The state of medical services

[Greendruid]

I wasn't quite sure where to put this thread - perhaps a section on Health issues needs to be created? However, it's just as much a political issue as it is an economic issue I suppose.

I live in Cape Breton, Nova Scotia. It's a small island off the east coast of the province with about 150,000 people living on it. We make up about 15% of the province's 1 mil. people. The Cape Breton Regional Municipality (formerly the city of Sydney and surrounding smaller towns) contains about 75% or 110,000 people.

We have a total of four hospitals in CBRM. All of them are ER capable but we have a recurring problem of staffing. This problem is so severe that since I moved here in 2005, the ERs at one or more of these hospitals will close every once in a while. I can't find any published statistics on this (of course) but to memory it seems like its about two weeks out of the year. It's usually only a 24h or 48h closure but I was wondering if this happens elsewhere in the world on such a regular basis?

Additionally, when we moved here I looked up the government website that shows you which doctors (GPs) are accepting new patients. For the capital region of the province (Halifax) that contains about 375,000 people in it's municipal boundaries there were 28 different doctor's offices to go to for new patients. In CBRM, there were three. There are now, in 2009 a total of one and it is the Sydney Walk-in Clinic which is open four nights a week from 5:00 p.m. to 9:00 p.m.

Are Americans sure they want socialised medicine? I had a lot more options when I was a struggling graduate student living in New Mexico where the main hospital had an indigent programme that we qualified for and essentially supplied us with the equivalent of free medicine. Should Canadian doctors, or doctors of any nation that has socialised medicine, be forced to work in regions that are less desirable than others? How about offering incentives in regions that are less desirable to offset the sacrifices of living at the edge of the world as we are sometimes made to feel about living here?

[Michael]

I wasn't quite sure where to put this thread - perhaps a section on Health issues needs to be created? However, it's just as much a political issue as it is an economic issue I suppose.

I live in Cape Breton, Nova Scotia. It's a small island off the east coast of the province with about 150,000 people living on it. We make up about 15% of the province's 1 mil. people. The Cape Breton Regional Municipality (formerly the city of Sydney and surrounding smaller towns) contains about 75% or 110,000 people.

We have a total of four hospitals in CBRM. All of them are ER capable but we have a recurring problem of staffing. This problem is so severe that since I moved here in 2005, the ERs at one or more of these hospitals will close every once in a while. I can't find any published statistics on this (of course) but to memory it seems like its about two weeks out of the year. It's usually only a 24h or 48h closure but I was wondering if this happens elsewhere in the world on such a regular basis?

Additionally, when we moved here I looked up the government website that shows you which doctors (GPs) are accepting new patients. For the capital region of the province (Halifax) that contains about 375,000 people in it's municipal boundaries there were 28 different doctor's offices to go to for new patients. In CBRM, there were three. There are now, in 2009 a total of one and it is the Sydney Walk-in Clinic which is open four nights a week from 5:00 p.m. to 9:00 p.m.

Are Americans sure they want socialised medicine? I had a lot more options when I was a struggling graduate student living in New Mexico where the main hospital had an indigent programme that we qualified for and essentially supplied us with the equivalent of free medicine. Should Canadian doctors, or doctors of any nation that has socialised medicine, be forced to work in regions that are less desirable than others? How about offering incentives in regions that are less desirable to offset the sacrifices of living at the edge of the world as we are sometimes made to feel about living here?
This is not a 'health' issue, it is a political-economic issue (as are almost all health discussions).

It is a well-documented phenomena that small towns and rural regions all over North America are suffering acute shortages of doctors, nurses, firefighters and teachers. This has been going on for many years and getting worse. I believe the problem is the absolute worst for 'specialist' doctors who overwhelmingly prefer to setup shop ONLY in the biggest cities.

It is the identical problem to that of immigrants - 95% of all immigrants settle in the three largest cities in Canada - this overloads immigrant services in those places and leaves other places empty.

This is not an issue of 'socialized medicine' since it affects a whole lot more than just that and even US private markets suffer the same issue.

Apparently lots of people who have a choice, are increasingly tending to prefer living in larger urban centers and our social service system isn't geared up for that.

[Sucre]

What's "socialist medicine" ?

