Tag Archives: canada

U.S., Canadian health care systems share some challenges

Trudy Lieberman

About Trudy Lieberman

Trudy Lieberman, a former president of AHCJ, is a contributing editor to the Columbia Journalism Review, where she blogs about health care and income security issues. She is a fellow at the Center for Advancing Health where she blogs about paying for health care. At Consumer Reports, she specialized in health care and health care financing. She has won more than 25 awards and five major fellowships.

Lieberman recently returned from a monthlong visit to Canada as a Fulbright Senior Specialist. She lectured on the American health care system and learned much about how Canadians get their medical care. She interviewed hospital executives, physicians, academic experts, former health ministers, reporters covering health care, and ordinary citizens. Lieberman also toured hospitals and long-term care facilities. This is the second of four posts reporting on that visit. Previously, Lieberman explained misconceptions that Canadians have about the U.S. health care system and the differences in the two systems.

canada-flagBoth countries are historically and practically steeped in fee-for-service medicine, and much of the power to control prices rests in the hands of the medical establishment. While provincial governments have periodic negotiations with medical and hospital groups, and there are global budgets for hospitals that try to constrain costs, the system is relatively expensive.

In 2011, the U.S. won the dubious honor of having the most expensive system in the world, spending about $8,500 per capita. Canada spent about $4,500, making it the third most expensive country among a group of OECD-developed nations.

Still, that number needs perspective. In 1970, a few years before Canada implemented its national health insurance system, both countries were spending about 7 percent of the GDP on health care. Thirty-nine years later the U.S. was spending 50 percent more of its national income on health care, leaving its patients with the highest out-of-pocket expenses in the world. When I explained the high out-of-pocket expenses to Canadians, that notion simply did not compute. There is some talk about imposing copays for some services as a way to help both the federal and provincial governments save money. But the idea of making people pay 50 percent of a bill or a family paying $13,000 out of pocket before insurance benefits kick in is wildly unpopular. Continue reading

Comparing U.S., Canadian health care systems

Trudy Lieberman

About Trudy Lieberman

Trudy Lieberman, a former president of AHCJ, is a contributing editor to the Columbia Journalism Review, where she blogs about health care and income security issues. She is a fellow at the Center for Advancing Health where she blogs about paying for health care. At Consumer Reports, she specialized in health care and health care financing. She has won more than 25 awards and five major fellowships.

Lieberman recently returned from a monthlong visit to Canada as a Fulbright Senior Specialist, where she lectured on the American health care system and learned much about how Canadians get their medical care. She interviewed hospital executives, physicians, academic experts, former health ministers, reporters covering health care, and ordinary citizens. Lieberman also toured hospitals and long-term care facilities. This is the first of four posts reporting on that visit.

canada-flagOne thing Americans and Canadians can agree on is that we don’t want each other’s health care systems. In truth, most Americans don’t know how Canada’s system works and Canadians don’t know much about the U.S. system.

What Americans know has come mainly from the negative talking points of politicians and others who have argued for years against national health insurance. Two decades ago The New York Times reported that Canadian women had to wait for Pap smears, a point vigorously refuted by the Canadian ambassador who shot back in a letter to the Times editor: “You, and Americans generally, are free to decide whatever health care system to choose, avoid or adapt, but the choice is not assisted by opinions unrelated to fact.”

Yes, there are waiting lists for some services – as I will explain in another post – but, no, Canadians are not coming across the border in droves to get American care.

There’s misinformation among Canadians, too. Wherever I went, Canadians told me they thought, mostly based on what they said they heard on CNN and Fox, that Obamacare meant America was getting universal health coverage like their country has.

Continue reading

Two AHCJ members earn Canada fellowships

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The Canadian Institutes of Health Research have announced all 18 recipients for their 2011 Journalism Awards, and two AHCJ members are among those who have earned fellowships worth as much as $20,000 Canadian to pursue health journalism projects.

Pamela Fayerman of The Vancouver Sun and Postmedia earned a fellowship to report on medical research and accountability (tweet your congratulations to @MedicineMatters), while independent journalist Meredith Levine will use her fellowship to report on vestibular disorders. Other winners included a trio of CBC reporters, who will focus on neuroscience, palliative care and medical tourism, as well as 10 freelancers, two of whom are focusing specifically upon the unique challenges of health care delivery in northern Canada.

This is the fourth year these fellowships have been awarded. Journalists looking to apply for a 2012 award can find more information at CIHR’s website.

Reporters spend 10 weeks immersed in end-of-life care

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Toronto Globe and Mail reporter Lisa Priest and photographer Moe Doiron spent two-and-a-half months embedded in a 20-bed critical care unit at a Toronto

ventilator

Photo by quinn.anya via Flickr

hospital, following four patients and their families and chronicling life in an environment where, Priest writes, “death is a constant, almost routine event, claiming one in five patients who enter.”

Their assignment was to find out “How does one prepare for the end of life?” and explore the medical, ethical and economic challenges of that stage of life.

The result is a sprawling, intensive report on the state of end-of-life care in Canada, heavy on anecdotes. Priest’s centerpiece is subtitled “Spending 10 weeks with patients facing death“) but remains cognizant of big picture issues like cost and quality of life.

Antipsychotic use booms among Canadian kids

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Writing for The Vancouver Sun and Postmedia News, Sharon Kirkey and Pamela Fayerman, report that, in an environment where the rate at which physicians are recommending certain antipsychotics for children has doubled since 2006, a local children’s hospital has launched what the reporters call “the world’s first clinic to help children cope with the side effects of such medications.

