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Public Vs. Private health care in canada
Transcript of Public Vs. Private health care in canada
The low hum of soft rock drifts through the operating room. A shortish, 63-year-old surgeon in white rubber boots stares at the video screen, his left and right hands deftly manipulating a series of instruments through two tiny incisions in Dennis Geidt's left shoulder.
After much meticulous work inserting screws and tying knots, the surgeon informs the anesthesiologist: “This is it, Bill.” A brief flurry of activity, then: “There's the tendon, reattached.”
Moments later, an hour after he began, Brian Day is rolling up his light-blue gown, stripping off gloves, mask and skull cap and heading out the door.
Other than the enduring magic of arthroscopic surgery, there is little that is remarkable about this tableau, except for one thing. Some would call it a crime scene Dr. Day and his 76-year-old patient have willfully contravened a sacred tenet of the Canada Health Act and British Columbia's own medicare legislation. Namely, that Canadians may not buy their way to the head of the queue for medically necessary treatment.
Mr. Geidt, the man on the operating table, has done exactly that. Rather than wait the year or longer he was told it would take to be treated under medicare, Mr. Geidt, racked by pain, opted to fork out $7,010 from his own pocket to have his left shoulder repaired – within weeks – by Dr. Day.
Neither Mr. Geidt nor Dr. Day is in any danger of being cuffed and carted away. The privately owned Cambie Surgery Centre, where Dr. Day plies his skillful trade, has been allowing patients to pay for such procedures for years. So far, authorities have done little more than wave an admonishing finger.
“It's the Neville Chamberlain approach,” said health-policy consultant Steven Lewis, a strong critic of for-profit medicine. “Peace at any cost. Don't ask. Don't tell.”
No one could accuse Dr. Day of not telling. As he said matter-of-factly of Mr. Geidt and countless previous patients who have sought costly but speedy relief at the Cambie clinic: “It is a violation of the B.C. Medicare Protection Act, and I make no apologies for that that.”
Is it sustainable?
The clash between Dr. Day and the Canada Health Act is a compelling example of the need for a vigorous, new, public examination of our creaking medicare system. Is it sustainable? As the price of providing universal health care continues its relentless drive upward, where will the money come from?
With federal transfer payments to the provinces and territories set to expire in just three years, critics of the status quo say we should consider a bigger role for private care in a system that is largely publicly funded.
What began as a government-paid insurance program to ensure physician and hospital care for all has expanded over time into an awkward amalgam of public and private funding. Distinctions between the two are often blurred.
Today, The Globe and Mail begins a weeklong series on health care, designed to clear up some of this confusion between private and public and set the tone for an informed discussion on where to go from here.
While never more urgent, a debate on the sins and virtues of private, profit-oriented health care is hardly new, and Dr. Day's state-of-the-art facility on a lovely, tree-lined Vancouver street remains ground zero.
No one has been more prominent than Dr. Day in espousing the controversial right of patients to pay for their own health care at for-profit clinics. His clear, outspoken views propelled him to the presidency of the Canadian Medical Association in 2007-2008.
While critics disparage the concept as two-tier medicine, the veteran orthopedic surgeon says it's the future.
“It is inevitable,” he said. “As baby boomers start to retire, the system is going to be hit with a tsunami of illness.” With the use of new, expensive technology expanding at the same time, costs will continue to rise dramatically, Dr. Day contends, and pouring more and more public dollars into medicare is simply not sustainable. “There's only one other type of money out there, and that's private money.”
Some provinces are already confronting the challenge, centralizing heavily sought procedures at designated hospitals, and increasing funding. They report success in reducing waiting times and increasing patient volume for many operations in demand.
B.C, in fact, is pioneering a concept known as patient-focused funding, a system that pays institutions for each procedure instead of providing them with huge sums, regardless of what they do.
Dr. Day, a long-time advocate of the idea, says the private sector should be allowed to compete for those patients. “There would then be no queue jumping, because there would be no wait lists.”
He believes the decades-long debate about the role of private clinics in Canada's public health-care system has finally reached a tipping point. There will simply not be enough tax revenue for medicare to manage the pending influx of aging baby boomers, Dr. Day argues, without opening the door to the private sector.
Full day of surgery
If he is correct, this is what the future looked like on an unseasonably warm fall morning at the Cambie Surgery Centre.
His full day of surgery was replete with patients thumbing their noses at the principle that no one should be able to buy their way to the operating table. Four had travelled here from Alberta, rather than wait for publicly funded treatment in their home province.
One was Daniela Acimov, a dental assistant. Dr. Day's initials were printed on her right knee in big black letters, marking the spot where he would reconstruct her torn anterior cruciate ligament.
After being told she faced lengthy waits for both consultation and surgery, Ms. Acimov opted to have her operation at the Cambie clinic for a hefty price tag of $10,250, some of which she may be able to reclaim from Alberta's health-care plan.
