One of the barriers faced by proponents of healthcare reform in Canada is the popular notion that healthcare in this country is “free”, or at least inexpensive. One of the reasons for this misconceptions is that Canadian clients of healthcare services are rarely ever presented with a bill for the services they receive under the government plan. Unlike virtually every other exchange of services in Canada, healthcare is shielded from the vulgar connection between providing a service and revealing it’s cost. Healthcare services are rendered to Canadians and the bill is never seen by those receiving the service. Not only are Canadians not able to check the bill for accuracy and confirm that services were indeed rendered, but they are denied insight and appreciation for the real cost of the care they have received.
In my view this lack of transparency can only contribute to a reduced regard for fiscal prudence on the part of patients, and an opportunity for error and abuse on the part of healthcare providers.
This lack of transparency is not only present at the point of service delivery, it is also very absent in our taxation system. Canadians are generally in the dark regarding how much of their own money is spent on healthcare services, and believe me: it isn’t free.
An recent article Nadeem Esmail does a nice job of breaking this down:
So how much do we really pay as individuals and families for our Medicare system?
In order to determine a more precise estimate of the cost of public health care insurance for the average Canadian family in 2008, we must determine how much an average family is expected to contribute in taxes to all three levels of government. The percentage of the family’s total tax bill that pays for public health insurance is then assumed to match the share of total government tax revenues (including natural resource revenues) dedicated to health care (22.6% in 2007/2008).
…
Looking at common family types, this calculation finds that the estimated average payment for public health care insurance in 2008 was:
- $9,572 for the average 2 adult family
- $9,855 for the average 2 adult and 1 child family
- $10,191 for the average 2 adult and 2 child family
- $3,484 for the average unattached (single) individual
It is critical to recognize that these estimates count only the direct costs of Medicare. They do not count administrative costs subsumed by other government departments that support health care through activities such as tax collection, or other privately borne costs related to the financing and operation of Medicare such as tax compliance or the private burden of waiting for health care.
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Related: After writing this post I came across this recent account of a visit to a major Toronto hospital and I was left wondering if the patient was ever informed of the charges related to that visit. And the logical next question would be “Did the patient feel they had received good value for those costs?”
I wish to point out I have witnessed excellent care given my mother at other Toronto hospitals. – Our experience with Toronto General Hospital however has left us both determined that we will do all that is possible to never have dealings with that Charnel House again.
An 84 year old woman who had a heart attack followed by an angioplasty was left in a hospital corridor with a hemorrhaging artery, it was 14 hours before proper treatment was received, her total stay was for 18 hours. What we witnessed was not caregiving professionalism but rather neglect meted out by incompetent union thugs.
The piece I wrote may be appearing in the National Post next week. I will not use our real names as I genuinely fear reprisals by staff against my Mother during a scheduled follow up visit to TGH.
I’m with you on the notion of visibility, if for nothing more to highlight the efficiencies of the Canadian system over the American model.
You’re right: healthcare isn’t free.
One thing that did bother me: when did healthcare become a “consumer” event using market terms like “value”? Not everything fits into a product/consumer framework.
Rob, I’m not sure we should be resisting a idea of introducing a “value” question when discussing healthcare. In fact I think that question would help to improve the services we receive. Can you explain to me what it is about healthcare services that makes you feel they should be exempt from this question?
I don’t think we’re too far apart on this one. Replace the question, “did I receive value from that doctor’s visit?” with “did my doctor treat me effectively?” and we’re talking about the same thing. Market terminology has a lot of baggage. (What terminology doesn’t.)
As for gaging value, I am insufficiently informed as to what constitutes “value” within healthcare policy. I have visibility only to front-line services (ERs, ambulances, GPs, nurses, etc.) and not the really expensive stuff (research, purchases, training, etc.). To rely on ‘customer focused’ planning would improperly align resources (eg. “Ask your doctor about _new_drug_with_super_side_effects_…”, sends the US system out of whack).
I’d be willing to consider “value” from patient’s perspective but within an efficient market model “value” is driven by competition. Shopping around for doctors isn’t the same as shopping around for groceries; and it drives up overall healthcare costs.
Markets are really good at managing commodities. Is healthcare a commodity? Maybe that’s the crux: can language about commodities be applied to healthcare?