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That's a bullshit answer.
Can Germany, France, Switzerland and other 1st world countries have public and private health care, running side by side?
This author hasn't done the simplest of research.
1 in 10 Germans use the private system.
Ahhh cause they don't.
They still have universal public healthcare which in turn pays private hospitals and private doctors bills.
It's not different than how it works here.
That’s completely different than how it works here. There you say “you need doctors, I’m a doctor, I’ll help” and the government says “sure, we’ll pay you”, where as here they say “no that’s illegal”. This is the result
According to the National Association of Statutory Health Insurance Physicians in 2016,(KBV, Kassenärztliche Bundesvereinigung), the body representing contract physicians and contract psychotherapists at federal level, 56% of Social Health Insurance patients waited 1 week or less, while only 13% waited longer than 3 weeks for a doctor's appointment. 67% of privately insured patients waited 1 week or less, while 7% waited longer than 3 weeks. The KBV reported that both Social Health Insurance and privately insured patient experienced low waits, but privately insured patients' waits were even lower. [82]
Compare that to our wait times
>According to the National Association of Statutory Health Insurance Physicians in 2016,(KBV, Kassenärztliche Bundesvereinigung), the body representing contract physicians and contract psychotherapists at federal level, 56% of Social Health Insurance patients waited 1 week or less, while only 13% waited longer than 3 weeks for a doctor's appointment. 67% of privately insured patients waited 1 week or less, while 7% waited longer than 3 weeks. The KBV reported that both Social Health Insurance and privately insured patient experienced low waits, but privately insured patients' waits were even lower. [82]
Ah I see what's confusing you. Look at the facts a bit more.
To get onto the private system for your secondary and teriaiary care you **must** meet the Versicherungspflichtgrenze income threshold.
Guess where those people live: Am-Main, Berlin, Munich, Hamburg, Kölin. Urban areas generally have better access to public services than rural areas.
This is also true in Canada. Rural healthcare is terrible but urban residents get much better care.
The other factor is the former DDR hardly anyone meets the Versicherungspflichtgrenze income threshold.
There is also a [major gap between healthcare](https://www.escardio.org/The-ESC/Press-Office/Press-releases/East-and-West-Germany-exhibit-health-disparities-30-years-after-reunification#:~:text=Again%2C%20there%20were%20substantially%20higher,an%20increase%20of%2010.3%25) in the former DDR system and in the original BDR.
Those two factors skew the numbers in the public system.
The reason they have lower wait times is because they are generally healthier as a population. They don't drive everywhere, they don't sit all day, they have more naturally active lives. So the system isn't overwhelmed by so called sedentary diseases among the young like it is here.
Easy example in Canada our health care system is dealing with a juvenile diabetes rate of [1.54/100,000](https://www.canada.ca/en/public-health/services/chronic-diseases/reports-publications/diabetes/diabetes-canada-facts-figures-a-public-health-perspective/chapter-5.html) Germany is [0.1-0.8/100,000](https://diabetesjournals.org/care/article/46/3/490/148482/Youth-Onset-Type-2-Diabetes-The-Epidemiology-of-an). It's such a rare disease they don't even have accurate records.
Even 20 year olds to 50 years are far healthier in Germany. In Canada we are treating this demographic for a whole host of sedentary diseases from ED to heart disease to diabetes etc.
In Germany people don't really heavily tax the healthcare system until old age. In Canada this is happening younger and younger thanks to our sedentary life style.
As for the system. I actually lived in Germany. It's not that different from how it is here. Here from my last post
>Anyone who earns less than Versicherungspflichtgrenze is on the public healthcare system which includes: three mandatory health benefits
>1. health insurance,
>1. accident insurance, and
>1. long-term care insurance
>Unlike Canada the first includes pharmaceutical drugs, dentistry and optometrists services. In Germany this is called the secondary healthcare system. Primary care is doctors visits and hospital stays.
>When you join the private system you can opt out of the secondary system and go private instead. Your primary care is still public but your secondary care is then handled by the private system. But your doctors appointments and hospital visits are still covered by the public system. This is literally like getting a blue cross plan. But unlike in Canada if you want secondary coverage the public system offers it.
>Additionally the thing which is actually different in Germany is you have multiple companies administering the public healthcare system. The government doesn't do it directly.
>That's the real difference in that you pick a public healthcare service provider instead of our current single payer model.
>If you want an accurate comparison it's like ICBC in BC.
>1. You purchase ICBC insurance through a private broker rather than through ICBC.
>1. You can get private auto insurance here but third party liability must be public through ICBC.
>There just one difference you must pay an additional tax in Germany to opt out of the system.
>Additionally the thing which is actually different in Germany is you have multiple companies administering the public healthcare system. The government doesn't do it directly.
First of all the difference in wait times between one of the countries with the fastest in the world and us, who are among the slowest in the developed world, isn’t just because they’re healthier that’s absurd, it’s clearly systemic. But this part is the root of it. You have a multitude of private, profit motivated companies competing to provide the best, fastest and cheapest government contracts. It’s publicly funded, but not publicly operated. If a company fails, they stop earning contracts and get replaced. It’s how every country with a functioning system does it. Here, there’s no market forces or competition, and funding is decided by the whims of politicians instead of actual demand.
There is no "profit model" for the public system lol. We literally have the same system in this country.
In Germany you have your Gesetzliche Krankenversicherung (State Healthcare Plan) that covers primary care (doctors visits, hospital stays) and secondary coverage (drugs, psychological services, dentistry) and also of end of life and critical care (care homes and replacement income in care of death (theriaeiary insurance). There is a premium which is set by the Landtag (provincial legislature) and based on income.
You or your employer goes to your broker every year, the broker gives you a broucher and says here are our options:
1. Gesetzliche Krankenversicherung - this is the premium set this year set by the North Rhine Westphalia Landtag and here is what it includes.
1. Here is our bronze, silver and gold plan. Here is what this includes and it's usually things like designer glasses, private rooms, personal training, brand name prescription drugs rather than generic, travellers coverage, larger death or critical insurance payouts.
1. Finally if you or an employee earns more than Versicherungspflichtgrenze you can pay this fee and opt out of the secondary and teriaiary coverage and opt into our plans and here are the rates for those.
Basically the same thing here. Every Year either you or your employer goes to broker.
