Physician Shortage vs. Surplus

[BoyInTheBubble]

No. The problem arises because you have a finite amount of OR TIME and facilities causing surgeons to operate maximum once a week when most of the time they would want to operate more (2 or 2 1/2 days a week).

 

Hence, why would a surgeon not want to increase the availability of his skills to the population in a private environment if he can't do it in the public system? Of course its services have a price (a fixed material price: the cost of the facility, nurses, RT, etc. and a variable price: the value of his "talent") but in the end he will often be payed the equal amount or sometimes even less than he would in the public system.

 

The issue is that the PATIENT will have to pay a fee that would have been covered in a public hospital.

 

No.

 

The most similar country with parallel public and private hospital systems is Australia. What you are describing is exactly what did not happen.

 

Private hospitals only function to make money. In health care terms, this means running hospitals that fix profitable patient problems. Procedural things with limited follow up are perfect, think knees or hips or cataracts. Those surgeons LOVE IT. They charge more, and do more (in the private system).

 

The public wait lists for these procedures (the ones done more commonly in private hospitals) INCREASES. (It's the same surgeons operating in both.)

 

Private hospitals don't take an equal share of the health system burden. They limit themselves on purpose. The public hospitals get stuck with dialysis, transplants, trauma, and everything else that is expensive. The obese, vasculopaths with COPD and DM end up getting their knee or hernia operated on in the public system. Private hospital system worsened their public hospital system.

 

Health care is not a simple commodity.

[rmorelan]

No.

 

The most similar country with parallel public and private hospital systems is Australia. What you are describing is exactly what did not happen.

 

Private hospitals only function to make money. In health care terms, this means running hospitals that fix profitable patient problems. Procedural things with limited follow up are perfect, think knees or hips or cataracts. Those surgeons LOVE IT. They charge more, and do more (in the private system).

 

The public wait lists for these procedures (the ones done more commonly in private hospitals) INCREASES. (It's the same surgeons operating in both.)

 

Private hospitals don't take an equal share of the health system burden. They limit themselves on purpose. The public hospitals get stuck with dialysis, transplants, trauma, and everything else that is expensive. The obese, vasculopaths with COPD and DM end up getting their knee or hernia operated on in the public system. Private hospital system worsened their public hospital system.

 

Health care is not a simple commodity.

 

There are some examples of exactly that happening in Canada as well with the few private hospitals we do have that limit themselves to very particular surgeries for a very select population.

[rmorelan]

No.

 

The most similar country with parallel public and private hospital systems is Australia. What you are describing is exactly what did not happen.

 

Private hospitals only function to make money. In health care terms, this means running hospitals that fix profitable patient problems. Procedural things with limited follow up are perfect, think knees or hips or cataracts. Those surgeons LOVE IT. They charge more, and do more (in the private system).

 

The public wait lists for these procedures (the ones done more commonly in private hospitals) INCREASES. (It's the same surgeons operating in both.)

 

Private hospitals don't take an equal share of the health system burden. They limit themselves on purpose. The public hospitals get stuck with dialysis, transplants, trauma, and everything else that is expensive. The obese, vasculopaths with COPD and DM end up getting their knee or hernia operated on in the public system. Private hospital system worsened their public hospital system.

 

Health care is not a simple commodity.

 

although I should say it isn't the same surgeon in both system often (the private sector is selective after all - it wants surgeons that it can use to INCREASE the apparent value of the service so it can correspondingly increase price. Note that apparent value could be true value as well - you could have the most experienced, most skilled, and most respected surgeons moved to the private sector. Often the care you receive is radically different between the two system - just check out the Henry Ford Hospital vs Detroit General for a rather extreme example).

 

It is possible for it to reduce wait time under a two tier system - for starters you can actually have MORE surgeons - start opening private clinics here and don't be surprised if there is an economic pull to have doctors practise there. Not to mention a overall collective increase in OR time. If you increase OR availability and surgeons overall you can reduce wait times. The price you pay for this is the shunting of more overall cost in the system. Of course if you pay more you can get more.

