privitization of healthcare...any thoughts?

[Guest monkey]

what are your thoughts on privitization and what do you think are possible solutions for 'fixing' Canada's healthcare?!

 

i think parallel two-tier system might be the way to go...but i'd like to hear your thoughts...

 

monkey

[Guest Liana]

The solution is simple.

 

Less big business tax breaks = more government money ===> more money to spend on social programs and healthcare. In this manner, healthcare improvement is linked to the private sector, but not in the way they might expect.

 

Social healthcare means not having to decide if it's worth the monetary risk to verify that you have a disease. Every Canadian should have a right to expedient medical service, appropriate diagnostic tests, and proper care. However, it should be a privelege to visit the ER on a regular basis for frivilous concerns (eg, coughs in an otherwise healthy child). Other "bonuses" could be available for an additional fee, but we have to be careful what we consider a bonus. Healthcare at a timely speed should not be a frill, especially if wealthier patients paying for the right to be seen first delays the speed at which less wealthy people can be seen. Private MRI facilities in Canada, for example, might be an option for those who can afford it: not only will these patients be able to get results sooner, but their leaving will reduce the waiting period for those who can't afford it.

 

The important concern in imposing a two-tier system is to offer the bonuses to those who can afford it, without compromising the quality of free healthcare that is offered to all.

[Guest Kirsteen]

Woah there Liana! Looking at the long-term, it's partly the big biz tax breaks that keep the big biz HQ in the country in the first place. If we hike up their taxes, many of the big boys may flee south of the border (as threatened many a time by John Roth when Nortel was at $204, instead of $4 per share!).

 

It's a bit of a mud puddle, the Canadian health care dilemma, eh? Although some may not realize it, we already have a booming private sector in health care. When hospitals have to make cuts and shorten the length of hospital stay for those who used to stay longer, all those drugs that are still required post-check-out are no longer provided "free of charge" by the hospital pharmacy and need to be paid for, as does the homecare often required by some patients. Those costs are pushed back to the Canadian public and constitute private, out-of-pocket expenditures.

 

Ciao,

Kirsteen

[Guest PeterHill0501]

Kirsteen,

 

I'm with you...I don't think the solution is quite as simple as Liana suggests...

 

I appreciate what you're saying about hiking the business taxes...they already contribute quite heavily in a number of areas, including healthcare...we have to be careful not to drive these businesses out of our country as we are so dependent on having them around for all sorts of things including employment, etc.

 

...I also think that many people, as you have correctly pointed out, don't realize that there are many procedures that are already paid for by patients...there is already quite a thriving private business for many minor surgical procedures, etc.

 

I personally believe in a two-tiered system...I'm not sure if it will alleviate the overcrowded emergency rooms, and lack of hospital beds...but I do believe it will make it possible to get faster and better quality service for those who are willing to pay for it. I also believe that people who come to emergency rooms for non-emergent situations or situations that should have been taken care of through regular family doctors should be billed to avoid situations like the following which I often overhear on the telephone when my wife is on call:

 

Time & Day: 2:30am, Sunday morning

State of Physician and Spouse: fast asleep, and enjoying it.

 

(a loud annoying beep startles the household...damn...it's the beeper)

 

Message Centre: Dr. X. I have a patient who has an emergent situation...they're vomiting blood.

 

Dr. X.: (drawing on all her stamina after receiving 5 or 6 calls prior to this one since 12:00am and after having just fallen asleep after pronouncing someone dead) Thank-you...you can put me through to them.

 

Dr. X.: Hello, this is Dr. X. how can I help you this morning?

 

Patient: Oh hi Doctor...I've been vomiting blood and I'm really worried.

 

Dr. X.: How long has this been going on?

 

Patient: For about 5 days...

 

Dr. X.: (doesn't say this but definitely thinks it)...Why on earth are you calling me at this time of the morning on a weekend with a problem that you've had for 5 days? Why haven't you called your family doctor?

 

This is a very common phone call...I'm sure stories from the emergency room get even better...

 

Perhaps some of the ways to make the system more efficient should include shaping patients through education. I know my wife and her business partner have a whole interview process they go through with new patients to set expectations and appropriate/inappropriate behaviours.

 

Just a few thoughts.

 

Peter

[Guest monkey]

hey guys

 

so when you say two-tiered system, you mean that all the services that are offered in the public sector should also be offered in hte private? to me that sort of a system makes sense, since ppl who can pay for it can take the private route and get out of the waiting list. those who cannot still have access to the public sector. everyone is part of the public sector, but it can be their choice to take the private whenver they want. in terms of drugs it gets really tricky b/c i am not sure how drugs would work out in this system. maybe we can have the provincial/federal govn set aside funds to pay for drugs for low-income families, and provide assistance to others according to their income tax...evryone one gets SMOE sort of assistance, but limited as your income rises. what i've described is the kind of system i am thinking of wheni say two-tiered....am i using the correct title? what do u guys think of what i've written?

 

Peter, i whole-heartedly agree with you about billing people who use ER needlessly. i volunteered in ER for a few months and in those months i saw so much abuse of the system by poeple with minor aches and twisted ankles. its really ridiculous, but also amazing how the docs and nurses keep their cool and help out the person as quickly as they can. Yaaa health care workers!