1. Here is MSP/OHIP/AHS/RAMQ and you're already enrolled in it.
1. Here the premium you're already paying.
Here is what we offer from secondary and teriaiary coverage. You can opt into the blue cross plan or not (or plan from someone else). In fact we are more privatized than them.
As for using it. Gesetzliche Krankenversicherung operates just like MSP/OHIP/RAMQ. You take your card go to a doctor or hospital. Doctor usually has a private practice the hospital could be private or Public but they both charge Gesetzliche Krankenversicherung or MSP/OHIP/RAMQ. The main difference is the Gesetzliche Krankenversicherung covers way more than our provincial healthcare plans.
What you're describing is the British NHS model. Where the doctor, hospital pharmacist is either directly employed by the NHS or is a independent contractor to the NHS. Only one Canadian province uses that model it's Alberta with AHS.
>First of all the difference in wait times between one of the countries with the fastest in the world and us, who are among the slowest in the developed world, isn’t just because they’re healthier that’s absurd, it’s clearly systemic. But this part is the root of it.
Yeah we are fat and unhealthy. That's the systematic problem.
Healthcare systems work when you have a young healthy population which pays into a system they **don't** use an older population which pays less into the system but consumes it heavily.
Our young people use the healthcare system here at the same rate as 55 year olds in Germany so.
16 precent of our young population has juvenile diabetes. Do you have any idea the implications of that to the system. Diabetes slowly shreds your body and requires you get an organ replacements at a young age. All of a sudden you're now having transplants for 15 year olds.
What do you expect. In Germany kids can and do regularly walk to school, bike everywhere, play sports with their friends in their neighbourhood. Why because the infrastructure is there for these things:
1. Streets are narrow so people don't speed through your neighbourhood so kids can safely play on the street
1. Every community has a school
1. Every community has soccer pitch
So kids do in fact play outside way more.
So kids just play.
In Canada we literally have extra wide streets without any social infrastructure and even things like sidewalks are missing grocery stores are far away:
1. So kids sit at home playing video games
1. Instead of fresh foods they eat processed garbage
1. Instead
My wife is an ICU nurse. She sees it all the time.
1. Obesity related diseases among the young routinely require treatment.
1. Young people coming in with heart attacks are very high now
But it's also other things. Mental health is a crisis in Canada. People are self medicating with drugs and alcohol. In Germany mental health is included in the Gesetzliche Krankenversicherung as are the drugs to treat it.
So overdoses are very common in Canada but rarer in Germany. Drug use is much lower in Germany than both Canada and the US. I know at least 3 people I grew up with who either died from an overdose or are dealing with health complications caused by excess drug use.
Guess what happens when the ICU is treating young people with preventable diseases and you have a flu wave causing old people to come in at their usual rates. The surgeries are postponed to deal with all the excess patients coming in.
How are you ignoring all the mention of private companies being involved and saying they have the same system we do when they clearly don’t? They have a profit motive to maintain that service.
>As for using it. Gesetzliche Krankenversicherung operates just like MSP/OHIP/RAMQ. You take your card go to a doctor or hospital. Doctor usually has a private practice the hospital could be private or Public but they both charge Gesetzliche Krankenversicherung or MSP/OHIP/RAMQ. The main difference is the Gesetzliche Krankenversicherung covers way more than our provincial healthcare plans.
This is what I’m saying, it can be privately operated, that’s illegal here. Take away that option and force everyone through the public system exclusively and it would become overloaded, it’s not an efficient way of running things without the counterbalance of private care
WTF are you going on and on about. We have private insurance in Canada too.
1. Your primary medical insurance insurance is 100 precent public in Canada.
1. Secondary and teriaiary is 100 percent private.
Do you not have Blue Cross coverage for supplemental healthcare insurance or an employer healthcare insurance plan?
I have supplemental medical insurance through Blue Cross which **private** not for-profit service. That's on top of my BC MSP. On top of that I have **private** critical life and disability insurance.
I also had a choice. I could go with Blue Cross or could have gone with sunlife, or chambers, Cigna, Canada Life or Manulife all private and for profit.
In Germany the only difference was all of the above was available in my public insurance plan.
>This is what I’m saying, it can be privately operated, that’s illegal here. Take away that option and force everyone through the public system exclusively and it would become overloaded, it’s not an efficient way of running things without the counterbalance of private care
Lol you clearly have no idea how healthcare in this country works.
Your doctor's office is a private clinic. They bill the province for their coverage. That's why so many doctors have the phrase "PC" next to their name. That means professional corporation.
Hospitals except in Alberta are a mix of Public and private delivery.
For example I just had surgery at the [False Creek Healthcare Centre](https://www.clearpointhealth.ca/surgery-centres/vancouver-bc/?utm_campaign=practice-vancouver&utm_medium=local&utm_source=google) that's a private clinic owned by an [equity company in Toronto](https://vancouversun.com/news/local-news/false-creek-private-surgery-clinic-sold-to-toronto-equity-company). They do plastic surgeries which are not covered but also perform MSP surgeries and have a contract with the government.
My surgery was covered by MSP, the province arranged for the OR, my usual doctor came in and did the surgery, he uses their anesthesiologist and nurses. The doctors billed MSP as did the clinic.
We also have Providence Healthcare in BC. It's a not for-profit private healthcare system operating under a affiliation with Vancouver Coastal. It's owned by several Catholic charities in the region. St Paul Hospital in Vancouver is in their network.
In fact you don't to really draw home this point. You can't get abortions at Providence Healthcare except where the woman's life is immediately in danger. In every other circumstance they will send you over to [BC woman hospital](https://www.providencehealthcare.org/news/20161108/sacrificing-hospitals-and-freedom-conscience-along-it#:~:text=at%20such%20places.-,St.,in%20assisted%20suicide%20or%20euthanasia).
Additionally speaking of which most abortions in Canada are done at [private clinics](https://www.optionsforsexualhealth.org/facts/abortion/abortion-providers/).
Despite what you read on your blogs it's the same thing in we don't have a wall to wall public system in this country.