[Michael]

What's "socialist medicine" ?
Where the costs of medicine are 'socialized' (spread evenly across the population through taxation).

It is also often called "single-payer" system (where the state health agency is the one who 'pays' doctors, nurses, hospitals, medicines, etc).

Most healthcare systems in the western world are 'socialized' systems. Only the US is not.

[Sucre]

Socialised medicine is a better term then than "socialist" medecine which is a bit derogatory in my understanding of the English language.

[Michael]

Socialised medicine is a better term then than "socialist" medecine which is a bit derogatory in my understanding of the English language.
Sure.

But what do you do with a socialized system where the doctors and nurses choose not to live/work in the remote rural areas? Big cities seem to be flooded with doctors and nurses (and specialists of every type). Remote rural places are all suffering from a shortage of doctors & nurses.

How can you address this in a socialized system? It is the socialized system that creates this problem.

Under a private market, one only has to charge higher rates in remote rural places and pay higher wages to doctors and nurses. This isn't really available under socialized systems (as this is athema to socialist philosophy that wills it all to work like magic and abhores market incentives). If the price of medical services as well as medical wages are uniform across the country, one will end up with a flood of doctors and nurses in the largest cities and a shortage in the rustic rural parts. This is simple economic logic.

[Sucre]

Uhmm not sure ... Do you have any statistics to prove your point ?

Nurses and doctors are not obliged to move anywhere in socialised systems. At least, not in the ones I know. In fact, since the wages and fees are basically identical, it would be logical that they move to rural places where the costs of living are lower than stay in cities where the costs of living are higher, therefore they get less for the money they are earning. :cool:

The reason why this is not happening is because ... nurses and doctors do not get paid the same way in socialized systems, at least not in the ones I know. They get more money from wealthy people and wealthy people tend to live in urban areas, therefore they stay in urban areas.

(This is at least true for doctors - for nurses, the problem is rather that they work in hospitals/ clinics and there are none in rural areas ...)

And before I continue, let me say this : what irritates me a bit about this kind of discussions is the lack of knowledge of the participants. They usually simply ... don't know what they are talking about. (**) And they can't. It's very complicated when you live in one country to understand the medical system. It is therefore almost impossible for outsiders to do so. Besides there is some brainwashing going on in the USA - proof : "socialised" systems being called "socialist" systems - i.e in a derogatory way, when ... all stats, all data, all figures etc. point to a superiority of these "socialist" system in general healthcare (in terms of infant mortality, life expectancy etc.) (*)

Let's put it this way -
From a personal point of view (if you are young, healthy etc.), it may make sense to opt for the "individualised system"
From a general point of view, society in general is better served by socialised systems. (*)

----
NB:

(*) I would even go as far as saying that the SOCIALIST health care system in Cuba is better than the privatized system in the USA.

(**) If I were on uspol, I would not even made an attempt in answering this thread. I am still traumatized by the waste of time I had with a thread entitled : "Is General Healthcare slavery ?"

[Michael]

And before I continue, let me say this : what irritates me a bit about this kind of discussions is the lack of knowledge of the participants.
I guess this is a good place to end this discussion.

Apart from the OP, the only posters in this thread are you and myself. Ergo, your insult is a direct and personal insult targeted at me.

They usually simply ... don't know what they are talking about. (**) And they can't. It's very complicated when you live in one country to understand the medical system. It is therefore almost impossible for outsiders to do so. Besides there is some brainwashing going on in the USA - proof : "socialised" systems being called "socialist" systems - i.e in a derogatory way, when ... all stats, all data, all figures etc. point to a superiority of these "socialist" system in general healthcare (in terms of infant mortality, life expectancy etc.) (*)
I repeat. This discussion is entirely about a medical issue in CANADA. That is clearly outlined in the OP. The only two people discussing the topic besides yourself are Canadians.

And yes, Canada has a universal healthcare system (socialized medical system).

No one has offered any critique of the Canadian healthcare system here, nor has the US healthcare system been addressed in any way.

I have no clue what you are going on about "US" issues. There are no Americans participating in this discussion or discussing the issue from US perspective.