The clinic, which helps children and their parents prepare for antipsychotic use or cope with its side effects, opened in April and has a four-week waiting list.

(Dr. Jana Davidson, a child and adolescent psychiatrist who helped establish the specialized clinic) said she helped create the clinic because of her increasing alarm over the side effects of treatment in her patients. While she believes the medications are sometimes prescribed inappropriately, they are often useful for a range of disorders including severe aggression, mania in bipolar disorder and schizophrenia. But the side effects can be serious.

“I would see kids with psychosis in the emergency department and then I would see them again 10 months later and they would be 30 to 50 pounds heavier,” she said.

Despite sometimes serious neurological side effects, more Canadian families are turning to the drugs and antipsychotic drug recommendations for youth jumped 114 percent in Canada from 2005 to 2009.

The drugs — which have not been approved in Canada for use in children under 18 — are being used for attention-deficit/hyperactivity disorder, conduct disorders, irritability related to autism, mood disorders, physical or verbal aggression and other behavioural problems.

Series, inquest illuminate Canada’s pill problem

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Writing for the reader-funded site rabble.ca with the help of a Canadian Institutes for Health journalism award, Ann Silversides is devoting a four-part series to Canada’s prescription drug problem, declaring the country to be a “world leader in prescription drug abuse.” Canada’s pill problem hasn’t hit the headlines with the vehemence it has in the states, but Silversides says evidence points to Canadian drug abuse that’s every bit as damaging as what’s happening south of their border.

medsPhoto by jypsygen via Flickr.

In the U.S., prescription opioids have been the leading cause of unintentional overdose deaths — far surpassing cocaine and heroin — since about 2001. The same is true in Canada, if the statistics from Ontario hold true for the rest of the country. (There is a striking lack of research in the area of prescription drug misuse in Canada, especially about the progression from use to abuse of these drugs.)

Yet in 2008, Canada had the highest rate per capita consumption of oxycodone in the world, surpassing even the United States, according figures from the International Narcotics Control Board.

The second installment in the series zeroes in on a specific Ontario inquest into two opiate overdose deaths, one which promises to shine a bright light on the nation’s broader struggle with the prescription drug abuse epidemic. Other articles in the series:

CBC, grad students cover palliative care and death in Canada

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The CBC’s new series on dying has a unique provenance: The stories are the work of 16 graduate students at The University of Western Ontario, as well as that of CBC health reporters, and are the final product of a unique journalism course focused on reporting on death and dying. gooddeathThe collaboration seems to have started with a definition of its title, “A Good Death.” In this case, it means one that is “peaceful, loving and comfortable.” Access to such an end, the journalists found, varied widely depending on economic, geographic and cultural circumstances.

The introduction to the package has wonderful descriptions of all the stories that went into it but they don’t link to the pieces. I’ve taken the liberty of adding relevant links, then copying and pasting that section below.

Ontario considers exempting some hospital records from FOI law

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Legal Feeds blogger Glenn Kauth, of the Canadian Law Times, reports that Ontario’s legislature is currently considering a law containing a little-known provision that would exempt from FOI law “information provided to, or records prepared by, a hospital committee for the purpose of assessing or evaluating the quality of health care and directly related programs and services provided by the hospital” starting Jan. 1, 2012 (scroll down to Schedule 15).

The leader of a provincial nurses’ organization took issue with the provision, telling the London Free Press that “The public has a right to know what’s happening in its local hospitals,” but Ontario health officials say hospitals need the exemption.

Health Minister Deb Matthews has defended the move to exempt information related to quality of care from public release. According to the Free Press, Matthews believes subjecting hospitals and doctors to greater scrutiny would prevent open dialogue about problems and how to fix them. “They must have a very open and frank discussion,” she said.

(Hat tip to Paul Levy, whose post on the matter also has some great first-hand material from Denmark)

CBC analysis finds resistant bacteria in raw chicken

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Reporters from the CBC’s “Marketplace” program visited supermarkets in Canada’s three largest cities, bought 100 samples of chicken, and sent them off to a lab for analysis. When the analysis came back, they weren’t particularly surprised to find that two-thirds of the samples were contaminated by bacteria – that’s the sort of thing you expect from raw chicken. What they didn’t expect was that every one of the bacteria strains present in those bits of raw chicken, purchased from major supermarkets and labeled with big-name brands, was resistant to at least one antibiotic. Some were resistant to as many as eight.

“This is the most worrisome study I’ve seen of its kind,” said Rick Smith, the head of Environmental Defence, a consumer advocacy group.

The culprits in this case of superbug proliferation will be all too familiar to regular Covering Health readers.

Doctors and scientists told Marketplace co-host Erica Johnson that chicken farmers are overusing antibiotics — routinely giving healthy flocks doses of amoxicillin, tetracycline, erythromycin and ceftiofur to prevent disease and to make the chickens grow bigger, faster.

The full CBC program is available for free online. The reporters have even shared a spreadsheet of their test results.

Taking stock of big pharma in Canada

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

CBC and Radio-Canada have cooperated to produce a comprehensive look at the nation’s pharmaceutical industry, which centers on Montreal, Canada’s second largest city.montreal

Pharma’s Canadian outposts have sputtered in recent months, and Quebec’s government has struggled to keep the companies in-country.

Part 1: Government incentives to pharmaceutical companies.
Part 2: Regulation of clinical trials.
Part 3: Pharma’s role in continuing medical education.

In addition to the stories, be sure to take a look at the top few comments below the story. Also, the “Quick Fact” box, which taught me that “Montreal has the largest number of clinical trial organizations of any city in North America.”