Ah, it’s been a while since we had one of these. But a story like this seems to pop up monthly, so I just thought I’d post it.
More than 100 Canadian women with high-risk pregnancies have been sent to United States hospitals over the past year – in what a doctors’ group attributes to the lack of a national birthing plan.
The problem has peaked, with British Columbia and Ontario each sending a record number of women to U.S. neonatal intensive care units (NICUs). Specifically, 80 B.C. women have been sent to U.S. hospitals since April 1, 2007; in Ontario, 28 have been sent since January of 2007, according to figures from the respective health ministries.
André Lalonde, executive vice-president of the Society of Obstetricians and Gynaecologists of Canada, said the problem is due to bed closings that took place almost a decade ago, the absence of a national birthing initiative and too few staff.
“Neonatologists are very stretched right now,” Dr. Lalonde said in a telephone interview from Ottawa. “We’re so stretched, it’s kind of dangerous.”
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Philippe Chessex, division head of neonatology for B.C. Women’s Hospital & Health Centre, said every effort is made to avoid out-of-province transfers. Even sick babies who aren’t sent to the U.S. can still face several moves while at home.
“We’re transferring babies across the province, in all directions, to try to find an extra bed for the next potential birth or for any baby already born,” Dr. Chessex said in a telephone interview from Vancouver. “We now have babies who have been transferred up to six times after leaving here before reaching home.”
For parents, the devastating news that their baby is sick due to a malformation, illness or being born prematurely is compounded by the reality that there simply is not a bed available for their infant close to home.
“Whenever a sick baby is born, it’s really a disaster for these families because it was unexpected. And it just puts a terrible stress on them,” Dr. Chessex said. “If they are sent out of country at that moment, it is just unbelievable the kind of pressure that they must go under.”
No one knows that better than Jade Pascoe, of Cranbrook, B.C., who went into labour 15 weeks earlier than her due date. She gave birth on March 29, to Nevin James William Moore, who came into this world weighing 1 pound 10 ounces. “They tried to get me somewhere in Canada,” said Ms. Pascoe, 19. “But there was nowhere to send me.” The hospital where she gave birth does not have a NICU. And when no NICU bed could be located in B.C. or Alberta, her son was sent to a hospital in Spokane, located in eastern Washington.
During that time, doctors, nurses and others took turns using a manual respirator for six hours on the boy, until he arrived by air ambulance at Deaconess Medical Center. He is expected to stay there until July.
Of her son, born at 25 weeks gestation, Ms. Pascoe said: “I didn’t know they came that small.” Though he is not yet stable enough for her to kiss or cuddle, she can touch him. Patrice Sweeny, assistant neonatal intensive-care unit manager at Deaconess Medical Center, said Nevin is on a ventilator and requires a lot of support but he is improving.
“Jade comes in every day and is very devoted and does everything that she can,” Ms. Sweeny said in a telephone interview. “She takes his temperature, changes the diaper. She is as involved with her baby as possible.”
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Though the province is adding NICU beds, he said that in itself is not the answer. For example, when extra NICU beds were added in Victoria, it took about a year before they were operational due to the difficulty in recruiting a neonatologist.
“You need a highly skilled nurse and you need a neonatologist to help manage the ward and that’s proven challenging,” said Mr. Abbott. He said the province is working with others to find a solution.
The numbers tell the story:
$11.6-million: Amount, in U.S. dollars, British Columbia has spent on prenatal care in the States since April, 2006
$1,700: Average cost per day for a Level III neonatal intensive care bed in B.C.
$5,400: Average cost, in U.S. dollars, for a Level III bed in the States
Now, before the liberals here crow about “look at the price difference!” remember that the average cost is simply what the gov’t pays. It’s in effect a price ceiling. Now, going back to Econ 101, what do price ceilings nearly always do? Did I hear ‘create supply shortages’? That’s right! Health care is a service, and is governed by supply and demand. The U.S. system has issues on this front of course, but one way we’ve responded by lavishly compensating our doctors, so that we attract the best doctors in the world. That’s one contributor to our higher health care costs. Personal anecdote: my wife’s OB/GYN is South African. Our primary care physician is Indian. His resident at this time is Iranian. So was the doctor who operated on my wife’s foot two years ago. His partner is Russian. My kid’s pediatrician is Filipino.
Of course, as noted earlier, the U.S. system has all kinds of inefficiencies which needlessly raises costs. Barriers to competition in health insurance, high malpractice rates, opaque fee schedules (who knows what a visit to the doctor really costs these days?), over-regulation, especially on new technologies and pharmaceuticals, and artificially high demand (people going to the doctor for sniffles because they think it only costs their $30 copay, then complaining when the copay goes to $35). The status quo is not satisfactory, obviously, so why not move towards less regulation, instead of more?
