From: golchowy@alchemy.chem.utoronto.ca (Gerald Olchowy)
Subject: Re: EIGHT MYTHS about National Health Insurance (Pt II)
Organization: University of Toronto Chemistry Department
Lines: 97

In article <1993Apr21.005756.1125@news.columbia.edu> gld@cunixb.cc.columbia.edu (Gary L Dare) writes:
>v140pxgt@ubvmsb.cc.buffalo.edu (Daniel B Case) writes:
>>Also, in the April 14 Globe and Mail, there was a letter from the
>>director of trauma services at St. Michael's Hospital in Toronto
>>responding to an article on a study comparing heart surgery in
>>California and Canada in which some Canadian doctor worried that

That study which was in the NEJM, I think, noted that the frequency
of heart surgery on patients over seventy increase with income in
California (I guess richer people have more heart disease in 
California -) ) whereas the frequency of surgery on patients over
seventy in Canada was relatively uniform across income distribution.
Heart surgery was more frequent in California, but mortality and
outcomes were essentially the same.

>>American analysts would seize on the results as proof that Canada
>>rationed vital services. The doctor (I can't recall his name) said
>>that Canada *is* rationing vital services "as any physician can
>>plainly see". He said that a system in which people are refused
>>treatment because they can't afford it is no different from a system
>>in which people are refused treatment because the government can't
>>afford it as a result of deliberate underfunding of the health
>>insurance plan. In fairness, he did say that both the US and 
>>Canadian systems are in the same situation.
>
>>(The NDP cleaning up a Tory spending mess? And just when I thought 
>>I understood Canadian politics).
>
>
>>There was one about a group of doctors in Calgary who have opened
>>Canada's first US-style MRI clinic, as an alternative to the
>>provincially owned one.
>
>It's about time!  I've ragged on my own doctor friends as to why they
>don't invest in their own private practices ... in the end, it's their
>money.  But they choose to spend it on America's Cup pipedreams, and
>that's none of my business.  As for "provincially owned" ... for sure
>it's against the law in Canada for governments to be directly involved
>in the provision of health care except in the military or native reser-
>vations.  What that term actually means is that the facility gets by
>on public grants to meet shortfall from *lack of use* ... no kidding.
>Medical practice itself is much more conservative up north.  My own
>best friend did two clerkships at the Mayo Clinic in Rochester, MN,
>and is no stranger to high tech medicine ... but his boat comes first.
>
>>There were some people expressing concern that it was the first wedge of
>>two-tiered health care and that it might violate the Canada Health Act.
>
>No, it's probably socialist whiners who are offended that we have
>private practices ... and always have.  They can all take cash
>anyways ... so why not have a particular facility?  The Canadian
>big government mentality often imagines government where it does
>not even exist ...
>

The only potential problem I see with the private MRI facilty in Calgary is the
self-referral problem to the facility for the doctors who have a financial
interest in it, which is basically unethical...but in Canada because
of our small population, there is likely only to be a few private
facilities involving only a small number of doctors,
and thus I don't think the self-referral problem, which is an epidemic in the
US, could ever get out of hand here.

>Look, nobody stopped the clinic when they planned on the MRI ...
>nobody stopped them when they bought it.  Nobody seems to be stopping
>them from using it, either.  Much ado about nothing.  Thank goodness
>that hockey playoffs have started ...
>

It is an experiment that will be certainly be watched carefully.

>>While it seemed currently unjustified, there was one anecdote told by
>>the head of the partnership to demonstrate the MRI. He showed an
>>image of an injured knee, which happened to belong to the manager of
>>the bank who approved the loan. He said that without it, the guy
>>might have had to wait a month or more at the provincial MRI, then
>>another length of time for treatment, after which the muscles would
>>have atrophied and rehabilitation would have been that much harder 
>>If that isn't the first whiff of two tiers, I don't know what is.
>
>I'm certain there is exaggeration somewhere, because the GAO study
>of Canada cited often on USENET did not find access to MRI to be a
>problem.  I'll bet the doctor is relying on people having listened 
>to American trash talk on cable so that he can puff his chest a bit.
>There are already a few treatment regimens for knee injuries without
>relying on MRI ... unfortunately, I've had a few. )-;  And I'm not
>a banker. (-;
>

What likely happened is the sponsors of the private MRI which include
doctors anticipated that Alberta would need more MRI's, and instead
of waiting for the health planners to realize they needed another
one or two, saw a business opportunity...where they would have a
secure business from the public insurance side of things, and they
could supplement people and businesses who want to pay cash.

Gerald