[Sucre]

I am sorry that you are taking my post so personally. No, my response was not targetted at you personally. Of course not. It's a general remark. In fact, with respect to the outgoing post, I am quite sure that you know more about the situation in Canada than I do.

Similarly, while I understand that the outgoing post of the thread is about a particular situation in Canada, my own posts did not relate to this. I argue about the use of the term "socialist" which is not the same as "socialized"... and what the use of a particular word reveals.

I happen to find that this is a very interesting topic (health care and how to make it work for most people) and wish I could have discussed it in a sane way in the past. As you see my frustration about previous discussions is so huge that it affects the tone of my messages and spoils this new thread. But no more than personal attacks, this was not my intention.

[Greendruid]

If I may intervene with some clarification, there was never a use of the term "socialist" medicine in the thread before you mentioned it Sucre. You can back search the thread to see that the first use of the word socialist was by you. What you might be mistaking as a non-English speaker is the difference in spelling of the word "socialised" and "socialized" that Michael and I differ on. They are the same word but I tend to use an "s" almost exclusively in English words because of my adherence to strict old British spelling standards whereas Michael is not as anal as me about this sort of thing :)

To address the thread more specifically, I think that 110,000 qualifies this location as non-rural. I submit Michael that you have a specifically metropolis biassed view of what constitutes urban and rural areas and the dichotomy, if one actually exists, is viewed by you through this particular lens. What you saw as a rural community when you were out here was indeed true of the original set-up of the little village I live in. However, the municipality as an entity is much more densely packed than this. I'm going to guess that anyone that considers themselves urban in the GTA (Greater Toronto Area) can make it to the city core in about 15 minutes or less. This is also the situation for me.

The fact that our transit systems are vastly different, our buildings smaller and our businesses fewer may be colouring your view of what the urban and rural distinctions really are. If we take a purely modern demographic definition of about 500 people per km2 then the CBRM definitely has an urban core at the heart of the city.

Moreso contributing to my argument you should consider that while socialised medicine is a federal reality, it is administered provincially and the only other place that is more populated that the CBRM is the HRM (Halifax Regional Municipality). I've already pointed out the small difference in size of the two places. Their rural components and densities are even comparable. There is no reason that this difference should exist between two places. I'm arguing that there is a draw to Halifax that is unfairly denying proper levels of medical treatment to a huge part of the population of this province and that needs to be stopped. I'm sure this problem is continually occurring in other parts of the country where a large city or several large cities are drawing all of the doctors to it. I don't mind that there isn't a great number of specialists in this area - that's understandable because their a rarer breed than the general practitioner. It is the disparity that is so grossly neglegent to the rest of the population and the fact that hospital emergency rooms have to close due to lack of attending physicians. Add to this the fact that we have a much older population here than in the HRM and the need for more GPs becomes quite evident.

So long as large cities and the politicians that are elected in them are in control of where money goes in this country, we will increasingly see this type of problem. My question to you is this, if large cities are so energetically more efficient than our rural areas, how would you justify/explain the funnelling of rural dollars to larger, more urban centres? One would expect that if larger cities are so much better at operating that they would require less money to operate.

[john]

From what I have seen of Mexico's socialized medical system I want no part of it. The main problem that I see is a lack of incentive in the system. Doc says "I'll make the same wage if I work hard or not." What do you think he will do?

Even though I pay into the system (obligatory), I don't use it and I buy private insurance for myself and my family.

[The Sister]

Should Canadian doctors, or doctors of any nation that has socialised medicine, be forced to work in regions that are less desirable than others? How about offering incentives in regions that are less desirable to offset the sacrifices of living at the edge of the world as we are sometimes made to feel about living here?

Is it true that here (in Canada) a doctor is paid the same amount for services across the country? Really? Isn't it like the dentist fee guide that varies from place to place to allow for COLA etc?
Surely that is only common sense? And wouldn't that allow the adjustments that would pay doctors/nurses/health professionals to live/work outside urban areas.

