Health care policy discussion thread!

[Alastriss]

Hey guys

Wanted to start a discussion thread concerning health care policy in canada, what you guys think are its pros and cons, compare it US health care policy, and discuss what you would rather have changed about canada's health care policy.

To kick it off, im going to start by vaguely stating that I think canada's health care needs to be more in the private sector than the public sector. I am strongly in favor of a two tier system.

[Newbie1234]

lol... to continue I'll have to disagree with the idea of 2-tier system. People have this idea that having a 2-tier system will make things better but the same problems will exist and more problems will occur. Besides, Canada is renowned for its health care policy so instead of changing its delivery maybe concentrate on extra resources/recruitment somehow...

[lost__in__space]

My worry concerning a two tier system is this: where will all these private docs/technicians/nurses/medical staff come from? They will be weaned from the public system in hopes of higher pay, less hours, etc., leaving less medical personnel in the public stream. I understand that by people "switching" over into private health care that it should "even out" between the two streams, but will it? How many average Canadians can really afford private health care? Not as many as you think.

 

Anyway good discussion thread

[EricC]

I'm against two-tier because I don't believe that it will deliver better healthcare for all canadians. It will only increase disparities: rich Cdns will go threw quickly, but the waitlist for the average canadians will get longer. (Unless we increase spots in medschool or higher salaries attract foreigners). However, I think you can increase the private element by outsourcing more services (testing, etc.). THe gvmt would still pay, but hopefully it would be cost efficient (and of good quality)

 

I guess the main thing I would do is user fees, as controversial as they are. We are an anomaly in the fact we pay 100% (or almost) of hospital fees, yet very little of pharmacy fees. Most countries have a more balanced approach. Even Norway, which I visited, has user fees. I believe they will reduce strain on the system and help infuse the system with more money (other than taxation). Also, I think it's a fairer way to charge people (in most cases). Now, I believe if your salary is under a certain threshold, you should not have to pay a user fee (as that would limit your accessibility). Furthermore, user fees would have to be reasonable (and perhaps escalate with your tax bracket). I'm also concerned about creating another bureaucratic machine (like in the US) here, but my gut feeling is that because doctors already bill per service and because of technology, this could be done somewhat easily. Imagine your healthcard become somewhat of a credit card, and you receiving a statement when you visit the hospital saying how much your care cost, how much the gvmt paid and the minimal fraction you will have to pay.

 

And yes, as a deterrent, it can be a positive and negative force. At first, this might deter ppl from consulting their doctor when truly needed. Perhaps we could not apply it to urgent care at first in order for ppl to wrap their minds around the idea.

 

Anyhow, those are my two cents and I hope they can get this debate going.

[Jochi1543]

Imagine your healthcard become somewhat of a credit card, and you receiving a statement when you visit the hospital saying how much your care cost, how much the gvmt paid and the minimal fraction you will have to pay.

 

You basically just described a private healthcare insurance plan, except for instead of showing what the government paid, it shows what your company paid. The "minimal fraction you have to pay" sounds good on paper, but it ****s over people with serious health problems and/or people with addictions. For example, when I volunteered at a hospital back in the US, a fellow (elderly) volunteer had to go to the CICU for a week. The bill was $100,000. I don't know what percentages you're thinking, but normally co-pays are 10-20%. Imagine paying $10,000-20,000 in co-pay fees because of a WEEK's stay. Then imagine if you had been in a serious car accident, had major surgery that required an extensive hospital stay, or advanced cancer - your co-pays would skyrocket into the realm of hundreds of thousands of dollars. A neighbor of mine died from alcoholism-induced liver failure last fall, and he had been in the hospital for 2.5 months. It wasn't an ICU, so let's say the actual cost of it was $50,000 a week and he had 10% co-pay.....that's a $50,000 bill for him for the 2.5 month stay.

 

The co-pays only really work for your run-of-the-mill visits to the GP/ob-gyn/pediatrician.

[The Law]

Two tier health care is not an option. It's horrible, it won't eliminate the problem, just appease the people who can afford to pay.

[vip_138]

UK has installed a 2tier system and it has been shown to increase waitlines and private sector picks up new diagnostic machines because they have the money, leaving public sector with crap

[EricC]

Hi Jochi,

 

I appreciate your comments and understand your concerns. I don't proclaim myself to be an expert in the matter, but my experience in Scandanavia has somewhat altered my perception.

