Canadian health care myths

Many alleged ‘facts’ of Canadian health care turn out, on close inspection, to be myths. One such ‘fact’ is that large numbers of Canadians are fleeing their health care system, crossing the US border in search of care that is inaccessible in Canada because of government rationing. Years ago, a group of researchers from the University of British Columbia and the University of Michigan examined this claim, and revealed it to be a myth. The researchers collected information on Canadians’ use of medical facilities located in Michigan, New York State and Washington State during 1994-1998. They supplemented this information with official data from several Canadian provincial and federal sources.

For more than a decade anecdotal reports of waiting lists for elective procedures in Canada and of hordes of Canadian “Medicare refugees” crossing the border in search of medical care in the United States have provided emotive fuel for critics of the Canadian health care system from both sides of the border. ….

All of the evidence we have, however, [shows] … the cross-border flow of care-seeking patients … to be very small. ….

Our results should probably not, on reflection, be surprising. Prices for U.S. health care services are extraordinarily high, compared with those in all other countries …. Private insurance for elective services, being subject to very strong adverse selection, is, not surprisingly, nonexistent. …. Furthermore, provincial governments have been lowering their rates of reimbursement and tightening preapproval criteria for cross-border care. In the absence of either source of health insurance coverage, it would be somewhat surprising if large numbers of Canadians were choosing to head south and pay out of pocket for care. ….

Despite the evidence presented in our study, the Canadian border-crossing claims will probably persist. …. Debates over health policy furnish a number of examples of these “zombies”—ideas that, on logic or evidence, are intellectually dead—that can never be laid to rest because they are useful to some powerful interests. The phantom hordes of Canadian medical refugees are likely to remain among them.

Steven J. Katz, Karen Cardiff, Marina Pascali, Morris L. Barer and Robert G. Evans, “Phantoms In The Snow: Canadians’ Use Of Health Care Services In The United States”, Health Affairs 21:3 (May 2002), pp. 10-31.

Their prediction was deadly accurate – the belief in Canadian medical refugees is stronger than ever. And many additional health care myths are circulating as facts. Clinical psychologist Rhonda Hackett is a Canadian who has lived and worked in the United States for the past 17 years, so is familiar with health care systems on both sides of the border. In an op-ed piece drafted for the Denver Post, she debunks several myths. Here is one example.

Myth: Canada’s government decides who gets health care and when they get it. While HMOs and other private medical insurers in the U.S. do indeed make such decisions, the only people in Canada to do so are physicians. In Canada, the government has absolutely no say in who gets care or how they get it. Medical decisions are left entirely up to doctors, as they should be.

There are no requirements for pre-authorization whatsoever. If your family doctor says you need an MRI, you get one. In the U.S., if an insurance administrator says you are not getting an MRI, you don’t get one no matter what your doctor thinks — unless, of course, you have the money to cover the cost.

Rhonda Hackett, “Debunking Canadian health care myths”, Denver Post, 7 June 2009.

Thanks to Christopher Willmore for the pointer to “Phantoms In The Snow”.

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