Blended health care could provide fiscal boost

Other nations’ public/private systems have merit, Dr. Charles S. Shaver says.

“We need to start operating as one country, as opposed to many provinces who are looking out for their own individual interests.” — Alberta Finance Minister Joe Ceci

After the First Ministers’ meeting in Montreal on Dec. 7, Manitoba Premier Brian Pallister stated that the premiers were willing to reduce trade barriers between their respective borders. Hopefully, he reminded Quebec Premier Francois Legault that this also includes portable medical benefits.

In order to promote tourism, trade, and to facilitate students who wish to attend out-of-province universities, all Canadians must be assured that they will have full health coverage throughout this country.

Because Quebec has refused to obey the Canada Health Act and sign the Reciprocal Medical Billing Agreement, its residents treated in Saskatchewan and other provinces usually must pay MDS directly and await partial reimbursement.

Ironically, in his mandate letter to Health Minister Ginette Petitpas Taylor, Justin Trudeau stressed only cracking down on user fees and extra billing, and completely ignored problems such as portability of medical benefits outside of Quebec.

At the Montreal meeting, Pallister discussed the impact of “slipping health transfers from Ottawa.” The federal government contributes slightly more than 20 per cent of health funding to most provinces. Saskatchewan has a public debt of $18.2 billion and Alberta one of $9.1 billion. Meanwhile, the federal deficit is $19.4 billion and the total debt is $688 billion; this will almost certainly rise with the closure of General Motors in Oshawa and the decline in oil prices with no new pipelines on the horizon. All provinces need new sources of revenue, especially if their physicians and other health professionals are to be fairly remunerated.

However, Ottawa remains intransigent over amending the CHA so as to permit provinces to find new sources of revenue.

Provincial governments desperately do need new sources of revenue. One potential source is medical tourism. This would not contravene the CHA. A recent survey found that 165 recent residents and fellows in orthopedics were seeking full-time employment in Canada and 73 were working outside the country. A knee or hip replacement costs US$60,000 to US$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 ORS devoted to elective surgery such as joint replacements on American, Chinese, 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.

More controversial is whether to amend the CHA so as to permit a limited amount of privatization for residents of Canada. Each provincial medical association could poll its members and ask persons to identify themselves if they ever worked in Australia, New Zealand, Taiwan, Israel, or most of the European countries — all 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. If they resulted in the public becoming more receptive, Sask. Premier Scott Moe, federal Conservative Leader Andrew Scheer, Pallister, Ontario Premier Doug Ford and New Brunswick Premier Blaine Higgs might more openly support these proposals.

According to a poll by the WHO of health-care systems, eight of the best 10 and 19 of the best 25 nations had a blended public/private system. (Canada was ranked 30th).

We should be open-minded and be prepared to learn from other countries with efficient systems.

Inasmuch as Trudeau seems to ignore these problems, perhaps the Council of the Federation — an organization of all provincial and territorial leaders — could establish a formal committee to study the advantages of modernizing and amending the CHA so as to permit a limited amount of privatization. Such health reform would continue to ensure universal coverage, but might also provide for greater fiscal sustainability.

Ottawa physician Shaver graduated from Princeton University and Johns Hopkins School of Medicine, and returned to Canada in 1970. He is chair of the section on General Internal Medicine of the Ontario Medical Association. The views here are his own.