First ministers: Take real action on health care
Dr. Charles S. Shaver offers three concrete suggestions.
One potential source (of revenue) is medical tourism.
On Friday, Prime Minister Justin Trudeau will host a First Ministers’ Meeting in Montreal. The group needs to act on two issues: providing fully portable medical benefits to Quebecers, and overall health reform nationally.
If trade barriers are to be improved, all Canadians must be assured that if they visit another part of the country on business or vacation, they will have fully portable medical benefits. This would be the case if Quebec were to sign the Reciprocal Medical Billing Agreement. Otherwise, the federal government should agree to pay physicians directly for treating out-of-province patients.
Health consumes about half of the budget of each province. The federal government provides slightly over 20 per cent. In Quebec, about 16 per cent of the Health and Social Services budget comes from federal funding.
Federal Finance Minister Bill Morneau announced that the deficit for this fiscal year would be $18.1 billion — more than three times what was initially promised. By 2023-24, the total debt would be $765 billion. Normally, in “good times,” the government is expected to pay down debt. Now with the closure of General Motors in Oshawa, and the continued drop in oil prices with no new pipeline on the horizon, these numbers could become considerably worse.
Ontario has a debt of $347 billion and Quebec has one of $187 billion. All provinces need new sources of revenue to support health delivery, especially if their physicians and other health professionals are to be fairly remunerated.
Yet Ottawa remains intransigent over amending the Canada Health Act to permit provinces to find new sources of revenue.
One potential source is medical tourism. At the First Ministers’ Meeting, a topic on the agenda is how to diversify international trade. One thing Canada can do less expensively than the United States is deliver health care. A knee or hip replacement costs US$60,000 to $80,000 in Boston or New York City, but only about C$20,000 at a private clinic near Montreal.
Encouraging expansion of hospitals across Canada with operating rooms devoted to elective surgery such as joint replacements on American and other foreign patients, would bring in much-needed revenue, and provide employment for orthopedic surgeons and other health professionals; they would remain in this country to service their fellow Canadians and shorten wait lists.
Much more controversial is whether to amend the Canada Health Act to permit a limited amount of privatization for residents of Canada. Each provincial medical association could co-ordinate this by polling its members and asking persons to identify themselves if they have ever worked in nations with blended public/private health care systems. Those with first-hand knowledge of such systems would be invited to participate in town hall meetings across each province. They would field questions concerning the pros and cons of health delivery in each country. If the public then became more receptive to modifications of our current single-payer system, politicians might more openly support these proposals.
According to a poll by the World Health Organization of health-care systems, eight of the best 10 and 19 of the best 25 nations for healthcare services had a blended public/private system. (Canada was ranked number 30.)
We should be open-minded and prepared to learn from other countries with universal, efficient systems, shorter wait times, and high rates of patient and physician satisfaction.
The Dec. 7 meeting should not be just another “photo-op.” Trudeau and the other premiers should strongly encourage Quebec Premier François Legault to sign the Reciprocal Medical Billing Agreement. They should also set up a committee to study modernizing and amending the Canada Health Act with a view to eventually permitting a blended public/private system.