Media messages

Canadian-born urologist Joel Teichman, MD, who became a naturalized American citizen, believes people have been getting distorted views of both countries’ health care systems from the media. He described a recent Canadian television ad sponsored by a political action committee. It featured a woman from Ontario who had a rare brain tumor that required her to seek treatment in the United States. According to the commercial, the woman would have died from lack of treatment in Canada. The message: Americans should avoid adopting the Canadian system.

“Meanwhile, the Canadian media offer stories of hardworking, tax-paying Americans who end up requiring some necessary medical treatment that bankrupts them,” Dr. Teichman told Renal & Urology News. “Americans learn to fear our ‘incompetent’ system, and Canadians learn to fear the ‘unfairness’ of the American system.” 

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Dr. Teichman was an Associate Professor at the University of Texas Health Science Center at San Antonio from 1994 to 2003. He moved back to Canada after being unable to resist a recruiting offer in Vancouver, where he is a professor at the University of British Columbia.

Streamlined billing

Dr. Teichman mainly sees patients suffering from kidney stones and interstitial cystitis, but he sees more patients in Canada than in Texas. According to Dr. Teichman, this may be attributable to the fact that there are fewer specialists per capita in Canada than in the United States or that he was not focused on competing for business in the United States. Moreover, in Canada, the much more streamlined billing process helps free up time and resources.

“In Texas, my urology group at the university employed multiple billing people full-time to preauthorize insurance claims, file claims, chase down insurance companies for failure to pay, and handle insurance denials,” Dr. Teichman said. “Here in British Columbia, I file all my claims electronically to the province insurer and am reimbursed within two weeks. It occupies five to 10 minutes per day. I employ no billing person.”

Lawsuit paranoia in the U.S.

Dr. Teichman may also be able to see more patients because he does not have to spend as much time conducting elaborate informed-consent discussions. “For my American patients, I spent more time detailing all the potential adverse outcomes for drugs, therapy, or surgery. In Canada, I feel more comfortable telling patients they do not need a certain test than I would have in the U.S. There’s a greater paranoia in American medical practice because of medicolegal ramifications.”

Physicians are concerned that “if you fail to dot the I’s and cross the T’s and go absolutely obsessively over every last possible complication, a patient will turn around and say, ‘You failed to give me appropriate informed consent,’ and sue you,” he explained.

As a result, Dr. Teichman said, physicians working in the United States have to spend a lot more time and money than their Canadian counterparts ordering irrelevant and costly tests “merely for the sake of covering themselves.”

Dr. Teichman has a working theory about why some Americans fight the prospect of what seems like a great deal—free health care: “Canada was founded around stability and good governance, and America on principles of individual freedom, liberty, and pursuit of personal happiness,” he said.

“An extension of the American sense of liberty is that many Americans distrust government and abhor lack of choice. A single-payer system conjures up the possibility of lack of choice and a heavy-handed, government-run boondoggle. I think most Americans would be surprised to learn that the majority of Canadians receive quality health care from their own physicians and without government intrusion. Some American insurance companies pose much more significant intrusion and interference on patient care, and limits choice, more than exists here in Canada.”

All in all, Dr. Teichman said, “The Canadian system covers everyone quite well, so no one is left behind—but a deluxe model of enhanced health care for purchase is not really available here. I believe the U.S. system is the best health care available anywhere—if you have insurance. Both systems work reasonably well as long as you have access to health care.”

Paucity of primary care docs

Barbara Ballermann, MD, who spent a large part of her career in the United States and who now is the President of the Canadian Society of Nephrology, said she appreciates the peace of mind that Canada’s universal health coverage brings to all constituents. “For Canadian people and physicians, the basic principle that everyone has equal access to health care without worrying about payment is an enormous advantage that cannot be overstated. I believe this could be achieved in the U.S., even without a single-payer system.”

The Canadian system, however, is not without its problems, said Dr. Ballermann, Professor of Medicine at the University of Alberta in Edmonton. One is that the provincial government system basically still pays more for procedure-based and specialty-based medicine than it does for primary care. “So we have a huge shortage of primary-care physicians.”

This is a familiar complaint in the United States as well, where a lack of insurance frequently prevents people from obtaining primary care services. In Canada, the problem stems from the fact that there simply are not enough general practitioners available. Consequently, Dr. Ballermann said, “People without a primary-care physician don’t see anyone for preventive care. When they feel ill, they usually come to the emergency room. Of course, the cost for treatment goes up. So, as in the U.S., access to primary care is not available to everyone.”

In addition, people get put on long waiting lists for primary care. “We’re trying to shrink that wait list,” she said.

Delays in specialized service

Delays also extend to more specialized services, an issue that became personal for Dr. Ballermann when her then 82-year-old father faced a three-year wait for hip replacement surgery. Knowing that the lag time could lead to severe neuromuscular de-generation that would impede her father’s recovery, Dr. Ballermann considered taking her father out of the country where she could pay for faster service.

She eventually found a way within the Canadian system to get her father his surgery within six months, but she can understand why small factions of practitioners and patients throughout Canada have lobbied for the right to provide and obtain private health care, even though such actions go against the spirit of the Canada Health Act.

At the University of Alberta, Dr. Ballermann and her colleagues have established a triage system. Patients requiring urgent care might be seen that same day or within a week, and a person with a non-urgent condition might wait up to two months for an appointment. “But you would never wait longer than three months. We have limits built in,” she said.

Another problem with the Canadian system, she said, is that it stifles innovation and removes “some of the incentives to do better.” Compared with Canada, the U. S. provides more opportunity to conduct innovative research, supported by both government and industry. “There’s a greater innovative spirit. It’s just part of the U.S. culture.”