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Clinical Laboratories and Pathology Groups

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Clinical Laboratories and Pathology Groups

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Canada’s Early Response to COVID-19 Garnered Praise, But Critical Shortages of Clinical Lab Tests and Delays in Test Results Brought Criticism of the Government’s Actions. Sound Familiar?

Though coronavirus infections were detected nearly simultaneously in both Canada and the US, total cases and total deaths vary dramatically leading experts to question how differences in healthcare systems might have contributed

Can clinical laboratories in the United States learn from Canada’s response to the COVID-19 pandemic? While our northern neighbor won praise for its early response to the coronavirus, since then Canada has faced criticism over a lack of access to SARS-CoV-2 testing and long wait times for test results—criticism levied at the United States’ response to the outbreak as well.

In “Canada Shows How Easy Virus Testing Can Be,” Foreign Policy reported that Canada was more prepared to mount a successful response to COVID-19 because it systematically improved its pandemic-response preparedness and testing capacity after the 2003 SARS coronavirus (SARS-CoV-1) outbreak.

“Provincial laboratories put the infrastructure in place that would allow them to run their own testing and validation without help from the federal government,” Foreign Policy wrote. “At the same time, the federally run National Microbiology Laboratory in Winnipeg expanded its own capacity to support those efforts.”

However, Canada’s pandemic response has not been criticism free. In “Health Minister Says Test Result Wait Times ‘Not Acceptable’ As Ontario Confirms 25 New COVID-19 Cases,” CBC News reported in late March about COVID-19 testing shortages and four-day wait times for test results that were “not acceptable,” particularly in Ontario, where people with mild symptoms were being refused testing and sent home unless they worked in high-risk settings.

In “Why It’s So Difficult to Get Tested for COVID-19 in Canada,” CBC News suggested that Canada’s test rationing was due to a laboratory-supply shortage, a problem which The New York Timesreports still has not been overcome in the US more than six months into the pandemic.

Government Bureaucracy’s Effect on Response to COVID-19

In “Canada’s Coronavirus Response Has Not Been Perfect. But It’s Done Far Better than the US,” The Washington Post reported that the initial exposure to the virus by the US and Canada was similar. Both the US and Canada have extensive ties to Europe and China, resulting in the two countries identifying their first cases of COVID-19 within a week of one another in January. Since then, however, the progression of the disease diverged dramatically in the two nations.

To date, the US has experienced 7,361,611 total cases with 209,808 total deaths, placing it in the number one spot globally on Worldometers’ COVID-19 tracking site. By contrast, Canada is in 26th place, with 155,301 total cases and 9,278 total deaths. However, to date the US has conducted 105,401,706 total clinical laboratory tests, as opposed to Canada’s 7,220,108 total tests. This might account for the disparity in total cases, but what accounts for the huge difference in total US deaths due to COVID-19 compared to Canada?

A Fraser Institute blog post authored by Steven Globerman, PhD, Resident Scholar and Addington Chair in Measurement at the Institute and Professor Emeritus at Western Washington University, titled, “US COVID Experience Highlights Risks of Centralized Management of Healthcare,” blamed the US’ “top-down, centralized approach to testing” for the “testing fiasco” that marked the US’ initial slow response to the pandemic. Globerman maintained the Centers for Disease Control and Prevention’s insistence on producing its own COVID-19 diagnostic test, rather than using a proven German-produced test, was the first of several missteps by the US.

Steven Globerman, PhD
“While there has been much criticism of the decentralized private insurance industry in the US, the major shortcomings in testing that characterize the US experience during the current pandemic seem to be the result of the government healthcare bureaucracy,” wrote Steven Globerman, PhD, (above), Resident Scholar and Addington Chair in Measurement at the Fraser Institute and Professor Emeritus at Western Washington University. (Photo copyright: Fraser Institute.)

Globerman also noted the problems were compounded by the US government’s low initial Medicare payments to private laboratories for COVID-19 tests. “Medicare is reputed to have paid about half the price it pays for a flu test, even though the coronavirus test is substantially more expensive to produce. The price forced labs to take losses on the test, blocking many labs from scaling up production to expand the nation’s testing capacity.

