Chile

It is wasteful to have such a high percentage of funds and resources be allocated to the private sector, when a quarter of those eligible are not actively participating. Maybe the private sector needs to be reevaluated and see how much of the funding is actually being used, and how much is being wasted and not properly distributed. Why is such a high percentage going elsewhere for care and is it because they receive higher quality of care for less money, or is it simply all about the cost?

It is also unfair that these people are using public sector resources when they were not taken into account for that budget to begin with. I think that there does need to be some changes made, because 25% is enough to make a difference. It is enough to have wasted resources in the private, and enough to dent the supply of resources in the public.

Wasteful!!!

It seems that most of the money is going to a sector that is not been used because of high co-payments. I do agree that it is really wasteful to allocate so much of the GDP to this sector. I have not researched much on Chile's health care system, but it seems the private sector is able to provide better services to its beneficiaries. Some of the services that it could provide would be more access to newer technology like diagnostics tests and treatment. This sounds like a good plan, except people choose to go to the public sector because they do not have to pay so much on co-payments. What is the point of allocating so much on a sector that people cannot benefit from it.
I could assumed that those that receive the quality treatment and services are those who have access, in other words, those who have money. It is sad to hear that in all of the countries we have studied so far, money has always been a factor when it comes to receiving quality health services. The people who need the most health care services are the ones that receive the least because they cannot afford it. This model seems to apply everywhere in the world regardless of how developed the country is at this moment.
Since a significant portion of the population is using public services, I wounder what is happening to the private health sector? Who is benefiting from all the services besides rich people?

It's all about the benjamins (Canada $)

Shona’s stance is not one we encounter in public health very often. Essentially, she is advocating for a system that treats health services as commodities, patients as consumers. Shona’s viewpoint on entitlement stands in stark contrast with the viewpoint upon which the Canadian health care system is built: it is an egalitarian culture emphasizing positive freedoms. To Shona, entitlement to health care in this sense is ineffective and counter-productive; more effective would be the entitlement granted to a paying consumer. The solution that Shona proposes is to introduce competition, namely by incorporating private health insurance into the system. While this may very well raise the quality and efficiency of medical services in Canada, it is by no means Canada’s only option. In fact, it is not even the only option if competition is to be included as an essential component of the health care system.

Competitors vie to be recognized as the one best able to accomplish a given task. As such, competitors must be judged in how they perform. In a market-based system, consumers—or patients, in this case—do the judging, because providers are first accountable to their patients if they want to get paid—which often is the bottom line. Competition, however, can still exist and work effectively in a non-market system. Take, for example, Great Britain’s National Health Service. Within this system, providers are given bonuses for keeping their patients healthy. British providers, then, are not only accountable to their patients, but also a third party—the government—whose judgment determines how much the providers are to be paid.

Shona wants to introduce competition, to create a system in which health care providers have incentive to provide efficient care of high quality. Though adding private health insurance to the system may accomplish this task, it is only one potential solution. Canada has more than this one option if it seeks to reduce the number of stories like that of Shona. Canada may look to Great Britain to see how it has introduced financial incentive into the system without also introducing additional private financing.

No perfect system!

From Shona's video, it is obvious that the Canadian health care system is not perfect. Actually, no health care system is entirely perfect. There will always be drawbacks and criticisms. Canada enjoys an universal system, in which every citizen is guaranteed access to health care. However, this comes with much longer wait times for procedures, less-advanced medical equipments, much higher taxes, etc. The US operates primarily on a private system, in which the patient is the "consumer"--and if he/she has the resources (financial/insurance)--health care will be provided--this is the type of health care system that leaves 42 million people with no access to health care. Bottom line--both systems need to change. The US definitely needs to expand health care access to the uninsured as well as the under-insured. And Canada needs to provide some sort of health care service that provides faster access to certain procedures--maybe a private insurance program? The consumer idea that the American health care system has is important--because it gives the patient more control on what services are offered and can easily get a procedure when it is needed (same day appointments, fast diagnostic procedures/tests, quick scheduling for major procedures). This is something that the Canadian system can take away--to effectively cater to those patients that want to get access to health care services faster. Again, at the end of the day, no system is perfect! every system needs work!