 

Let me first start by stating that I believe in universal accessibility and firmly disagree with the US model. I think our geographical proximity to the US makes us reticient to consider implementing fees. I understand your concerns about high costs being pushed on to vulnerable, less fortunate individuals. Perhaps I wasn't as eloquent as I should have been earlier this morning. User fees should of course be small, and ideally scaled with income (ie free or minimal for low-income individuals). Here's a table I found regarding Sweden's experience

 

Type of Treatment Canadian Dollar Equivalent

Physical therapist $7.50 - $45.00 (generally $45.00)

GP/family doctor $15.00 - $22.50 (generally $15.00)

Medical specialist $22.50 - $37.50 (generally $30.00)

In hospital stays $45.00 a day

 

The idea behind these is that you pay a fraction of the cost but it always reaches a maximum very quickly. Therefore, you would not pay 10000 or 20000 for a hospital visit. What I find unacceptable is that we offer no or little support for medication here in Canada. So patients with chronic illnesses must often bear the burden of increasingly expensive drugs. Therefore, I would like to see such a policy extended to pharmacare.

 

This system also allows for competition, allowing doctors some flexibility in establishing fees (although there are caps). Such competition can encourage innovation. However, given our lack of healthcare professionnals, it might not be as beneficial here (they have somewhat of a monopoly, we are all desperate for their services).

 

You basically just described a private healthcare insurance plan, except for instead of showing what the government paid, it shows what your company paid.

 

I think this statement is unfair. User fees are much different than a private system. For one, they are more efficient as you do not have the bureaucracy involved between hospitals and the many insurance companies/health care plans/HMOs, etc. Secondly, it's universal and not restricted to the wealthy.

 

I hope this clears up my stance a bit more and, again, I'm no expert, and I look forward to reading the continuation of this debate.

[darknight]

One big problem is a shortage of doctors. I dont feel that med schools should lower their standards all that much to the point where the quality of doctors becomes jeopardized, but there are a lot of people who get rejected but would very likely make competent doctors. THe problem isnt because med schools want to be very competitive and picky, it is mainly due to a lack of funding, expenses are mainly govt subsidized and its not so easy to increase the number of seats in the med school.

less government subsidization of tuition fee per student can eventually lead to reallocation of fundings to increasing seats. The average student will be in debt longer yes, but It may be possilbe that long term benefits will outweigh the short term burdens.

Now im not saying double tuition, increase it by a little, but allow students to more easily take out loans to fund the higher tuition fees. In the long run, it is beneficial for any government to do so since more of the popuation will be able to provide a medical service and country GDP will go up. I have only taken intro econ btw, maybe someone can comment on this?

 

I know I wouldn't be happy with this policy at all from a student point of view It may work in theory, but i wouldnt behappy with it. I don't feel there is a policy that can be instituted that will not benefit the general population at the expense of incurring costs on a select few.

[darknight]

One more thing, in response to the fees, one way that the fees could be instituted is based on individual income. It will be a progressive one, where richer people may more. Once again, not everyone will like this, but canada seems to favor progressive policies, especially since our taxes operate in such a manner.

 

From my volunteer experience, I've learned that people who go to the ER have to wait for hours. I'v seen people wait 5 hours b4 a physician got to them. Most of the time they just end up walking out because they feel its "not so serious". A story: a my friend's boyfriend got this infection on his hand after he went on a business fishing trip. After waiting for about 3 hours he just figured it was a mosquito bite that he scratched too much and it got swollen. I'm not sure about the details, but his girlfriend's (my friend) sister was a doctor and she saw it when he was over at the same day, and she said he needed to get rushed cuz if he didnt receive treatment they would have had to amputate his hand.

 

Now your thinking, better safe than sorry and he shoulda waited and I agree wholeheartedly. But how many people out there have even taken a pathology course or have a general knowledge of things like this? general population may dismiss something as not serious and not have a clue as to what it could be. "wait lists" for anything healthcare related is something i, like everyone, would like to get rid of.

 

Making it private wont solve the problem, you just took a barrier like Time, and made it money. Instead of waiting, people won't want to pay the 20 bucks for what seems to be a mild condition. progressive fees might solve this problem, but this will make the rich population grumpy.