“Only after major lab organizations made public pleas for increased Medicare reimbursement, and long backlogs emerged for testing and reporting test results, did Medicare agree to double its payments for coronavirus tests,” Globerman wrote.

Could National Differences in Healthcare Systems Be to Blame for Disparate COVID-19 Outcomes?

In “Canada Succeeded on Coronavirus Where America Failed. Why?” Canadian public health experts told Vox differences in the two countries’ political leadership, public health funding, and healthcare systems are to blame for the US experiencing a worse coronavirus outbreak than Canada.

Is that true? Sally C. Pipes, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute, a former resident of Canada and an ardent critic of single-payer healthcare, argued that Canada’s healthcare system is plagued by long waits for elective procedures, equipment shortages, and limited access to cutting-edge drugs and therapies.

In “The Canadian Health-Care Scare,” Pipes wrote, “Our northern neighbors wait months for routine care and lack access to the latest life-saving medications and technology. Importing this system would lead to widespread misery,” adding, “Is a six-month wait for a knee replacement—the median in Canada last year—reasonable, when it keeps someone in pain and unable to work? One study puts the total cost of waiting for joint-replacement surgery after taking into account lost wages and additional tests and scans at almost $20,000. It’s no wonder that more than 323,000 Canadians left the country to seek care abroad in 2017.”

A Fraser Institute study of wait times in Canada for medically-necessary treatments underscores Pipes’ claims. According to the study, the median wait time—from general practitioner referral to treatment—across 12 medical specialties was 20.9 weeks in 2019, the second highest recorded by the Institute. If this is the case, how did Canada earn praise for its early COVID-19 response?

It’s unclear what lessons American clinical laboratories can glean from Canada’s response to COVID-19. Nevertheless, lab managers should closely watch their counterparts in other nations around the world. The coronavirus does not respect borders or care about disparities in healthcare systems.

—Andrea Downing Peck

Related Information:

The Canadian Health-Care Scare

Waiting Your Turn: Waiting Times for Healthcare in Canada, 2019 Report

Worldometers COVID-19 Coronavirus Pandemic Tracking

Canada Succeeded on Coronavirus Where America Failed. Why?

Coronavirus Test Results Are Still Delayed

U.S. Doctor in Canada: Medicare for All would Have Made America’s COVID Response Much Better

Canada’s Coronavirus Response Has Not Been Perfect. But It’s Done Far Better than the U.S.

Why It’s so Difficult to Get Tested for COVID-19 in Canada

Health Minister Says Test Result Wait Times ‘Not Acceptable’ as Ontario Confirms 25 New COVID-19 Cases

Canada Shows How Easy Virus Testing Can Be

Hospitals in New York State and throughout the United States Are Advertising to Attract the Growing Number of Medical Tourists from Canada

Syracuse, New York, aims to position itself as the healthcare destination of choice for Ontarians right across the border who are weary of waiting for free healthcare from their provincial health service

There is a new twist in medical tourism! United States hospitals are advertising to Canadians who are frustrated by increasingly long waiting times for elective medical procedures from their national health service. U.S. providers are hoping to lure them across the border for quicker access to care.

Until recently, U.S. hospitals were not motivated to attract Canadian patients as a way to generate new admissions. However, years of sustained cuts to prices paid to U.S. hospitals by health insurers have made it economically attractive for U.S. hospitals to advertise to Canadian patients just across the border. The medical laboratories of American hospitals serving medical tourists benefit from this source of patients.

Number of Canadians Coming to U.S. for Medical Care Each Year Growing

While Canadians get most of their medical care for free through a nationwide, single-payer system administered by each province, thousands of Canadians come to the U.S. each year seeking medical care. In 2014, an estimated 52,513 Canadians received non-emergency medical treatment outside Canada. The largest number of patients leaving the country for healthcare are from the Province of Ontario and total 26,252, according to the Fraser Institute, a Canadian research organization. The number of Canadians seeking medical care outside the country’s borders was up 26% from a year earlier, the study showed. (more…)