Canada's public health-care system, often cited in the United States as a shining example of quality and efficiency, is facing problems with escalating costs and growing patient waiting lists.
Canadians in need of heart surgery are paying for operations at U.S. hospitals rather than waiting for months in Canada, where there is a shortage of facilities, equipment and staff.
With its expanding national debt, Canada is under pressure to curb its health-care costs. It spent $1,483 (U.S.) per person on health care in 1987, more than any other country except the United States, which spent $2,051, mostly through private insurance plans.
The figures, from the Organization for Economic Cooperation and Development, a group that promotes trade and economic growth, were the latest available.
"We (the U.S. and Canada) both have less than two-thirds the elderly population of a number of European countries, yet we are both outspending them by as much as two times per person on health care," said Dr. Martin Barkin, deputy minister of health in Ontario.
"When we reach their demographic mix, and we will, both our countries will have to face health-care expenditures twice what we now spend, unless we introduce some changes."
Ake Blonqvist, an economist and health-care expert at the University of Western Ontario in London, said there is little evidence North Americans get better care for the money spent.
"We don't rationalize high-technology procedures as efficiently as some of the European countries," Blonqvist said. "Doctors have no financial incentive. All they have incentive to do is scream as loud as they can on behalf of themselves and their patients for more government funding."
Canadians are aware health-care costs are high and their government is strapped for cash, but they are not keen to tamper with the health system.
Since it was established in 1971, it has been a source of pride for Canadians, who believe that everyone, regardless of income, should get the best health-care the country can offer.
The federal government has continually prevented any U.S.-style private plans from existing alongside publicly funded medicare systems administered by the provinces. And if doctors try to charge patients over and above the permitted rates, the government withholds funds.
While there is little demand for private medical plans in Canada, waiting lists for emergency cancer and heart treatment at certain centers are prompting Canadians to go to U.S. hospitals.
In Ontario, the province will reimburse 75 percent of the medical costs, while the patient is left to pay the balance. But the U.S. hospitals, eager to do business, have been waiving the additional 25 percent of the fees.
A private voluntary group in Ontario, "Heartbeat Windsor," says it has referred 400 Canadians to U.S. hospitals for critical heart operations.
In Vancouver, the British Columbia Health Department sent a group of patients to Seattle for cardiac surgery.
In response to the waiting lists, Ontario has made cardiovascular and cancer treatment "priority " areas, while British Columbia has established a royal commission on health .
Recently, Quebec also outlined several measures to curb abuse and spiraling costs. Among other things, it wants to impose a $5 fee for each unnecessary visit to an emergency room and to raise awareness of the cost of health care by sending everyone annual accounts of services received.