Physician Shortage vs. Surplus

[bloh]

If the government could somehow stop people from going to the US for health care and instead have that money spent in Canada in theory would have the health care budget rise. Part of that additional revenue could actually partially pay for the 78 year old's care and allow perhaps in theory as well more staff and improve wait times in general. Ha - again I am not exactly pro two tier but we are all aware of these arguments of course and they are not exactly trivial to dismiss - and there is a huge movement based on these ideas out there including a lot of doctors. It is a rather dangerous time in Canadian health care.

 

That makes absolutely zero sense because the government is paying for it. Every government would actually prefer if you went down to the states and paid out of your own pocket because that's the money that they wouldn't then have to spend. I don't know how this is hard to understand....

 

All those "revenue" examples happen whether it's public or private. Those "profits" will happen regardless of the stream because at the end of the day no government is manufacturing their own tongue depressors. The only difference is the additional markup in a private sector. You are welcome to google some hilarious medical bills from the states to look at the price of Qtips, swabs, gloves, etc... It's absurd.

[A-Stark]

Plus the fact that other countries DON'T have it as an essential service makes it messy as well. Our system is relatively unique after all in the world.

 

Interestingly, Taiwan explicitly modelled its system on ours. I'm not sure what you mean otherwise; by all means, point out some other rich countries that are not the US that lack universal health coverage through some means or other.

 

If the government could somehow stop people from going to the US for health care and instead have that money spent in Canada in theory would have the health care budget rise. Part of that additional revenue could actually partially pay for the 78 year old's care and allow perhaps in theory as well more staff and improve wait times in general. Ha - again I am not exactly pro two tier but we are all aware of these arguments of course and they are not exactly trivial to dismiss - and there is a huge movement based on these ideas out there including a lot of doctors. It is a rather dangerous time in Canadian health care.

 

They are not trivial concerns, but there is also little to no evidence that this would actually occur. It's also important to clarify that the structure and role of private insurance differs markedly from country to country (see here). For example, in Germany, people who choose to purchase private insurance are required to opt-out from public coverage; that works because health care is financed from direct payroll and income deductions instead of general taxation.

 

A few problems:

1) Private capacity will not appear without substantial investment (from whom?) and has not appeared as a full parallel system in any provinces where it is legal.

2) If the goal is greater access on an equitable basis, then the means are greater public funding (i.e. through taxation), with whatever innovation is required in the nature of health care delivery.

3) What additional revenue would be obtained by preventing people from going across the border? The capacity has to exist prior to this happening, and that would only happen if there were sufficient demand and funds to make it happen. What are the incentives for this?

4) It has not been made clear what disincentives exist to private health care exist, but this article clarifies (somewhat old, unfortunately). The idea that it's "banned" persists, but this is not really the case. Considerable measures have been taken to avoid direct and indirect subsidization of a private system, however, and I object to any attempts to eliminate them.

[rmorelan]

Interestingly, Taiwan explicitly modelled its system on ours. I'm not sure what you mean otherwise; by all means, point out some other rich countries that are not the US that lack universal health coverage through some means or other.

 

They are not trivial concerns, but there is also little to no evidence that this would actually occur. It's also important to clarify that the structure and role of private insurance differs markedly from country to country (see here). For example, in Germany, people who choose to purchase private insurance are required to opt-out from public coverage; that works because health care is financed from direct payroll and income deductions instead of general taxation.

 

A few problems:

1) Private capacity will not appear without substantial investment (from whom?) and has not appeared as a full parallel system in any provinces where it is legal.

2) If the goal is greater access on an equitable basis, then the means are greater public funding (i.e. through taxation), with whatever innovation is required in the nature of health care delivery.

3) What additional revenue would be obtained by preventing people from going across the border? The capacity has to exist prior to this happening, and that would only happen if there were sufficient demand and funds to make it happen. What are the incentives for this?

4) It has not been made clear what disincentives exist to private health care exist, but this article clarifies (somewhat old, unfortunately). The idea that it's "banned" persists, but this is not really the case. Considerable measures have been taken to avoid direct and indirect subsidization of a private system, however, and I object to any attempts to eliminate them.

 

Absolutely! there are a bunch of arguments that oppose the straight forward two tier money redistribution problem. They just aren't really talked out that much I find.

 

Universal coverage by solely public health care is relatively rare - not universal coverage itself

 

1) It hasn't appeared for the types of services often people travel for BECAUSE it is illegal. Cannot open a private radiology clinic for instance, or operating room for things that are in high wait list situations. Two tier supporters say remove barriers to investment - the government is getting in the way.

2) The goal of people that support this is don't think we should have equitable access. It is the standard capitalism argument that the markets direct themselves and people with resources will spend them optimally. Some will pay for faster service. Stopping that is a bad idea economically.

3) Additional revenue for Canada would occur if you somehow let those people spend the money they would have spent in the US here - move the second tier out of the US and into Canada. If there is going to be two tier system regardless, shouldn't we config that to our advantage (or so is the argument)?

 

gah this is throwing me back to the huge debates in health economics - fun things to discuss. My biggest concern I think is now we are ignoring a lot of funding and structural issues in our health care system - and I think on some level doing it on purpose - to generate the sort of crisis that would politically motivate people to change the current system to be more private. That seems very silly to me - I think people are often not that aware of how much many doctors really hate the constraints of the current system (it hasn't been that unusual for high ranking members of the CMA structure to openly support a two tier system - a lot of the staff I have worked with are equally open as well).

[A-Stark]

1) It hasn't appeared for the types of services often people travel for BECAUSE it is illegal. Cannot open a private radiology clinic for instance, or operating room for things that are in high wait list situations. Two tier supporters say remove barriers to investment - the government is getting in the way.

 

As I mentioned previously, there is a private radiology clinic in Halifax that does ultrasound, MRI, and bone density studies. You can even look up the prices on their website. It is certainly legal. In Vancouver, former CMA president Brian Day runs the Cambie Surgery Centre, a controversial private ambulatory surgical centre. In Toronto (and elsewhere), there are "executive" and "boutique" clinics that guarantee preferred access and ancillary services for block or membership fees.

 

Private health care exists, and though the laws vary across the country, it is most certainly NOT illegal. That is simply wrong as a general statement.

 

That doesn't mean opening up a private acute care hospital is a profitable enterprise for investors. Not much money to be made with stroke units or ICUs, unless you're out to sell PEG tubes or new ventilators or CVVHD machines. I have said repeatedly that there is no reason to expect a great rush to provide expensive inpatient care, and have yet to hear any compelling arguments showing otherwise.

 

I mean, for ****'s sake, most people can't even afford Plavix after PCI.

[cheech10]

Private clinics that offer "executive" or "boutique" services (like Medcan in Toronto) are only able to do so by offering "non-medically necessary" services. Using them to get around wait times for medically necessary services IS in fact prohibited in Ontario, but enforcement has been lax. See here for info on how they have created a "grey area" to allow them to operate.

[Mourning Cloak]

The study, From Perceived Surplus to Perceived Shortage: What Happened to Canada's Physician Workforce in the 1990s?, was released June 6. It tracks physician–patient ratios over the last decade and examines the factors that created change, but author Ben Chan was careful not to describe the current situation as an “actual shortage” of physicians. Instead, he referred to it as a “shortage perception.”

 

Is this a clever spambot or a clueless human?

 

I honestly can't tell.

[leviathan]

Is this a clever spambot or a clueless human?

 

I honestly can't tell.

 

Me either...

[Real Beef]

Me either...

 

If spam bot they have certainly evolved ... nice touch with the avatar.