It is common knowledge that medical care in the United States is among the most expensive in the world. But beyond acknowledging that questionable accomplishment, we rarely inquire as to why. During my recent trip to Canada as a Fulbright scholar, I had the opportunity to pose this question to one of their foremost authorities on health care.
His name is David Dodge, and he is an economist who has held positions including that of federal deputy health minister and governor of the Bank of Canada for seven separate terms.
Right quickly, he zeroed in on the problem of rising medical costs that are plaguing both of our nations. “Medical technology is exciting in that it is similar to consumer electronics in that it generates new items at a prodigious rate,” he added. “The pace at which new products are developed in both of these fields is astounding.”
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Once we figure out how to make use of genetic data, we will be on the cusp of yet another wave of innovative new products. It will be a “quantum jump” into the unknown in the next quarter of a century, both in terms of medicine and finances, according to Dodge, and it will revolutionize the way medicine is practiced.
Dodge, on the other hand, made a clear difference between consumer electronics and medical technology almost immediately. However, the price of older technology does not continue to decrease as it has with consumer goods such as computers and television sets.
This is in contrast to the continuing trend of the healthcare business to produce new items that are more expensive than their predecessors. Why hasn’t the price of cataract surgery dropped by 90 percent since new laser procedures have been introduced?
Dodge asked. “The price has decreased somewhat, but not by a significant amount. For the surgery, you used to have to stay in the hospital for two weeks. Now it takes fifteen minutes.”
Dodge offered the following hypothesis as a possible justification for the situation: “Perhaps there is something wrong with the economic mechanism.” The market doesn’t appear to be functioning properly.
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Perhaps the provision of medical care stands apart from other types of commodities and services. Another illustration was given by him: Despite the fact that there is a significant amount of interest in their services, geriatricians in Canada receive the lowest salaries of all the medical experts.
If the market mechanisms of supply and demand were functioning normally, then the strong demand for their services might cause prices to rise. When there is an increase in the cost of gasoline, the oil industry typically cites this justification.
Our discussion on that day in Ottawa did not result in the production of any concrete answers. Dodge hypothesized that the failure of healthcare markets might be due to the fact that patients typically do not experience the discomfort of paying their bills directly.
They are compensated by the provincial governments of Canada. In the United States, the majority of people have their medical expenses covered by either Medicare, Medicaid, or health insurance provided by their employers.
When it comes to the supply and demand equation for physician compensation, he also stated that the self-regulation of medical professionals in both nations would be partly to blame for the lopsided nature of the equation. Dodge explained to me that governments, for understandable reasons, do not want to take on the self-regulatory parts of many professions.
To put it another way, they don’t want to meddle too much with the rates that professionals charge for their services. The majority of medical professionals are compensated on a fee-for-service basis in Canada, just as they are in the United States.
On the other hand, it’s possible that the Canadian government will negotiate more strongly with professional associations. Check out why MBBS in Canada is good for Asian students.
Patients are also somewhat at fault for the cost dilemma that exists today. Dodge observed that the majority of patients prefer to be cared for by physicians rather than the more affordable nurse practitioners; when something is wrong, patients prefer to speak directly with physicians rather than someone else, even if the other person is capable of managing their care just as effectively.