Strong Medicine: How to Save Canada's Health Care System

Paul G. Thomas is a political science professor at the University of
Manitoba and the co-author of Canadian Public Administration:
Problematical Perspectives.

The authors of the earlier bestseller Second Opinion are back again with
a readable, penetrating analysis of what is wrong with Canada’s
health-care system. The main message of this valuable book is that
health-care costs are not out of control and that the crisis in the
system does not arise from underfunding. The real crisis is about
redistribution of authority among the so-called stakeholders in the
system. “What needs fixing,” write the authors, “is the unplanned,
uncoordinated and unaccountable way that we deliver health services.”
If we fix the system, some groups and institutions will be winners and
others will lose status and power. This political struggle among
competing interests within the health systems adds to the appearance of
crisis, an appearance that the media are happy to sensationalize.

Of the $70 billion spent annually on health care by Canadians,
approximately 52 percent is spent on hospitals and 22 percent is spent
on physicians’ remuneration. In other words, how much health care is
provided and how much it costs are primarily a function of how many
hospital beds are funded and how many doctors work in the system. It
should also be noted that doctors largely determine the use of
hospitals; therefore, dealing with the power of doctors within the
system remains the central challenge. Community and public health
currently account for only 6 percent of expenditures, but they represent
the emphasis for the future. Ideas like per-diem charges for hospitals
and extra billing for physicians’ services are described by the
authors as “zombie ideas” (in Robert Evans’s memorable phrase)
because they keep reappearing even though they do not represent real
solutions. Less than 10 percent of the health-care budget is open to
patient abuse. The authors fear that we may be headed toward a
two-tiered health system and that the national government will be unable
to enforce the concept of universal health services without financial
barriers. There are many more stimulating points in this well-researched
book, which presents specialized information in an interesting and
accessible manner. Anyone interested in where the health-care system
ought to be heading should read this book.