When the uninsured become a majority in the US, we will have national health care.
The last time the majority of people in the US were uninsured we didn’t get national healthcare out of it. What makes you think the next time will be different?
The last time the majority of people in the US were uninsured we didn’t get national healthcare out of it. What makes you think the next time will be different?
Since that time, national health care systems have been established in all advanced nations, and Americans can see their advantages. A referendum on national health care in the US would pass if it were held today, despite the any efforts health insurers and private care providers to stop it.
That suggests if health insurers and private care providers think you are right, their most effective way to stop national healthcare from happening would be to stop low-wage legal and illegal immigrants from entering the country and becoming voters. They would be both without health insurance and also more used to the idea of the national government meddling in health insurance.
Anyone have any data that those kinds of organizations are already onboard with various anti-immigration or anti-illegals efforts?
The last time the majority of people in the US were uninsured we didn’t get national healthcare out of it. What makes you think the next time will be different?
Since that time, national health care systems have been established in all advanced nations, and Americans can see their advantages. A referendum on national health care in the US would pass if it were held today, despite the any efforts health insurers and private care providers to stop it.
The VA medical care system is an efficient example of a prototype for national health care. Try taking that away from the veterans and see how they react. Seniors citizens would be furious if an attempt were made to remove medicare. Our current patchwork of private and public services makes us pay more for what is in many cases inferior health care. About 10% of our total health care costs are attributable to insurance company paper mills designed to deny claims wherever possible.
And much more is attributable to government meddling in health care. Example: Pap smear costs.
“in many cases” is an euphemism that allows Mellie to search for isolated incidents and proclaim them standard. While there is no doubt that there are incidents of bad care, on the whole, health care provided in the United States is of high quality, and generally higher than that provided in Canada, Britain, France, Germany, or any other of your “advanced” nations.
The legal profession is responsible for a great deal of health care costs, in the form of malpractice fears and malpractice suits. It almost cost the State of Florida it’s OBGyn coverage a couple of years ago. Any surgical subspecialty pays enormous premiums, which are passed on to the consumer in the form of high charges. If tort reform would happen (I am sure that Mellie is against that), much of the upward pressure could be removed.
In the Netherlands only pregnancies that are considered high risk are even born in a hospital or with a Dr. Routine births are handled at home with a midwife. God forbid something go wrong. One of my best friends, who is a cardiac nurse like myself, has a sister in the Netherlands. The sister is a linguist with a large corporate who ended up marrying a boy from there. First baby she was scared to death to have the child at home, so despite being a cardiac and not a baby nurse my friend went for the birth. She found the whole system quite shocking. In England they have 20 bed wards still, private rooms do not exist like they do here. This includes those who have had babies.
My ex husband, also a nurse, lives in Canada with his now wife, but works in upstate New York. He much prefers the American system despite its flaws to what is offered in Canada.
If you think also that you don’t already pay for people who don’t have health insurance your very wrong. I take care of drug seeking patients every week, and guess who pays for them? I guarantee you they don’t give a damn if their bills get paid or not. But since Joint Commission is bound and determined that a patients pain is what they say it is, instead of allowing me to use assessment skills, drug addicts know all they have to do is come through the ER, holler chest pain and their golden. Docs are too afraid of the one time someone of these frequent flyers drop dead they would be sued. The fear of a lawsuit very much increases the cost of health care in this country. And if you have a resident who are too often clueless and allowed to fish in the name of education, you might as well mortgage your first born to pay for the stay. A bit of common sense would go a huge distance in fixing what is wrong, instead of imposing more government intervention on top of what is already more than a bit of a problem. That and insurance reform.
And don’t tell me it can’t be done, anything can be done if there is enough will to do it.
That doesn’t matter, my dentist told me he knows somebody whose cousin lives in Canada and said the health care is really great.
Few things:
First, since vlad can only counter a factual news article with a joke so inane it makes John Kerry’s jokes look like a Robin Williams routine, I assume he’s got nothing more to add to this debate.
But on a brighter note, at least vlad didn’t remind us about the millions of Americans who pull their own teeth every year (I was never quite clear whether he was actually including all the kids whose baby teeth have to be given that last little pull or not).
Finally, I find it interesting that vlad is actively in support of a system that regularly forces high-risk newborn babies to be transferred up to six times, sometimes to another country, in order to receive proper medical care.
In the Netherlands only pregnancies that are considered high risk are even born in a hospital or with a Dr. Routine births are handled at home with a midwife. God forbid something go wrong.
