"New B.C. legislation already leading patients to US...

[Guest Ian Wong]

Here's a couple of very interesting articles by the Vancouver Sun regarding incoming legislation that would lead to huge fines for any private surgical clinics in BC that charge patients for medically necessary procedures (as this contravenes the Canada Health Act). Of course, procedures that aren't medically necessary, like cosmetic surgery, are unaffected and will keep on running. Interestingly enough, the second link below also leads to a web feedback forum (a pretty clunky one, but functional nonetheless), where members of the public can post their comments on the story.

 

There's an awful lot of support for private clinics within those messages, and a lot of emotion from proponents of both sides.

 

www.canada.com/vancouver/...4311E48FFB

 

www.canada.com/vancouver/...20910E3CEB

 

Clinics stop surgeries, fear for survival

New B.C. legislation already leading patients to seek treatment in the U.S.

 

Jim Beatty

Vancouver Sun

 

Friday, December 05, 2003

 

VICTORIA -- Private clinics in B.C. began cancelling surgeries Thursday in response to a crackdown by the province on British Columbians who pay for their own medical treatment.

 

Astrid Levelt, spokeswoman for a group of private surgical and diagnostic treatment centres known as the Coalition for Options in Health Care, said the group fears B.C. legislation passed this week will drive private health care centres out of business.

 

That, in turn, will increase the time British Columbians wait for things such as hip replacements, cancer surgery and cataract removal at local hospitals.

 

"They are cancelling surgeries now for fear of retribution," Levelt said. "Surgeons have cancelled because of the intimidation factors of Bill 92."

 

Derek Green, 43, was to have had his injured knee operated on today at a private North Vancouver clinic -- surgery that would have cost him about $900 -- but it was cancelled. His knee is so bad, he said, that throws his back out of alignment, causing excruciating pain.

 

"The silly thing is that I was prepared to do this because I can afford to do it, and I didn't want to take up a spot on the waiting list that someone else needs more," Green said.

 

"Now I'll either go to Seattle where the mighty greenback reigns supreme, or I will be whining and crying and snivelling that my back hurts and I need to be bumped up the list."

 

For years, British Columbians have jumped health care waiting lists by paying private clinics for surgery or diagnostic treatments such as MRI or CT scans.

 

Until now, governments have generally turned a blind eye to what many suggest is creeping two-tier medicine.

 

But now, Health Canada has pressured B.C. to enforce the law.

 

Through Bill 92, the Medicare Protection Amendment Act, the province will have the power to audit doctors and clinics and levy penalties of up to $20,000 for those who accept payments for medical treatments that should be covered by the public system.

 

"As provinces, we don't have the luxury of ignoring violations of federal law. Health Canada has made it quite clear that we have to do our follow-up," Health Services Minister Colin Hansen said Thursday.

 

But as a patient willing and able to pay, Green said he doesn't accept the federal government's argument that what he's doing is a violation of the Canada Health Act. The province's new legislation is misguided, he said.

 

"The federal government can't argue that we don't already have a two-tiered health care system and what the province is doing is taking more arrows out of the quiver that doctors have to deal with these backlogs," Green said.

 

But health authorities suggested the new legislation, which will be proclaimed next spring, won't dramatically impact surgical waiting lists.

 

"Vancouver Coastal Health Authority does not expect a significant number of surgical cases to be diverted to its acute care facilities as the result of Bill C-92," said Viviana Zanocco, a health authority spokeswoman. "By law, private clinics cannot charge people for medically necessary procedures. Since hospitals only perform medically necessary procedures, it would follow that they are all in the public system."

 

That kind of circular logic ignores the reality that there are thousands of people unwilling to wait for long periods of time on surgical lists for medically necessary procedures, said Dr. Brian Day, who runs the private Cambie Surgical Centre in Vancouver.

 

"The biggest question people should be asking is, how does this legislation help patients get better access to medical care," he said. "I can't think of one way that it helps patients. It helps enforce the Canada Health Act, but that won't speed up one more necessary surgery."

 

Earlier this year, B.C. was penalized for not enforcing the Canada Health Act for surgeries performed in 2000.

 

At that time, two British Columbians received surgeries in a Vancouver clinic. One patient lodged a complaint while the other was featured in the media.

 

In both cases, Health Canada demanded the provincial government investigate whether the Canada Health Act was violated.

 

Because the B.C. government did not have the legal tools necessary to audit the private clinics, it couldn't provide answers to Health Canada.

 

In turn, Health Canada withheld $4,600 in transfer payments to B.C.

 

Although the financial penalty was minor, B.C. risked losing "huge" dollars in the future, Hansen said.

 

At present, 55 alleged violations of the Canada Health Act in B.C. are being investigated.

 

Those are people who have either complained about the care they received in private clinics or who may have been featured in the media as having paid to receive medical care.

 

Neither the government nor private operators will even attempt to estimate how many surgeries and diagnostic tests are being done in contravention of the Canada Health Act.

 

Since the B.C. Liberals were elected in June 2001, waiting lists have increased by 22.5 per cent.

 

Waiting lists have grown in nearly every category of surgery including urological, vascular and general. The number of people waiting for orthopedic surgery has increased to 18,181 -- nearly 60 per cent higher than two years ago.

 

Hansen doesn't deny the increase but says waiting lists are a poor gauge of anything.

 

"I know anecdotally of physicians who put individuals on wait lists not because they need surgeries today but in anticipation of them needing a procedure down the line ... that has the effect of artificially extending the number of people on wait lists."

 

Although public waiting lists may increase in the short term, New Democratic Party leader Carole James said the crackdown on private medicine is long overdue. "Treatment shouldn't be based on whether you can afford the surgery or not," James said. The public health care system "is one of the jewels of our country. I fear we are moving further and further away from that."

 

The B.C. Nurses Union was so pleased with the government enforcement plan Thursday, it added a telephone snitch line for patients to report when they have been billed for medically necessary services.

 

The nurses' union hotline can be reached at 1-800-667-1079.

 

jbeatty@direct.ca

 

PATIENTS NEED PATIENCE

 

The length of time B.C. residents wait for most surgeries has increased since 2001. Here are the waiting lists by procedure:

 

Procedure June 2001 Oct 2003 % Change

Neurosurgery 1,142 1,325 16.0%

Ophthalmological 15,262 17,323 13.5%

Corneal Trans. 511 627 22.7%

Dental 1,787 1,615 -9.6%

Ear, Nose, Throat 4,515 5,057 12.0%

Vascular 1,082 1,356 25.3%

Cardiac 584 593 1.5%

Organ Transplant 431 416 -3.5%

Gynecological 5,864 5,874 0.2%

Urological 4,044 5,972 47.7%

Orthopedic 11,409 18,181 59.4%

Plastic 3,611 4,189 16.0%

Cancer 347 294 -15.3%

General 10,915 12,493 14.5%

TOTAL 61,504 75,315 22.5%

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