 

In the long run part of the problem is back pressure on the public system to actually get less money in taxation - after all a large vocal part of the population just paid for the procedure on their own. Now you want them to pay for a service via taxation they do not use. They argue taxes should be lower as a result - this is the same group that complains about any from of socialized medicine in the US. We see the same effect in other sectors in Canada as well - there is a big political movement to have people that pay for private schooling have a tax reduction - after all they just paid for a service they don't use. There is little reason to expect the same effect wouldn't occur with health care - ha, more debates

 

Overall the system would be more expensive - not just because the second tier is more expensive due to the need for profit but also because the very nature of private care is to provide a different type of service. If you HAVE to have short wait times - which private hospitals must or they cannot compete with the free public one - then you have to build in redundancy - there are days those ORs will simply not run once the backlog clears. You need spare capacity increase you do need to run them. Another example - everyone has to get that MRI within a day so sometimes that MRI just isn't running. This is the age old efficiency vs flexibility tradeoff you see every where - public systems are not very flexible but they can be as a result very efficient. Private system can have the opposite problem. And wait times is just one of the ways the systems are different. I am pretty sure you don't eat off of china at your local hospital. At Henry Ford anything else would be unthinkable in their marble lined cafeteria If you want people to pay more, you have to make it look like you are worth more.

[bloh]

 

It is possible for it to reduce wait time under a two tier system - for starters you can actually have MORE surgeons - start opening private clinics here and don't be surprised if there is an economic pull to have doctors practise there. Not to mention a overall collective increase in OR time. If you increase OR availability and surgeons overall you can reduce wait times. The price you pay for this is the shunting of more overall cost in the system. Of course if you pay more you can get more.

 

By the same accord, we can shorten the doctor shortage right away by handing out licences to every IMG that wants it! Awesome! More doctors, EVERYWHERE!

 

What could possibly be bad about that?

 

Healthcare is not a simple commodity. Period. Full stop.

 

As such, you can't apply the same principles you apply to apples and Ipads. As soon as you introduce profit, things change dramatically.

[jock2doc]

Healthcare is definitely not a simple commodity. It suffers from market failures that make public provision better than private. However, even our public system has it's faults. There is no one clear way to improve its function. The biggest issue that I notice is that in order to generate more capital on a public system, more revenue is required. Now seeing as how taxation is a 4 letter word to many, they can't be too keen on forking over a bigger chunk of their paycheque to build new OR's/hire non-MD staff. However, these same tax payers are funding the residencies for many physicians who are having a tough time finding work in Canada after completion. Furthermore, many of them are waiting much longer for procedures than in most western nations. Kind of a paradox.

[NutritionRunner]

No.

 

The most similar country with parallel public and private hospital systems is Australia. What you are describing is exactly what did not happen.

 

Private hospitals only function to make money. In health care terms, this means running hospitals that fix profitable patient problems. Procedural things with limited follow up are perfect, think knees or hips or cataracts. Those surgeons LOVE IT. They charge more, and do more (in the private system).

 

The public wait lists for these procedures (the ones done more commonly in private hospitals) INCREASES. (It's the same surgeons operating in both.)

 

Private hospitals don't take an equal share of the health system burden. They limit themselves on purpose. The public hospitals get stuck with dialysis, transplants, trauma, and everything else that is expensive. The obese, vasculopaths with COPD and DM end up getting their knee or hernia operated on in the public system. Private hospital system worsened their public hospital system.

 

In Germany, from what I understand, it is all one system. What differs is whether the patient has health insurance provided by the government (public) or by private industry (private). Patients with both types of insurance use the same hospitals, see the same doctors, etc. So there is no separation. The only difference is who pays for the office visits, the procedures, etc. - the government or the private insurance company.

 

While I don't have any direct personal experience with it, my friends in Berlin say the system seems to work wonderfully for both those covered by the private system and the public system. Of course, Germany does have much higher taxes than Canada, has a much smaller land mass (so rural/remote coverage isn't as big an issue), and has a different medical education system.

 

Having both a public and private system doesn't mean having separate hospitals, separate clinics, doctors only working in one system, etc. My friends in Berlin have a family doctor who sees both public and private patients. They tell me most doctors see individuals with both types of insurance.

 

So if Canada went to a two tier system, why do you assume it would be like Australia or the U.S.? Why couldn't Canada have a system more like Germany's? (Yes, I know we have issues with rural/remote communities, as I previously mentioned, and no doubt physician remuneration is higher in Canada currently, etc.) I would never want to go to a U.S.-style system, but I see nothing wrong in looking at solutions to our current problems (and if you don't think our health care system is broken, then you've never had to wait months and months in pain waiting for a specialist or a procedure/surgery).

[rmorelan]

By the same accord, we can shorten the doctor shortage right away by handing out licences to every IMG that wants it! Awesome! More doctors, EVERYWHERE!

 

What could possibly be bad about that?

