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STANFORD -- The Canadian health-care system, an object of considerable debate in the U.S. presidential campaign, is running into formidable cost problems, a Stanford expert reports.

Health-care costs are now drawing one-third of the budgets of the provinces, the Canadian federal government is reducing its contributions, and political pressures are preventing reforms, Spyros Andreopoulos wrote in the April issue of the Western Journal of Medicine. Andreopoulos is director of the Stanford Medical Center News Bureau and a recognized authority on the Canadian system.

Under the Canadian system, the government pays almost all medical costs. But Andreopoulos warns that "for those Americans with a fascination for the Canadian approach, one thing is clear. It is not a panacea. Apart from better efficiency and fiscal control, as well as more equitable accessibility, Canada's system has left many issues unresolved."

By three years ago, the province of Alberta was spending more than $3 billion on health care, about a third of its budget. Yet, when a government-commissioned report called for changes in the way it pays for health care, the province rejected most of it because of public outcry, Andreopoulos said.

The Rainbow Report: Our Vision for Health, did not suggest backing away from government-supported health care. Rather, it recommended that:

  • Basic health-care benefits be redefined and Albertans be allowed to supplement their government coverage with private health insurance.
  • The government divert 1 percent ($30 million) to promoting self- reliance and the prevention of illness and injuries as a way of holding down costs.
  • Each Albertan be issued an electronic "smart card" containing medical information and a personal "health-care allotment." Those spending more than their allotment were to receive counseling, those spending less would get awards.
  • Several procedures be dropped from government coverage.

The suggestion of a role for private insurers created the most controversy. Opponents said it would create a two-tiered system based on ability to pay, the philosophical antithesis of the universal health plan envisioned by the country. No other province permits private insurance, except as a minor supplement for procedures not covered by the government system.

Meanwhile, the federal government has reduced its contributions to provincial health plans, Andreopoulos wrote, increasing pressure on Alberta and creating even more problems for such poor provinces as Newfoundland.

Among the system's other problems, Andreopoulos said, is difficulty in getting a room in hospitals that are cutting costs to stay solvent. Doctors customarily put their patients on as many waiting lists as possible and take the first opening they can get. For some non-essential procedures, wealthier Canadians cross the border into the United States.

"While the Canadian system still has much to recommend it - no one is seriously thinking of abandoning it - developments in Alberta are throwing a spotlight on a key question now troubling policymakers in Canada, the U.S., Great Britain, France and other developed countries: how much health care is enough, and which medical services will be considered essential and eligible for payment from government or private insurers in the future?" Andreopoulos wrote.



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