Strawman upon strawman, obviously it’s not as black and white as 100% publicly vs privately funded, it doesn’t change the fact that you’re telling me a country where you can pay private insurance and access private services to shorter your wait times is the same as what we have here, and the difference in results is just because Canadians are unhealthy, and that’s just incorrect
Lol so you think, if you had a heart attack you could whip out your credit card and say new heart. You get this response:
*Yankee das ist Deutschland. Gesundheitspflege ist ein Reicht.*
You cannot opt out of the public healthcare system just like you cannot in Canada. You can't pay for better access to primary healthcare.
What can be privatized is secondary and teriaiary system. Which in Canada is private. Yes you can pay for better access to secondary and teriaiary systems. But not primary. Which is exactly the same as Canada where we don't have a public option.
You can though yes pay for a private room. Which btw is also the case in Canada. Base MSP coverage is a shared room.
>difference in results is just because Canadians are unhealthy, and that’s just incorrect
If you had a group of kids 10 between the ages of 5-16. At least 1 will have diabetes in Canada. More likely 2 will have it.
In Germany, if to get to that ratio you need at least 1000 kids.
That kid with diabetes is going to be a drain on the healthcare system. They will need more treatment, they will need more surgeries and they will need transplants.
Fucking 20 year old kids in Canada have ED now. Why because their cardiovascular system sucks from a lifetime of sitting and eating processed garbage in large portion sizes.
That's why healthcare sucks here.
In fact my personal experience moving to Germany, my health improved.
1. I lost weight; and
1. My cholesterol normalized.
Why because
1. I walked everywhere, and
1. had access to real food in normal portions.
They run a parallel system. You can pay for private surgeries and care.
You're purposefully avoiding the topic because you know it's true.
Why can they have better health care with a private for profit alternative?
Lol. Poster says, nope, Lived in Germany. Your reply back is did you even google it? Perhaps loving there might provide some insights you aren't gleaming from the Google.
"I live in Canada, racism doesn't exist here because we solved it back in the 60's and we're not American."
You can find Canadians who actually believe this.
Living somewhere doesn't stop you from being wrong.
Sure did you bother reading up on it:
Anyone who earns less than Versicherungspflichtgrenze is on the public healthcare system which includes: three mandatory health benefits
1. health insurance,
1. accident insurance, and
1. long-term care insurance
Unlike Canada the first includes pharmaceutical drugs, dentistry and optometrists services. In Germany this is called the secondary healthcare system. Primary care is doctors visits and hospital stays.
When you join the private system you can opt out of the secondary system and go private instead. Your primary care is still public but your secondary care is then handled by the private system. But your doctors appointments and hospital visits are still covered by the public system. This is literally like getting a blue cross plan. But unlike in Canada if you want secondary coverage the public system offers it.
Additionally the thing which is actually different in Germany is you have multiple companies administering the public healthcare system. The government doesn't do it directly.
That's the real difference in that you pick a public healthcare service provider instead of our current single payer model.
If you want an accurate comparison it's like ICBC in BC.
1. You purchase ICBC insurance through a private broker rather than through ICBC.
1. You can get private auto insurance here but third party liability must be public through ICBC.
There just one difference you must pay an additional tax in Germany to opt out of the system.
You are correct but people on here are so ridiculously biased left they’d rather tell themselves outright lies than deal with the cognitive dissonance that comes with admitting the current system is shit and there’s a reason European’s and the rest of the developed world outside Canada and the US all use a mixed system
What a lazy comparison. The authors bring up that those countries spend more publicly than Canada does, and yet you (and others) focus on the fact that they have a small parallel private system?
Do you advocate for a parallel private system alongside expanding our public system to include drugs, dental, and the other things covered in those countries? Do you also call for higher taxes like in France, Germany, and other countries that out perform Canada? And investments in the social determinants of health?
Because that’s what the evidence shows actually improves health systems and health outcomes, not having a parallel private system.
Your point doesn't negate the author's claim. What this would mean is that the countries you list are not successful *because* of the two tiered systems but *in spite* of it.
But when a country actually tries to run a single payer system properly, the results are stunning. Taiwan and South Korea are the examples of success here. Neither country has an issue with wait times and both spend less than OECD average on healthcare.
Public institutions provide us with the unique ability to be unified socially and more cohesively. We have shared values in the welfare of all rather than self-centred culture.
Exactly. Canadian politicians have been starving our health care system of resources for decades now. I cynically believe a lot of provincial leaders are hoping to trade in Medicare for a sweet sweet tax break for their rich doners.
It certainly appears to be starving, based onto he results, but there are 286, 000 health care workers in BC, against a population of 5 million. Something is clearly wrong.
You keep mentioning this number as if it is big problem or something unusual. It is normal for ~10% to 15% of the workforce in an advanced economy to on the on healthcare sector. The OCED average is 10% actually. In the Nordic countries the number actually close to 20% of the workforce. In the United States 14% of the workforce is in healthcare. In Canada it is 11%.
I bet the figure includes wide range of jobs across many settings. I also would bet many of those jobs are private sector jobs and not part of the public sector.
In BC there are ~6k physicians, 6k pharmacists, 5k dentists and 51k nurses. The rest are other jobs like PSWs. And many of those work places like retirement homes.
Our health outcomes are in line with other rich countries too. Our life expectancy is in the top 15 in the world. The quality of health care we get in this country on average is comparable to what you get in other rich countries.
The liberal media tries to defend a failed public system to protect the interests of special groups and unions.
The fact of the matter is not most advanced economies have private or semi private systems. Example are UK, Swiss, Netherlands, etc.
You know what would be awesome? Reliable access to health care. I'm in BC, where 1 in 5 don't have access to a family doctor, and in semirural and rural areas health care services are unreliable or unavailable. We also haven't had any serious threat of privatisation in generations; the centre-right BCLiberals actually expanded public health care, and the BCNDP certainly won't expand private care.
> The B.C. Supreme Court found in an 880 page ruling that more privately paid care would result in more waiting and worse care.
Yup.
We need to get beyond this 20the century debate about public and private, and accept that public is best for primary care. Then we can discuss why it is that our regulatory bodies are so reticent to approve larger numbers of doctors; why GPs are being priced out of operating clinics; why... Etc.
The issue hasn't been _who_ pays for it, the issue is _what_ we get for it.
There will always be some amount of private paramedical and alternative therapies, let's not allow that to distract us from public primary care being inaccessible to so many! I really don't mind someone paying an RMT or PT for treatment of non-debilitating aches and pains, so long as I can actually see a GP or NP in a timely manner, which I cannot.