 

Healthcare is not a simple commodity. Period. Full stop.

 

As such, you can't apply the same principles you apply to apples and Ipads. As soon as you introduce profit, things change dramatically.

 

well that wouldn't work because there is no corresponding increase in OR availability. If you got people to pay for that OR increase then yes would have reduced wait times IF you held all other variables constant (ha!) - you would just be paying more.

 

It isn't a simple commodity - but you can model it as a two goods system (private vs public) and experiment with the effects. It does follow economic principles

[rmorelan]

Healthcare is definitely not a simple commodity. It suffers from market failures that make public provision better than private. However, even our public system has it's faults. There is no one clear way to improve its function. The biggest issue that I notice is that in order to generate more capital on a public system, more revenue is required. Now seeing as how taxation is a 4 letter word to many, they can't be too keen on forking over a bigger chunk of their paycheque to build new OR's/hire non-MD staff. However, these same tax payers are funding the residencies for many physicians who are having a tough time finding work in Canada after completion. Furthermore, many of them are waiting much longer for procedures than in most western nations. Kind of a paradox.

 

I actually am a big fan of the public system - but still you have to be careful saying public provision is simply better The "freedom minded" US think their system is better in many cases - it is just a part of how they structure their society.

 

It isn't a paradox though - I mean the longer wait times is almost a predictable effects of how we happen to have set up our public model - there are other public models where it isn't as much of a problem. A lot of it is how we allocate our total resources within our system.

[jock2doc]

Having both a public and private system doesn't mean having separate hospitals, separate clinics, doctors only working in one system, etc. My friends in Berlin have a family doctor who sees both public and private patients. They tell me most doctors see individuals with both types of insurance.

 

I am not sure how insurance companies could affect wait times. Canadians have private health insurance companies too (eg Blue Cross). I can not speak for others, but when I was referring to a two tiered system, I was talking about doctors working the government funded hospitals.

[jock2doc]

I actually am a big fan of the public system - but still you have to be careful saying public provision is simply better The "freedom minded" US think their system is better in many cases - it is just a part of how they structure their society.

 

It isn't a paradox though - I mean the longer wait times is almost a predictable effects of how we happen to have set up our public model - there are other public models where it isn't as much of a problem. A lot of it is how we allocate our total resources within our system.

 

Hahah true. The Tea Party would have me tried if I spoke like that in the south. As far as the system setup is concerned, a Med 1 is obviously not as familiar with it as a PGY1. Therefore, I will trust your judgement on that one.

[bloh]

 

It isn't a simply commodity - but you can model it as a two goods system (private vs public) and experiment with the effects. It does follow economic principles

 

No it doesn't. The private system always has a "profit" markup.

 

We already have a 2-tier healthcare system. If you want a private option that you can pay for, go down south. They will gladly take you on, every time. . There's no need to introduce it here.

[jock2doc]

No it doesn't. The private system always has a "profit" markup.

 

We already have a 2-tier healthcare system. If you want a private option that you can pay for, go down south. They will gladly take you on, every time. . There's no need to introduce it here.

 

The profit markup is true. And that is a cause for concern because it provides too many reasons to overtreat. However, and I am saying this as a liberal who is very pro public-provision, the private market is more efficient. This efficiency increase arises because there is an incentive to maximize profits. Attempting to maximize profits brings on innovation in an attempt to gain a competitive edge on your competition. Therefore, just because something has a profit markup does not necessarily mean that it is more expensive on the whole, if everything else can be done at a reduced cost (because of increased efficiency). Again, I am not saying I am in favor of private provision, just playing devil's advocate.

[rmorelan]

I am not sure how insurance companies could affect wait times. Canadians have private health insurance companies too (eg Blue Cross). I can not speak for others, but when I was referring to a two tiered system, I was talking about doctors working the government funded hospitals.

 

That is one two tiered system certainly - but so far in Canada two tier attempts have centred on the creation completely secondary facilities (of course usually this attempts have been shot down but not always).

[rmorelan]

No it doesn't. The private system always has a "profit" markup.

 

We already have a 2-tier healthcare system. If you want a private option that you can pay for, go down south. They will gladly take you on, every time. . There's no need to introduce it here.

 

That has always been one of the long term arguments FOR a two tier system. You are shunting economic resources outside of the country by refusing to do it here. Associated jobs, skills development and taxes are thus lost to the Canadian economy.

