It has recently been purported that other civilized nations have better healthcare than the United States. If we were to adopt systems similar to Canada or Europe, then our care would be cheaper, faster and better.
Canada and some European countries have tax-subsidized healthcare. Legal residents, but no illegal immigrants, obtain “free” healthcare. But by “free”, Canadians, Scandinavians, Swiss, French, Belgians, Dutch, Australians, etc… all pay higher taxes per capita. The US is actually a little below average in taxes. Amongst the middle-class specifically, middle-class Canadians pay more in taxes than middle-class Americans. Amongst the rich, wealthy Americans pay higher taxes than wealthy Canadians. All Canadians pay higher sales tax and higher cost of goods.
Canadian “free” healthcare only covers “medically-necessary services”. Each province decides what this means, but “life-threatening” issues are the focus. Many elective procedures, pursued by Americans, are not approved in Canada.
Based on Canadian 2018 statistics, we can compare the speed and outcome of their neurosurgical treatment compared to ours. Since Canadians pay higher taxes and have “free” healthcare, they must get it quicker and better?
For neurosurgery care, many patients need a primary care provider (PCP) to provide a referral or to provide medical clearance for surgery. The patient then needs to see the neurosurgeon for their brain or spine care. They may need to see an oncologist if a tumor is present. The patient will need to obtain brain or spine imaging.
- In the United States, according to Medicare and Medicaid in 2017, it took an average of 24 days (~3 weeks) to schedule a new patient appointment with a primary care provider (PCP), in 15 of the largest US cities. Of course, commercially insured patients could see their providers sooner, because many PCPs have stopped accepting Medicare and/or Medicaid. The massively decreased reimbursement rates by government issued insurance compared to commercial insurance, the months delay in receiving those payment from the government, and the risk that Medicare/ Medicaid can refuse payment all together even after the service was provided, are some of the reasons for this.
- In Canada, there is an average 20 week (140 day) wait just to see a PCP
- In the United States, the average wait to see a spine surgeon was 12 days (~2 weeks)
- In Canada, the average wait to see a spine surgeon was 39 weeks.
- In the United States, the median time to start brain cancer treatment (not just seen an oncologist) is 21 days
- In Canada, the average wait to get an initial appointment with an oncologist is 3.8 weeks.
- In the United States, there are free-standing imaging centers charging a few hundred dollars to obtain a MRI the same or next day. If insurance is used, it may take 7-14 days to obtain a CT or MRI.
- In Canada, the average person must wait more than a month for a CT scan and 10 weeks for an MRI.
Wait time isn’t just an inconvenience. Waiting to see a PCP or specialist can result in lost work and income. In Canada, last productivity while waiting for treatment is about $5,600 per patient per year, and about $5.8 billion of lost income nationwide.
Healthcare outcomes, between Canada and the United states seem to show fairly equivalent results. Specifically regarding neurosurgery, however, “defensive neurosurgery” is far more likely to be practiced in America compared to Canada due to the medicolegal differences. Neurosurgery malpractice premiums are averaged to be $19,110 per year in Canada, versus $128,181 per year in the United States.
Of course, Canadians have a pressure reliever… 90% of Canadians live within 90 miles of the US border, so they can just come to here to obtain their neurosurgical care. Centers in Buffalo, Rochester and Chicago receive tens of thousands of Canadian patients every year who are unhappy with their system, and who can blame them?