equal than others.

Dragon Horse said at July 5, 2008 6:56 PM:

One problem is, in these countries with national health care, I lived in one (Japan) it is good for simple primary care, very good. The problem is when it comes to specialist, there is no incentive, so they always have a shortage, also there might be a shortage of equipment, but the shortage of specialized doctors is most important.

When I was in Japan, I got my wisdom teeth taken out and they were impacted. Here I could have been put under sedation, but in Japan they did not have anyone trained who could do that, anywhere, unless I wanted to wait a month or so. One of my teeth was already infected so I just got the local pain killer...didn't work well, it was horrible. The doctor was a regular dentist, not equipped or trained in doing this, it was a nightmare. It was so bad I got one tooth out (the infected one) and waited to get the other out until I came back from the U.S. When I came back to America the procedure was literally painless, the medicine they prescribed was superior.

Now on the other hand there was a boy in Maryland who recently died from tooth decay as the infection was so bad it spread from his jaw into his brain. The mother took him to several doctors but no one would take Medicaid.

So if you are poor, I would say national health care is a good thing and very helpful, but if you have good insurance then it is not a good thing. It is like bringing everyone to equilibrium, you bring the poor up and bring the rich down. :-) In America though there are more poor and a lot of people who have limited or no insurance.

LPG said at July 6, 2008 10:16 AM:

Knee and hip replacement surgery should be rationed. It has a track record of mixed to very unsatisfactory results. Look at Tiger Woods. One would imagine that he would have the best possible treatment team, yet these brilliant surgens have to go back for more tinkering. Each procedure could ruin his career. Micky Mantle played with bad knees all his career which was long and distinguished. If Tiger keeps fooling around with these elite charlatans, his career may be spectacular but short. Orthopedic surgens do a great deal of good but the gravy for them lies in these elective proceedures which tend to need constant upgrades. I know that their patients have mixed and sometimes very unfavorable results, but once they cut you are sucked into their ever more radical treatments. The patient starts out with minor minimally invasive surgery which doesn't work. Next the surgen goes in for deeper treatment and the next step is a knee or hip replacement. One of the most rediculious aspects is that these proceedures are being done on 90 year olds. Come up with a high tech oil can just like Dorothy used on the Tin Man.

Bob Badour said at July 6, 2008 7:55 PM:

Dragon Horse,

About 15% of the population of Canada are effectively cut off from primary health care because they do not have a family doctor. While things vary from province to province, in Ontario, without a family doctor I had no access to medical care other than to show up at emergency, which is the same level of care a homeless person in the US might expect.

Some of these people can afford to pay for medical care, they are simply prohibited by law from doing so.

Socialized medicine is an obscenity plain and simple.

Ned said at July 7, 2008 5:08 AM:

Knee and hip surgery aren't the only procedures rationed in Canada:


Bob Deschambault said at May 15, 2009 11:26 AM:

If anyone has had to live with the pain with bone on bone in the hip joint, he wouldn't call a hip replacement an elective procedure. It is a simple matter of being able to walk, climb stairs, or go to the bathroom without suffering intense pain. Probably the use of pain killers is more damaging than to have the procedure done. I am 53 and right now I am a candidate for two new hips ... without which I would need a wheelchair to just get around. The pain is intense even with the use of several pain killers.

Karen Bracken said at September 25, 2009 7:19 AM:

This is what will happen to the USA if they adopt the currently proposed Health Care Reform. The proposal is not Health Care Reform for the good of the people it is at the expense of the American people. It will cost you more in the end and you will get less care. Is this what we really want. Common sense tells you there is no other way to implement this reform without it costing more and providing less services. It will be the older Americans that will suffer and other countries that send their patients here for care (because their socialized medicine in their own country won't give them the needed care) will have no place to go. We care so much more about the illegals in this country than we do about the hard working tax payers and people from other countries that pay for services out of their pocket. Ten years from now all the people that supported this monstrous Socialism will regret the day they did and will be paying the price for their ignorance. People are watching TV and listening to Obama tell lies rather than digging into the bill. Remember whatever is not stated "will not be covered" in this bill leaves an open door to cover it in the future. So if there is not proof of citizenship required what does common sense tell you that means....it means the bill doesn't require proof of citizenship so therefore anyone that walks in to a hospital will be covered. Well folks we have that today and without rationed care and a high price tag. People this is just a ruse to get more of your money in their pockets so they can give it to ruthless countries. They can't take anymore from us than they already do so they have found a new way to get more of our money and make us think we will get better health care. Wake up people. They are raising Medicaid services.....this means higher state taxes. Reducing Medicare services.....when you are old you will just have to age gracefully and die. Well when you are 70 lets see if you feel the same way then as you do today about the aged population.

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