Under that system, two of my children would be dead.
$1,700: Average cost per day for a Level III neonatal intensive care bed in B.C.
Good GRIEF!
Only $1,700 per day for “neonatal intensive care”? No wonder doctors (specialists) don’t want to work in that country. That $1,700 is what they charge here per day for a semi-private room for a standard stay no matter the malady.
and yes, that $1,700 also pays for illegal aliens’ free care
Living in a state that borders Canada, the specialists and “imaging centers” here are loaded with Canadian patients. The normal wait HERE for an MRI is 1-3 days, and, depending on the immediacy, can be done right NOW. In Canada, it’s 1-3 MONTHS.
Anyone who thinks that the Canadian system is better than America’s is woefully ill-informed.
We have a friend who relocated here from Canada 15 years ago when he married an American. He called my husband last month to get info on U.S. inguinal hernia repair for his brother. His 30-something year old brother cannot exercise and is in pain because of an inguinal hernia. The earliest he could have his hernia repair is Dec. in Canada.
So if we go to socialized medicine, bitwize, where do people go for “procedures which requires specialized equipment or technicians”? What’s funny is that Canada’s “objectively superior” system needs the U.S. as a backup, whereas here we don’t have problems with lack of facilities and staff forcing people to travel to another country for treatment. Without U.S. backup, what would happen to Canada’s “objectively superior” numbers?
The truth is that the numbers you cite are also influence by higher rates of death from auto accidents, violent crime, obesity, substance abuse, etc., all of which occur with greater frequency in the U.S. than in Canada. So your assertion that Canada’s “objectively superior” system is almost certainly the cause of the disperity ignores the very components of the statistics you cite. The U.S. system has problems of its own, but perhaps the way to deal with it is not moving to a single payer system, which has produced shortages of doctors, equipment, and facilities nearly everywhere its been tried, but to a more competative market-oriented solution.
Anyone who thinks that the Canadian system is better than America’s is woefully ill-informed.[/size]
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No health-care system is without its flaws. For procedures which requires specialized equipment or technicians, there is indeed a long wait so many Canadians come here. However, for routine care as well as preventative care, the Canadian system is cheaper and you are guaranteed care.
Fun fact: The U.S. and Canada used to have roughly the same statistics in terms of average life span and infant mortality rates. Canadians started becoming healthier and longer-lived in the seventies—round about the same time they implemented universal single-payer healthcare.
Canadian healthcare taken as a whole is, by empirical measurement, objectively superior to U.S. healthcare. This is almost certainly due to the implementation of a nationalized, single-payer healthcare system.
You need to do some more research on Canadian health care.
Lifespan and infant mortality are only cursory indicators of health status and are not measurements of quality of health care.
No health-care system is without its flaws. For procedures which requires specialized equipment or technicians, there is indeed a long wait so many Canadians come here. However, for routine care as well as preventative care, the Canadian system is cheaper and you are guaranteed care.
There are a couple of themes in this little paragraph.
First, what exactly does “specialized equipment and technicians” mean? Are we talking about guided imaging or PET scans? or perhaps we’re talking about canadian patients biting the leather instead of recieving anesthetics? This is simply too vague. And why is a long wait for anything acceptable to us?
Is the Canadian system in fact “cheaper”? And what does “cheaper” mean? Does it mean that their cost per unit of service is less, and if so why? For example what does it cost to care for a surgical patient in an acute care hospital? What’s the cost per patient day? What’s the ALOS? The rate of return to home? the amount of functional improvement? What exactly are we measuring?
If we are measuring the “cost” in terms of % of GDP, what is the driver for demand in Canada VS the US? If a given province says “When we burn through the budget nobody gets any more care” wouldn’t that lower the “cost” by simply trading time for money?
as for being guaranteed care, what’s the difference between that guarantee and the charitable mission of the vast majority of America’s hospitals? Are the catholics in the business of denying care? I hardly think so.
the slide off that the socialized medicine proponents use is clever but obvious. Their trick is to confuse “uninsured” with “uncared for”. The two are dramatically different. Being uninsured doesn’t mean that no source of care is available. Watch how the socialists attempt to blend the two different concepts into one “crisis”.
From a 4 month old thread titled “Life expectancy and infant mortality: the problem with international comparisons”:
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Life Expectancy
Life expectancy is a poor statistic for determining the efficacy of a health care system because it fails the first criterion of assuming interaction with the health care system. For example, open any newspaper and, chances are, there are stories about people who die “in their sleep,” in a car accident or of some medical ailment before an ambulance ever arrives. If an individual dies with no interaction with the health care system, then his death tells us little about the quality of a health care system. Yet all such deaths are computed into the life expectancy statistic.
