Letters to the Editor


Letter to Physicians Money Digest

Your recent Editor’s Note, “Canada’s Doctors Heading South,” suggests to me it’s time to call a halt to bashing the Canadian health system. First, because the data cited is invariably misleading and often mendacious. Second, far more important, it takes attention away from our own health care catastrophe which is a national disgrace.

Your essay starts with a whopper, harbinger for the disinformation further down the line. We learn “that nation [Canada] of 59 million people” … you’re off by a magnitude: Canada has 31.5 million as of 2001.

Giving no hard numbers, we are told “doctors leaving the country jumped nearly 70% last year.” A recent report, September 25, 2002, by Rachlis and Evans, et. al., takes a serious look at the doctor drain question. “In fact, Canada now has more doctors than ever before—58,546 in 2001 and the per capita ratio has remained approximately the same for 10 years—now one doctor to every 532 Canadians, compared to one to 950 in the 1960s. Most recently, between 1997 and 2001, the number of physicians grew by 6%, considerably above the 3.7% growth in the Canadian population.”

“In 2001, 609 doctors left Canada, while 334 Canadian doctors returned, for a net loss of 275 or 0.5% of the physician work force. In addition, in 1997, almost 850 non-Canadian physicians entered Canada,” augmenting the continued growth of physician to population ratio.

The fiction that Canadians in significant numbers cross the border to the US for care is analyzed in depth in the May/June 2002 Health Affairs. The headline is “Phantoms In The Snow: Canadians’ Use Of Health Care Services In The United States; Surprisingly few Canadians travel to the United States for health care, despite the persistence of the myth.” For example, “several sources of evidence from Canada reinforce the notion that Canadians seeking care in the United States were relatively rare during the study period. Only 90 of the 18,000 respondents to the 1996 Canadian National Population Health Survey indicated that they had received health care in the United States during the previous twelve months, and only twenty indicated they had gone to the United States expressly for the purpose of getting that care.”

The authors ask, “Why is cross-border care seeking so low? Our results should probably not, on reflection, be surprising. Prices for US health care services are extraordinarily high, compared with those in all other countries, and this financial barrier is magnified by the extraordinary strength of the US dollar. Private insurance for elective services, being subject to very strong adverse selection, is, not surprisingly, nonexistent.”

The authors conclude, “debates over health policy furnish a number of examples of these zombies’— ideas that, on logic or evidence are intellectually dead—that can never be laid to rest, because they are useful to some powerful interest. The phantom hordes of medical refugees are likely to remain among them.”

On November 28, former Saskatchewan Premier Roy Romanow, released his report on Canada’s health system, based on an 18-month study by his commission. This historic document concludes that the system is extremely popular and basically sound. It is, predictably, in need of improvement, notably more funding (bear in mind that Canada has a system of universal coverage, expending $2,000 per capita, compared to US $5,000 per capita with over 40 million uninsured). Romanow calls for restoration of the federal contribution to the provincial health systems. There are other constructive recommendations, notably marked increase in attention to prevention, expansion of high-tech capability, coverage of pharmaceuticals, and development of more professional teams to serve the people of Canada. While this report will be vigorously debated, it appears to be the blueprint for the next phase of Canada’s magnificent health system.

How long, I wonder, will it take for the United States, with our vastly superior resources—in dollars, workforce, and plant—to create our own, hopefully better version of a universal, single-payer health benefit for all our people?

Quentin Young, MD
National Coordinator, Physicians for a National Health Program