Does the ideal health care system exist? Will it be accepted in Canada?

1Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia; 2Division of Plastic Surgery, University of Manitoba, Winnipeg, Manitoba Correspondence and reprints: Dr Jugpal S Arneja, University of British Columbia, British Columbia Children’s Hospital, Division of Plastic Surgery, K3-131, 4480 Oak Street, Vancouver, British Columbia V6H 3V4. Telephone 604-875-2794, fax 604-875-2749, e-mail [email protected] Let’s face it, surgery is expensive, resource intensive and complex. In most Canadian provinces, health care has assumed >50% of the overall provincial budget and these costs show no signs of falling. On a cursory count, at least one dozen separate processes need to dovetail for a surgical procedure to occur, including a suitable infrastructure (preoperative, operative, recovery), appropriate equipment, adequate human resources (nursing, anesthesia, surgery and support staff) and aligned patient variables (correct indication, informed consent, fasted, etc). In the United States, health systems leverage the operating room as a profit centre, passing these costs to the insurer, while in Canada (and other socialized health care systems), the operating room is the most expensive cost centre in any facility. Currently, the United States leads the world in health care spending, which has surpassed 17% of gross domestic product (GDP). Although not as high in Canada, health care spending was approaching 12% of GDP. Throughout the world, many surgical techniques have been standardized, with reportable standardized outcomes related to the specific surgery. Little comparative data are available to evaluate the system providing the resources for the reconstructive surgeon and their patients. As these health delivery systems evolve, the question as to what is ideal continually arises.