Testimony before the US Senate Committee on Health, Education, Labor and Pensions, March 11, 2014

 

Sen. Richard Burr (R-N.C.): Why are doctors exiting the public system in Canada?

Danielle Martin: If I didn’t express myself in a way to make myself understood, I apologize. There are no doctors exiting the public system in Canada, and in fact we see a net influx of physicians from the United States into the Canadian system over the last number of years.

What I did say was that the solution to the wait time challenge that we have in Canada — we do have a difficult time with waits for elective medical procedures — does not lie in moving away from our single-payer system toward a multipayer system. And that’s borne out by the experience of Australia. So Australia used to have a single-tier system and did in the 1990s move toward a multiple-payer system where private insurance was permitted. And a very well-known study by Duckett, et al. tracked what took place in terms of wait times in Australia as the multipayer system was put in place.

And what they found was in those areas of Australia where private insurance was being taken up and utilized, waits in the public system became longer.

Burr: What do you say to an elected official who goes to Florida and not the Canadian system to have a heart valve replacement?

Martin: It’s actually interesting, because in fact the people who are the pioneers of that particular surgery, which Premier [Danny] Williams had, and have the best health outcomes in the world for that surgery, are in Toronto, at the Peter Munk Cardiac Center, just down the street from where I work.

So what I say is that sometimes people have a perception, and I believe that actually this is fuelled in part by media discourse, that going to where you pay more for something, that that necessarily makes it better, but it’s not actually borne out by the evidence on outcomes from that cardiac surgery or any other.

Burr: On average, how many Canadian patients on a waiting list die each year? Do you know?

Martin: I don’t, sir, but I know that there are 45,000 in America who die waiting because they don’t have insurance at all.


Danielle Martin, Primary care physician, Women’s College Hospital, Toronto.