A health system for the future


We often compare our health system to the United States and United Kingdom. But why compare to countries with systems that are not better than ours rather than looking at those that work well?  We are familiar with the situation in the United States but do we know, as recently reported in the London Times, that some 8000 elderly are sent home from an acute care hospital in the United Kingdom every week, between 11pm and 6 am, to make room for other patients showing up in the emergency room?

I would rather compare Canada to France and Germany, two countries recognized as having some of the best health care systems in the world.

According to The Organisation for Economic Co-operation and Development (OECD), Canada spends 11.3 per cent of its GDP on health. Germany and France spend a little more at 11.6 per cent and 11.8 per cent respectively.
The public share of these expenses are also similar.

Canada spends $3157 per person from the public purse while France spends a little less at $3100 and Germany a little more at $3242. These two countries have private hospitals and doctors, which shows that the presence of a strong private sector does not reduce what is spent from the public purse. It is not one or the other.

These two countries have larger populations, slightly older than ours, with a lower rate of urbanization.

Still when you read about their system, both have the reputation of being among the best in the world. In 2000, the World Health Organization (WHO) considered that, globally, France provided the best health care in the world, with basically no wait.

And Canada? The WHO ranked Canada 30th in the same survey. The three countries enjoy similar life expectancy, infant survival and immunization accessibility rates. They even spend about the same amount per capita on health care. The biggest difference lies in speed of access to specialists and diagnostic technology.

I lived in France for three years, from 2004 to 2006 and had the opportunity to use the French health system several times. Although I knew no one, I was able to get an appointment with a family physician in two days, and with an orthopedist in 24 hours.

Twice we called SOS Médecins, a one number private service throughout France, and we had a physician at home within an hour. When I needed cataract surgery, everything was done in two weeks.

I thought that it was faster because I was a foreigner who had to pay for the services. But, actually, when I called, nobody asked me if I was insured with the French system. Discussing with friends who live there, I learnt that they all expect a similar level of service, and they get it. The difference was that , in my case, I had to pay 100 per cent of the cost while, for them, the government would pay around 70 per cent, and the rest would come either from their own pocket or, more likely, from their private or group insurance at work.




This explains a lot but begs the question: How can they afford it?

First, salaries are lower. This applies to nurses, to physicians, and to hospital CEOs.

Second, physicians in these two countries have a choice of practicing entirely in the public system, entirely in private practice or partly in both systems, which reduces the need to limit admission to medical schools.

These two countries have a parallel private system but have universal coverage. We think of our system as public. But actually, only doctors and hospitals are exclusively public. We do not cover drugs, dental care, or eye care. Are these less essentials? The systems in France and Germany are as public as ours; but they are organized differently.

I am not proposing that we adopt the French or the German system, I am just suggesting that we should stop looking at the US and Great Britain and rather look at those systems that work best; and also that we stop considering the current approach as a dogma.

Waiting for treatment should not be part of what it means to be a Canadian.