US and Canada

There is always a trade off in a system. Health care in US is good in terms of availability of specialties and high tech equipments. Yet, they are only available to people who can afford it. The question now, of course, how can US reallocate these resources and make them available to everyone. On the other hand, Canada is good with making health care accessible to everyone regardless of income status. The backslash is that they don’t have enough resources for everyone, thus the long wait entails. How can Canada increase availability of resources without draining the fund in the system?

I think both countries need to reassess what is working and not working in the system. They both need to look at what will serve best for the people and how to meet the needs of people. Generally, people want more when they can get for free. Healthcare is the most expensive in the market. There has to be a price to pay for it. People should not expect the government to take care it. It is easy to state, but not so easy in practical. If the government managed the system, people’s wants may not be met. If the government didn’t manage the system, people’s needs may not be met. Therefore, the government and its people should work together collaboratively and cooperatively for their best interests.

Yes we can!

Well, that video presents a very important point that we should all take from the American health care system. The testimonial from Shona was in stark contrast to Michael Moore’s documentary where he shows relatives of his who are scared to go to the U.S. for even one day without Canadian health insurance. One should always suspect that there are two sides to every story and this video proves that. First of all, we should keep in mind that singular experiences are an invalid way for judging anything (they are great for propaganda purposes) and evaluation should be done on the basis of statistics. Statistics shows that Canadian wait times are quite high but U.S. wait times are not the lowest either. The biggest point with this testimonial is that although Shona survived, she will probably be in debt for the rest of her life. While the Canadian system may have people that fall through the cracks, the American system has large gorges where millions of people are falling through. In other words the American system needs to move towards the Canadian system if we are to take care of the millions of uninsured and underinsured.

That is not to say that there is nothing to be learned from this testimonial. The consumer idea of American healthcare is quite interesting, that is to say instead of taking the healthcare provided, in America the person is in a position of being able to demand services like a “consumer” and demand the services he or she wants. This works great for those who can afford it, but fails miserably for those in no position to demand anything. To answer the blog question more fully, the U.S. should step away from the consumer mentality towards a more public provision and financing of healthcare in order to cover more people. Since we elected those in government we can find politicians directly accountable for poor healthcare provision so in that respect we can demand services be provided. Now, one may argue that in order to bake a cake you need to break a few eggs and Shona was one of those eggs. I would tend to reject this argument in case of healthcare – no government or organization should be able to calculate people’s lives as chips to gain or lose, and zero tolerance is required. Thus, cases like Shona’s should be carefully considered and used to amend the system to avoid such cases in the future. Though unfortunate her case may merely be a symptom of the balancing act the Canadian government is undergoing to try and cover the largest population with the most health care access.

O Canada!

I felt that the interview with Ms. Holmes, as well as the other related clips recommended on the site, were quite revealing.  While in the past I have heard that national health systems had their problems, this was the first time I had heard such vehement opposition.  Granted, just as Michael Moore cherry-picked people’s stories to reinforce his argument, I imagine BigGovHealth.org did the same for theirs.  As is generally the case, I’m sure the truth is somewhere in the middle. 

 I did think the videos were beneficial in highlighting some of the main problems that can occur with nationalized health care systems such as long wait times or simply unavailable procedures.  I was particularly struck by the older gentleman with macular degeneration in one eye that was told he would have to wait for the problem to occur in his other eye before he could seek treatment.  Ms. Holmes case was intriguing because of her use of both the U.S. and Canadian systems to resolve her condition.  It would be easy to assume that there is simply a trade-off between quantity over quality (Canada) and quality over quantity (U.S.).  However, then one has to take other socialized health care schemes into consideration, as Alia mentioned, France and Japan, which are not so easily lumped with Canada.  Though these two countries seem to face their own major issues, primarily massive deficits.  I am by no means an economist, but all of this makes me wonder:  is it actually possible to provide truly universal coverage in a timely manner without running up huge budget deficits?  The more I learn, the more I feel the answer is no and that there are only different degrees on the quality versus quantity argument.  Attempt to cover everyone and you run the risk of effectively disenfranchising people through wait times or bankrupting the system.  Yet endeavor to provide quick, efficient, and all-inclusive procedures and you exclude a huge portion of the population.  The U.S. aside (because it aggravates my argument since the U.S. excludes many AND is neither particularly quick nor efficient), perhaps it is up to each individual society to decide through their particular values/identities/cohesiveness, which system performs best?