“I couldn't believe how hard it would have been to get this done in Alberta,” Ms. Acimov said, before being wheeled into the operating room. “I was in a lot of pain. I couldn't go to work. It was just ridiculous.”
Dr. Day pioneered arthroscopic ACL reconstruction. He's done thousands over the years, and he has no problem combining a steady stream of chatter (“It's supposed to be 23 degrees today…”) with the work at hand.
But near the end, it was all business. “The drill next,” said Dr. Day, as the complex, interior network of bones, sockets, tendons and ligaments played dramatically across the video screen. A short while later, there was an audible tap, tap with a small hammer on an awl-like instrument, then bang, bang, bang.
“I'll have a 9x30 tibia screw, please,” he told the nurse. Soon, the operation was over.
At noon, there was time for a brief checkup on patient Mike Klein, a stocky equipment operator wearing a T-shirt extolling jailed pot crusader Marc Emery. Mr. Klein's knee operation was paid for by WorkSafeBC, formerly the Workers' Compensation Board, which has been using Dr. Day's clinic to obtain early treatment for injured workers since the mid-1990s. Their clients still comprise nearly 40 per cent of the facility's patients.
“It's worth it,” Mr. Klein said. “If I had to wait two years, that sucks.”
Dr. Day never tires of pointing out the ethical conundrum of having patients injured on the job green-lighted for treatment at his clinic, while individuals who suffer identical injuries at home have to wait months for their procedures at public hospitals.
WCB patients, plus members of the RCMP, the military and inmates of federal prisons, are excluded from the Canada Health Act. There are halting moves to rein in the Cambie clinic's skirting of medicare rules, which Dr. Day says provides about 10 per cent of its business. B.C. health officials are seeking an audit of the facility, and the B.C. Nurses' Union has a longstanding lawsuit to force a government crackdown on Dr. Day. Both cases have bogged down in court.
“The Canada Health Act is more of a bikini than full Islamic regalia,” said Mr. Lewis, the health policy consultant. “It doesn't cover every conceivable circumstance. There is deliberate, unenforceable vagueness on what must be carried out in the public sector.”
For his part, Dr. Day has filed a B.C. version of the landmark Chaoulli case that opened the way for residents of Quebec to buy health insurance for private delivery of medically necessary procedures. “If we win, it will be the best thing that ever happened to medicare, because medicare is going bankrupt,” Dr. Day said.
Critics despair at his prescription for the future, however, arguing that he plays fast and loose with facts and medicare is not doing nearly as poorly as he suggests.
Mr. Lewis agrees that medicare needs to improve its delivery of services, but the answer is not to allow someone to pay for something others can't afford. “That's not fair,” he said. “The solution is to make the public system good enough, so we don't have facilities like Dr. Day's clinic cherry-picking low-risk, high-volume, lucrative services.”
No one should be too surprised by Dr. Day's incessant punching away at Canada's health-care system. He comes by it honestly. A schoolmate of Paul and George of the Beatles, Dr. Day was raised in the rough, impoverished Liverpool district of Toxteth, He was a promising young boxer, until he stopped growing at 5 foot 4. He retains a scar from a one-sided knife fight when he was 10.
His pharmacist father was gunned down by a couple of thugs looking for drugs during the Toxteth riots in 1981. Several years later, his mother died at 61, a victim of misdiagnosis.
It's a background that has doubtlessly helped forge Dr. Day's combativeness and determination to stay the course. “There is nothing unethical about spending your own money on your own health care, and no one will ever convince me that it is,” he declared.
The pros and cons of private-versus-public meant little, however, to Dennis Geidt, willing to pay to stop pain so severe he couldn't pick up a jug of milk or sleep at night. He just wanted the hurting to stop.
That night, in a downtown Vancouver hotel, Mr. Geidt, who travelled from his Rocky Mountain home in Revelstoke, B.C., for the operation, had his first pain-free, restful sleep in months.
“It was damned expensive,” he said. “But when you're my age, who cares?” Published Friday, Nov. 05, 2010 9:39PM EDT
Last updated Saturday, Nov. 06, 2010 12:30AM EDT Discussion questions Equity – the notion that healthcare should be provided to all without regard to income – is medicare’s defining feature.
Vancouver— From Saturday's Globe and Mail
Published Friday, Nov. 05, 2010 11:33AM EDT
Last updated Wednesday, Dec. 08, 2010 2:06PM EST Analysis
No one has been more prominent than Dr. Day in advocating the right of patients to pay for their own health care at for-profit clinic, which to me that’s a very valid point assuming these people are jumping in line of a life or death situation it's not only reliving them of their pain and taking them out of the line and shortening it for the rest.
