Those Goody Goody Canadians Not So Good

C’mon admit it: you’re sick of hearing how those goody-goody Canadians provide comprehensive health care to all, while we let an estimated 22,000 Americans die each year ( ) because they don’t have coverage. Or the way their cost of prescription medications is so much lower than ours that Congress finally threw up its hands and legalized the equivalent of small-scale (prescription) drug smuggling. Heck, Canadian provinces even do comparative effectiveness research  without anyone calling them Nazis

Now comes word from the Fraser Institute in Toronto that Canadians are not so goody-goody after all. The institute puts out a peer-reviewed and risk-adjusted report card comparing hospitals in Ontario, the nation’s largest province. Last year, the first for the report, just 43 of 136 acute-care hospitals agreed to participate. This year, though, the number of participants plunged 60 percent, to just 17 hospitals, according to a story in Healthcare IT News.

The report card provides 39 indicators of inpatient quality and patient safety, as well as a Hospital Mortality Index that shows overall performance across nine indicators of mortality. “By refusing to be identified, Ontario hospital administrators are hiding vital information from Ontario taxpayers and patients about the quality of tax-funded healthcare provided in their community,” fumed Nadeem Esmail, director of health system performance studies at the institute and co-author of the report.

Excuse me, Mr. Esmail, but if it’s taxpayer money, why doesn’t your government require hospitals to report? Like we capitalist Americans are starting to do in order to encourage an efficient market? (Oh, yeah — and protect sick people, too.)

Of course, even mandates don’t guarantee the reports will be accurate, as a recent report by the New York City Office of the Comptroller demonstrates. Though New York City hospitals accounted for almost half the patients statewide in 2006, they reported about 39 adverse incidents per 10,000 patient discharges, compared with nearly 70 per 10,000 in the northern suburbs and upstate and nearly 64 per 10,000 on Long Island, according to a story in the New York Times. And talk about variation: one major academic medical center reported 3.6 post-operative infections per 10,000 discharges while a similar hospital had 32 per 10,000. None of these hospitals were named in the report.

Apparently some hospitals believe that “Don’t ask, don’t tell” constitutes a quality improvement strategy.

Categories: Uncategorized

Tagged as:

12 replies »

  1. “What for profit model?”
    Below is 1st Place Winner of the Fraser Institute’s 2008 Essay Contest High School Category.
    “What Canada’s health care system needs is progressive change; reform that is both moral and practical. The answer is a laissez-faire approach where all decisions about health care are made by private individuals and organizations with absolutely no government ownership, service, regulation or any other such trampling of individual rights.”
    Even though it is a high school essay, it did win 1st place and expresses the sentiments of the Frazier Institute.

  2. Americans could do a lot to better the health care situation. Heart disease is one of the #1 killers of men and women (or at least very high up there) yet many live on a processed food diet and smoke anyway. I wonder what that 22,000 figure would look like if Americans had a little discipline in taking care of themselves. There are always exceptions but lets get real here people. It is not Government’s responsibility to give people health care at a Taxpayers expense…what is America going to demand next? …clothes? …housing? Many people I speak with in this “young generation” think that Obama is going to fix everything with a magic wand. The transparency to me is obvious but I’m old fashioned I guess 🙂
    Universal Health Care will bring new problems. …i can’t wait to hear them.

  3. Peter… “Agree Frazer Institute is not unbiased and would be happy if Canada healthcare adopted the U.S. for profit model”.
    What for profit model?

  4. Agree Frazer Institute is not unbiased and would be happy if Canada healthcare adopted the U.S. for profit model, so I can see why hospitals would not be comfortable reporting. For Ontario hospital reportings you can look at these reports:
    on the Ontario Hospital Association (OHA) website. I will conceded that the OHA may have an agenda for it’s own members – but I can’t say for sure.
    Also the Canadian Institute for Health Information (CIHI)
    Has lots of unbiasd info on healthcare in Ontario and Canada. No political or ideology axe to grind here.

