Many Americans harbor fears about the Canadian health care system, and I would like to clear up some misconceptions. A fundamental premise of the system is that all Canadians are entitled to health care as a right, not a privilege. Health care access is based on medical necessity, which generally means all services excluding cosmetic procedures, certain aspects of ophthalmology, and dentistry. The Canadian system is government funded, not government run. Canada's federal government sends money to each province, which then develops a health care budget based on data available to them. Physicians are mostly independent fee-for-service practitioners who bill one payer (the government). Canadians may have waiting lists for non-essential tests and procedures, but no Canadian is denied care based on age or economic or employment status.
The Canadian system is a cost center for the government. As such, the system emphasizes prevention to contain costs, with the goal of ensuring that the entire system remains intact. In contrast, in the United States, various health care institutions are profit centers for shareholders. In Canada, CKD patients who are progressing and are medically eligible are offered pre-emptive transplants. All nephrologists have reasonable access to dialysis and transplantation for their patients. They do not own dialysis units, which avoids conflict regarding referral and potential loss of revenue. The reduced societal costs of transplantation compared with dialysis provide incentives to facilitate transplantation. Patients who require dialysis services have access to them. From time to time, that access may not be as convenient as the patient wants because of scheduling or location, but overall, the system serves the patients well.
In addition, the myth that Canadian doctors are underpaid and resources are severely constrained is simply unfounded. The average salary for academic nephrologists in Canada is around $350,000, with higher incomes for those in non-academic positions.
The Canadian system is not perfect. Inefficiencies, provincial boundaries, and differential budgets lead to inequities and disparities in care across the country or across geographic regions. But despite growing challenges to the Canadian system, the fundamental tenant of that system—that all Canadians are entitled to health care—is as Canadian as the maple leaf.
Dr. Levin is Clinical Associate Professor of Nephrology at the University of British Columbia in Vancouver.
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