First min­is­ters must fo­cus on health care

North Bay Nugget - - OPINION - Dr. Charles S. Shaver

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-of­province pa­tients.

health con­sumes about half of the bud­get of each prov­ince. The fed­eral gov­ern­ment pro­vides slightly more than 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 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 pend­ing clo­sure of gen­eral mo­tors in oshawa, and the con­tin­ued drop in oil prices with no new pipe­line on the hori­zon, these num­bers could be­come 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 so as 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 $60,000 to $80,000 u.s. in bos­ton or New york city, but only about $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 if any­one has 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 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 health care ser­vices had a blended pub­lic-pri­vate sys­tem. (canada was ranked No. 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.

Fri­day’s meet­ing should not be just an­other photo-op. Trudeau and the 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.

Dr. Charles S. Shaver is chair of the sec­tion on gen­eral in­ter­nal medicine of the On­tario Med­i­cal As­so­ci­a­tion. The views here are his own.

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