  5. It is pretty silly comparison. We have here also over 100,000 deaths in hospital due to errors.
    I have been to Canada and to emergency or unscheduled. I got to see a doctor within 2 hrs. Those who think we have better here need to tell me how many times they get to see a doctor at the appointed time. I have had to wait from 15 min to 3 hrs in USA. In fact in one case, the guy was on phone discussiing golf. I started walking out after 2.30 hrs and then they came to get me….

  6. LOTS of good points, folks. Please let me respond.
    1 – Tweaking Canada not funny because you’re used to over-the-top right-wing attacks? Well, just remember, if you lose your sense of humor you’ll end up like Rush Limbaugh. (No, not “rich.”)
    2 — I’m a simple blogger, relying upon the “wisdom of crowds”:Fraser may be headquartered in BC (their Web site doesn’t say),but the story was datelined Toronto, as is their press release. Which says their methodology is based on that used by AHRQ in the U.S. and various other reliable methods (given the technology).
    Meanwhile, I have no idea why, if the Canadian government is doing such a good job, the Fraser Institute would want to jump in. Perhaps a Canadian can enlighten us? By all appearances, the Fraser Institute was, shockingly, doing what they say their mission is; i.e., helping people take personal responsibility for their care decisions.
    I know, I know: the Canadian press think their schools report card was biased politically and that they’re right-wing nuts. But a little Googling shows the BC government is going to publish its own report card to compete with the Fraser one because they don’t trust the methodology. (What, we American methodologists aren’t good enough for you?) See:
    Let the free market in free information begin!

  7. Mr. Millenson,
    I guess you just wanted to attract attention to your post with a catchy headline and introduction … but yuo have to blame only yourself (not us “folks”) when your “tongue in cheek” comment is not recognized as such, given all the right wing misinformation about HC in Canada.
    And re. a conservative think tank: they might not do incorrect risk adjustment, but they might use the official looking data for erroneous, foregone conclusions. A left wing think tank might do the same, although I personally think that not much data mining/distorsion is necessary to come to basic left wing conclusions in HC (the blind spot the left has with re. to HC is – for a few – ignoring cost explosion/overutilization, and – for many – ignoring defensive medicine/tort reform).

  8. Quote: “Excuse me, Mr. Esmail, but if it’s taxpayer money, why doesn’t your government require hospitals to report?”
    Hospitals *are* reporting – to the government. Which is exactly where taxpayer accountability data should be reported. (For some examples of public reports based on this data, see CIHI’s Hospital Report series and the Hospital Report Research Collaborative’s Hospital Performance Results series.)
    The Fraser Institute, I guess, is choosing not to jump the hurdles necessary to use that data, attempting rather to recreate some sort of hospital reporting dataset on their own.
    To echo the above poster, I wouldn’t give my data to the Fraser Institute (which, incidentally, is in BC not Toronto), either — not only because of their clear ideological bias, but because double reporting of hospital data does not strike me as wise use of valuable resources that could be used in patient care.

  9. Hey, folks, read carefully please: the post is not ABOUT how we take care of the uninsured. It refers to that tongue-in-cheek. AS I’ve written previously in The Washington Post, our ignoring that problem is a moral scandal.
    On the narrow question of transparency and accountability, the post says the Ontario hospitals were not forthcoming — precisely because, as the post says, it was NOT the government asking. (See, when the government “asks,” most people say yes.) I’m not sure if a libertarian think tank risk adjusts better or worse than a liberal think tank; not a question I’ve pondered, I must admit.

  10. Looks to me like it’s the Fraser Institute, not Health Canada, who’s compiling the report. Fraser is a conservative/libertarian/free market think tank. If I were running a hospital and they asked me, I’d probably ignore them.

  11. No nation on the planet has completely figured out the complexities health care (access,quality and cost, etc.)
    But this I know- It would be a disaster of monumental proportions if we had the hubris and stupidity to export our current model of US health care to nations who want to get it right.
    Dr. Rick Lippin

  12. You can not seriously be comparing the failure to send reporting indicators to the fact that we have so many in this country who are unable to receive care of almost any quality are you? Sure, I’d love to see great results on the indicators but if I have a choice of mediocre treatment or no treatment at all I think I’d take my chances.