Editor's Note: This article appeared in the September 2009 issue of our sister publication, Renal and Urology News.
President Obama's initiative to reform the American health care system has stirred vigorous debate about the best way to accomplish the objectives of reining in costs and expanding coverage to the uninsured and underinsured. Some individuals believe the country should emulate Canada and adopt some type of single-payer system of universal coverage. Opponents claim such a system would result in long delays for care. Is this the case? And how do the American and Canadian systems compare with regard to the quality of patient care and the effect on medical practice? To find out, Renal & Urology News interviewed Canadian urologists and nephrologists who have practiced on both sides of the border. Overall, they indicated that although the Canadian model is not perfect, it is a good system in which patients generally receive timely and competent care and physicians have fewer practice hassles compared with their American counterparts.
“I think universal coverage works,” said Hesam Farivar-Mohseni, MD, of Ontario's Brampton Civic Hospital, a Canadian citizen who spent nearly 11 years in the United States. Following a two-year fellowship at Memorial Sloan-Kettering Cancer Center in New York, he spent time working in New York and at West Virginia University Hospitals in Morgantown.
Misconceptions on both sides
“Patients in Canada are not being denied anything,” he said. “People in the U.S. think that patients here [in Canada] are waiting outside the hospital, they have no access to the hospital, and they're dying because this is government-sponsored health care. That's not true at all. If there's a serious disease the family doctor calls a specialist and the person is seen right away. If a patient has a kidney stone or something similar, they may wait for eight hours, but that's true in the States, too. Such patients don't get seen in the emergency room there right away, either.
“And the funny thing,” he continued, “is that people here think people in the States are dying on the street corner because they have no insurance, and that's not true, either. They go to a university hospital and get the same treatment that most patients get.”
Dr. Farivar-Mohseni said he believes the Canadian health-care model could be successfully implemented in the United States. “I have no doubt in my mind,” he said. “The good thing about the Canadian system is it's much cheaper and provides the same quality of health care in general. In the U.S. there are middlemen: You have the insurance companies and the hospitals, which need to make money. Here, only the physician and the pharmacy need to make money. So that's a totally different attitude, and the cost is definitely lower because there's no profit there.”
Because Canada's coverage is not only free but portable, there is no such concept as going out-of-network. “You can go anywhere in the country and should not be denied any treatment by any doctor,” Dr. Farivar-Mohseni said. “You can ask to be referred to a particular doctor or location. For example, if you are from Toronto, you can go to London, Ontario, or to Ottawa if you want. That's one of the advantages here.”
Despite the disparities in the Canadian and U.S. medical infrastructures, “there's not much difference between the two systems,” Dr. Farivar-Mohseni said. “We treat the patients exactly the same way—the same medications, the same surgeries, the same instruments.”