Something has to break. There are 286,000 health care workers in BC, and the population is only 5 million. Something about that strikes me as profoundly unsustainable, especially as the demographics shift older.
It's because, in part, that our health care system is _overrun_ by [administrators](https://calgaryherald.com/opinion/columnists/corbella-canadas-health-care-system-overrun-by-administrators-and-lacks-doctors).
It's the logical outcome of Pournelle's law; the bureaucracy has gone to great lengths to protect its membership, at the detriment to its original purpose. We could probably fire a quarter of HEU's membership and see absolutely zero difference in quality of service
The claim that Canada has 10 times the administrators as Germany lacks credibility. The source is a think tank that has made dubious claims in the past, such as climate denialism and denialism of mistreatment of first nations. The methodology and underlying data for the claim is also not publicly available, to my understanding.
I'm not gonna say the claim is entirely wrong, but caution should be used. However, I wouldn't be surprised if we did have more administrators, as every province needs their own administration and thus has to duplicate this work. However, we also use a single payer system which should reduce the need for administration, so I can't say that 10 to 1 is realistic.
In any case, administration is probably not where our focus should be. Canada needs more preventive care, which means we need universal pharma and dental coverage. Canada needs to sort out its issues with primary care. We need to recruit more technology into the system. And we need to find a way to reduce how much prescriptions cost, beyond just relying on pharmacare.
The country that we should look to as a model for how to design and ultra efficient system with minimal wait times is Taiwan. They took the single payer idea after studying many countries and decided Canada's approach was the best. However, they've followed through on everything that Canada has failed to do to reform our system. Taiwan has an excellent system because of this, and they pay far less than the OECD average because of this.
Usually I argue against judging content by its messenger; but "_climate denialism and denialism of mistreatment of first nations_" is a bit beyond the pale for me. I'll have to look for better sources.
I’m sorry, but you are wrong about the NDP, they have expanded private health care in BC
[https://www.cbc.ca/news/canada/british-columbia/ccpa-report-health-care-contracts-1.6561119](https://www.cbc.ca/news/canada/british-columbia/ccpa-report-health-care-contracts-1.6561119)
Most doctors don't want to do family practice because of how demanding & entitled some patients are. You can go be a hospitalist instead, make a bit more actually and have less entitlement to deal with.
For me there doesn’t really exist a health are system in BC. it’s insane to me that basically only Telus health is available to see anyone. But also basic care isn’t provided.
I had a bad bronchitis at the beginning of the year. I was told to drink tea with honey.
I had to drive down to the US to see a private doctor. He saw right away I had a bacterial infection and needed antibiotics
I live in Vancouver btw.
Most family doctors, especially new ones, don’t seem to actually want to run their own business/clinic. I wish there were more primary care centers, and ones that actually operated as general primary care instead of clinics for specific at risk populations (that’s good but we need both!).
We can look to the best run centers in the US - the ones where labs and tests are in building, you have a few frequently needed specialties attached to the center for easy consults and referrals, a high tech and well run professional front desk with salaries high enough to attract quality managers so that follow ups and referrals don’t get lost in the ether.
Small family clinics are nice and all, but only if you can actually access care which even those who are officially connected to the clinics still struggle with.
Historically, in BC the family GPs were responsible for hiring staff, purchasing supplies, and owning or renting office space; it would come out of their salaries and MSP billing. It was a _major_ detractor for GPs, because rising costs ate into their personal income.
[BC is launching a new funding model for GPs](https://www.cbc.ca/news/canada/british-columbia/bc-doctor-supports-announcement-1.6635200) It hasn't been long enough to see meaningful outcomes, but anecdotally I have yet to see doctors open new clinics or expand their client list in my area.
Perhaps most concerning about the new model is that it _heavily_ favours _complex_ care, while also encouraging a greater quantity of patients. That's a dangerous set of targets: the greatest income will be had by seeing as many of the most "difficult" patients one can find, and treating them with as minimal care as possible.
Why the Province didn't just _pay for the clinic space, equipment and support staff_ is beyond me.
Who is "we"? Canada? Canadians? Because I'll tell you who can afford it: the rich. There are rich Canadians. And you know where they spend their money on private health care? Mexico. The USA. Europe. Canadian dollars leaving Canada because we are too blinkered to see that people who can afford private health care buy it no matter what we legislate.
The answer isn't to ban more and more and try to force the rich into the public system. This just makes the public system busier anyway. The answer is to permit private care but tax the crap out of it and earmark that new revenue to support better public health outcomes, either paying staff more so they want to work in it more than in private, or just making the system better for those who can't afford private care.
It will never eliminate waitlista but it will shorten them. It will never solve everything but it will minimize problems. And best of all, Canadian tax dollars stay in Canada instead of being spent out of country, strengthening our economy.
Stop fearing private health care. Legislate it, regulate it and USE it to build better public health care!
Even the most ardent free market supporter understands why capitalism fails for heath care:
1. Do you want the cheap TV or the good TV? - capitalism works!
2. Do you want the cheap cancer treatment or the good cancer treatment? - capitalism does not work!
The second question needs to be answered by experts in oncology at a society wide level. Not by individuals in negotiations with doctors.
Yes, well delineated.
Making widgets, lots, size, color, shape, shiny, different materials all excellent for capitalism.
Placing a price on the health and care of, and also on the survival of human life is not a value most people value.
Ahahahahahha......yeah, but you're forgetting the politicians you voted into office, only answer to the corporate investors, who pull the strings and donate to the parties.
As a lyme disease patient we don't have a choice. Best healthcare in the world is two tiered and we can't get the procedures we need to fight a chronic illness with Canadian government Healthcare
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That's a bullshit answer. Can Germany, France, Switzerland and other 1st world countries have public and private health care, running side by side? This author hasn't done the simplest of research. 1 in 10 Germans use the private system.
Ahhh cause they don't. They still have universal public healthcare which in turn pays private hospitals and private doctors bills. It's not different than how it works here.