[EricC]

Hey Darknight,

 

I think you struck an excellent point with government policy, it's not always the best in the long run. One can imagine that longterm plans are hard to sell to an electorate. However, even if we were to increase medschool places and have more of the cost transferred to students, I'm not quite sure the governement has the resources to have a huge amount of doctors working/on the ''payroll'' (I realize doctors are not gvnmt employees but the expression fits).

 

I think we must also be careful with anecdotal evidence as it might cloud our judgement/rationality. However, I understand your point. Perhaps a better solution with be greater awareness campaigns and use of services like Tele-Health, etc. (I know, they aren't as effective as they could be). I think waitlists/waittimes can be healthy, although not at the point they are today. Reasonable waittimes mean doctors are seeing patients continuously while on shift and one would assume/hope this is efficient.

 

In order to make our health care system sustainable, we have to ideally diminish our use of it. Prevention of obesity and other ailments that are due largely to lifestyle choices would go a long way in reducing strain. Just adding doctors can't (to a large extent) solve such societal problems. Prevention is difficult to do, no one agrees on the best way to do it and its outcome is hard to measure over long periods (its difficult to attribute causal relationships).

 

And this is were I get very ''holistic'' in my thinking. ONe interesting thing is that income is one of the (if not the) greatest social determinants of health. That means your income is the strongest thing that correlates with your health in the general population. Poorer families are generally less educated. They don't have as much money to buy healthy foods, enroll their kids in sports, know about healthy lifestyles and risks, etc. They tend lead less healthy lives. There are growing social disparities in North America right now, and they should be addressed. These things are often topics in population health and are quite interesting...the stats are mind-numbing.

 

Those are my 2cents!

[NLengr]

I just skimmed the posts, but one fact that hasn't been mentioned here, and I think bears major relevance, is performance of private and public systems vs. their costs.

 

If you look at the comparative studies done of the US and Canadian healthcare system, you'll see that the Canadian system consistently outperforms or equals the US system when it comes to major indicators of population health (age expectancy, heart attack survival etc.). Yet, from the cost aspect, the US spends much more per capita on healthcare then we do in Canada. Add to this the fact that 40 million citizens do not have health insurance.

 

Cost data: http://www.oecd.org/topicstatsportal/0,2647,en_2825_495642_1_1_1_1_1,00.html

 

Simply put, the user pays private system of the US costs the country more money, and has not been shown to improve the health of the population.

[Wolvenstar]

First of all I haven't read everyone's posts (sorry guys). I must assume that most of the people living in larger towns are the ones who are against the two tier system.

 

I was raised in a small mining town in BC. Back in the day our hospital was pretty good, but over the years they kept pulling everything out of town cause...well they never really gave any reasons, politicians never do. So there is a string of three towns around it (town Podunk, Wodunk, and Bob). We have 3 doctors for the 2 "hospitals" that cover these three towns. These hospitals can only cover minor injuries (if you do anything worse then break a leg you are transferred). One of the hospitals also covers elderly patients who must stay in hospitals, but not many. The Second hospitals only has beds in emergency room now. If there is an emergency, and the ambulance is needed. Patients are taken to either Calgary (2hrs away driving 170km/hr) or to a smaller town that has a true emergency ward. (but this can only be done when the road there which is on the side of a mountain isnt closed due to snow, and that town is about 1.5hrs away). So we have several mines here and as you can expect a couple serious accidents every year. Only 4/10 accident victims survive. Before we lost all the funding for the hospitals 7/10 was the statistic of survivors.

 

A Two Teir system would be amazing for help in small towns out in the middle of nowhere. The higher management at the mines has previously stated that if we could develop a private health care system they would fund the hospital in our region.

 

As for the private sector getting good equipment and the public sector getting crap. If a private sector opened up, yes it would get better equipment due to the fact that its private and makes more money. But this hardly impedes the public sector. The quality of equipment in the public sector would not see significant change if a private sector were opened up.

 

 

As for where we could get Doctor's from. Yes a portion would end up being pulled from the public health care system, but I believe some would also get pulled from the states. From what I have heard of the statistics, the states has stolen a significant number of doctors and nurses from Canada. If a private sector opened up it would be able to offer higher wages and enticed these doctors and nurses back to Canada.