 To actually answer the question posed, I think we play into the consumer idea because that is what our society is based upon.  Consumerism is our modus operandi, so why would we treat healthcare any differently?  I think it would not be wise for either country to adopt the other’s healthcare system, as there are far better examples out there to emulate.

The reality of Canada's health care system

After viewing Shona's clip, I realized the true magnitude of Canada's health care system. In Canada's attempt to cover most of their population, they had to compromise on quality of care. Shona also made a good point about the role of a consumer and how if you are paying for a good or service, you have the right to demand good quality in a timely fashion. She argues in Canada, citizens are stripped of these rights in terms of health care.

Unfortunately, with our market-based approach, we provide excellent quality in a timely fashion, but are excluding the most vulnerable. We compromised on quantity in favor of supposedly better quality (in terms of Canada that might be true). While Canada's system evidently has some serious flaws as seen in Shona's case, health care is still a right of every human and efforts need to be made to cover the vulnerable populations; who are in the most need of health care and the greatest burden on the health care system. In terms of Canada, I don't believe people should be denied care for an extended period of time, especially in a case similar to Shona's. Countries such as France and Japan are great models to which the US can look towards in order to learn how to expand coverage to include all citizens.

Private or Public?

Chile is a country where most of the population receives health insurance from the public sector where only about 35% is covered by private insurance. It seems odd that the private health care system (ISAPRES) would receive such a high percentage of the national health care budget when it does not serve a majority of the Chilean population. What is the point in putting so much effort, time, money into something that won’t be used frequently? In a country like Chile that only has a GDP per capita of about 12,000 (USD), funds need to especially be allocated more appropriately in order to help relieve any strain on their economy.

With so many people choosing to use the public sector as opposed to the private because of the high costs of co-payments, this would certainly lead to inefficient spending and wasting of resources. With less people using the private system, those that are using it and plan to will be affected negatively because co-payments will continually rise to help offset the costs of the services and resources that are not being used. If this trend does not change over time, the misallocation of resources should persuade policy makers to address the needs of the people better by making sure that they would be able to purchase private insurance before investing more funds in that system. Somehow, more economic progress would need to occur in order to even give Chileans the option to choose between using public insurance or private insurance. Until this happens I don’t think there is a viable reason to increase funds into the private health care system.

Think Twice--Canadian Reality

When I viewed the clip, it was sad to see Shona deprived of timely appointment and necessary surgery. Though Canadian health care demands no money from its citizens--supposedly, it also does not provide the quality cares that meet the patients' needs.
Patients are treated as another case but the choice is lost in this tedious process.

This is the darker side not shown in "sicko" film. It's absolutely not free, Canadians pay for it. The money got to come out from somewhere not nowhere. Shona stressed the point of "CONSUMER" mentality and its power. As a consumer, one does have certain power to demand service as well as monitor its effectiveness. As a patient buried in heavy caseload, one can be trivialized and faded into the sea of bureaucracy. How about if this happened to you or your loved ones? It must be devastating. As we favor the universal health care in this presidential election, we must also be aware of its ramification. US is the free market, if you have the money for exchange, one can get whatever the best in the market. If you are poor, you might stay in the sickness even though the treatment is available. The access becomes a moral issue. In order to "fix" the failing system, we don't have to go for the extremes for answers. More importantly, we need to be thoughtful and take into the considerations of many facets. We may not come up with a perfect system, but we certainly don't want to end up with a new dysfunctional monster. Shona's saga provides us another insight into the universal care in a highly industrialized nation. Shona is a lifelong resident in Canada and holds a strong belief that her country would rescue her from a deadly disease if she needs it. Her belief dashed to broken pieces when she encountered the harsh reality of Canadian care system. Deserve our attention while we try to overhaul our system. For better NOT for worse.

Canada, eh?