The article also mentions how some provinces have already started to confront the challenge, by centralizing heavily sought procedures at designated hospitals, and increasing funding. These provinces have reported success in reducing wait times and increasing patient volume for many operations in demand. As well as B.C. in fact, is looking at the concept know as patient-focused funding, a system that pays the institutions for each procedure instead of providing them with huge sums of money, regardless of what they do.
So, In conclusion the article really shows Dr.Day's point of view and his evidence that a show why he thinks Canada is inevitably headed towards a two-tier health care system. For example, the federal transfer of payment to provinces and territories is set to expire in the next three years as well as that the cost to sustain our current health care system is only going to continue increase due to our aging population and new, expensive technologies, but you tax revenues are not increasing. The evidence seems to show that our waiting lists are far too long, and that maybe it's time to re-assess the criteria of the Canada health act because without the introduction of the private sector our health care system is simply not going to be sustainable. http://timelymedical.ca/ There are approximetly 875,000 Canadians on a waiting list for medical care today.
Procedure Wait Time in Public System* Private-pay Wait Times for Clients of TMA** Prices as low as:
Knee Replacement Up to 2 Years 2 Weeks $16,000
Gall Bladder Removal Up to 3 Years 2 Weeks $7,550
Angioplasty Up to 12 Months 48 Hours $8,000
Cardiac Bypass Up to 12 Months 48 Hours $16,000
Arthroscopic Shoulder Surgery Up to 2 Years 2 Weeks $7,625
Spinal Discectomy Up to 3 Years 2 Weeks $7,000
MRI Up to 6 Months 3 Days $600
CT SCAN Up to 4 Months 3 Days $500
Ultrasound Up to 4 Months 3 Days $600
Weight Loss Surgery Up to 5 Years 2 Months $12,500
Hip Replacement Up to 2 Years 2 Weeks $16,000
Cardiac Ablation Up to 3 Years 1 Week $13,450
* Wait times in the public system depend on many factors that include, but are not limited to:
• Which province you live in
• Whether you are an urban or rural resident
• The urgency of your condition
• Your age. Many elderly patients are simply never going to get elective surgeries such as hip replacements
** Wait times for clients of Timely Medical Alternatives depend only on:
• The urgency of your condition. As an example – we can arrange for cardiac consultations normally within one week. In emergencies, we can arrange for next-day consultations with the surgery/procedure to follow immediately. Other countries with universal health systems – notably those in Europe, which are consistently ranked as the most equitable and cost-effective – have not made Canada’s mistake of confusing equity with sameness. Rather, European countries have done what Ottawa and the provinces know they need to do: Adopt a model that pragmatically mixes public and private elements both in funding and delivery while staying true to values. This push-me pull-me approach typifies the overly-cautious Canadian approach. “There’s no law that says private health care is illegal. What there is instead is a whole bunch of laws that dampen the ability of private care providers to be parasitic on the public system.
The result is an oft-illogical patchwork that has left Canadians – and to a large extent policy-makers themselves – perplexed. To wit: Physician visits are covered by medicare but the drugs they prescribe are not – unless the patient is over 65; physicians cannot bill patients but they can refer them to imaging clinics and laboratories that do; private clinics can offer knee surgery but not heart surgery; a citizen cannot jump the queue for care unless they were hurt on the job and they are the responsibility of Worker’s Compensation; homecare nursing is provided by private companies but hospital nursing is not.
People get all tied up in knots about private-public when they should be focusing instead on ensuring we have a system that delivers the highest quality care in a cost-effective manner,” said Jeffrey Turnbull, president of the Canadian Medical Association.
As Dr. Turnbull says, it is imperative that Canadians get away from the notion that there is black-and-white choice between public and private.
“There is no one-size-fits-all model for funding and there’s no one-size-fits-all model for delivery. There is a spectrum,” Dr. Turnbull said.
And in that spectrum lies the opportunity to create a more responsive, innovative health system.
Canadian health care is unusual in that the system is bifurcated. There is virtually no private insurance or private delivery in some areas (like physician services – which are 98 per cent public) and in other areas there is virtually no publicly insured or delivered care (like dentistry – which is only five per cent publicly-funded).
By comparison, in European countries, there is almost always a private option for consumers and, at the same time, there is greater public funding and regulation for every aspect of the health system. For example, in France, only 74 per cent of physician services are paid from the public purse and, in Germany, 68 per cent of dental care is covered by public funding.
This approach, generally speaking, has resulted in lower per capita health costs and better outcomes.
Quebec has gone further than any other jurisdiction, quietly becoming the hotbed of private healthcare by adopting legislation that allows 56 surgical procedures to be done in private clinics. They are de facto private hospitals.
But, again, there is a catch: The provincial health insurance plan has priority in these clinics. So, in the end, the government is essentially contracting out services.
At the same time, Quebec is the only province with a universal pharmacare program. The law decrees that everyone must have prescription drug insurance: Employers must provide the insurance to workers, while others must buy private insurance or, if they are seniors or low-income, register for government-sponsored prescription drug insurance.