 

Secondly when the private sector pulled doctors from the public sector. The would be a demand for more doctors. The public health care system employs X number of doctors. The private sectors takes x/5 (random number) from the health care system. To accomadate for this increased demand for doctors, the government would encourage Canadian schools to expand their medical schools. More people get into medical school, will mean we end up with more doctors, which will fill the void.

 

Now not all doctors will go into the private sector. As it is private and the public sector is governmentally run, I would assume that doctors in the private sector will end up paying more in taxes. This would not only increase the funds the government can put into the public sector, but it would also keep the number of doctors in the private sector and public sector relatively equal. It would also need some more regulations created but it would be possible to keep the public/private health care systems balanced.

 

Those with the money could get treatment faster (there is nothing wrong in my mind with a patient getting faster treatment regardless of how much money they make, lets not be prejudice against those who make more money). This would also cause a minor decrease in waitlines in the public health sector as, X number of patients would no longer be attending the public health sector.

 

As for people who don't like this idea of people who make more money getting in faster, I think you have a fairly negative stereotype of those are in the "higher class" (aka those who make more money). My family would fall into the category, but my father started a business from the ground up and it flourished. He still works 48+ hours a week in addition to owning this business and my mother works about 20hrs a month. We have worked hard for the money we have, and I think there are alot of Canadians in this "rich people" category, who are like us. I dont see why paying for faster treatment is wrong. Not only that but I think many families who are middle class, and have a relative who is seriously ill, would gladly pay a large fee to get their family member faster treatment. I know my parents would be willing to move into a smaller house and sell their current one if it meant my cousin or my aunt or my sister got faster treatment.

 

We can't say no just because not everyone can afford it. It might sound fair if you word it right, but what you are doing is forcing these people to wait longer for treatment which isnt fair. Your also putting these people in the same waitlists that the "poorer" Canadians are in, thus making them wait longer as well. Not only that but by having only a public health sector, you are ensuring that small towns -like the region I told you I am from- will never get any sort of medical service that could be called similar to the standard received in Calgary or a larger city. Smaller towns are usually based around a large primary resource (like coal mines). These businesses are rolling in dough and are quite willing to fund a private hospital if it were allowed.

 

 

Now I know the UK has this kind of system and that is isnt working very well for them, but this two-tier system would need strict regulation by smart people (which means we have to get rid of our members of parliament too, lol). Here's an analogy;

 

North Korea has communism and they are in the toilet. China has communism (it is communism no matter what the US propaganda wants to classify it as not communism) and they are one of the richest countries in the world.

 

It all depends on how the program is run.

 

Well I hope this hasnt offended anyone, or is too long winded.

[Vallinar]

Jsut wondering what everyone thinks of having a system by which everyone pays for their own care (no insurance companies, no Universal coverage)

 

This would surely avoid all the problems with the US system, it would reduce waititmes, doc shortages.

 

The only issue would be poor people having difficulty getting access.

 

We could implement publically funded emergency services. But everything else would be fee/service.

[Alastriss]

Jsut wondering what everyone thinks of having a system by which everyone pays for their own care (no insurance companies, no Universal coverage)

 

This would surely avoid all the problems with the US system, it would reduce waititmes, doc shortages.

 

The only issue would be poor people having difficulty getting access.

 

We could implement publically funded emergency services. But everything else would be fee/service.

 

 

I still think that some of the healthcare should still be privatized. There are a ot of people out there who would pay for receiving the same quality of health care but just not wait as long, and for equality's sake the government can forumate a team that assesses the quality of hospitals to make sure they are all on par with each other.

 

I think that a lot of people use the US as a model to aniticipate what would happen if we push health care in the private sector. However I do want to bring to everyone's attention that Canada's med schools are on par with each other, while the US has a greater disparaty in doctor quality among its med schools, which can transate to a disparaty in the quality of healthcare that is received strictly from a physician-point-of-view

[yogi53]

One thing that I would like to see changed in the Canadian health care system is eliminating unions. They were once needed to protect the worker but now they protect the lazy and incompetent. Doctors do not have a union but have a professional groups that represent them. If nurses, physios, OTs, etc... consider themselves professionals then start acting like it.

