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It's hard to tell if there are inefficiencies and waste or if health care is just simply really expensive.

Health care is done by the Provinces in Canada, with transfers from the Federal Government to help out. The most recent Alberta budget[0] puts the cost of health care at about $20B. This represents approximately 40% of Alberta government spending.

Is that due to waste or inefficiencies? I honestly have no idea. I just know that it's a big number.

Another thing to keep in mind is that, at least in Canada, the government provides some base amount of health services, but there are still other things that aren't covered. In Alberta, someone might go to the ER for a severe asthma attack and that's covered, but the prescriptions to keep the asthma under control are paid for out of pocket or from a benefit plan (which could be an individual plan or through an employer). Similarly, dental is not covered, but may be covered under a benefit plan.

[0] http://finance.alberta.ca/publications/budget/budget2016/fis...

There was talk of starting to cover dental.

The prescription thing is a pain in the butt. My mom had to pay out of pocket for her medication for years, until she got a job with prescription coverage.

Why do you say inefficiencies? 40% is entirely out of context, because you haven't listed what other budgeting responsibilities Canadian provinces have.

Canada spends far less per capita on health than the us, and gets better outcomes.

It's certainly expensive, but it's hard to make the case that Canadian care is expensive relative to the US.

> Health care is done by the Provinces in Canada, with transfers from the Federal Government to help out. The most recent Alberta budget[0] puts the cost of health care at about $20B. This represents approximately 40% of Alberta government spending.

Worth considering:

Per http://www.chcf.org/publications/2016/05/health-care-costs-1...

> US health spending reached $3.0 trillion in 2014, or $9,523 per capita, and accounted for 17.5% of gross domestic product (GDP).

The Population of Alberta is around 4,196,457 per a statscan estimate for 2015.

4,196,457 * 9,523 = 39962860011

So we're spending ~20,000,000,000 CAD = ~15.5 Billion USD, versus 39,962,860,011 USD for the same population in the US.

edit: The US number seems to include prescription drug spending. Per http://www.statista.com/statistics/436305/medication-spendin..., it's $867 per person in Alberta, or $3,638,328,219 CAD -- so it's closer to $18.5 Billion USD for health spending in Alberta.

That's a better deal any way you look at it, especially when you bear in mind that Canada has better overall outcomes than the US.

>That's a better deal any way you look at it

I'm Canadian and can't get a family doctor (nor can my wife). I don't consider that a "good deal". Maybe if it was more lucrative (read: doctors made more money, budgets were higher) we could attract more talent and I could?

I would really like to see a breakdown of the actual costs to provide a given service. Take something simple like removing an appendix or gall bladder. You have one surgeon, one or two surgical assistants (typically med students / interns), plus a couple nursing staff, and the anesthesiologist, for about an hour. 6 people, assume 200K per year, that's $100 per hour, so $600 in people salaries. (Throw in another couple hours total for prep time, consultation, planning, etc, still you are talking less than 2k).

Then you have amortization of the equipment and operating room, and some fraction of the hospital support staff during the prep and recovery stages. But even with that I still don't see where the $80,000 for the surgery cost comes from.

The US system has the same issue -- many people don't have a regular family doctor and rely on clinics. It's a more complicated problem than pay -- family medicine simply isn't an attractive speciality to many medical students. Money could move the needle a bit, but treating strep throat is never going to be a prestigious pursuit versus a lot of other specialties. And if it doesn't improve overall longterm outcomes, it's not worth spending the money to move that needle.

At any rate, it's rarely impossible to find a family doctor, but it can take some persistence to find one accepting new patients. Almost every provincial medical association maintains a list of family doctors accepting new patients. If you're in a small town it might be a challenge, though.

edit: to put some numbers on this, 15% of Canadians don't have a family doctor (http://www.ctvnews.ca/health/canada-ranked-last-among-oecd-c...). In the much higher spending US system, 20% of Americans don't have a family doctor (http://www.fiercehealthcare.com/healthcare/one-five-american...).