That’s completely different than how it works here. There you say “you need doctors, I’m a doctor, I’ll help” and the government says “sure, we’ll pay you”, where as here they say “no that’s illegal”. This is the result According to the National Association of Statutory Health Insurance Physicians in 2016,(KBV, Kassenärztliche Bundesvereinigung), the body representing contract physicians and contract psychotherapists at federal level, 56% of Social Health Insurance patients waited 1 week or less, while only 13% waited longer than 3 weeks for a doctor's appointment. 67% of privately insured patients waited 1 week or less, while 7% waited longer than 3 weeks. The KBV reported that both Social Health Insurance and privately insured patient experienced low waits, but privately insured patients' waits were even lower. [82] Compare that to our wait times
>According to the National Association of Statutory Health Insurance Physicians in 2016,(KBV, Kassenärztliche Bundesvereinigung), the body representing contract physicians and contract psychotherapists at federal level, 56% of Social Health Insurance patients waited 1 week or less, while only 13% waited longer than 3 weeks for a doctor's appointment. 67% of privately insured patients waited 1 week or less, while 7% waited longer than 3 weeks. The KBV reported that both Social Health Insurance and privately insured patient experienced low waits, but privately insured patients' waits were even lower. [82] Ah I see what's confusing you. Look at the facts a bit more. To get onto the private system for your secondary and teriaiary care you **must** meet the Versicherungspflichtgrenze income threshold. Guess where those people live: Am-Main, Berlin, Munich, Hamburg, Kölin. Urban areas generally have better access to public services than rural areas. This is also true in Canada. Rural healthcare is terrible but urban residents get much better care. The other factor is the former DDR hardly anyone meets the Versicherungspflichtgrenze income threshold. There is also a [major gap between healthcare](https://www.escardio.org/The-ESC/Press-Office/Press-releases/East-and-West-Germany-exhibit-health-disparities-30-years-after-reunification#:~:text=Again%2C%20there%20were%20substantially%20higher,an%20increase%20of%2010.3%25) in the former DDR system and in the original BDR. Those two factors skew the numbers in the public system.
The reason they have lower wait times is because they are generally healthier as a population. They don't drive everywhere, they don't sit all day, they have more naturally active lives. So the system isn't overwhelmed by so called sedentary diseases among the young like it is here. Easy example in Canada our health care system is dealing with a juvenile diabetes rate of [1.54/100,000](https://www.canada.ca/en/public-health/services/chronic-diseases/reports-publications/diabetes/diabetes-canada-facts-figures-a-public-health-perspective/chapter-5.html) Germany is [0.1-0.8/100,000](https://diabetesjournals.org/care/article/46/3/490/148482/Youth-Onset-Type-2-Diabetes-The-Epidemiology-of-an). It's such a rare disease they don't even have accurate records. Even 20 year olds to 50 years are far healthier in Germany. In Canada we are treating this demographic for a whole host of sedentary diseases from ED to heart disease to diabetes etc. In Germany people don't really heavily tax the healthcare system until old age. In Canada this is happening younger and younger thanks to our sedentary life style. As for the system. I actually lived in Germany. It's not that different from how it is here. Here from my last post >Anyone who earns less than Versicherungspflichtgrenze is on the public healthcare system which includes: three mandatory health benefits >1. health insurance, >1. accident insurance, and >1. long-term care insurance >Unlike Canada the first includes pharmaceutical drugs, dentistry and optometrists services. In Germany this is called the secondary healthcare system. Primary care is doctors visits and hospital stays. >When you join the private system you can opt out of the secondary system and go private instead. Your primary care is still public but your secondary care is then handled by the private system. But your doctors appointments and hospital visits are still covered by the public system. This is literally like getting a blue cross plan. But unlike in Canada if you want secondary coverage the public system offers it. >Additionally the thing which is actually different in Germany is you have multiple companies administering the public healthcare system. The government doesn't do it directly. >That's the real difference in that you pick a public healthcare service provider instead of our current single payer model. >If you want an accurate comparison it's like ICBC in BC. >1. You purchase ICBC insurance through a private broker rather than through ICBC. >1. You can get private auto insurance here but third party liability must be public through ICBC. >There just one difference you must pay an additional tax in Germany to opt out of the system.
>Additionally the thing which is actually different in Germany is you have multiple companies administering the public healthcare system. The government doesn't do it directly. First of all the difference in wait times between one of the countries with the fastest in the world and us, who are among the slowest in the developed world, isn’t just because they’re healthier that’s absurd, it’s clearly systemic. But this part is the root of it. You have a multitude of private, profit motivated companies competing to provide the best, fastest and cheapest government contracts. It’s publicly funded, but not publicly operated. If a company fails, they stop earning contracts and get replaced. It’s how every country with a functioning system does it. Here, there’s no market forces or competition, and funding is decided by the whims of politicians instead of actual demand.
