Two tiered health care system?

[astudentis]

What is it, how is it implemented?

 

Also what areas of health care needs more funding, and where can costs be reduced?

[Jixe]

Take a look at the UK health care system. It's the de-facto two-tier health care system. It consists of two parts: private health care and NHS (FULLY public). By fully public I mean that NHS-employed doctors are employed and funded for by the government. NHS would also own the clinic and equipment. I'd be inclined to call it a true socialist health care system. Canada's universal health care system is considered public in that the doctors bill the government for work done, but also private in the sense that practitioners own their own practices; essentially it's a blend. Now in the UK, they also have a fully private health care system. In this system, doctors practise privately and bill patients DIRECTLY. The patient (and maybe his/her insurance provider) would foot the bill. Obviously there are exceptions. For example, there are many cases where the public system (NHS) is overloaded and the government has to cover private health-care costs for its patients.

 

As far as I know, there ARE fully private health care clinics in Canada and I'm talking about medical clinics (not optometry/physiotherapy/etc). Try googling "private MRI clinics in Canada," as well as "Copeman Private." In terms of how it would be implemented in Canada, since hospitals and clinics are already privately owned it's as simple as having doctors bill their patients directly. The concern for many is that by permitting private health care in Canada, the government would be inclined to reduce public health care funding. This could have many (positive and negative) implications.

[JohnDakota]

In Toronto there are some operation specific private clinics.

 

In Canada we have on the surface what would be 'socialized' healthcare, but in reality it's single payer healthcare. Truely socialized healthcare would suggest that the doctors are paid salary, however here in Canada it's pay per service.

 

Just remember, if you argue that a two tier healthcare system is better than what we have now, be prepared to defend yourself against how would you prevent the tallent drain going to private institutions, leaving the publically funded healthcare system crippled.

 

Honestly, for the Canadian population that lives relatively close to the American boarder (which is most of the Canadian population) we have a defacto truely two tier healthcare system. If you don't want to wait 6 months for an MRI, just go across the boarder and pay for next day service.

[Guest rpuff]

remember, in theory Canada does have a sort of two-tiered system already because there are health care services you can pay for. For example, not all dental checkups and cleanings are covered, optometry, rehab med like occupational therapy or physiotherapy, long term care facilities, etc. Even drugs plans can vary, and obviously the rich can get the newest brands while low-income individuals will find it very difficult with coverage.

[A-Stark]

In Canada we have on the surface what would be 'socialized' healthcare, but in reality it's single payer healthcare. Truely socialized healthcare would suggest that the doctors are paid salary, however here in Canada it's pay per service.

 

Careful, many doctors in academic centres especially are indeed paid by salary rather than fee-for-service. (That's how general surgery works in Halifax, for example.)

[JohnDakota]

Careful, many doctors in academic centres especially are indeed paid by salary rather than fee-for-service. (That's how general surgery works in Halifax, for example.)

 

Since healthcare is provincially regulated that's probably how NS sets their system up. All my reading is for Ontario since I want to stay in my home province. Quebec, from what i've read, is also pay-per-service, so I simply assumed. I doubt and interviewer would go in that depth anyway. My point was simply the systems we have in Canada are single payer, but not exactly socialized.

[A-Stark]

They may mention it - alternate payment plans (i.e. salary) are becoming more and more common and, as I said, are especially the norm in academic centres. It might be worth saying something about "public funding" versus "mixed public/private delivery".

[JohnDakota]

They may mention it - alternate payment plans (i.e. salary) are becoming more and more common and, as I said, are especially the norm in academic centres. It might be worth saying something about "public funding" versus "mixed public/private delivery".

 

Man.. you're talking about educational institutions. Ever consider that these profs you're interacting with are considered differently than straight MDs? Are the practicing MDs in NS on pay-per-service? Unless Canada is building 'more and more' educational institution then I'd love to see where you get your 'more and more common' facts. That extremely vague statement is so very convenient. Requires no proof whatsoever.

[A-Stark]

No, I'm talking about a broader trend occurring across the country. Alternate payment plans are still in the minority in most parts of the country, but that is changing. I don't know why you're being so thick-headed about this - not necessary to accuse me of making up stuff. I hope you don't act like that during your interview(s).

