Are our health dollars being put to best use?
At last, a recognition that Canadian citizens have a stake in the health-care system.
After decades of federal-provincial squabbling over funding, a report from the Public Policy Forum entitled “Taking Back Health Care: How to Accelerate People-Centred Care Now,” has shifted the focus to those who actually fund it.
Until now, Canadians have been on the sidelines as the beleaguered system they treasure above all else has been unravelling.
Perhaps the moment has arrived for them to cease being spectators and demand accountability for the billions of their tax dollars that have been poured into health care.
To do this, they need to understand it better and the learning curve will be steep, especially the funding piece. However, as a start, it would be useful to take a look at proposals to contract out routine surgeries to private, for-profit providers. There are numerous examples of this being done already.
On its face, this move seems innocuous and legal under the Canada Health Act. Patients are not required to pay at the point of service, but the devil is in the details and the details determine whether this is a sound financial move.
There are two questions that arise when a province chooses this route: one relates to the confidentiality of these contracts and the other to the fact that none of these facilities is equipped to deal with an emergency.
Although it is not necessary, in most cases, the contract a government enters into is behind an iron curtain of secrecy. Consequently, it isn’t possible to assess whether we are getting value for our money.
Alberta has been contracting out surgeries for many years and there have been comparisons between publicly-funded procedures and those done in private facilities.
It was found that there was a higher cost in the for-profit facilities. The government deemed that the additional costs were offset by the benefits of reducing waiting lists. The findings in the Alberta case are consistent with international studies which conclude that for-profit incursions into health care are costly and lack accountability.
The rationale that increasing contracting out will reduce wait times, is questionable because the pool of surgeons and anesthetists will not expand. Another statistic from Alberta is instructive: A comparison of wait times for cataract surgery in Calgary (where 96 per cent are contracted out) and Edmonton (where the figure is 18 per cent) found that Calgarians wait six weeks longer than Edmontonians do.
The other issue relates to what happens when something goes wrong. Surgical centres, equipped to carry out specific, uncomplicated surgeries, have all the equipment they need to do those and only those procedures. In an emergency, the patient has to be shipped to a fully-equipped, public facility. Absent access to the contract, it isn’t clear whether the centres are liable for these additional costs.
A major strength of our singlepayer system is that administrative costs are kept to a minimum. However, with an increasing number of providers, the (relatively) streamlined compensation scheme will become much more complex.
Princeton health economist Uwe Reinhardt argues that an unusually large administrative bureaucracy contributes to the high cost of American health care.
An expert panel of the Institute of Medicine in the U.S. estimated that in 2009, administrative waste accounted for $190 billion in health-care spending that year.
The most important question is not whether medical care should be public or private, but whether public dollars are being put to the best use.
Why, despite ever increasing spending, are problems persisting and even getting worse?
As the prime minister and the premiers meet this month, they would do well to remember that Canadians will be watching them. Concrete solutions have been suggested by dozens of experts who have weighed in on this topic for decades.
The most critical change that is required is a commitment to opening up the books so taxpayers can judge whether their money is being spent wisely.