Changes in hand surgery in Canada over the past 40 years: Some personal observations.

Hand surgery in Canada versus tHe united states Since the introduction of universal health care in Canada approximately 30 years ago, every patient with a hand injury has received the same care, regardless of their financial status or their place of employment. Although future changes to the health care system in the United States (US) may occur during the current administration, it does not appear that every patient with a hand injury will be able to receive the same care without incurring a cost, which could be prohibitive. In the US, a patient with a hand injury can receive treatment in a private outof-hospital unit; in Canada, this is neither practical nor desirable. Hand surgeons in the US usually have to deal with third-party representatives who often are the decision makers regarding whether the proposed surgery will be covered by their company. Fortunately, this is not the case in Canada.