[thecoolest47]

I still think that some of the healthcare should still be privatized. There are a ot of people out there who would pay for receiving the same quality of health care but just not wait as long, and for equality's sake the government can forumate a team that assesses the quality of hospitals to make sure they are all on par with each other.

 

I think that a lot of people use the US as a model to aniticipate what would happen if we push health care in the private sector. However I do want to bring to everyone's attention that Canada's med schools are on par with each other, while the US has a greater disparaty in doctor quality among its med schools, which can transate to a disparaty in the quality of healthcare that is received strictly from a physician-point-of-view

 

People need to do research in the Private vs. Public debate. Most of the points are listed above. A new one, not mentioned, was introduced to me through the Romanow Report. Canadians VALUE this one tier, universal system of health care. Policy makers can't simply go against a concept that has been ingrained in the identity of a nation.

 

A poster above mentioned how private health would improve access to care in remote regions. While some mining corporations may open up hospitals, I can't see this being the case for other under-served regions. In fact, I think that a private system would put a greater strain on the resources that are already scarce (doctors, nurses, etc.), causing these regions to have LESS access to care.

 

There has mention of how when the private system pull doctors from the public sector, then this will create more of a demand for doctors, and the government can respond to this demand by increasing enrollment to medical school. This argument makes NO sense. There is a shortage of doctors as it is, so if the government wants to increase enrollment, it can do it within a strictly public system.

[Alastriss]

People need to do research in the Private vs. Public debate. Most of the points are listed above. A new one, not mentioned, was introduced to me through the Romanow Report. Canadians VALUE this one tier, universal system of health care. Policy makers can't simply go against a concept that has been ingrained in the identity of a nation.

 

A poster above mentioned how private health would improve access to care in remote regions. While some mining corporations may open up hospitals, I can't see this being the case for other under-served regions. In fact, I think that a private system would put a greater strain on the resources that are already scarce (doctors, nurses, etc.), causing these regions to have LESS access to care.

 

There has mention of how when the private system pull doctors from the public sector, then this will create more of a demand for doctors, and the government can respond to this demand by increasing enrollment to medical school. This argument makes NO sense. There is a shortage of doctors as it is, so if the government wants to increase enrollment, it can do it within a strictly public system.

 

Apparently the consideratin that we will not be losing as many doctors to overseas if healthcare can be pushed into the private sector wasn't establish.

Furthermore, we aren't establishing the new healthcare policy right here on premed101.com, we are simply discussing different ideas.

 

Canadians may VALUE the 1 tier system we have, but that is a big difference between valueing a 1 tier system and believing it works.

Secondly, we should take a lesson from Adam Smith's invisible hand and observe what is happening now.

People with money just pack their bags and go to the states to receive healthcare that they cant receive anytime soon in canada, which you may think is a good thing because its one less person to bog the line down, but why increase the US's GDP when we can do that to our own.

Secondly, the mere fact that this is happening shoud clue us in that maybe the system needs to be renovated.

 

And coolest47, this ISN'T a public vs private debate, so before we throw all of this into that category lets reconsidering. Its a private and public, and a closer look at all this will reveal that the publc system we have no is not radically different than if it were private..all that your doing is substituting one resource (time waiting in line) with another (money). Ridiculous wait times in the ER do stop people from receiving health care (especially those conditions that appear to have harmless symptoms at firs) in the same manner that they would stop people from receiving health care if you had to pay for it. A difference, and this is a big difference, is that making u 'pay' in terms of your time resources as opposed to making you pay money will be more inclusive. My idea merely suggested that people who have a lot of time say time X can affort to get the free healthcare by waiting for a fraction of that large X. While people who cant afford a lot of time but have a lot of money, summed Y, can pay a fraction of Y. (In that weird economic state of mind, this i think..cheapens healthcare) Thats all that im suggesting.

 

 

But before we even begin to talk about making a new system, there are a lot of things that can be done in the midde run, and some in the short run.

I think that more power shoud be given to pharmacists and nurse practioners along with more education) so that they take the load off doctors and handle the cases are aren't severe and don't need the attention of a doctor. clinical pharmacists already do consultations and are involved in the diagnostic process, so it wont be a huge jump for them.

Disease prevention programs should be emphasized, how to stop yourself

from getting sick when there are drastic changes in the weather, what to eat and what not to eat (ie dont eat leftovers that have been in the fridge for 5 days) etc.

