Need discussion on health-care financing
The cost of healthcare in Canada continues to rise at a rate in excess of general inflation. If this trend continues unabated, within a decade virtually every province and territory will be spending 90 per cent or more of their existing budgets on this single item.
Alternatively, taxes will have to increase significantly. What Canada needs is an open and forthright discussion on the financing of health care — with no holds barred on issues normally considered too sensitive to table.
A major problem we face in any discussion of reforming healthcare delivery is a belief on the part of some (particularly politicians) that there is no winning solution; better to cling to the status quo rather than face scare tactics aimed at riling up the electorate.
For example, consider a very basic issue: how to compensate physicians.
Most, though not all, physicians are compensated by the province on a “fee for service” basis. When you go to your doctor, each visit generates a fee. The way to increase a doctor’s earnings is to see more patients in any day. This could lead to a decrease in the quality of care.
As my family physician says, “Taking time to cover all of your concerns when you come in means a lower income for me because it takes time, but I think it means better care for you.”
An alternative is paying physicians an annual wage independent of their patient visits. Many feel that could be problematic, with some doctors lessening their work load thereby increasing the need for family doctors — who are already in short supply. Even if wages are tied to the number of patients on a physician’s roster (rather than to the number of times he or she sees each patient and for what), there remains a need for accurate reporting of treatments undertaken because this information is vital to tracking public health trends.
Further, setting the compensation of any given physician would require a consistently-applied policy concerning experience, updating of technical training, location and place of work.
A range of working conditions may have to be factored in: single versus group practice and work hours (Monday to Friday 9 to 5, versus evenings and weekends). Would compensation include just income or would it reimburse overhead expenses as well?
Then there is the perennial question whether physicians should be allowed to collect patient fees directly in addition to being paid by the public purse?
If “yes,” the result would be a two-tier system of public and private healthcare alternatives. Would private doctors be charged for the use of public facilities such as hospitals? Would patients be able to deduct fees paid from their taxable income?
Finally, whichever method (or methods) is chosen, we need a full public discussion and then a clear policy established by the B.C. government. Perhaps the best way of doing this would be a Royal Commission.
Another pressing issue is the supply of doctors in rural areas. One potential remedy might involve allowing foreigntrained physicians to establish practices in remote communities, subject to audit either by the College of Physicians and Surgeons or a panel established and run by the provincial government.
After a suitable period of satisfactory performance, a doctor would receive a normal licence and be allowed to practice anywhere in the province.
Another possible solution could involve the treatment of student debt that graduating doctors, on average, have accumulated in gaining their training, which can range from $158,000 to over $200,000. The province might establish a program to assume the debt of new doctors who work in a rural community for 5 years (up to a fixed amount of, say, $150,000).
While the complexities involved are substantial, and while such initiatives address only one element of cost in health care systems, we need to start working on finding solutions now.
Otherwise provincial finance ministers and taxpayers will find themselves over a barrel.
David Bond is an author and retired bank economist. To contact the writer: curmudgeon@harumpf.com.