Universal health care and high-tech medicine

The purpose of this article is to review the Canadian universal health care system, focusing on the benefits and consequences of high-tech medicine. Such knowledge could be valuable in guiding the evolving universal health care system in Taiwan. The Canadian Health Care System was developed under the ideals of universality, accessibility and portability. It has successfully provided health care to all citizens regardless of their financial resources and is supported by the great majority of Canadians. However, in spite of various efforts to control health care costs, the governmental financial burden continues to escalate, seriously affecting the development and availability of high-tech medicine for patients who require such services. Delay in the acquisition of high-tech equipment, scarcity of high-tech resources relative to the population size and long waiting periods for certain services have been experienced in Canada. An aging population and advances in medical technology will force the continued escalation of health care costs in spite of optimization of the health care delivery system, and the most serious impact will be felt in high-tech medicine. A number of possible solutions such as user fees or rationing of health care services in high-tech medicine are so far unacceptable in Canada, both for ideologic and ethical reasons. However, rationing and user fees, which the author considers to be inevitable, can be designed to diminish undesirable effects and address the problem of deteriorating high-tech medical care in a universal health care system. Approaches such as a graded user fee based on income, and technologic rationing based on a cost/utility ratio may have to be explored.(ABSTRACT TRUNCATED AT 250 WORDS)