[The following letter comes from Konrad Brenner, an Estonian-Canadian reader in Ramara, Ontario. Mr. Brenner left Estonia in 1941 and spent twelve years living in Germany before moving permanently to Ontario, where he worked as a civil engineer.]
To the Editor,
Eesti Elu recently carried an article [“Canada’s Healthcare Paradox: High Spending, Low Returns” by Evi Mustel] indicating that the Estonian health system is much better than the Canadian. Below are a few comments on this from a person who has never worked in the health system but has used it in Estonia before the Soviet times, in the Third Reich, in post-Second World War Germany, and in Ontario. The following comments deal with reducing medical delivery cost and do not touch on what should be done to improve the service, which is not excellent these days.
The reported difference in health cost per person is great. Even if the estimates are not very accurate, the reported costs are a disappointment from a Canadian’s viewpoint. My comments are based on Ontario, as we have provincial health systems and not a national system. To change this would require extensive legislative changes.
“… centralizing of the records will save some money but not to the extent that our per person cost is comparable to the Estonian cost.”
Ontario is working on digitizing and centralizing medical records, but it appears to be moving ahead slowly. Such centralizing of the records will save some money but not to the extent that our per person cost is comparable to the Estonian cost.
Our costs are higher than in Estonia for several reasons. One is that our doctors appear to earn more income compared to the cost of living than doctors in Estonia. The other reason is that much of the health service is provided as a private business with costs billed to the Ontario Government. (Most doctors and clinics are private businesses/contractors.) This arrangement has higher administrative costs than the Estonian system, where more doctors are just employees and receive a salary. Thirdly, the moving of patients between specialists and general doctors is too complicated and costly.
Considering the history of medicine in this country, I suggest that the most realistic approach would be for the government to work on implementing central medical records, speeding up the transfer of patients between doctors. In the longer run, look at moving healthcare from the Provincial to the Federal Government level and also look at transferring more doctors from a private contractor system to government employment.
Konrad Brenner
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