 

Profit doesn't stop economic modelling, or even one good with profit and one without. Gosh we must have ground through 100s of those with every possible variation

[NutritionRunner]

I am not sure how insurance companies could affect wait times. Canadians have private health insurance companies too (eg Blue Cross). I can not speak for others, but when I was referring to a two tiered system, I was talking about doctors working the government funded hospitals.

 

Look at it this way: if say 70% of the population is taken care of by private insurance, then that is either more money that is being funnelled into the health care system or money that doesn't need to be provided by the government (taxes). That means the government can: maintain its funding to the health care system, which means there will be more money overall in the system, thus allowing for more resources (and therefore reducing wait times) OR it can use those funds in other ways that are also important to having a healthy population (look at the social determinants of health: stuff like income and income equality have HUGE effects on the health of a population and therefore the health care resources they use. If your population requires fewer health care resources, then wait times will also go down).

 

Also, with private insurance paying for stuff that, in Canada, is funded by the government (ie. doctor's appointments, most surgeries, etc.) you have an incentive to make things more efficient. Granted, I'm not a medical student yet, but I've experience the health care system from the perspective of a dietetic student, and I've talked to many doctors and administrators in health care, and they all tell me that Canada's current health care system is incredibly inefficient. We waste a lot of money with things like bureaucracy and duplication of efforts that aren't required. Private health care insurance companies will push for a more efficient system. If that can be done while still maintaining quality (such as is the case in Germany), then that also can help reduce wait times.

[jock2doc]

My apologies. I stand corrected.

[A-Stark]

Look at it this way: if say 70% of the population is taken care of by private insurance, then that is either more money that is being funnelled into the health care system or money that doesn't need to be provided by the government (taxes). That means the government can: maintain its funding to the health care system, which means there will be more money overall in the system, thus allowing for more resources (and therefore reducing wait times) OR it can use those funds in other ways that are also important to having a healthy population (look at the social determinants of health: stuff like income and income equality have HUGE effects on the health of a population and therefore the health care resources they use. If your population requires fewer health care resources, then wait times will also go down).

 

This isn't really realistic in the slightest. First, this fails to distinguish between funding and provision of services. There is no Western country in the world that provides much less than 50% of total funding from the public sector, and the "best" systems tend to have higher levels of public funding than not. That of course says nothing about the provision of services, which in Canada encompasses publicly-funded, locally or regionally-managed hospitals, and privately-owned and operated primary care clinics.

 

One of the distinctive features of the Canadian system is that almost all physician payments come from public funds, while dental and eye care is mostly privately funded. In most other countries (UK, Germany, France), physicians have greater access to private payments of one sort or another, though the lion's share still arises from public funds.

 

Also, with private insurance paying for stuff that, in Canada, is funded by the government (ie. doctor's appointments, most surgeries, etc.) you have an incentive to make things more efficient. Granted, I'm not a medical student yet, but I've experience the health care system from the perspective of a dietetic student, and I've talked to many doctors and administrators in health care, and they all tell me that Canada's current health care system is incredibly inefficient. We waste a lot of money with things like bureaucracy and duplication of efforts that aren't required. Private health care insurance companies will push for a more efficient system. If that can be done while still maintaining quality (such as is the case in Germany), then that also can help reduce wait times.

 

What exactly is going to become more efficient about your GP's office? The billing system incentivizes efficiency by directly compensating volume rather than time. That's why we have "one issue per visit" medicine at walk-in clinics and many family medicine practices. Whether that's good medicine is debatable but it is most certainly efficient. Similarly, OR turnover in the community is fast and efficient, in contrast to the situation in many academic hospitals.

 

In general, the billing system is anything but inefficient. Hospital block-funding, however, tends to militate against some forms of increased efficiency. Volume doesn't really matter since a certain number of beds are funded with a certain number of OR hours and a certain capital budget. Many staff in the academic area are on salary-esque alternate payment plans. There has been a move toward "activity-based" funding to reward volume.

 

This is NOT a simple issue, and it has very, very little to do with any kind of public vs private debate. Microeconomics 101 is pretty irrelevant to this.

 

Regarding the German system, it's absolutely necessary to point out that it is structured entirely differently from Canada's system. We have a single-payer insurance system that provides universal coverage irrespective of someone's tax contribution (even though some provinces have so-called health "premiums"). In Germany, people pay into "sickness funds", which are non-profit insurance funds administered separately from the government, not unlike the HMOs in the US (and, in fact, that's what they're based on). People may opt out for private funds if they earn a sufficient income. I don't fully understand the mechanics of it, but suffice it to say it's complicated.