I was replying to this part of the parent comment when I used the words "inefficiencies" and "waste":

> Does the lack of a large private insurance market in countries with government-provided health insurance cause lots of inefficiencies and waste?

I also acknowledged that I have no idea if $20B is good or bad. And I did not make the case that it's more or less expensive relative to the US.

Another commenter took the Alberta budget numbers and ran with it to get to a per-capita cost relative to the US.

Where do you live that you are having these problems? I was able to find a family doctor within a month of searching and reading reviews. Granted I'm based in a major city (Ottawa), but I was normally directed to other physicians when I called one that wasn't accepting patients.

The anesthesiologist alone will be $5k.

They are the person most able to kill you when they screw up, so a significant portion of that bill is insurance. They also make $300-500k.

Also recovery room or ICU time is very expensive -- something like $1000/hr in some cases.

That type of procedure (gall bladder) will cost something like $15-20k.

When I had a spinal fusion, it was a 4-5 hour procedure involving a neurosurgeon, his PA, an anesthesiologist and his nurse, and 4-5 others. That procedure cost ~ $125k.

Yikes. In that case it'd be cheaper to fly to London and have it done privately here. It should typically be less than $8k for a gall bladder removal.

It's all relative. Alberta is "high" compared to other provinces though in the ball park of the other prairie provinces (Sask & Manitoba) per capita, though BC only spends $18B-ish for a higher population.

Ontario spends $50.8B, pop 13.1m, which seems more efficient per capita than Alberta; France is inline with that per capita ; the UK spends $195.8B (CAD), pop 64.1m, which is even lower.

In general, health care is really damn expensive.

Aren't healthcare list prices in the US really really distorted and nonsensical, due to decades of messed up incentives between hospitals and insurers?

It's because in healthcare, the vendor never knows if or when they will be paid, and how much it will cost to get paid, so the strategy is to charge as much as possible and just hope for the best. That means people who are dead broke get their care for free since they have nothing to pay with, insurance companies and the government strong arm the vendor into discounts since they buy in volume, and the person that gets screwed is the little guy who makes enough money to not be poor, but not enough money to have gold plated insurance but he also can't fight the hospital.

1. Health care is, indeed, really expensive. Most places with government-provided health care try to make sure the most expensive items aren't over-bought, reducing waste. For example, MRI machines. Some folks have to travel quite far to get a non-emergency MRI in Canada and wait some time, yet in the states, there might be 3-4 places in a city with 50k people. Neither extreme is ideal.

2. There are always going to be a few inefficiencies in health care, just like every other business. Some of these can't be helped as much. We want well-stocked emergency rooms and pharmacies to visit after the 2am visit said emergency rooms, for example. Drugs expire: Pharmacies take manpower even in slow times.

3. The other thing with health care is that it does somewhat cost what it costs. There are ways to reduce some of the costs by public education, generic drugs, not providing antibiotics when they aren't needed, and other such things. But folks get sick and hurt regardless.

Side note: The bit about the prescriptions is interesting. I'm in Norway. Private health care is available, but everyone is covered by the state health care. You pay a certain amount per year, then the government covers most things. Prescription coverage vary once the government starts paying. Things you need for life - such as heart medicines - will wind up covered, but some things like allergy meds you might have to pay a portion of the cost regardless. Most hospital expenses are free.

Dental is free for children under 18: 18 and 19 year olds get 75% covered and adults have to pay out of pocket.

Cannot speak for the cause, but the prices are distorted. I was taken to ER a couple of months ago and x-ray of chest cost $3500 and CT of chest $5500. The equivalent prices at the private sector of my home country would have been $70 and $120 and I could have gotten those done just as quickly as in ER in US.

In most places in the US, you can't even get list prices. Calling up providers for quotes gets you hung up on.

Singapore, which has a significant market portion to their health care industry, mandates posting of prices.

I've actually found that you can get list prices from hospitals. The problem is that they're distorted and sky-high and not necessarily very reflective of what you will have to pay if you have insurance, because the insurers have negotiated their own rates. Those rates are treated as top secret by everyone involved (that is, until you get a bill).