2. If Canada were to adopted a two-tier system, do you think health care would become segregated into health care for the rich and health care for the poor, leaving those with low income with a lower quality of health care? André Picard | Columnist profile | E-mail
From Monday's Globe and Mail
Published Sunday, Nov. 07, 2010 8:33PM EST
Last updated Monday, Nov. 22, 2010 12:44PM EST
André Picard | Columnist profile |
Published Sunday, Nov. 07, 2010 8:33PM EST
Last updated Monday, Nov. 22, 2010 12:44PM EST Is this private clinic surgeon a crusader or criminal?
To really sum the article up there seems to be a general consensus that Canada’s heath care system is in need of some major reform. The article is about how Mr. Geidt was suffering from pain because of his shoulder and that it's against the Canada health act to seek health care on a for profit basis and "jump the line". As well as just like it Sais in the article, "it's a compelling example of the need for a vigorous, new, public examination of our creaking Medicare system. Is it sustainable? As the price of providing universal health care continues its relentless drive upward, where will the money come from?"
The article also points out that the federal transfer of payment to provinces and territories is set to expire in the next three years as well as the rapidly increasing geriatric population. Maybe it's not a bad idea to look at private-health care playing a bigger role in Canada’s health care system. Dr. Day points out that with the cost of new technologies and the aging population, it’s simply not sustainable for Canada to continue to put public money into Medicare. He also said that "There is only one other type of money and that private money". Dr. Day believes that Canada's public health-care system has finally reached a tipping point and without opening the doors to private health-care, there is simply not going to be enough tax revenues to handle the added weight from the aging baby boomers and Medicare will go bankrupt.
However, there are halting moves being put into action at the Cambie clinic's bypassing the rules of medicare. B.C health officials are looking to audit the facility, and the B.C Nurses' Union has a longstanding lawsuit to force the government crackdown on Dr. Day. Mr. Lewis, the health policy consultant Sais, “The Canada Health Act is more of a bikini than full Islamic regalia; It doesn't cover every conceivable circumstance. There is deliberate, unenforceable vagueness on what must be carried out in the public sector.” Mr. Lewis also agrees that the delivery of Medicare services need to be improved, however allowing people to pay for something others can afford isn't fair and that instead we need to improve the public system enough so we don't need facilities like Dr. Day's.
So Dr.Day filed his case towards the Canada health act, to try leading the way for residents of B.C to buy private health insurance for delivery of medically necessary procedures. Similar to the Chaoulli case in Quebec. Dr. Day said “If we win, it will be the best thing that ever happened to Medicare, because Medicare is going bankrupt.”
So the article seems to be more focused on Dr. Days opinion and how he thinks that it's imperative that private health care becomes a larger part of Canada’s health care system, more so then it is focused on Mr. Lewis's opinion that offering expensive health care services that allow the people who can afford it to "jump the Queue" is unfair for those who can't. Although that’s a valid point Dr. Day is convinced that by introducing the private sector and allowing physicians to compete for those patients, he said "There would be no queue jumping, because there would be no wait lists." Reference list All provinces in Canada have seen an increase in the proportion of seniors in their populations. Saskatchewan has the highest percentage of seniors (14.9% in 2006). However, due to varying growth rates of the senior population among provinces, by 2031 it is expected that the Atlantic provinces will have the highest proportion of seniors.
Note: Population projections use a medium-growth and medium-migration trends scenario. For further information see: Statistics Canada. Population Projections for Canada, Provinces and Territories (2005-2031). Catalogue no. 91-520 XIE.
Source: Statistics Canada. Estimates of Population, Canada, the Provinces and Territories (Persons), CANSIM Table no. 051-0001; and Statistics Canada. Population Projections for Canada, Provinces and Territories (2005-2031). CANSIM Table no. 052-0004
http://www4.hrsdc.gc.ca/.3ndic.1t.4r@-eng.jsp?iid=33 1. Under what conditions or circumstance would you be willing to pay out of pocket for a procedure? 3. What type of effects would it have on our health care system if Canada did adopt a two tier, system that would allow physicians to run private health care clinics with the catch that the provincial health insurance plan has priority in these clinics? So, in the end, the government is essentially contracting out services. Mickleburgh R. (2010, November 5). Is this private clinic surgeon a crusader or criminal?
The Globe and Mail. Retrieved from http://www.theglobeandmail.com
Picard A. (2010, November 7). Canada, it's time to get our Health Act together.
The Globe and Mail. Retrieved from http://www.theglobeandmail.com
Canadians in context — aging population. (2011, March 10). Human Resources and Skills Development Canada.
Retrieved from http://www4.hrsdc.gc.ca/.3ndic.1t.4r@-eng.jsp?iid=33