 

I have firsthand experience only with the similar Austrian system. The major difference vs. Canada is a higher level of organization, technological penetration, and capital spending. But then that goes for all public services in both Austria and Germany. In both, public spending on health care comprises about 80% of total spending, compared to about 70% in Canada. Private healthcare is expensive - and more expensive than public healthcare - everywhere. Suggesting otherwise is either dishonest or ignorant.

 

Personally, I would quite appreciate the level of infrastructure and public services available in Germany. All we need are higher taxes and a business sector which focuses on value-added exports rather than crude tar sands oil, lumber, and selling off our mining sector to foreigners.

[jock2doc]

Personally, I would quite appreciate the level of infrastructure and public services available in Germany. All we need are higher taxes and a business sector which focuses on value-added exports rather than crude tar sands oil, lumber, and selling off our mining sector to foreigners.

 

Agreed! +1

[rogerroger]

Agreed! +1

 

Higher taxes? Hell no. I like to decide how my money is spent rather than some politician.

 

We will see a two tier system during our careers. The writing is on the wall.

 

Health care already makes up a huge proportion of provincial budgets. The population is getting older and older. The working taxable population is getting smaller. People are living longer and longer. Medical technology is advancing faster and faster which makes it ever more expensive for the latest and greatest resources. It is pretty clear where all this leads.

 

Speaking about the German system... I once got sick in Berlin with pharyngitis. I went to the emerg as I needed penicillin. I was seen immediately after registering at the emerg. They thought I may have a peritonsilar abscess and I saw an ENT doc 15 min after seeing the emerg doc. I was out the door in about an hour. It was pretty neat, the whole thing cost my insurance ~200 euros.

[Patrick1234]

Speaking of cost, why does our medical education cost so much in North American? I know canada is a lot cheaper because its subsided by the government but why does it need so much subsidizing in the first place? I mean in the first 2 years, it's just lectures in one room taught by various profs, with like 200 students and labs, why does that cost so much per year compared to undergrad? Where's the money all going to?

[A-Stark]

Higher taxes? Hell no. I like to decide how my money is spent rather than some politician.

 

We will see a two tier system during our careers. The writing is on the wall.

 

Right. Obviously there's no need for adequate pharmacare, to say nothing of the billions in infrastructure spending needed around the country. A two tier system is beside the point. That will certainly benefit certain physicians and surgeons; whether it will benefit anyone else is debatable and certainly doubtful.

 

Health care already makes up a huge proportion of provincial budgets. The population is getting older and older. The working taxable population is getting smaller. People are living longer and longer. Medical technology is advancing faster and faster which makes it ever more expensive for the latest and greatest resources. It is pretty clear where all this leads.

 

The whole "the system is not sustainable" rhetoric is just that. People these days are also able to afford to spend $70/month for their mobile bills. The idea that we somehow are going to be starved of resources in the future - or that relatively higher taxes are anathema to pay for higher costs - are simply the usual right-wing talking points. Whether it's sustainable to expect to be able to get the newest, coolest device for the angio suite may be in question, but then it's equally true that all these expensive devices arrive without any kind of validation or strong evidence for their utility.

 

Speaking about the German system... I once got sick in Berlin with pharyngitis. I went to the emerg as I needed penicillin. I was seen immediately after registering at the emerg. They thought I may have a peritonsilar abscess and I saw an ENT doc 15 min after seeing the emerg doc. I was out the door in about an hour. It was pretty neat, the whole thing cost my insurance ~200 euros.

 

And in Germany, public spending comprises 80% of all healthcare spending, there are 50% more physicians per capita, and said physicians most certainly do not make as much as we do in Canada. The level of public services and infrastructure is higher across the board. In Austria, in a small city like Innsbruck, the buses run every five minutes at peak periods, and the main *public* university hospital has a higher level of technological penetration (more than any Canadian ORs I've been to). Infection control rules are far stricter (forget about street clothes in the hospital), the OR lounge has freshly made soup, bread, and sparkling water daily, doors are automatic, and the daily list is visible to anyone on a dynamic monitor display, with scheduling, case details, and staffing.

 

In short, it is a system that is not perpetually on the brink of overcapacity or underinvestment. And before you say that that's because of the "relief" of the private system, patients with private care end up in the public hospital too. For one such patient, the staff made numerous derisive comments about all the excessive, unnecessary investigations the patient had undergone since, after all, they were all through private billing.