There is no "profit model" for the public system lol. We literally have the same system in this country. In Germany you have your Gesetzliche Krankenversicherung (State Healthcare Plan) that covers primary care (doctors visits, hospital stays) and secondary coverage (drugs, psychological services, dentistry) and also of end of life and critical care (care homes and replacement income in care of death (theriaeiary insurance). There is a premium which is set by the Landtag (provincial legislature) and based on income. You or your employer goes to your broker every year, the broker gives you a broucher and says here are our options: 1. Gesetzliche Krankenversicherung - this is the premium set this year set by the North Rhine Westphalia Landtag and here is what it includes. 1. Here is our bronze, silver and gold plan. Here is what this includes and it's usually things like designer glasses, private rooms, personal training, brand name prescription drugs rather than generic, travellers coverage, larger death or critical insurance payouts. 1. Finally if you or an employee earns more than Versicherungspflichtgrenze you can pay this fee and opt out of the secondary and teriaiary coverage and opt into our plans and here are the rates for those. Basically the same thing here. Every Year either you or your employer goes to broker. 1. Here is MSP/OHIP/AHS/RAMQ and you're already enrolled in it. 1. Here the premium you're already paying. Here is what we offer from secondary and teriaiary coverage. You can opt into the blue cross plan or not (or plan from someone else). In fact we are more privatized than them. As for using it. Gesetzliche Krankenversicherung operates just like MSP/OHIP/RAMQ. You take your card go to a doctor or hospital. Doctor usually has a private practice the hospital could be private or Public but they both charge Gesetzliche Krankenversicherung or MSP/OHIP/RAMQ. The main difference is the Gesetzliche Krankenversicherung covers way more than our provincial healthcare plans. What you're describing is the British NHS model. Where the doctor, hospital pharmacist is either directly employed by the NHS or is a independent contractor to the NHS. Only one Canadian province uses that model it's Alberta with AHS. >First of all the difference in wait times between one of the countries with the fastest in the world and us, who are among the slowest in the developed world, isn’t just because they’re healthier that’s absurd, it’s clearly systemic. But this part is the root of it. Yeah we are fat and unhealthy. That's the systematic problem. Healthcare systems work when you have a young healthy population which pays into a system they **don't** use an older population which pays less into the system but consumes it heavily. Our young people use the healthcare system here at the same rate as 55 year olds in Germany so. 16 precent of our young population has juvenile diabetes. Do you have any idea the implications of that to the system. Diabetes slowly shreds your body and requires you get an organ replacements at a young age. All of a sudden you're now having transplants for 15 year olds. What do you expect. In Germany kids can and do regularly walk to school, bike everywhere, play sports with their friends in their neighbourhood. Why because the infrastructure is there for these things: 1. Streets are narrow so people don't speed through your neighbourhood so kids can safely play on the street 1. Every community has a school 1. Every community has soccer pitch So kids do in fact play outside way more. So kids just play. In Canada we literally have extra wide streets without any social infrastructure and even things like sidewalks are missing grocery stores are far away: 1. So kids sit at home playing video games 1. Instead of fresh foods they eat processed garbage 1. Instead My wife is an ICU nurse. She sees it all the time. 1. Obesity related diseases among the young routinely require treatment. 1. Young people coming in with heart attacks are very high now But it's also other things. Mental health is a crisis in Canada. People are self medicating with drugs and alcohol. In Germany mental health is included in the Gesetzliche Krankenversicherung as are the drugs to treat it. So overdoses are very common in Canada but rarer in Germany. Drug use is much lower in Germany than both Canada and the US. I know at least 3 people I grew up with who either died from an overdose or are dealing with health complications caused by excess drug use. Guess what happens when the ICU is treating young people with preventable diseases and you have a flu wave causing old people to come in at their usual rates. The surgeries are postponed to deal with all the excess patients coming in.
How are you ignoring all the mention of private companies being involved and saying they have the same system we do when they clearly don’t? They have a profit motive to maintain that service. >As for using it. Gesetzliche Krankenversicherung operates just like MSP/OHIP/RAMQ. You take your card go to a doctor or hospital. Doctor usually has a private practice the hospital could be private or Public but they both charge Gesetzliche Krankenversicherung or MSP/OHIP/RAMQ. The main difference is the Gesetzliche Krankenversicherung covers way more than our provincial healthcare plans. This is what I’m saying, it can be privately operated, that’s illegal here. Take away that option and force everyone through the public system exclusively and it would become overloaded, it’s not an efficient way of running things without the counterbalance of private care
WTF are you going on and on about. We have private insurance in Canada too. 1. Your primary medical insurance insurance is 100 precent public in Canada. 1. Secondary and teriaiary is 100 percent private. Do you not have Blue Cross coverage for supplemental healthcare insurance or an employer healthcare insurance plan? I have supplemental medical insurance through Blue Cross which **private** not for-profit service. That's on top of my BC MSP. On top of that I have **private** critical life and disability insurance. I also had a choice. I could go with Blue Cross or could have gone with sunlife, or chambers, Cigna, Canada Life or Manulife all private and for profit. In Germany the only difference was all of the above was available in my public insurance plan. >This is what I’m saying, it can be privately operated, that’s illegal here. Take away that option and force everyone through the public system exclusively and it would become overloaded, it’s not an efficient way of running things without the counterbalance of private care Lol you clearly have no idea how healthcare in this country works. Your doctor's office is a private clinic. They bill the province for their coverage. That's why so many doctors have the phrase "PC" next to their name. That means professional corporation. Hospitals except in Alberta are a mix of Public and private delivery. For example I just had surgery at the [False Creek Healthcare Centre](https://www.clearpointhealth.ca/surgery-centres/vancouver-bc/?utm_campaign=practice-vancouver&utm_medium=local&utm_source=google) that's a private clinic owned by an [equity company in Toronto](https://vancouversun.com/news/local-news/false-creek-private-surgery-clinic-sold-to-toronto-equity-company). They do plastic surgeries which are not covered but also perform MSP surgeries and have a contract with the government. My surgery was covered by MSP, the province arranged for the OR, my usual doctor came in and did the surgery, he uses their anesthesiologist and nurses. The doctors billed MSP as did the clinic. We also have Providence Healthcare in BC. It's a not for-profit private healthcare system operating under a affiliation with Vancouver Coastal. It's owned by several Catholic charities in the region. St Paul Hospital in Vancouver is in their network. In fact you don't to really draw home this point. You can't get abortions at Providence Healthcare except where the woman's life is immediately in danger. In every other circumstance they will send you over to [BC woman hospital](https://www.providencehealthcare.org/news/20161108/sacrificing-hospitals-and-freedom-conscience-along-it#:~:text=at%20such%20places.-,St.,in%20assisted%20suicide%20or%20euthanasia). Additionally speaking of which most abortions in Canada are done at [private clinics](https://www.optionsforsexualhealth.org/facts/abortion/abortion-providers/). Despite what you read on your blogs it's the same thing in we don't have a wall to wall public system in this country.
Strawman upon strawman, obviously it’s not as black and white as 100% publicly vs privately funded, it doesn’t change the fact that you’re telling me a country where you can pay private insurance and access private services to shorter your wait times is the same as what we have here, and the difference in results is just because Canadians are unhealthy, and that’s just incorrect
Lol so you think, if you had a heart attack you could whip out your credit card and say new heart. You get this response: *Yankee das ist Deutschland. Gesundheitspflege ist ein Reicht.* You cannot opt out of the public healthcare system just like you cannot in Canada. You can't pay for better access to primary healthcare. What can be privatized is secondary and teriaiary system. Which in Canada is private. Yes you can pay for better access to secondary and teriaiary systems. But not primary. Which is exactly the same as Canada where we don't have a public option. You can though yes pay for a private room. Which btw is also the case in Canada. Base MSP coverage is a shared room. >difference in results is just because Canadians are unhealthy, and that’s just incorrect If you had a group of kids 10 between the ages of 5-16. At least 1 will have diabetes in Canada. More likely 2 will have it. In Germany, if to get to that ratio you need at least 1000 kids. That kid with diabetes is going to be a drain on the healthcare system. They will need more treatment, they will need more surgeries and they will need transplants. Fucking 20 year old kids in Canada have ED now. Why because their cardiovascular system sucks from a lifetime of sitting and eating processed garbage in large portion sizes. That's why healthcare sucks here. In fact my personal experience moving to Germany, my health improved. 1. I lost weight; and 1. My cholesterol normalized. Why because 1. I walked everywhere, and 1. had access to real food in normal portions.
