Alice Hyde tempts Canadians tired of wait lists

Alice Hyde Medical Center in Malone, NY. Photo: Mark Kurtz

Alice Hyde Medical Center in Malone, NY. Photo: Mark Kurtz

Here’s a basic truth about the complex issue of medical care in the U.S. and in Canada: both systems have real strengths and glaring flaws.

In general, Canadians across the political spectrum like the principles of their health care system. They are genuinely baffled so many Americans seem to fear something as simple as each province providing health care for nearly all residents.

In terms of cost and outcome, the Canadian system delivers pretty good results. (For facts and figures, here’s more on spending and outcome by country in this PBS Newshour article from 2012.)

In terms of peace of mind, it is a solid foundation Canadians count on, with the responsibility being shared on a societal basis.

Speaking personally, after spending close to four decades in the American system, the Canadian system strikes me as humane and civilized. No worries about having no insurance if a job is lost. No such thing as being denied coverage for pre-existing conditions. Basic needs are covered, full stop.

Businesses in Canada can offer employees and their families supplemental health benefits – like dental, drug or vision plans. But businesses here have a significant competitive cost advantage by not having to provide basic health care plans for broken arms, cancer, etc.

Ah, but let’s be honest. There are some pretty big flies in that ointment. Depending on where they live, Canadians can find it very hard to find a personal physician. It can take many months to see a specialist. And simple diagnostic tests can take a long time to schedule.

You might think big cities would be the best place to get procedures done, but sometimes they have the longest lines. Here’s an article about wait times in Ottawa from the Ottawa Citizen:

For example, province wide, patients in need of a hip replacement will get one in 188 days, nine times out of 10. At the Ottawa Hospital, these patients waited 426 days, according to Ontario Ministry of Health figures for April, May and June.

A patient in need of a knee replacement waited 300 days for surgery at The Ottawa Hospital, compared to 214 days across the province.

There’s a not-so-funny joke in Canada that it’s easy to get an MRI right away – if you’re a dog or a cat with an owner who can pay. Canadian humans, rich or poor, have to get in line and wait.

This recent story out of CBC highlights cross-border medical traffic where Canadians who can’t (or won’t) wait head to places like Alice Hyde Medical Center in Malone, New York for routine joint replacements.

Some of the wait times in Ottawa make alternatives like Alice Hyde very tempting, according to the CBC story:

The online and Ottawa newspaper ads boldly claim, “Pain-free knees and hips are just 30 days away.”

“It’s really all about looking to our neighbours who are not far from us to our north and saying, we are an alternative, and you should look at all of your options before you decide whether it makes sense to wait for access through your current health-care provider,” said Doug Divello, president of the not-for-profit Alice Hyde Medical Centre.

Go ahead and quiz this official “wait time” site from the province of Ontario. Wait times vary by location and procedure. But the day I wrote this post, the target wait time for an MRI was 28 days. Actual wait times ranged from 29 to 78 days. Province wide, 9 out of 10 patients could expect to get an MRI in 62 days.

Now, emergencies and those with the greatest need do get seen faster. And not all tests or treatments are urgent. But still. Waiting a month for a mere diagnostic test can seem excessive.

Medical tourism is one result. Going to India, or Mexico or New York to pay for what can’t be had quickly at home. The Canadian system knows some who can pay more to be seen faster are doing so. And there’s debate about if those patients should or should not get follow-up care in Canada for un-regulated services provided outside the system.

Do less-than-optimal statistics and experiences mean Canadians are ready to abandon their decades-long relationship with provincially-provided medical care? Hardly. Most just wish their system had fewer bottlenecks.

Remember, it could take a year or more to get that new hip. But the high-quality procedure will be close to free, meaning even poor people can get that relief, eventually. (How many poor or uninsured people in the U.S. can hope for a free hip or knee replacement?)

Of course, “free” isn’t really free. It all comes from the tax coffers. But Canadians see a good chunk of those taxes come right back as direct health care, without the expense and duplication of the U.S. insurance layer with its maze of claim form paperwork.

Many Canadians would welcome the option of twin tracks: public care for all and the option of private care for those who can afford it or can’t bear to wait.

Many Americans wish the U.S. would adopt a Canadian-style system.

I feel both systems have vast room for improvement – keeping in mind that providing the very best health care to everyone – right away – would probably bankrupt any nation. Sometimes it comes down to imperfect choices.

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12 Responses to “Alice Hyde tempts Canadians tired of wait lists”

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  1. newt says:

    Excellent summation of the costs and benefits of the two systems.

    I was amazed at the Canadian wait times for MRIs. At AMC in Saranac Lake, for my (reasonably well-insured)wife and I it’s been like getting a blood test.

    On the other hand, our uninsured 30-year-old daughter pays $120 a month for diabetes supplies, and often went untreated for other related, or unrelated, illnesses because she cannot afford treatment from her low-paying job (she recently moved partly seek better employment). We have helped, but usually only when an untreated medical crisis has resulted in her friends contacting us. As for preventive care, for her this amounts to watching her diet and hoping for the best. She’d certainly be better off in Canada.

    Whenever someone talks about American Exceptionalism, I think about this.

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  2. Hank says:

    I agree, Lucy, an excellent summary!

