Canadian Wait Times

One of the arguments often used against Canada's public health care system - and in support of privatized services - is the wait times. The Canadian Institute for Health Information has released a report [pdf] that claims that 8 out of 10 Canadians receive treatment within medically recommended wait times in provincially identified priority areas including cancer treatment, cardiac care, joint replacement, and vision restoration.

80% doesn't seem so terrible, unless of course you're in the 20% where wait times can be as much as three times the recommended benchmark. And if you're suffering with a hip fracture, 48 hours might seem like an eternity even if it is the evidence-based benchmark. Generally, although there is variation, Ontario, Quebec and British Columbia are your best bets for receiving timely care. Click the picture to enlarge or check out the full report for a more detailed look.

The study also looked at CT and MRI imaging, though there are currently no pan-Canadian benchmarks. In Ontario, where the provincial target for non-emergency, non-urgent CT scans is 4 weeks, the median wait time is under 10 days and the 90th percentile is about 35 days and trending downwards. MRIs on the other hand, with the same non-emergency, non-urgent target of four weeks have a median wait time of close to 40 days with the 90th percentile mark at 120. And these times have gotten longer over recent years.

Other items of note: If you need a knee replacement, avoid Nova Scotia (only 42% meet benchmark wait times). Ditto for cataract surgery in Alberta (48%). And PEI doesn't offer cardiac services? No wonder Matthew Cuthbert didn't make it.

The Costs of Cancer Treatment

Something to think about from a Slate book review, via Thus Spake Zuska:

Provenge has shown some success against advanced prostate cancer. But it also costs about $93,000. Gleevec can cost $4,500 per month. Revlimid, another cutting-edge treatment for multiple myeloma, can cost $10,000 per month. It's hard to see how these prices might come down when the market consists of patients increasingly fragmented not only by type of cancer but even by types of mutation.

Or course this isn't a call for 'silver bullet' treatments; cancer isn't just one disease. But the economics can be tricky. Simple supply and demand suggests that market fragmentation and personalized medicine will only drive prices up and split research dollars. It isn't quite so simple, though. Most personalized medicines will be built on common technologies which could even have the opposite effect - higher demand for core technology, modified on a case-by-case basis. Still, looking at the above costs of cancer treatment, I'm glad to live in a country with universal health care.

Won't Somebody Think of the Insurance Companies?

Will Ferrell and others point out the REAL victims of health care reform.

Protect Insurance Companies PSA from Will Ferrell

Comparing medical systems

It's been a few weeks now that I've been embedded in a research hospital in Japan for the bayblab. I've gotten to know some of the doctors here quite well, and we've shared notes about how our medical systems operate. I've found out some interesting tidbits, like the near monopoly of apple products here in the hospital, the difficulties of only having MD/PhD doing health science because of clinical duties etc. But one of the more interesting topics was health care coverage.

In Canada there is much debate about whether or not we should allow a two tier system. Currently any trip to the hospital is free, but there is no way to pay to get private surgery done earlier. Some people argue it would lessen the burden on our system and reduce waiting times. The Japanese health care system is interesting. Here you do have to pay if you have a job but it is subsidized depending on how much money you make, and will be covered if you need an extended stay like say in case of cancer. Childcare is the same, you pay depending on your salary, which for a doctor here would set you back approximately 500$/month.

Upon comparing notes I happened to ask whether medical marijuana was legal, as it is for us. I was a bit setback by the reaction I got. Not only is it not legal, but possession is a huge offense here. In fact the doctors here had no idea it had any medical properties and considered cannabis to be a very potent and toxic drug. I really wonder how such a view became so prevalent. Coming from a country where 17% of the population smokes regularly, and almost 2/3 have used it at some point in their life, I know fully well it is anything but dangerous. I applaud the efforts of patients in the United States who fight so hard despite their illness, to make sure they can get the medicine they need without being labeled a criminal... For more on this subject check out our latest podcast!