[The Sister]

since the wages and fees are basically identical, it would be logical that they move to rural places where the costs of living are lower than stay in cities where the costs of living are higher, therefore they get less for the money they are earning. :cool:


I'd same this is definitely not true in Canada. Certainly living in Toronto or Vancouver is not cheap and most small towns have cheaper real estate. But food is the same or more expensive and with less quality and variety and options. Education, libraries, entertainment, cultural and support services are all easier to access and therefore cheaper in the cities.
And in the city you can live without a car, not so in the suburbs and country.
So given the same salary would one choose to live in Toronto with all it's possibilities or in Wawa (very small place in Northern Ontario) with all it's limits and a whole lota space? I think outside the true 'outdoor' spirit type in the health care profession, most would people would choose the city.

[Greendruid]

Is it true that here (in Canada) a doctor is paid the same amount for services across the country? Really? Isn't it like the dentist fee guide that varies from place to place to allow for COLA etc?
Surely that is only common sense? And wouldn't that allow the adjustments that would pay doctors/nurses/health professionals to live/work outside urban areas.

According to one of my students whose wife is our only Endocrinologist, doctors do not get paid the same across the country. This is not only a function of off-setting COLA as you say but also is a function of how many patients you have. The more patients you see the more money you make. Specialists have a harder time with this in some regards because a re-visit of a patient is not a new bill whereas for a GP, it is. Also, specialists work on a referral basis only. They of course charge absurdly higher prices but this counters the other two inequities I suppose.

The main Halifax hospital today reported wait times of up to 24 hours in EMERGENCY!!! There seems to be a glut of illnesses and accidents due to bad, icy weather lately. They're getting the triage wait time down to a maximum of 7 hours but I can't imagine sitting in the waiting room with my dislocated eyeball in a cup for more than an hour without losing my mind.

In case you're wondering why Cape Breton has the only Endocrinologist in the province, we probably have the highest rate of diabetes per capita of any municipal region in the country save some aboriginal communities in the north.

[Sucre]

If I may intervene with some clarification, there was never a use of the term "socialist" medicine in the thread before you mentioned it Sucre. You can back search the thread to see that the first use of the word socialist was by you. What you might be mistaking as a non-English speaker is the difference in spelling of the word "socialised" and "socialized" that Michael and I differ on. They are the same word but I tend to use an "s" almost exclusively in English words because of my adherence to strict old British spelling standards whereas Michael is not as anal as me about this sort of thing :).
Re-reading the thread I have to agree with you : I am the one who used the term "socialist", projecting my experience from other threads on this one.

Mea culpa and my apologies for the inconvenience, thank you for jumping in. :)

However, I will stick to my opinion that there is definitely a prejudice - and it is really a prejudice - in the USA about what you nicely call "socialized" (or socialised ;)) medicine. OK, I submit that you (?) are Canadian and that the thread is about Canada - but Canadians are most probably influenced by the media from the other side of the border, aren't they ?

The fact that this thread exists at all i.e are making an entire system for the particular flaws in your area supports my view.

If you speak French good enough to surf on the forum of Le Monde, for instance, you will never find such a thread. On the contrary, posters will probably be bitching on the ever growing "two-way" medicine, one for the masses and one for the "rich".

I don't think that in this kind of discussions it is ever a good idea to pick out one single example and to offset it against another single example. Examples are unconsciously selected to comfort one's prejudices.

Fact is that socialized systems perform better in term of health care than privatized systems. I am insisting on the terms "performance" and "health care". A politician making a rational decision for his Nation and basing his decision on hard facts, data, infant and adult mortality statistics, would have to chose the socialized system and that is why most governments in the world usually go this way when they can afford it.

That said, this does not mean that the "socialized" system is perfect or unexpensive and quite obviously countries with aging populations, as we have in Europe, will be confronted to plumeting costs. Another drawback is that doctors and nurses are significantly less paid.

Last but not least a personal note : I just opted out the general system in Germany this year. For me personally, considering my age, health and my salary, it is better to get a private insurance. I will be saving 60 EUR/ month and 100, - EUR when my older daughter will be on her own, 150, - EUR when the second one will go (at the moment, they are both insured on my general system and covered by the monthly fee calculated as a percentage of the gross salary). My private decision is based solely on financial and egoistic considerations. I have been 15 years in the general system and never had to complain. When I was earning little, it was a "good deal", now it's a bad deal because I earn too much and I am in good health - besides I need cash.

