Canadians Stand for Fairness But Would Pull Strings for Better Care

Published February 1, 2008

Many Canadians who advocate “fairness” in health care would pull strings or give gifts or donations to see a doctor sooner than the national health care system there will allow, and a significant number actually do so, according to a study published in the European Journal of Medicine.

Dr. Steven Friedman, an emergency physician and professor, was the principal investigator for the study, which he called the “Do as I say, not as I do” survey. The report examines the opinions of residents of Toronto, Ontario.

“A good proportion of people said yes, under certain circumstances they would take actions that would jump the queue, even though that sort of defeated the principles of fairness that they themselves said they advocated,” Friedman said.

Cheating Admitted

Friedman randomly selected 101 people from the Toronto telephone book to survey. Of those, 95 percent advocated equal access to health care based on needs.

The study, published in October, defined queue-jumping as favorable placement or prioritization of a patient in the waiting list for reasons other than medical need.

About half the people surveyed said they would call a friend who is a doctor, works for a doctor, or is a hospital administrator to improve their position on a waiting list. Sixteen percent admitted they had actually done so.

Doctors Bribed

In high-impact medical scenarios, Friedman found 51 percent would try to bribe doctors with material goods, and 71 percent would offer non-material bribes to get treated more quickly.

This doesn’t mean Canadians don’t advocate fairness or prefer another form of health care system, Friedman said. In fact, he wrote in the study, “public, universal health care in Canada has been strongly associated with Canadian identity and values.” It’s just that when their own health is on the line, Canadians won’t necessarily act in accordance with their values, the study concludes.

John R. Graham, director of health care studies at the Pacific Research Institute in San Francisco and a native Canadian, said the study is a good piece of information about how people manipulate Canada’s medical system. It’s also relevant to the United States, he notes, as more politicians here are beginning to advocate socialized medicine.

“Talk is cheap,” Graham said. “People have almost unanimity in terms of happy talk, but when it comes to really getting health care, you do what you’ve got to do. American politicians are just like any politicians in any other country. They’re just as liable to fall into happy talk.”

Inner Workings Revealed

In a free country, some people will choose not to buy health insurance, no matter what, Graham points out. But forcing health care on citizens could have unintended consequences, as this study would seem to suggest, he said.

“It’s shocking to me that they use the term ‘material inducement for preferential access,'” Graham said. “If it’s as blunt as bribery now, the iron curtain of Canadian health care will fall.”

Greg Scandlen, president of Consumers for Health Care Choices, a group based in Hagerstown, Maryland, said Friedman’s study is useful because as Americans consider a more universal, mandated health care system, it’s worthwhile to take a look at the on-the-ground workings of nationalized systems.

“The more we find out about them, the less attractive they would be to Americans,” Scandlen said. “I think it’s fair to say that will always be true with a politically managed system. It becomes who you know more than anything else, and political influence becomes the predominant measure of success.”

Jillian Melchior ([email protected]) writes from Michigan.

For more information …

“Do as I say, not as I do: A survey of public impressions of queue-jumping and preferential access,” by Dr. Steven Friedman, Lee Schofield, and Sam Tirkos, European Journal of Medicine, October 2007:;jsessionid=HQMHfrKmVmz9LZJ7BTTwWhc9n51TBjsJGJ2SM2NPRTP6yTqCxsrp!65375592!181195628!8091!-1