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Canada’s Single-Payer Health System: What Is True? What Is False?

In the American well being care debate, “single-payer” is hardly a brand new idea.

The concept has grabbed headlines and sparked numerous political and coverage discussions, to not point out marketing campaign commercials. Other nations with single-payer systems embody South Korea and Taiwan. But “single-payer” merely implies that the federal government pays all of the payments. The mechanics can range from nation to nation.

Sen. Bernie Sanders (I-Vt.) just lately visited Canada, touting that system’s advantages. How a lot do you actually learn about it?

Take KHN’s interactive problem to check your understanding.

ANSWER: FALSE. The Commonwealth Fund, an American nonprofit, ranks Canada’s system above America’s — nevertheless it fares poorly in contrast with some others, inserting ninth out of 11 Western techniques. (The United States is in final place.) The Commonwealth Fund used metrics similar to fairness, entry to well being care and outcomes in its rankings.

“It’s unclear to me that the Canadian model is necessarily the solution the United States wants. And I think there may be other models that can be considered,” stated Dr. Peter Cram, an inner drugs physician and well being care researcher who just lately moved from Iowa to Toronto. “The narrow focus on the Canadian system — it shortchanges the array of options.”

ANSWER: FALSE. For hospitals and docs, Canadian sufferers gained’t pay a greenback out-of-pocket. But Canada doesn’t cowl dental and imaginative and prescient care, prescription drugs, psychotherapists and bodily remedy. About two-thirds of Canadians get personal insurance coverage to complement Canadian “Medicare,” because it’s identified, which accounts for about 70 p.c of Canada’s well being spending.

“I’ve had patients who could not afford their diabetic medications, so they would become acutely unwell,” stated Dr. Ali Damji, a household drugs resident in Toronto. “They would become sick enough to go to the hospital, and [then] we would pay for the treatment.”

That being stated, Canada does have worth controls for drugs. So, in comparison with the United States, prescribed drugs are typically far cheaper.

ANSWER: TRUE. The Canadian Institute for Health Information estimates that in 2017 the nation can have spent about 11.5 p.c of its gross home product on well being care. The United States, in contrast, spends about 18 percent. And life expectancy up north is bigger, based on the World Health Organization. This constitutes considered one of Sen. Bernie Sanders’ favorite talking points. But Canadian officials nonetheless need to deliver down the nation’s well being care spending, particularly because the inhabitants ages.

“We are seeing increased costs,” stated Ontario Premier Kathleen Wynne, whose administration is testing new packages to handle well being spending.

ANSWER: FALSE. On the 2016 marketing campaign path, then-candidate Donald Trump said, “When they need a big operation, when something happens, they come into the United States in many cases, because their system is so slow.” This doesn’t seem like the case.

No proof suggests Canadians are fleeing en masse for remedy within the United States. A recent report suggesting this has come below scrutiny, with experts raising severe methodology considerations.

There are definitely circumstances when the Canadian authorities will transport a affected person overseas for care that isn’t accessible — or unavailable in a well timed method — in Canada. When this occurs, it’s coated by Canadian Medicare.

ANSWER: FALSE. Wait instances in Canada are usually longer for non-emergency, specialty procedures — suppose knee surgical procedures, diagnostic MRIs or cataract surgical procedure. But emergency care is prioritized and often positioned on the entrance of the road. In reality, research suggests that when Canadians are sick most expertise wait instances akin to these of their American neighbors.

“That’s one falsehood: that there’s these ridiculous wait times,” stated Nate Kreiswirth, a twin citizen who lives in Toronto. “If you actually have something that’s a serious condition, or something that is urgent, you’re not going to wait. You are not going to die because you’re waiting.”

Comparing Canadian and U.S. wait instances is tough and an often-politicized dialogue, Cram famous. The United States additionally doesn’t observe wait instances as rigorously as its northern neighbor — particularly for individuals who can’t afford medical care — so it’s tough to actually examine.

ANSWER: TRUE. Everyone is equal below the eyes of Canadian Medicare. It’s unlawful to purchase personal insurance coverage that competes with the federal government’s, so wealthier Canadians can’t purchase their method forward of the queue. (In different nations with common well being care, similar to Germany and Great Britain, individuals can decide out of nationwide techniques and purchase privately.)

Of course, idea and apply aren’t in good sync. Research suggests low-income Canadians might have extra problem getting well timed main care, though the single-payer system doesn’t give docs a motive to favor wealthier sufferers. It’s unclear how widespread that is. But, says Dr. Irfan Dhalla, a Toronto-based well being high quality researcher and common internist, insurance coverage alone can’t repair that.

“Humans are humans and there are always — in any system — humans with discriminatory attitudes toward indigenous people, or people who are low-income,” Dhalla stated.

 

ANSWER: FALSE. Primary care docs work for themselves, however their charges are negotiated and paid by the federal government.

There was a severe exodus of Canadian docs within the 1990s, however that has since reversed. In the mid-2000s, extra Canadian docs have been coming back from the United States than leaving. At this level, research suggests, southern migration is negligible.

And 2014 data from the Canadian Medical Association means that extra docs could also be transferring the opposite method, leaving the United States to apply in Canada, to keep away from complications like insurance coverage paperwork and claims processing needed south of the border.

ANSWER: FALSE. Canada spends far much less on well being care than does the United States, nevertheless it too is grappling with the climbing price of medical remedy. Health care accounts for almost 40 percent of provincial budgets.

“The government gives provincial governments a bunch of money, and they pay the doctors and say, ‘As long as people aren’t dying, and voters are happy, we’re OK,’” stated Dr. Kaveh Shojania, a Toronto-based internist who researches affected person security and well being care high quality. “Now they’re starting to realize there’s more that needs to be done.”

Meanwhile, left-leaning advocates are pushing to develop the single-payer system in order that Canada additionally covers prescription drugs.

Shefali Luthra: ShefaliL@kff.org”>ShefaliL@kff.org, @Shefalil

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