 

(Consider that clinical payments to physicians on APPs went up by more than 20% in Ontario in 2005-2006. The data I've linked to are old, so you should expect this to be even more common than it was then.)

[JohnDakota]

I don't know why you're being so thick-headed about this - not necessary to accuse me of making up stuff..

 

Absolutely it's necessairy. I should hope you dont just swallow everything people say to you as gospel. This is particularly important since people are going to be putting their lives in your hands. The very last thing I would want to epitomize as a medical doctor is someone who is uncritical of what they're hearing/reading.

 

Using the standard generalities like 'more and more common' is a tactic of those who don't know what they're talking about. So I asked for your evidence.... sooooooorrrry.

 

I hope you don't act like that during your interview(s). ..

 

Ya.. because interviewers want you to be a naieve, uncritical sheep , who accepts everything they say. Dont' ask questions, and don't you DARE ask for where they get their information! What medschools want are robots who can't think for themselves.

 

And while this is a moot point (you apparently are already in medschool); I should hope you didn't call your interviewers names (eg thick headed) simply because they wanted to know your sources. If I were forced to balance someone who critically thinks for him/herself and wants to see source data, with someone who calls people names because they don't accept his/her statements as fact, I would have no problem accepting the critical thinker.

 

I should hope they dont teach you that critical thinkers are 'thick headed' at Dal. I doubt they do. Maybe this is just your own personal impression of those who like to think for themselves though. In that case..... grow up.

[funkmunk]

don't forget the capitation model and how it ties into FFS...

[Dr.Notyet]

Absolutely it's necessairy. I should hope you dont just swallow everything people say to you as gospel. This is particularly important since people are going to be putting their lives in your hands. The very last thing I would want to epitomize as a medical doctor is someone who is uncritical of what they're hearing/reading.

 

Using the standard generalities like 'more and more common' is a tactic of those who don't know what they're talking about. So I asked for your evidence.... sooooooorrrry.

 

 

 

Ya.. because interviewers want you to be a naieve, uncritical sheep , who accepts everything they say. Dont' ask questions, and don't you DARE ask for where they get their information! What medschools want are robots who can't think for themselves.

 

And while this is a moot point (you apparently are already in medschool); I should hope you didn't call your interviewers names (eg thick headed) simply because they wanted to know your sources. If I were forced to balance someone who critically thinks for him/herself and wants to see source data, with someone who calls people names because they don't accept his/her statements as fact, I would have no problem accepting the critical thinker.

 

I should hope they dont teach you that critical thinkers are 'thick headed' at Dal. I doubt they do. Maybe this is just your own personal impression of those who like to think for themselves though. In that case..... grow up.

 

As I'm not directly involved in this conversation I think I can be safely assumed to be a level-headed, unbiased second-opinion

 

JD - you are coming across as a hot-headed, argumentative person who doesn't like to be challenged or have his opinions challenged - your veiled insults, know-it-all attitude and perceived inability to constructively approach this situation make me hope that I never have you as a physician some day. There are other ways to settle this without getting uppity.

perhaps instead of attacking the validity of what he was saying you could have asked in a polite way for some more information about APPs - ie in a professional manner as would be expected of a physician dealing with his/her colleagues or anyone for that matter

 

AS - stoking the flames with "thick-headed", while some may agree probably wasn't the best idea, but I'm glad you pointed out the salaried docs as I had not come across this info yet.

 

to both: Just because we are protected by the anonymity of the board doesn't mean we have the right to be disrespectful. Have a nice day

[funkmunk]

well put.

[JohnDakota]

 

JD - you are coming across as a hot-headed, argumentative person ...

Argument/debate is how people learn and become more comfortable with their own knowledge. So what if I enjoy a good argument. If I come across as hot headed. Sorry for that.

 

.....who doesn't like to be challenged or have his opinions challenged -

 

Untrue. I prefer to be challanged because then I learn more about a subject. For example, in this instance I learned about APP as it was a vague concept to me before. I took some time to do further reading on it and now I understand salary vs. capitation vs. blended systems vs. FFS and the various pros/cons of them all (even though the CIHI article doesn't really discuss all that.) I have this argument specifically to thank for my deeper understanding of the subject.

 

... your veiled insults, know-it-all attitude and perceived inability to constructively approach this situation make me hope that I never have you as a physician some day.....

