最初由[开心点]发布
听您这么强烈的个人感觉, 但居然还待在这儿"有若干年头了...汽车,house也早就买了..", 这是不是有点奇怪? 这若干年头下来岂不是很痛苦? 我要是您早回去了.
请不要随便代表"大多数技术移民". 我和周围的绝大多数技术移民经过几年努力下来,在专业领域和家庭收入方面都达到或超过了本地白领水平,我们不觉得加拿大是个垃圾国家,相反是个很nice,适合家庭人居,并在世界经济中有极好发展前景的国家. 人们可能不会每天都大声赞美阳光,但在心里都喜欢艳阳天.
加拿大的医疗服务制度是个巨大的话题,不是几个网贴能讲清楚,也确有需改进之处,如轮候时间长等. 我经历过几次家人的入院治疗手术,感觉加拿大的医疗服务与中国大不相同,不单是绝不以金钱谋利为重,其全套的治疗及跟进制度,医生和护士的专业服务水平都给我留下良好的印象.
感觉我们新移民特别需要的一点是:在到处抱怨甚至想用自己原来熟悉的方式去改变周围之前,先试着以谦虚尊重的心态去理解加拿大与北美的方方面面,入乡随俗以本地的游戏规则行事,会发现这个世界没有那么糟糕,而是充满机会.
How Good Is Canadian Health Care? zt
Nadeem Esmail and Michael Walker
1. How much does Canada spend on health care
compared to other countries?
It is often said that Canada spends too little on health care. But is it true? In order to
answer the question, we first recognize that the average age of a country’s population
is a big determinant of the amount of money it will have to spend in order to provide
adequate health care. In Canada, those aged 65 and over consumed over 45% of provincial
health care expenditures in 2004 while making up only 13.0% of the population.
In order to compare countries, we adjust the data for the age of the population and
discover that Canada spends more on health care than any other industrialized OECD
country except Iceland and Switzerland [ExSum Figure 1].
2. Which countries other than Canada do not have user fees
and other forms of cost sharing?
An important consideration in the use of health care resources is the cost of access
at the point of consumption. The evidence surveyed in this study suggests that health
care costs can be significantly reduced if consumers of care have to participate in paying
for the care they demand. While bearing in mind that low-income citizens may be
exempted from paying user fees, the question is, do other universal-access countries
share Canada’s notion that user charges should be banned? In fact, most do not. More
than three quarters of the universal-access countries in the OECD also charge user
fees for access to hospitals, general practitioners, or specialists—in many cases, to all
three. In banning user fees, Canada is very much in the minority.
3. Do other countries follow Canada’s model of monopolistic
public provision of health insurance?
No, Canada is the only country in the OECD that outlaws privately funded purchases
of core services. Every other OECD country has some form of user-pay, private provision
of health care. Also, while many OECD countries require that only public hospitals
provide publicly insured services, it is also the case that more than half of the
countries permit private providers to deliver publicly funded care.
4. Does Canada have too many doctors and should it
put the doctors it has on salary?
On an age-adjusted, comparative basis, Canada, relative to comparable countries of the
OECD, has a small number of physicians: it ranks twenty-fourth out of 28 countries
with 2.3 doctors per 1,000 people for a total of 68,171 doctors [ExSum Figure 2]. To rank ashighly as the first-ranked Greece, for example, Canada would have to have had 61,679
doctors more than we actually did in 2004. In 1970, the year when public insurance
first fully applied to services from physicians, Canada ranked second among the countries
that could be ranked in that year. Whether we have too many or too few doctors in
an absolute sense is an impossible question to answer; but we have many fewer doctors
per capita on an age-adjusted basis than most other countries in the OECD and report
longer waits for access to treatment.
A recent survey of sicker adults in six countries by the Commonwealth Fund
punctuates the problems of access to care in Canada. In the survey, Canadian respondents
were more likely than any other universal access country surveyed except the
United Kingdom to experience waiting times of four months or more for electivesurgery. Patients in Canada were also least likely to wait less than one month for
elective surgery. For access to specialists, Canadians were again more likely than any
other universal access country save the United Kingdom to experience waiting times
of more than 4 weeks. Access to see a doctor when sick was also relatively poor in
Canada: Canadians were most likely to wait six days or longer. Finally, Canadians
were least likely to wait less than 1 hour in ER and most likely to wait 4 hours or more
(Schoen et al., 2005).
Another survey, also by the Commonwealth Fund, found that access to care
is not uniform among socioeconomic groups in Canada. Those with below-average
incomes were 9% less likely than those with above-average incomes to rate care as
excellent and 6% more likely to rate care as poor. These Canadians were also more
likely to have difficulties seeing a specialist (Blendon et al., 2002).
