Private medical services could help medicare
Increasing taxes isn’t an option, says Charles Shaver.
“But universal health care is an aspiration, not a destination. All countries must continuously consider the depth and scope of coverage that is politically achievable and fiscally feasible …” — DR. DANIELLE MARTIN (TORONTO) ET AL., THE LANCET, APRIL 28-MAY 4, 2018, PAGE 1718. This recent, scholarly article on the Canadian health care system nonetheless fails to answer whether equity can only be achieved by continuing to make any privatization illegal, despite the side-effect of long waiting times.
Across Canada, operating room time is inadequately funded and chronic patients remain in acute care beds. Elective surgery is often cancelled, so that the waiting times for cataract surgery, knee and hip replacements have increased since 2015. In British Columbia, onethird of patients did not receive joint replacements or cataract surgery within government benchmarks.
Martin admits that the proportion of Canadians waiting more than two months for a specialist referral is 30 per cent, and is 18 per cent for over four months — both the worst of the Commonwealth Fund’s comparison of 11 countries. Not coincidentally, all those with shorter waiting times have a blended public-private system.
Martin fears that if Dr. Brian Day’s challenge of the Canada Health Act is successful, that this would “reshape” medicare and lead to user fees and a two-tier system. She also never mentions the possibility of amending the CHA to permit medical tourism. For example, a clinic in Laval, Que., charges $20,000 for a knee or hip replacement, including a five-night stay. The cost for these procedures in Boston or New York is about US$60,000 to $80,000.
With the federal and most provincial governments running deficits, there is no point arguing over the size of federal-provincial health transfer payments, and raising taxes is not the answer. We must seek new sources of revenue. This includes medical tourism and possibly limited private health care for Canadians who are not members of special groups.
Hundreds of Canadian physicians — especially in orthopedic surgery — complete years of training yet are unable to obtain hospital privileges or sufficient surgery time. In frustration, many leave for the United States or other countries. Medical tourism could solve this problem.
It could also provide extra revenue in major Canadian hospitals and reduce demand for government funding. New non-medical employment and business opportunities could occur in each city. After all, relatives of visiting American and Chinese patients would require hotel rooms, eat in restaurants, might visit sporting events, the theatre, and other tourist attractions.
Well before the next federal election, the public must be made aware of possible changes that could improve access and shorten waiting times.
Physicians need to be more proactive. Many members of the public, politicians, and even some physicians are skeptical about even the hint of privatization. They need first-hand knowledge of what seems to work well in most other Western countries that share our values of not only fair health care delivery, but also fair treatment of physicians and other professionals.
Well before the next federal election, I urge each provincial and territorial medical association to ask whether any ever worked or was a patient in Australia, New Zealand, Taiwan, or one of the European countries with a blended public/private health delivery system. These MDs would be asked to field questions at town hall meetings in major cities across Canada. At these meetings would be physicians, nurses, other health professionals, the public, politicians, and the news media. The panels would answer the following:
1. How do these countries ensure that indigent patients are covered?
2. If partly covered by private insurance, what safeguards are in place to ensure that patients with pre-existing illnesses are not excluded?
3. What incentives/disincentives are in place to keep MDs from abandoning the public system for the private one?
4. What are the incomes of physicians in these countries relative to the general population and to other businessmen and professionals? This would include pensions and other benefits.
There are many lessons to be learned from other jurisdictions with blended public-private systems. As Martin, asserted, “Reform requires a willingness on the part of governments to pursue change, rather than simply managing the status quo …”