Health care on the agenda

First min­is­ters must come to grips with need for im­prove­ment, new rev­enues

The Welland Tribune - - Opinion - DR. CHARLES S. SHAVER Ot­tawa physi­cian Charles S. Shaver was born in Mon­treal. He 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 Ont

Prime Minister Justin Trudeau and the premiers are in Mon­treal Fri­day for a first min­is­ters meet­ing. They need to act on a cou­ple of is­sues: pro­vid­ing por­ta­ble med­i­cal ben­e­fits for Que­be­cers and over­all health re­form.

In his re­cent fall eco­nomic state­ment, Fi­nance Minister Bill Morneau an­nounced that the deficit for this year would be $18.1 bil­lion — over 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 clo­sure of Gen­eral Mo­tors in Oshawa and the drop in oil prices, these num­bers will be much worse.

Mean­while, On­tario has a debt of $347 bil­lion and a deficit of $14.5 bil­lion.

Health now con­sumes nearly half of most pro­vin­cial bud­gets, yet Ot­tawa con­trib­utes only slightly over 20 per cent. There is no point in prov­inces de­mand­ing in­creased health trans­fer pay­ments from Ot­tawa. In­stead, they must look for new revenue to sup­port health de­liv­ery and to pro­vide fair re­mu­ner­a­tion to physi­cians, nurses, and other health pro­fes­sion­als.

One po­ten­tial source of this is med­i­cal tourism. And when premiers and fed­eral of­fi­cials talk about how to di­ver­sify in­ter­na­tional trade, that should be on their agenda.

One thing Canada can do less ex­pen­sively than the United States is de­liver health care. A knee or hip re­place­ment costs US$60,000 to $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 op­er­at­ing rooms 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 for other health pro­fes­sion­als.

More con­tro­ver­sial is whether to amend the Canada Health Act so as to per­mit a lim­ited amount of pri­va­ti­za­tion for res­i­dents of Canada. Ot­tawa re­mains in­tran­si­gent about do­ing so. Fed­eral Health Minister Ginette Petit­pas Taylor has crit­i­cized Que­bec for al­low­ing pa­tients to pay out-of­pocket for care in their own prov­ince. Para­dox­i­cally, she turns a blind eye when Que­bec res­i­dents re­quire med­i­cal care in an­other prov­ince and are of­ten re­quired to pay di­rectly and await par­tial re­im­burse­ment.

If in­ter­provin­cial bar­ri­ers are to be im­proved so as to pro­mote tourism and trade, 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 is sup­pos­edly guar­an­teed by the CHA but ig­nored by Que­bec.

When cut­ting ex­pen­di­tures, Doug Ford was forced to de­fer es­tab­lish­ment of an $83.5-mil­lion French univer­sity in Toronto. New Que­bec Premier Fran­cois Le­gault ex­pressed “dis­ap­point­ment” at Ford’s de­ci­sion. How­ever, he over­looked one chronic prob­lem that his own prov­ince has cre­ated:

Such a univer­sity would likely at­tract a num­ber of stu­dents from Que­bec. While liv­ing in On­tario, they would lack com­plete med­i­cal cov­er­age thanks to Que­bec’s con­tin­ued re­fusal to sign the Re­cip­ro­cal Med­i­cal Billing Agree­ment (RMBA). Que­bec stu­dents al­ready pay ex­tra non-re­fund­able fees when vis­it­ing the Univer­sity of Ot­tawa Health Ser­vices.

Le­gault should stop chid­ing Ford on this is­sue un­less he is will­ing to sign the RMBA. If he still refuses, Ot­tawa should pay physi­cians di­rectly for treat­ing out-of-prov­ince pa­tients.

Each pro­vin­cial med­i­cal as­so­ci­a­tion should poll its mem­bers and as­cer­tain which MDs have worked in Euro­pean and other coun­tries with blended pub­lic/pri­vate health care sys­tems. Those with first-hand knowl­edge could be in­vited to par­tic­i­pate in town hall meet­ings across each prov­ince, and field ques­tions con­cern­ing the pros and cons of health de­liv­ery in each coun­try. This would ed­u­cate the pub­lic, me­dia, and politi­cians.

We should be open-minded and learn from coun­tries with more ef­fi­cient sys­tems, shorter wait-times, and high rates of pa­tient and physi­cian sat­is­fac­tion.

This week’s meet­ing should not de­gen­er­ate into just an­other “pho­toop.” Trudeau and the other premiers should strongly en­cour­age Le­gault to sign the RMBA. They should also set up a com­mit­tee to study mod­ern­iz­ing and amend­ing the CHA with a view to even­tu­ally per­mit­ting a blended pub­lic/pri­vate health de­liv­ery sys­tem. Such health re­form would con­tinue to en­sure uni­ver­sal cov­er­age, but might also pro­vide for greater fis­cal sus­tain­abil­ity.

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