Is the Canadian health care system better for neurologic care?

Abstract

Canada and the United States have much in common, including the world’s longest undefended border, but when it comes to health care, they have taken strikingly different paths in the last 40 years. The education and training of providers, including physicians and nurses, is similar, but major differences are seen in the organization and financing of health care. The net results of these differences are substantial and can be compared by examining specific measurements: costs, access, and health outcomes such as mortality, as well as less-easily quantified patient or provider satisfaction. I write from several perspectives; first, as a career academic neurologist and until 2003 Chair of a leading Canadian Department of Clinical Neurosciences, and now as Vice-President of Capital Health in Edmonton and Associate Dean Clinical Affairs at the University of Alberta. I have also lived, trained, and experienced the health care systems in the United States and England. The Canadian and American health care systems began to diverge in the late 1950s when Canada developed universal hospital insurance. Insurance for physician services was added a decade later. The overall system is guided by the Canada Health Act of 1984, which set out five principles: 1) public administration and payment; 2) comprehensiveness—must cover all medically necessary health services provided by hospitals and physicians; 3) universality—all insured services must be provided on “uniform terms and conditions,” to all citizens and residents; 4) portability—insured services must be paid for even if the patient is treated in another province; 5) accessibility—the plan must provide “reasonable access” to services and “reasonable compensation” to medical practitioners. This act defines Canadian “medicare,” a system where all citizens and residents are covered by the government for the direct costs of hospital and medical services, anywhere in the country. However, Canadians are not permitted to purchase “medically …