post by Bill Gardner
fans of the Canadian single-payer system should know that virtually the same share of people with a heart attack fail to receive beta-blockers in Canada as in the United States.
Not a surprise to me. We have only been working at our Canadian hospital for a couple of weeks, but it is quite clear that holding doctors accountable for meeting standards of care is just as serious a problem here as it is in the United States.
There is a single payer in Canada (although it is the province, not the federal government). The provinces, however, just pay for the care. The hospitals and the doctors are independent contractors, and they and the patients make the decisions about care. There is no one from the government in the building giving orders.
But, you ask, why can't the party paying the bill demand improvements in care as part of the contract? I hope they can. However, a principal can only influence an agent to the degree that the principal can measure the agent's performance. That is just as big a challenge here as it is in the US.