 

Anyhow, when I had fairly severe allergic conjunctivitis last spring, I was into the optometrist with a same-day appointment, given some analgesic and antihistamine drops at the office, and on my way with the script in the space of 15 minutes. And all covered under provincial insurance (except the script, of course).

 

One thing we might consider, though, is moving away from globally funded insurance to a more separately administered "sickness fund" model in Germany. People would still be taxed directly for health insurance, but instead of going to government general revenue, it would go to these funds. But maybe that's a change in search of a problem.

[rogerroger]

Speaking of cost, why does our medical education cost so much in North American? I know canada is a lot cheaper because its subsided by the government but why does it need so much subsidizing in the first place? I mean in the first 2 years, it's just lectures in one room taught by various profs, with like 200 students and labs, why does that cost so much per year compared to undergrad? Where's the money all going to?

 

I suspect a proportion goes into other non-medical programs run by the university. They university charges that tuition because they can IMHO. Especially in the pre-clerkship years...

[rogerroger]

 

The whole "the system is not sustainable" rhetoric is just that.

 

Tell that to the 80 year old guy who is on ALTC basically indefinitely or the frail elderly lady with the fractured hip who was in the emerg hall for 32hrs, no beds, no OR. Or how about the people being flown via Ornge to Buffalo for surgery, on the tax payer dime I might add, because we have no neurosurgical beds in the entire province... Demographics are fact and the trend towards a more elderly more resource demanding population is not changing any time soon.

 

Don't get me wrong, there is a lot that is great about our system. But the system unsustainability argument is real if you believe what I mentioned above is unacceptable.

 

You either tax people more and potentially weaken the whole economy and also not get elected, accept resource limited care for all and maybe not get elected, or offload and open up the second tier. Heck, the second tier already exists informally. The move towards this started long ago.

[A-Stark]

So your solution is simply to "open up" the second tier without fixing the clear capacity problems in the public system? How does that fix anything or help the 80-90% of the population that will still rely exclusively on the public acute care sector?

 

What government fired nurses, merged/closed hospitals, and cancelled transit expansion in the mid-90s in Ontario to pay for tax cuts? Are you suggesting that taxes have not been steadily reduced at the expense of public services since at least 1998? Total government program spending as a percentage of GDP is at its lowest level and decades and we can't afford to fund the system properly?

 

This is bull****. Period. I am sick to death of hearing about we must open some private sector that will inevitably require subsidization (indirect or direct) from the public system, since that's what happens in EVERY other country.

 

It's not going to "weaken" the entire economy to make our hospitals more efficient and effective, increase the affordability of prescription drugs, or improve public infrastructure which itself yields dividends for health outcomes.

 

The idea that we can go on underinvesting and underfunding and simply let the private sector "take over" to fill the gap is false based on experience around the world and absolutely disingenuous. Canadian health care spending is already over 30% private - that's delivery and funding - and any "private" solutions to current issues amount to screwing over everyone who can't afford out-of-pocket payments or pricey private insurance. Even in Germany, you have to be at a certain income threshold to be allowed to opt out of paying into a public sickness fund.

 

Honestly I don't really care about whether we allow more privately-funded care. We already have that in spades when it comes to dental and eye care. However, I don't want even a dime going to subsidize it, and it will not add any sufficient capacity with sufficient accessibility to solve ANY issues in the public system.

 

Or are you arguing that private neurosurgery centres are going to open with full stepdown units and ICUs, to say nothing of ancillary services as in a large hospital? What private centres are going to be doing emergent hips or vascular or trauma or oncology or dialysis?

 

The old demographic argument doesn't really bear much treatment. Most elderly people are reasonably healthy and manage fine in the community. We see only the sickest in hospital, and while it's difficult to predict where things will go in the future, suggesting that the private sector is going to start admitting complicated medicine patients is fanciful. It's just ridiculous.

 

At best, private centres will be doing elective joints on ASA I or II patients, scopes, minors, hernias, and maybe a bit of "worried well" lifestyle-type counselling. I don't really have a problem with contracting private ambulatory centres to perform publicly-funded procedures - not everything need happen in a tertiary care hospital - but that has only limited scope. Inpatients are expensive and unprofitable.

[BoyInTheBubble]

 

We will see a two tier system during our careers. The writing is on the wall.

 

 

The Canadian health care system is already a combination of public and private. The two tiers exist.

 

The limits to the private sector are placed on things covered by government insurance. There is already a lot that is not covered, for example drugs, physio, dentists. You can pay for hotel services (eg private rooms, televisions, etc) if they are not medically needed elsewhere.