I think that Shona makes a valid point when stressing the fact that the Canadian health care system, and any national health service for that matter, is not free. These systems are paid for by the citizens of the country through taxation. In that sense, even though it is a government run system versus private, the tax payer should certainly retain the opportunity to act as a consumer and demand services in a timely fashion.

When diving into the Canadian health care system a bit deeper, it seems that about 30% is privately funded. This mostly goes to expenses not paid for by Medicare, like prescription drugs, dentistry, and optometry. The remaining 70% of health care is publicly financed, yet provisions are private. More and more, services are not being covered publicly and citizens are being forced to pay out of pocket or with secondary insurance. Oddly enough, the Canadian Health Act of 1984 does not explicitly ban private insurance for publicly insured services, but it provides financial incentives to discourage people from acquiring it (http://en.wikipedia.org/wiki/Canada_Health_Act). This would be acceptable if the publicly insured services, especially those of an urgent nature, were delivered expeditiously. Instead, Canadians are forced to endure long waiting times for not only screening procedures but, in Shona’s case, life-saving surgeries. While Canadians enjoy low out of pocket expenditures, this doesn’t matter much if they aren’t around to enjoy them.

The US lies on the opposite end of the spectrum with regards to health care consumerism. The largely private system encourages Americans to demand services to the extreme. This demand of access and excellence most certainly lends to the litigious nature of our health system. Problems arise when we have unrealistic expectations of health care providers and do not understand their limitations. Costs continue to spiral out of control as clinicians are forced to adopt astronomical insurance policies.

It seems then, that Canada and the US fall on opposite ends of the spectrum when it comes to the notion of consumerism in health care. When thinking about the faults on each end, it is clear that the best case scenario will be a more moderate move to the middle.

Healthcare "Consumers" in the U.S. and Canada

I never realized the seriousness of waiting times until I watched the video clip on Shona and her brain tumor experience. If I was in her situation I would have preferred the health care system in the U.S. because I would have more chances of surviving. In the U.S., as we all know, its all about the money...which in terms of less serious health problems may seem unfair but when it comes to the serious life-threatening illnesses, if I can afford it, I would rather pay money and survive than wait. Of course if we start talking about the issue of universal healthcare, I want everyone to have equal access to treatment...but then it made me think...if I was the one with the life-threatening condition...and I had enough money...I would probably be selfish and go with the market-based approach in the U.S. that would give me the highest quality of care according to how much money I paid..and of course with little to no wait time. But if I didnt have money or if my condition wasn't serious, I would prefer the universal health care system in Canada. So I guess there is a positive side to the health care system in the U.S. In more simple terms, as a "rich consumer" I prefer America, as a "poor consumer" I prefer Canada.

Chile

Public vs Private insurance utilization is usually a clear indicator of economic stability. The increased utilization of public resources due to the inability to pay for private insurance or manage out-of-pocket methods will undoubtedly place a heavy strain on health care resources and result in wasteful spending. A couple of ways to offset this overburden of the health system is two-fold:

- Primarily, strengthen the economic infrastructure to rebuild a self-reliant and sustainable workforce so as to promote an affinity toward purchasing private insurances (and thereby the increased likelihood of better quality care).

- Secondly, if the first approach isn't as progressive and an "above-average-use" of public resources seems impending, an alternative route to help mitigate the impact of the over-utilization of public resources would be to strengthen public health education in regard to health condition etiologies and effective best-practice steps without the overuse of medical services. In particular, outreach should be done among those that are not vulnerable so as to preserve resources for those that are most in need.

Blog Question

Canada:
Please watch the short clip below:
http://www.biggovhealth.org/testimonials/patients/shona-holmes/

Using Shona's clip and any other information that you may have, what are your perceptions of Canada's health care model? how do you think we as US citizens play into this "consumer idea" as Shona put it and which country (US or Canada) should change in that regard in terms of health services?

Chile

ISAPRES is a private health care system in Chile that received approximately 45% of the
government's national health care budget.  Twenty-five percent of beneficiaries, however,
chose to use the public sector because the copayments in private institutions are too
high.  What effect do you feel this has on resources and health care expenditures, and is
this wasteful?