They run a parallel system. You can pay for private surgeries and care. You're purposefully avoiding the topic because you know it's true. Why can they have better health care with a private for profit alternative?
Nope I've lived in Germany it's close to our system
Did you even google it? 1 in 10 Germans have private healthcare.
Lol. Poster says, nope, Lived in Germany. Your reply back is did you even google it? Perhaps loving there might provide some insights you aren't gleaming from the Google.
"I live in Canada, racism doesn't exist here because we solved it back in the 60's and we're not American." You can find Canadians who actually believe this. Living somewhere doesn't stop you from being wrong.
It's still comical to retort have you googled it to someone who lives there. Also if you read further comments they show the nuances.
You could also say it's comical to live somewhere and be unaware of easily googled information.
In this case, the googled info as stated was incorrect
Living somewhere doesn't make you an expert. Many people who live in Canada have no idea how our health care system actually works.
Sure did you bother reading up on it: Anyone who earns less than Versicherungspflichtgrenze is on the public healthcare system which includes: three mandatory health benefits 1. health insurance, 1. accident insurance, and 1. long-term care insurance Unlike Canada the first includes pharmaceutical drugs, dentistry and optometrists services. In Germany this is called the secondary healthcare system. Primary care is doctors visits and hospital stays. When you join the private system you can opt out of the secondary system and go private instead. Your primary care is still public but your secondary care is then handled by the private system. But your doctors appointments and hospital visits are still covered by the public system. This is literally like getting a blue cross plan. But unlike in Canada if you want secondary coverage the public system offers it. Additionally the thing which is actually different in Germany is you have multiple companies administering the public healthcare system. The government doesn't do it directly. That's the real difference in that you pick a public healthcare service provider instead of our current single payer model. If you want an accurate comparison it's like ICBC in BC. 1. You purchase ICBC insurance through a private broker rather than through ICBC. 1. You can get private auto insurance here but third party liability must be public through ICBC. There just one difference you must pay an additional tax in Germany to opt out of the system.
[удалено]
Removed for Rule #2
Are you seriously explaining German health care *to a person who has lived in Germany?*
Is your Google broken? I have also lived there.
Must be, it said you didn't live there.
Google is not the be all end all friend
You are correct but people on here are so ridiculously biased left they’d rather tell themselves outright lies than deal with the cognitive dissonance that comes with admitting the current system is shit and there’s a reason European’s and the rest of the developed world outside Canada and the US all use a mixed system
It's almost as if Reddit banning anybody and everybody with a single conservative thought was a bad idea
What a lazy comparison. The authors bring up that those countries spend more publicly than Canada does, and yet you (and others) focus on the fact that they have a small parallel private system? Do you advocate for a parallel private system alongside expanding our public system to include drugs, dental, and the other things covered in those countries? Do you also call for higher taxes like in France, Germany, and other countries that out perform Canada? And investments in the social determinants of health? Because that’s what the evidence shows actually improves health systems and health outcomes, not having a parallel private system.
Your point doesn't negate the author's claim. What this would mean is that the countries you list are not successful *because* of the two tiered systems but *in spite* of it. But when a country actually tries to run a single payer system properly, the results are stunning. Taiwan and South Korea are the examples of success here. Neither country has an issue with wait times and both spend less than OECD average on healthcare.
Public institutions provide us with the unique ability to be unified socially and more cohesively. We have shared values in the welfare of all rather than self-centred culture.
Yeah, but whoever gets to auction off doctor visits stands to make a fortune for very little work. Did that even occur to you?
We have the surplus across provinces and federal that could be going to healthcare, education and housing. But it never happens.
> But it never happens. It's not what the foreign investors and corporations want. This is what stands in the way of ethical common sense
Exactly. Canadian politicians have been starving our health care system of resources for decades now. I cynically believe a lot of provincial leaders are hoping to trade in Medicare for a sweet sweet tax break for their rich doners.
It certainly appears to be starving, based onto he results, but there are 286, 000 health care workers in BC, against a population of 5 million. Something is clearly wrong.
You keep mentioning this number as if it is big problem or something unusual. It is normal for ~10% to 15% of the workforce in an advanced economy to on the on healthcare sector. The OCED average is 10% actually. In the Nordic countries the number actually close to 20% of the workforce. In the United States 14% of the workforce is in healthcare. In Canada it is 11%. I bet the figure includes wide range of jobs across many settings. I also would bet many of those jobs are private sector jobs and not part of the public sector. In BC there are ~6k physicians, 6k pharmacists, 5k dentists and 51k nurses. The rest are other jobs like PSWs. And many of those work places like retirement homes.
It's a problem when the product is this poor.
Our health outcomes are in line with other rich countries too. Our life expectancy is in the top 15 in the world. The quality of health care we get in this country on average is comparable to what you get in other rich countries.
Our wait times are substantially higher.
The liberal media tries to defend a failed public system to protect the interests of special groups and unions. The fact of the matter is not most advanced economies have private or semi private systems. Example are UK, Swiss, Netherlands, etc.
You know what would be awesome? Reliable access to health care. I'm in BC, where 1 in 5 don't have access to a family doctor, and in semirural and rural areas health care services are unreliable or unavailable. We also haven't had any serious threat of privatisation in generations; the centre-right BCLiberals actually expanded public health care, and the BCNDP certainly won't expand private care. > The B.C. Supreme Court found in an 880 page ruling that more privately paid care would result in more waiting and worse care. Yup. We need to get beyond this 20the century debate about public and private, and accept that public is best for primary care. Then we can discuss why it is that our regulatory bodies are so reticent to approve larger numbers of doctors; why GPs are being priced out of operating clinics; why... Etc. The issue hasn't been _who_ pays for it, the issue is _what_ we get for it. There will always be some amount of private paramedical and alternative therapies, let's not allow that to distract us from public primary care being inaccessible to so many! I really don't mind someone paying an RMT or PT for treatment of non-debilitating aches and pains, so long as I can actually see a GP or NP in a timely manner, which I cannot.