 

Since I highly doubt I'll be an e-doctor you have nothing to fear in terms of interacting with me in this capacity. I'm sorry if I'm very direct on the internet. I can't be bothered to be warm, fuzzy, and cuddle with people I don't know. More to the point, when people tell me to be "careful", wag their finger at me, and then proceed to call me 'thick headed' obviously I"m going to be even more pointed with them. Calling those people out on their generalities (more and more common) and their lack of evidence was a given.

 

There are other ways to settle this without getting uppity.

 

I would call it being direct.

 

 

perhaps instead of attacking the validity of what he was saying you could have asked in a polite way for some more information about APPs

 

When did our society get insecure about attacking validity of statements or arguments? I didn't attack AS personally (ad-hominem), I pointed out he hadn't supported his position. There's a difference, and I find that people take it as a personal insult if you point out they're lacking support. It's not a personal insult. A personal insult is something along the lines of calling someone 'thick headed' or 'bigot' or 'nazi' etc. Those kinds of statements serve to only end debates. Getting someone to support their position furthers the debate. The only reason I didn't ask for his citation directly was because of the Mr. Waggy Finger approach ("careful) and the vague generality statement.

 

To address the 'politeness' critique; Would a smiley suffice next time? How about this =)

 

ie in a professional manner as would be expected of a physician dealing with his/her colleagues or anyone for that matter

Ok.. =)

 

 

to both: Just because we are protected by the anonymity of the board doesn't mean we have the right to be disrespectful. Have a nice day

 

Calling someone on vague generalities isn't being disrespectful. It's saying they haven't supported their point. Its not a big deal, infact a link to the CIHI article would have sufficed.

 

Anyway this whole APP argument was tangential to my original point in that Canada isn't truely socialized. That's all I was trying to say.

[Laika]

In Canada we have on the surface what would be 'socialized' healthcare, but in reality it's single payer healthcare. Truely socialized healthcare would suggest that the doctors are paid salary, however here in Canada it's pay per service.

 

I don't mean to fan the flames... but there are certainly salaried doctors in Ontario, including ones who don't work in academic centers. For example, I know docs at community health centers are salaried, and it is becoming more common for ER docs to be salaried as well. I'm sure there are other examples but can't remember them off the top of my head.

 

It may just be a point of terminology, but I don't see your connection between remuneration method and private vs. socialized healthcare. In the US (i.e., a privately financed system with private delivery), there are (some) salaried docs. In the UK's NHS (i.e., a publicly financed system with public delivery), there are (some) fee-for-service docs.

[rmorelan]

I don't mean to fan the flames... but there are certainly salaried doctors in Ontario, including ones who don't work in academic centers. For example, I know docs at community health centers are salaried, and it is becoming more common for ER docs to be salaried as well. I'm sure there are other examples but can't remember them off the top of my head.

 

It may just be a point of terminology, but I don't see your connection between remuneration method and private vs. socialized healthcare. In the US (i.e., a privately financed system with private delivery), there are (some) salaried docs. In the UK's NHS (i.e., a publicly financed system with public delivery), there are (some) fee-for-service docs.

 

Yeah, I agree - I remember reading the salaries of many specializations from the Ontario wide publication of public employees who earned more than 100 000 dollars. It included many doctors not at academic institutions.

[A-Stark]

Well, this turned into a nice little flame war (or skirmish) while I was out today.

 

JD: I don't much appreciate being accused of making up facts as if I have no idea what I'm talking about. If the growth of alternate payment plans came as a surprise to you, by all means say so. In fact, whenever you hear something unfamiliar, the appropriate, respectful and non-confrontational reply would be simply to ask for some references for further reading. You see, expressions of curiousity are generally taken better than know-it-all-ism.

 

And it's necessary to accuse me of making stuff up? Why? I trust you wouldn't do that when your staff tells you something. (I also don't recall any interviewers asking me to provide annotated bibliographies in support of what I was saying. It's an interview not a journal club.)

[silvermen85]

I don't mean to fan the flames... but there are certainly salaried doctors in Ontario, including ones who don't work in academic centers. For example, I know docs at community health centers are salaried, and it is becoming more common for ER docs to be salaried as well. I'm sure there are other examples but can't remember them off the top of my head.