The reason why I am providing this example out of my private life is to show that general considerations do not always match with personal considerations. What may be good for the society as a whole may not be good for you personally.

[Sucre]

Last but not least a personal note : I just opted out the general system in Germany this year. For me personally, considering my age, health and my salary, it is better to get a private insurance. I will be saving 60 EUR/ month and 100, - EUR when my older daughter will be on her own, 150, - EUR when the second one will go (at the moment, they are both insured on my general system and covered by the monthly fee calculated as a percentage of the gross salary). My private decision is based solely on financial and egoistic considerations. I have been 15 years in the general system and never had to complain. When I was earning little, it was a "good deal", now it's a bad deal because I earn too much and I am in good health - besides I need cash.

The reason why I am providing this example out of my private life is to show that general considerations do not always match with personal considerations. What may be good for the society as a whole may not be good for you personally.
And to make things clear - I am largely in favour of "general" health systems, covering the entire population. (I'd rather use the word "general" than "socialized") against private systems. Not because I have a positive prejudice but because hard facts show that the general health of the population is better off with general health systems. The fact that, in Germany, salaried staff may opt out of this system when they earn more than a certain amount in the year is a concious loophole of the German health care system. I am not making the laws. It would be stupid of me to stay in the general system just because I want to stick to my convictions. :angel:

[Michael]

According to one of my students whose wife is our only Endocrinologist, doctors do not get paid the same across the country. This is not only a function of off-setting COLA as you say but also is a function of how many patients you have. The more patients you see the more money you make. Specialists have a harder time with this in some regards because a re-visit of a patient is not a new bill whereas for a GP, it is. Also, specialists work on a referral basis only. They of course charge absurdly higher prices but this counters the other two inequities I suppose.
From what you say here, from a comparative purposes, doctors are essentially getting paid the same rate for their services per patient regardless of geographic location.

The differential in income that you are point at is coming from those doctors that see/treat more patients and those who see/treat less. In that respect, doctors in large cities are obviously going to be able to make more money given the larger availablity of patients.

What I'm saying is that the only viable solution to the shortage of doctors and/or nursing staff in rural areas is for them to be paid a higher fee per service per patient (or higher wages in the case of nurses). That would actually act as a stimulus for increasing numbers of available doctors and nurses in those rural areas. But of course, with universal health insurance this just (essentially) becomes yet another tax subsidy for rural areas (which already get lots of tax subsidies).

[Michael]

However, I will stick to my opinion that there is definitely a prejudice - and it is really a prejudice - in the USA about what you nicely call "socialized" (or socialised ;)) medicine. OK, I submit that you (?) are Canadian and that the thread is about Canada - but Canadians are most probably influenced by the media from the other side of the border, aren't they ?
Socialized healthcare is correct terminology. In Canada, we have 100% universal healthcare insurance for all Canadians. One cannot 'opt out' of this.

Thus, in Canada, the cost of the healthcare insurance is socialized across the entire population. It is to be noted that for all intents and purposes, a majority of the medical and healthcare sector is privately owned and operated.

This type of system is also called "single-payer" because it is the Government run healthcare insurance company that pays ALL the money that goes to the hospitals and doctors and ambulance services to pay for it all. Thus there is only one "single-payer" of primary healthcare services in Canada.

And any "single-payer" system is 'socialism' by definition - centralized government control of market pricing/services.

If you speak French good enough to surf on the forum of Le Monde, for instance, you will never find such a thread. On the contrary, posters will probably be bitching on the ever growing "two-way" medicine, one for the masses and one for the "rich".
That is a constant theme of discussion on Canadian healthcare issues and has been for many years.

It is also a constant theme of ANY socialist style program. Indeed, some have argued that issue was one of the issues that caused the Soviet system to fail.

It is also highly related to the issue that Greendruid raised in the OP (shortage of rural doctors/specialists). Under the present system, urban dwellers get better and more available healthcare services than rural dwellers. And any urban/rural distinction tends to mirror the wealthy/poor distinction.

For the most part, both Greendruid and myself are strong supporters of Canada's socialized healthcare system and we are debating about how that particular problem can be addressed, given the socialized healthcare system that we use.

(Note to Greendruid: I have chosen to use American English when posting on the net - hence the "z" in socialized)