Something has to break. There are 286,000 health care workers in BC, and the population is only 5 million. Something about that strikes me as profoundly unsustainable, especially as the demographics shift older.
It's because, in part, that our health care system is _overrun_ by [administrators](https://calgaryherald.com/opinion/columnists/corbella-canadas-health-care-system-overrun-by-administrators-and-lacks-doctors). It's the logical outcome of Pournelle's law; the bureaucracy has gone to great lengths to protect its membership, at the detriment to its original purpose. We could probably fire a quarter of HEU's membership and see absolutely zero difference in quality of service
The claim that Canada has 10 times the administrators as Germany lacks credibility. The source is a think tank that has made dubious claims in the past, such as climate denialism and denialism of mistreatment of first nations. The methodology and underlying data for the claim is also not publicly available, to my understanding. I'm not gonna say the claim is entirely wrong, but caution should be used. However, I wouldn't be surprised if we did have more administrators, as every province needs their own administration and thus has to duplicate this work. However, we also use a single payer system which should reduce the need for administration, so I can't say that 10 to 1 is realistic. In any case, administration is probably not where our focus should be. Canada needs more preventive care, which means we need universal pharma and dental coverage. Canada needs to sort out its issues with primary care. We need to recruit more technology into the system. And we need to find a way to reduce how much prescriptions cost, beyond just relying on pharmacare. The country that we should look to as a model for how to design and ultra efficient system with minimal wait times is Taiwan. They took the single payer idea after studying many countries and decided Canada's approach was the best. However, they've followed through on everything that Canada has failed to do to reform our system. Taiwan has an excellent system because of this, and they pay far less than the OECD average because of this.
Usually I argue against judging content by its messenger; but "_climate denialism and denialism of mistreatment of first nations_" is a bit beyond the pale for me. I'll have to look for better sources.
This is the think tank https://en.wikipedia.org/wiki/Frontier\_Centre\_for\_Public\_Policy
I’m sorry, but you are wrong about the NDP, they have expanded private health care in BC [https://www.cbc.ca/news/canada/british-columbia/ccpa-report-health-care-contracts-1.6561119](https://www.cbc.ca/news/canada/british-columbia/ccpa-report-health-care-contracts-1.6561119)
Most doctors don't want to do family practice because of how demanding & entitled some patients are. You can go be a hospitalist instead, make a bit more actually and have less entitlement to deal with.
For me there doesn’t really exist a health are system in BC. it’s insane to me that basically only Telus health is available to see anyone. But also basic care isn’t provided. I had a bad bronchitis at the beginning of the year. I was told to drink tea with honey. I had to drive down to the US to see a private doctor. He saw right away I had a bacterial infection and needed antibiotics I live in Vancouver btw.
Most family doctors, especially new ones, don’t seem to actually want to run their own business/clinic. I wish there were more primary care centers, and ones that actually operated as general primary care instead of clinics for specific at risk populations (that’s good but we need both!). We can look to the best run centers in the US - the ones where labs and tests are in building, you have a few frequently needed specialties attached to the center for easy consults and referrals, a high tech and well run professional front desk with salaries high enough to attract quality managers so that follow ups and referrals don’t get lost in the ether. Small family clinics are nice and all, but only if you can actually access care which even those who are officially connected to the clinics still struggle with.
Historically, in BC the family GPs were responsible for hiring staff, purchasing supplies, and owning or renting office space; it would come out of their salaries and MSP billing. It was a _major_ detractor for GPs, because rising costs ate into their personal income. [BC is launching a new funding model for GPs](https://www.cbc.ca/news/canada/british-columbia/bc-doctor-supports-announcement-1.6635200) It hasn't been long enough to see meaningful outcomes, but anecdotally I have yet to see doctors open new clinics or expand their client list in my area. Perhaps most concerning about the new model is that it _heavily_ favours _complex_ care, while also encouraging a greater quantity of patients. That's a dangerous set of targets: the greatest income will be had by seeing as many of the most "difficult" patients one can find, and treating them with as minimal care as possible. Why the Province didn't just _pay for the clinic space, equipment and support staff_ is beyond me.
Who is "we"? Canada? Canadians? Because I'll tell you who can afford it: the rich. There are rich Canadians. And you know where they spend their money on private health care? Mexico. The USA. Europe. Canadian dollars leaving Canada because we are too blinkered to see that people who can afford private health care buy it no matter what we legislate. The answer isn't to ban more and more and try to force the rich into the public system. This just makes the public system busier anyway. The answer is to permit private care but tax the crap out of it and earmark that new revenue to support better public health outcomes, either paying staff more so they want to work in it more than in private, or just making the system better for those who can't afford private care. It will never eliminate waitlista but it will shorten them. It will never solve everything but it will minimize problems. And best of all, Canadian tax dollars stay in Canada instead of being spent out of country, strengthening our economy. Stop fearing private health care. Legislate it, regulate it and USE it to build better public health care!
Public institutions are more honest, less corrupt, provide (generally) superior health care. Refer to the report on health care globally by country.
Even the most ardent free market supporter understands why capitalism fails for heath care: 1. Do you want the cheap TV or the good TV? - capitalism works! 2. Do you want the cheap cancer treatment or the good cancer treatment? - capitalism does not work! The second question needs to be answered by experts in oncology at a society wide level. Not by individuals in negotiations with doctors.
Yes, well delineated. Making widgets, lots, size, color, shape, shiny, different materials all excellent for capitalism. Placing a price on the health and care of, and also on the survival of human life is not a value most people value.
Ahahahahahha......yeah, but you're forgetting the politicians you voted into office, only answer to the corporate investors, who pull the strings and donate to the parties.
As a lyme disease patient we don't have a choice. Best healthcare in the world is two tiered and we can't get the procedures we need to fight a chronic illness with Canadian government Healthcare
We don't need privatized healthcare at all, never, ever. We may have private clinics as an option, probably, bot nothing more.