 

It may just be a point of terminology, but I don't see your connection between remuneration method and private vs. socialized healthcare. In the US (i.e., a privately financed system with private delivery), there are (some) salaried docs. In the UK's NHS (i.e., a publicly financed system with public delivery), there are (some) fee-for-service docs.

 

Just because docs are been paid by salary doesn't necessarily indicate the system is public. Many hospital administrators of private health care provider are salaried staff, they still belong to for-profit private health care system. Socialized medicine has more to do with tax-payers money is used to pay for doctor's salary, not the revenue that is generated.

[A-Stark]

"Socialized" health care is a fairly nonspecific term in the end. PBS's Frontline has a good description of the different models in use. For Canada:

 

The National Health Insurance Model

 

This system has elements of both Beveridge and Bismarck. It uses private-sector providers, but payment comes from a government-run insurance program that every citizen pays into. Since there's no need for marketing, no financial motive to deny claims and no profit, these universal insurance programs tend to be cheaper and much simpler administratively than American-style for-profit insurance.

 

The single payer tends to have considerable market power to negotiate for lower prices; Canada's system, for example, has negotiated such low prices from pharmaceutical companies that Americans have spurned their own drug stores to buy pills north of the border. National Health Insurance plans also control costs by limiting the medical services they will pay for, or by making patients wait to be treated.

 

The classic NHI system is found in Canada, but some newly industrialized countries -- Taiwan and South Korea, for example -- have also adopted the NHI model.

 

I should add that many provinces are a bit closer to the British system, insofar as regional/district health authorities exist to oversee hospital, outpatient, and long-term care together, though how well everything works in practice is another question. Ontario is the major exception, where such authorities are a relatively new in the Local Health Integration Networks. I have only a vague idea how they work.

[Laika]

Just because docs are been paid by salary doesn't necessarily indicate the system is public.

 

Right. That was my point, in response to JD's earlier comment.

[Alastriss]

In Toronto there are some operation specific private clinics.

 

In Canada we have on the surface what would be 'socialized' healthcare, but in reality it's single payer healthcare. Truely socialized healthcare would suggest that the doctors are paid salary, however here in Canada it's pay per service.

 

Just remember, if you argue that a two tier healthcare system is better than what we have now, be prepared to defend yourself against how would you prevent the tallent drain going to private institutions, leaving the publically funded healthcare system crippled.

 

Honestly, for the Canadian population that lives relatively close to the American boarder (which is most of the Canadian population) we have a defacto truely two tier healthcare system. If you don't want to wait 6 months for an MRI, just go across the boarder and pay for next day service.

 

actually if we are going to get technical technical, truly socialized health-care is a system where the prices are set by the government and are not negotiable. So the opposite of free competitive market.

 

regarding the bolded part that's not entirely two tier. That's having a privately provided public insurance system like us but with the capacity for supplementation.

[Meditopia]

How about private clinics?

 

Some provinces in Canada such as BC, Alberta and Quebec have these privately operated clinics where patients pay about $2000 a year to receive care from a family physician and diagnostic team. The government in my home province put 1 million dollars towards a feasibility study to see whether it could be introduced here. In my opinion such clinics seem to be a move toward a two-tier system. What do you guys think?

[hellosc]

i have a question, is physiotherapy covered under medicare?

[truffle]

i have a question, is physiotherapy covered under medicare?

 

depending on what you need it for. the more necessary kind is. for example, you are a 75 yo woman and you broke your leg, first you are treated at a hospital (but not necessarily a hospital). then after your cast go off, you get physiotherapy covered under medicare. another example, if you are an amateur marathon runner and you need physiotherapy to relieve some running-induced soreness/whatever in time for your next run, it's not covered. i don't know the details, but you should be able to find it somewhere, probably online.

another general example: toronto rehabilitation hospital is connected to the university health network. the UHN offers out-patient care and in-patient care mostly for the more acute problems. the rehab hospital offers out- and in-patient assessment/care and home visits. the two systems are parallel (i.e. after hospitals treat your more acute problems, you may need physiotherapy to restore/recover function). so i think you need doctor's referrals or something to get into toronto rehab.

[truffle]

read this: http://pr-usa.net/index.php?option=com_content&task=view&id=137416&Itemid=29

i found it just now. it's pretty interesting.