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Professor Gordon Guyatt, MD, MSc, FRCP, OC is a Distinguished University Professor in the Department of Health Research Methods, Evidence and Impact and Medicine at McMaster University. He is a Fellow of the Canadian Academy of Health Sciences.
The British Medical Journal or BMJ had a list of 117 nominees in 2010 for the Lifetime Achievement Award. Guyatt was short-listed and came in second-place in the end. He earned the title of an Officer of the Order of Canada based on contributions from evidence-based medicine and its teaching.
He was elected a Fellow of the Royal Society of Canada in 2012 and a Member of the Canadian Medical Hall of Fame in 2015. He lectured on public vs. private healthcare funding in March of 2017, which seemed like a valuable conversation to publish in order to have this in the internet’s digital repository with one of Canada’s foremost academics.
For those with an interest in standardized metrics or academic rankings, he is the 14th most cited academic in the world in terms of H-Index at 222 and has a total citation count of more than 200,000. That is, he has the highest H-Index, likely, of any Canadian academic living or dead.
We conducted an extensive interview before: here, here, here, here, here, and here. We have other interviews in Canadian Atheist (here and here), Canadian Students for Sensible Drug Policy, Humanist Voices, and The Good Men Project.
As a specific topical interview, we focus on the efficiency, equity, and autonomy associated with national healthcare programs.
I got the opportunity to speak with professor Guyatt on national healthcare programs in developed countries. Guyatt spoke on things relevant to national healthcare in Canada. Those items Canada may have that other countries do not have.
Guyatt said, “It depends. There are two ways of doing national healthcare. One is a model like the German model. It is not a government program. It is a program that started as a job-based program. There are a whole bunch of organizations that the government ensures that, effectively, in the end, everybody is insured.”
He continued to say that this is not an overall government program, which is less efficient. For physician and hospital services, we have a single program. That program is provincially administered, but, at its core, amounts to a national program. That means increased efficiency.
For physician and hospital services, Guyatt talked about the funding being more by the funding than most other places. He described the ways in which places have a private section for the ability to pay for better and quicker care.
However, for physician and hospital services, we lack that, which becomes a bi equity advantage for Canadians. By equity, this means more people can use it. More of the general public gets access to the physician and hospital services.
“On the other hand, for everything other than the physician and hospital services, we are quite severely disadvantaged. The only people who have their drugs covered are those on social assistance over 65,” Guyatt noted.
If you are under 25 in Ontario, there are some support programs. If a drug costs too high, then this becomes burden for the low-income people. Where, for many low-income people, it becomes a situation in which they simply cannot afford their drugs.
Guyatt explained that drugs are a big gap and dental care is another gap. Where “we have essentially no coverage for public dental care, other countries to some degree cover dental care. The drugs and dental care the big deficiencies in the Canadian program,” he stated.
As the conversation progressed, I wanted to focus on the things Canada has, which other developed nations do not.
“I do not know the details, but I would have thought that it was hit and miss if some things get developed here and there are some enthusiastic and leading physicians bringing something in,” Guyatt explained, “Then there may be areas where we do particularly well. In other countries, they have other physicians.”
Guyatt talked about the United States healthcare system. He describes theirs as in many ways a disaster. For those who can pay for it, for the well insured, for those who can pay out of pocket, the US does the best for highly advanced medical technology. However, it “is a hit and miss thing.”
Canada, by comparison, does not have a particular are in which we are far more advanced for the medical technology.
When I questioned about lifespan and health span differences for those who do and those who do not have efficient and equitable access to health in their country, Guyatt made the opening salvo statement, “So, universal coverage is universal coverage.”
“If you are now talking about gradients, you are talking about gradients of insurance that come with gradients of income. That then becomes impossible to tease out,” Guyatt explained, “The lower income people are sicker and live shorter lives than high-income people. They are also the people when there is no government insurance who are not insured. It is also confounded with that.”
He described some professional research into the health outcomes in Canada and the US. If anything, the outcomes were a small advantage for Canada. That was attributable to more universal healthcare coverage. “You have many Americans who cannot afford drugs, hospitals, and so on. They are at a disadvantage in health outcome because they are poor and because of a lack of health coverage,” Guyatt stated.
Overall, the equity and efficiency associated with national healthcare programs (read: public) tends to produce better outcomes for more people on those two metrics with marginal or questionable autonomy benefits on privatized healthcare programs (read: private).
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Photo credit: Getty Images