    Since I don’t know much about national health systems in other countries (England, Germany, Sweden, Australia come to mind) it would be interesting to get someone’s take on how they compare with what we have here in Canada and the US.

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  3. Peter Hahn says:

    Newt – the difference with MRI wait times is cost. If you maintain enough extra capacity so that anyone can get an MRI the second they need one (or just want one), they need to charge about $2000 for each one to pay for the machines. If you reduce the number of machines/population so that you make people wait in line – especially if they dont need it right away – the cost goes way down. Im not sure what the Canadians pay – maybe less than $500 per MRI?

    Ironically its the single payer systems that introduce the cost control measures.

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  4. Peter Hahn says:

    ACL surgery is the classic. If you tear up you knee in the US, it gets fixed right away. You could be back on the field before the season is over. In Canada it might be a year or more. But the ACL has no effect on longevity or whether you can go to work or not. So technically, you dont need an ACL so you can wait. Or you could go to the US and pay for it out of pocket, but it would be really really expensive.

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  5. Peter Hahn says:

    In Canada public costs for an MRI are around $300. (Just checked). Lucy – maybe you have better numbers? Private costs are around $800.

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  6. Lucy Martin says:

    Oh, I’m very glad to have others research specific numbers, Peter!

    It’s a bit daunting to generalize about an entire country’s medical system, which does vary to some degree by province.

    And this is a fascinating, frustrating topic. The U.S. system is top-notch – for the well-off.
    The U.S. system can also be overly complex, needlessly wasteful and ruinously expensive. And much of it remains out-of-reach for many.

    In Canada, there’s better equity and cost-efficiency. There’s much less cover-your-rear testing, done in fear of malpractice lawsuits, and that has to be a plus all around.

    Anecdotally, I would opine that the system here seems to handle easy cases – and serious cases – pretty well.

    I’d generalize that it’s the stuff in the middle that can get pretty frustrating, for conditions that are important, but not critical. That needs improvement in Canada, for sure.

    As usual, it comes down to funding and administration and how to improve both. Aspects that are always a challenge, in any system.

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  7. James says:

    Very balanced, one of the best items I`ve seen on this comparison. Right leaning Canadians think everything should be like it is in the USA, and left leaning Canadians refuse to question the system we have and admit there are problems. There are major differences between provinces too. In Gatineau Quebec, unless someone is extremely ill or injured, people generally travel across the river to Ottawa to seek treatment at hospitals or walk-in clinics there. The waiting times in Quebec ER`s are horrible. I once waited three hours at a Gatineau Hospital and people who had been there 10 hours were just finally seeing the triage nurse. One patient actually was so ill that she was laying on the floor and sat up to vomit in a sick bag she had been given. I was disgusted by the inefficiency and lack of compassion. I gave up and drove to a walk in clinic in Ottawa where a doctor saw me in less than an hour. However, since wait times for tests are unacceptably long in Ontario, many Ontario patients drive over to Quebec where most testing is offered by private clinics with storefront facilities. There are MRI clinics in my neighbourhood in Gatineau like this. That said, having a dual public-private option might make things go faster, but it unfortunately means that those who are able to pay their way ahead will receive attention and possibly a higher quality of care before those without the financial ability to do so.

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  8. Diane Colbert says:

    And I know uninsured people who have crossed to go to Canada to get surgery because the Canadian system keeps costs lower overall. They pay out of pocket so they go where it’s more affordable – Canada, or overseas. Also, It would be better get in line for a year in Canada then to wait for several years lacking treatment you need because you don’t have insurance and you can’t afford it. I’ve been in a line for years waiting for needed treatment in the U.S. The American system produces expensive services that nobody can afford.

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  9. Alan says:

    I have to say I have never see this Canadian wait time thing. In our family we have had cancers, quad bypass, eye surgeries, preemie babies, stitches, kidney stones, appendicitis, etc. Maybe it is just Kingston but a few days gets you a specialist, a few hours and you are back out of the ER after treatment. We have a useful system of family health clinics and, when my parents passed I learned how good the palliative care was. Got a cat scan or MRI (can’t recall) on a walk in on the kidney stone. A pal once said a distinction is made between morbidity and mortality. Maybe that’s the case. Wonky knees are not a priority compared to chemo for all. Makes sense if we are all living within our means and working hard to get back to balanced budgets.

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  10. Yea, many Americans know what it’s like to have to wait for medical procedures too. Wait to scrimp up the money for it. Wait for the insurance company to stop jerking you around. Wait to get into the doctor’s office…

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  11. Paul says:

    Not any more. In fact now you can wait till you are sick and then you can buy insurance and get treatment. I have no idea why millions of young and healthy Americans would scramble to get health insurance when they don’t have to worry about preexisting conditions and the fines are much cheaper that signing up. I am afraid that the millions clogging the new exchanges are sick and that is going to drive costs through the roof.

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  12. Saul Good says:

    A great article, Lucy…informative, entertaining and balanced. And those descriptors apply to the replies also. No flaming, no political hoot ‘n’ holler, no rants and not a one had a spelling errer! :-) I’m walking away with some new education and a continuing appreciation for NCPR and its ‘viewers’. Great job humans!

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