Life expectancy also largely violates the second criterion - a health care system has, at most, minimal impact on longevity. One way to see this is to reexamine the table constructed by the Center for Economic and Policy Research. The interpretation that the Center for Economic and Policy Research wants readers to derive from Table 1 is that the United States would be better off with a system of universal health care. However, a careful examination of that table yields a more accurate interpretation: There is no relationship between life expectancy and spending on health care. Greece, the country that spends the least per capita on health care, has higher life expectancy than seven other countries, including Belgium, Denmark, Finland, Germany, Netherlands, the United Kingdom and the United States. Spain, which spends the second least per capita on health care, has higher life expectancy than ten other countries that spend more.
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GDP per capita is one of the more consistent predictors of life expectancy.
Yet the United States has the highest GDP per capita in the world, so why does it have a life expectancy lower than most of the industrialized world? The primary reason is that the U.S. is ethnically a far more diverse nation than most other industrialized nations. Factors associated with different ethnic backgrounds - culture, diet, etc. - can have a substantial impact on life expectancy. Comparisons of distinct ethnic populations in the U.S. with their country of origin find similar rates of life expectancy. For example, Japanese-Americans have an average life expectancy similar to that of Japanese.
A good deal of the lower life expectancy rate in the U.S. is accounted for by the difference in life expectancy of African-Americans versus other populations in the United States. Life expectancy for African-Americans is about 72.3 years, while for whites it is about 77.7 years.11 What accounts for the difference? Numerous scholars have investigated this question.12 The most prevalent explanations are differences in income and personal risk factors. One study found that about one-third of the difference between white and African-American life expectancies in the United States was accounted for by income; another third was accounted for by personal risk factors such as obesity, blood pressure, alcohol intake, diabetes, cholesterol concentration, and smoking and the final third was due to unexplained factors.13 Another study found that much of the disparity was due to higher rates of HIV, diabetes and hypertension among African Americans.14 Even studies that suggest the health care system may have some effect on the disparity still emphasize the importance of factors such as income, education, and social environment.15
A plethora of factors influence life expectancy, including genetics, lifestyle, diet, income and educational levels. A health care system has, at best, minimal impact. Thus, life expectancy is not a statistic that should be used to inform the public policy debate on health care.
At first glance, infant mortality appears to be a good measure of a health care system. First, it assumes interaction with a health care system since most babies born in the industrialized world are born in a hospital or other health care facility. It also satisfies the second criterion of assuming that health care professionals can affect the outcome, since doctors and nurses have a direct impact on the survival chances of a newborn. If infant mortality were accepted as an adequate measure based on those two criteria alone, then the U.S. health care system is one of the least effective in the industrialized world.
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But infant mortality tells us a lot less about a health care system than one might think. The main problem is inconsistent measurement across nations. The United Nations Statistics Division, which collects data on infant mortality, stipulates that an infant, once it is removed from its mother and then “breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles… is considered live-born regardless of gestational age."16 While the U.S. follows that definition, many other nations do not. Demographer Nicholas Eberstadt notes that in Switzerland “an infant must be at least 30 centimeters long at birth to be counted as living."17 This excludes many of the most vulnerable infants from Switzerland’s infant mortality measure.
Switzerland is far from the only nation to have peculiarities in its measure. Italy has at least three different definitions for infant deaths in different regions of the nation.18 The United Nations Statistics Division notes many other differences.19 Japan counts only births to Japanese nationals living in Japan, not abroad. Finland, France and Norway, by contrast, do count births to nationals living outside of the country. Belgium includes births to its armed forces living outside Belgium but not births to foreign armed forces living in Belgium. Finally, Canada counts births to Canadians living in the U.S., but not Americans living in Canada. In short, many nations count births that are in no way an indication of the efficacy of their own health care systems.
The United Nations Statistics Division explains another factor hampering consistent measurement across nations:
...some infant deaths are tabulated by date of registration and not by date of occurrence… Whenever the lag between the date of occurrence and date of registration is prolonged and therefore, a large proportion of the infant-death registrations are delayed, infant-death statistics for any given year may be seriously affected.20
The nations of Australia, Ireland and New Zealand fall into this category.
Registration problems hamper accurate collection of data on infant mortality in another way. Looking at data from 1984-1985, Eberstadt argued that, “Underregistration of infant deaths may also be indicated by the proportion of infant deaths reported for the first twenty-four hours after birth."21 Eberstadt found that in the U.S. and Canada more than a third of all infant death occurred during the first day, but in Sweden and France they accounted for less than one-fifth.