Canadian doctors are paid generally on a fee-per-service basis and, in this particular
area of policy, Canada is aligned with the majority of OECD countries. Of the
countries in the OECD, 50% rely partly or wholly on salaried general practitioners.
Only 7% of the countries rely exclusively on salary compensation. For specialists, 89%
of OECD countries rely partly or wholly on salaried professionals, while 29% rely on
it exclusively.
5. Do other countries follow Canada’s model of funding health care
primarily from general tax revenues?
Regrettably, international comparison does not enable us to choose between the
greater transparency and potentially shorter waiting times of a segregated social
insurance program or general taxation funding since 12 OECD countries use general
taxation, 12 use segregated taxation or a social insurance program, and four have
mixed financing systems.
Canada spends more on health care than any other universal-access,
industrialized country save Iceland and Switzerland. Canada is also unique in banning
private medicine.
6. Do we get our money’s worth and are we well served
by our government-centered health care system?
While it is easy to calculate the comparative costs of health care amongst the OECD
nations, it is more difficult to know whether we receive value for money expended. In
this study, 12 indicators of access to health care and outcomes from the health care
process are examined. One relates to access to physicians, four relate to access to high
technology equipment, and seven relate to health outcomes.
With regard to age-adjusted access to high-tech machinery, Canada performs
dismally by comparison with other OECD countries. While ranking number three as
a health care spender, Canada ranks thirteenth of 24 in access to MRIs [ExSum Figure 3],
eighteenth of 24 in access to CT scanners [ExSum Figure 4], seventh of 17 in access tomammographs, and ties with two other nations at seventeenth of 20 in access to lithotriptors.
Lack of access to machines has also meant longer waiting times for diagnostic
assessment, and mirrors the longer waiting times for access to specialists and to treatment
found in the comparative studies examined for this study.
One of the great problems for the worldwide debates about health care is the
dearth of measurement of health care outcomes that could be used to determine the
effectiveness of health care systems. However, a number of comparative rankings are
available that are suggestive of the ability of the health care system to deal with disease.
In this study, seven outcome measures have been employed to rank the performance
of the OECD countries: healthy life expectancy versus total life expectancy;
infant and perinatal mortality; mortality amenable to health care; potential years
of life lost to disease; and the death rates from breast cancer and colorectal cancer
[ExSum Table 1]. The study finds that Canada, while spending more on health care than
any other industrialized country in the OECD save Iceland and Switzerland, ranksseventeenth in the percentage of total life expectancy that will be lived in full health,
ranks twenty-second in infant mortality and fifteenth in perinatal mortality, ranks
fourth in mortality amenable to health care, ranks ninth in potential years of life lost
to disease, ranks tenth in the incidence of breast cancer mortality, and ranks second
in the incidence of mortality from colorectal cancer.
Most notable about this international comparison of outcomes is that all of
the countries that have fewer years of life lost to disease and that have lower mortality
amenable to health care than Canada also have private alternatives to the public
health care system and all have user fees at the point of access to care. Furthermore,
only two of these countries (Iceland and Switzerland) spend more on health care than
Canada after age adjustment. All of the countries whose populations experience a
greater proportion of life lived in full health have a private care sector competing for
patient demand and more than three quarters of them also have some form of cost
sharing for access to the system. Looking at a specific, treatable, catastrophic disease
such as breast cancer, Canada ranks tenth. All of the comprehensive, universal-accesscountries that do better than Canada in preventing mortality from breast cancer have
private health care alternatives and some form of user fees at the point of access, and
all but two spend less of their countries’ GDP on health care.
Conclusion
The comparative evidence is that the Canadian health care model is inferior to those
that are in place in other countries of the OECD. It produces inferior age-adjusted
access to physicians and technology, produces longer waiting times, is less successful
in preventing deaths from preventable causes, and costs more than almost all of
the other systems that have comparable objectives. The models that produce superior
results and cost less than Canada’s monopoly-insurer, monopoly-provider system have:
user fees; alternative, comprehensive, privately funded care; and private hospitals that
compete for patient demand. The overwhelming evidence is that, in comparative terms,
Canada’s system of health care delivery under-performs and needs to emulate the more
successful models available elsewhere in those countries that offer their citizens universal
access to health care.
How Good Is Canadian Health Care? 2007 Report
http://www.fraserinstitute.org/COMM...odHC2007rev.pdf |
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发表于 2008-2-3 22:16:46
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