Self-diagnosing programs should be approached with caution, maybe a common cold can be stopped easily by the average person, but we dont want people diagnosing a stomach flu and then neglecting the blood in their stool.

 

Finally, and this is what I've been itching to talk about, is the obesity problem in Canada. When it costs the government 13.2 Billion dollars to deal with obesity and obesity related problems (diabetes and the like) it is worthy of some attention. 13.2 is a large number, but its not so unbelieve considering that ~ 24% of canada's population is obese.

 

Physical fitness programs and a strong encouragement of treating the underlying symptoms is a MUST. Maybe even government promoted healthy eating venues? I don't know, but something has to be done here, even if that includes patients who won't treat the underlying causes of their symptoms.

 

Coolest47, good point on doctor shortage. THis one as quickly overlooked. Maybe with some sort of healthcare in the private sector, we would be losing less doctors, but will it be enough? Probably not..I will leave it there and have it open for discussion cuz i g2 run

[Alastriss]

for some reason I couldnt edit a lot of the spelling mistakes so don't mind those

 

but I anted to say that people value the VALUES behind a tier 1 system, not the system in practice from an economic point of view, and drawing that distinction is necessary.

[Vallinar]

One thing that I would like to see changed in the Canadian health care system is eliminating unions. They were once needed to protect the worker but now they protect the lazy and incompetent. Doctors do not have a union but have a professional groups that represent them. If nurses, physios, OTs, etc... consider themselves professionals then start acting like it.

 

I'm not quite sure i understand what your getting at. So its ok for docs to be protected, but nurses shouldn't be?

[Vallinar]

I still think that some of the healthcare should still be privatized. There are a ot of people out there who would pay for receiving the same quality of health care but just not wait as long, and for equality's sake the government can forumate a team that assesses the quality of hospitals to make sure they are all on par with each other.

 

I think that a lot of people use the US as a model to aniticipate what would happen if we push health care in the private sector. However I do want to bring to everyone's attention that Canada's med schools are on par with each other, while the US has a greater disparaty in doctor quality among its med schools, which can transate to a disparaty in the quality of healthcare that is received strictly from a physician-point-of-view

 

I agree that moving to a pseudo-two-tier system may help. But it would have to be regulated if possible to prevent degradation of the public sector. For example (if this could somehow be implemented) we could make it so that each doc has the option of practicing privately but can only devote say 2 days/week at most to the private practice, with the remainder of the week being devoted to their public practice. This would keep more docs in Canada and allow for innovation/increased quality while reducing wait times.

 

But i was also wondering why not just adopt a system by which everyone pays out of thier own pocket for primary care and have public funding fund tests (x-rays/ MRIs etc) and surgeries? We could also have the public sector fund ER services. This would keep alot of docs in Canada and promte innovation. Also it would take a huuuge load of the system and the waiting lists would decrease drastically. As for the poor and the chornically ill, perhaps there could be a separate program (publically funded) by which they can get some rembursement (ie 70% of the primary care fees).

[yogi53]

A quick response to your question. Nurses, Physios, etc... do have professional organizations, exactly like doctors, but they also belong to unions. For example, some of the professionals above belong to the Canadian Autoworkers union. My point, which I had hoped would have generated some discussion like this, is that there is no place for unions in health care. They have too much power and interfer with patient care.

[J2thaLE]

To Yogi... so what about non-professional workers in health care settings? ie. people who work in hospital kitchens? Should they not be allowed to have unions? I am not a fan of unions myself, and as a health care professional, i do not enjoy being part of one at all. But to say that health care workers should have their unions dismantled, while everyone else in the working world can go on and keep their unions, i think would be unfair. I don't really see banning unions as a way to improve the delivery of health care in Canada. I am honestly really curious to hear what you think would be better if we didn't have unions?

 

And I think it is offside to say that health care professionals are not 'acting like professionals' because we are required to pay union dues...

[NLengr]

My point, which I had hoped would have generated some discussion like this, is that there is no place for unions in health care. They have too much power and interfer with patient care.

 

Do you have any hard data to back that claim up?

[yogi53]

I would like to point you to the site http://www.settlementswithoutstrikes.com

 

take care and i look forward to your reply