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Inconsistent measurement explains only part of the difference between the U.S. and the rest of the world. Were measurements to be standardized, according to Eberstadt, “America might move from the bottom third toward the middle, but it would be unlikely to advance into the top half."22 Another factor affecting infant mortality Eberstadt identifies is parental behavior.23 Pregnant women in other countries are more likely to either be married or living with a partner. Pregnant women in such households are more likely to receive prenatal care than pregnant women living on their own. In the U.S., pregnant women are far more likely to be living alone. Although the nature of the relationship is still unclear (it is possible that mothers living on their own are less likely to want to be pregnant), it likely leads to a higher rate of infant mortality in the U.S.
In summary, infant mortality is measured far too inconsistently to make cross-national comparisons useful. Thus, just like life expectancy, infant mortality is not a reliable measure of the relative merits of health care systems.
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Anyone who thinks that the Canadian system is better than America’s is woefully ill-informed.[/size]
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No health-care system is without its flaws. For procedures which requires specialized equipment or technicians, there is indeed a long wait so many Canadians come here. However, for routine care as well as preventative care, the Canadian system is cheaper and you are guaranteed care.
Fun fact: The U.S. and Canada used to have roughly the same statistics in terms of average life span and infant mortality rates. Canadians started becoming healthier and longer-lived in the seventies—round about the same time they implemented universal single-payer healthcare.
Canadian healthcare taken as a whole is, by empirical measurement, objectively superior to U.S. healthcare. This is almost certainly due to the implementation of a nationalized, single-payer healthcare system.
Okay, lets be objective. There is such a thing as “ideal care”. For example, “ideal care” for cholelithiasis (gallstones) is to get them to surgery soon, before simple stones becomes inflammation (cholecystitis). There is a measurable increase in mortality and morbidity in cholecystitis versus cholelithiasis. The wait for surgery in Canada for cholelithiasis is literally months, compared to much less for the US. This translates into more cases of cholecystitis, which is inherently more serious than gallstones. Their statistics on cholecystitis outcomes are similar in every respect to the US outcomes - what they don’t tell you is how many cases of simple gallstones BECAME cholecystitis because they waited so long. No one can tell you that. But we know that it increases with time, and we know that they wait much longer than us.
To wait up to 9 months for knee replacement or to wait up to 6 months for hip replacement would just not be tolerated here. And the cost of that is for the patient to live in pain longer. This doesn’t show up in mortality statistics, but it exists nonetheless.
I contest your statement above that Canadian is, by empirical measurement, superior to US medicine. There is a lot more involved than simplistic comparison of longevity studies. Yet this is what you seem to be basing your opinion on. Even Canadian physicians don’t think that. And to say that a “single-payor” system is RESPONSIBLE for improvements in people’s health - you’ll have to demonstrate how that could be. A temporal association is not strong enough evidence.
Okay, lets be objective. There is such a thing as “ideal care”. For example, “ideal care” for cholelithiasis (gallstones) is to get them to surgery soon, before simple stones becomes inflammation (cholecystitis). There is a measurable increase in mortality and morbidity in cholecystitis versus cholelithiasis. The wait for surgery in Canada for cholelithiasis is literally months, compared to much less for the US. This translates into more cases of cholecystitis, which is inherently more serious than gallstones. Their statistics on cholecystitis outcomes are similar in every respect to the US outcomes - what they don’t tell you is how many cases of simple gallstones BECAME cholecystitis because they waited so long. No one can tell you that. But we know that it increases with time, and we know that they wait much longer than us.
To wait up to 9 months for knee replacement or to wait up to 6 months for hip replacement would just not be tolerated here. And the cost of that is for the patient to live in pain longer. This doesn’t show up in mortality statistics, but it exists nonetheless.
I contest your statement above that Canadian is, by empirical measurement, superior to US medicine. There is a lot more involved than simplistic comparison of longevity studies. Yet this is what you seem to be basing your opinion on. Even Canadian physicians don’t think that. And to say that a “single-payor” system is RESPONSIBLE for improvements in people’s health - you’ll have to demonstrate how that could be. A temporal association is not strong enough evidence.
And what else doesn’t show up is the impact and cost of a decline of worker productivity related to long waits for treatments. Take the example I gave previously on the Canadian having to wait 9 months of a hernia repair. Suppose he worked in a job that required physical stamina to perform or someone who misses work because of nausea & vomiting from cholelithiasis while waiting for surgery? None of these costs are captured as “costs” to the Canadian health care system that I can see. The pain and suffering these poor chaps endure while waiting for surgery would probably get them a cool million here in the U.S.