 

And i also agree with kirsteen and peter on the tax breaks. we cannot penalize our big industries any more since we have such a huge competition by the south to keep them here!

 

but to be honest i did tink of the tax breaks as a possible solution, so Liana, u're not the only one!

 

let me know u're guys' thoughts on my little query....

[Guest AniyaSG]

The major problem with a health care system composed of two separate streams is that the 'lower income, government subsidised' stream will slowly degenerate. As a doctor would you take less money to do the same procedure for a 'public' hospital? Some might, but many won't. Also, if large amounts of revenue become generated by private hospitals, the gap will simply widen in terms of quality of care. This is what it all comes down to: not speed of service but quality of care. And those who will suffer will be those who are obliged to use state-subsidized heathcare. Furthermore, if the money I'm paying in taxes for healthcare is not being used for that purpose, why on earth am I paying such high rates of tax?? It has been shown that the US pays more for health care that most other countries, and also that the quality of care is less than that of most other industrialized countries. I would hate to have that happen here.

[Guest PeterHill0501]

AniyaSG,

 

You bring up some good points...I think one of the ways we keep docs in the public stream is to re-think how docs are compensated. I believe that, if given the choice, not all docs like the fee for service structure. Many of my friends who are currently practicing would give up fee for service in an instant if it meant having more time with patients and some benefits. More time with patients equals less stress for the physicians and better quality care for the patients. I think you're right though...if nothing else changes, introducing a second 'patient pays for service' tier could end up disadvantaging the public tier as many docs would choose to work for the private tier.

 

With respect to people in the US paying more for care and receiving poorer quality...I'd like to see the data which supports that. Again, from an unrepresentative sample of friends living in the states, I've heard that it is much quicker to get service and that quality of care (for those who have money, of course) is actually much better because to command the high premiums the docs have to be providing customer-centered, high quality service. I have no idea what the base, publicly funded care is like...I suspect it is sub-standard relative to what we're used to but I have absolutely no data to back that up.

 

I would also hate to have our medical system collapse. Canadians are known to have one of the best health care systems in the world. Unfortunately, I don't believe medicare was ever intended to handle the load it is currently experiencing...they type and volume of use has extended, I believe, way beyond what anybody had ever imagined. I believe to save what we so much value and need is going to require some new and creative approaches and will also require doctors, regulatory bodies and patients to be open to new models of delivering healthcare.

 

Peter

[Guest ItsmeMelissa]

Nice to be able to discuss these things here. When I mentioned some opinions and suggestions similar to those found here to my family, did they ever FREAK OUT!!!!!

Anyway, I agree with most of what has been said, but find myself with one nagging concern. Does anyone really believe that the government will provide adequate funding for a public system when they will have clear and decisive numbers (due to private system use by those who can affort it) to support funding cuts in the future? I have no faith.

 

Sorry if this is a little incoherent. Recovering from the 2-4........ :x

[Guest AniyaSG]

Peter,

 

The figures I got were from some article I read, unfortunately I don't remember the exact source (probably a link from this site ). As I recall it was an average value. I am sure that many people can obtain the care they need when they need it, others cannot.

 

I do agree that fee-for-service the way it is set up now is not ideal. IMO, doctors should be paid more, but how to set that up is a mystery to me. I don't know enough about the system at this point.

 

The major problem is the driving force behind politics is the influence of the wealthy and socially powerful. These people can afford whatever they need and, as anyone would, want to get what they want when they want it. As things are now, almost noone gets that.

 

Overall this is just a brutal problem with no perfect solutions. Most of the ideas I come up with to improve things end up awful upon reflection. Very interesting to discuss though, especially when bored at work

[Guest chochi]

Hi All,

 

Perhaps its worth mentioning that corporations, those wonderful things that everyone seems to love these days, derive enormous financial benefit from locating their head offices/production facilities in Canada, owing in part, to our public health care system (also, from a publicly funded education system resulting in a skilled workforce). American companies pay enormous direct costs for health care insurance for their employees that these same companies do not pay in Canada (General Motors, for example). Although as many of you have pointed out, taxation rates are higher here.

But, if we are concerned about taxation, why not look at the fact that while corporate taxes continue to decline, personal income taxes and other hidden taxes (tire tax, licensing fees etc.) on the consumer continue to increase or have seen only modest reductions. On a recent trip to the U.S.A. I was surprised to hear a news story report saying that in a local Baltimore hospital, 70% of patients were either not insured or underinsured. This hospital is located in the same city as the famous John's Hopkins Medical School. How is this possible? In my opinion, it happens because of a profound social inequality in American society demonstrated by patients receiving either the best care (John Hopkins' scenario) and at the other end of the spectrum, a public hospital with little or no support. Why would we as Canadians want to pursue this option if it is designed to benefit only the privileged few?

That being said, I agree with many of the excellent points that have been raised in this thread.

Peter's suggestion that the public take responsibility for their health is essential in the long term. If I'm ever fortunate enough to gain a seat in medical school, a major goal of my career will be public education particularly in relation to the long-term health benefits of exercise, a healthy diet and other risk-factor reducing behaviours. Perhaps this is one of the only ways to stem the tide of uncontrollable expenses and unnecessary ER costs that others have mentioned. Knowledge is power for the patient and I think a knowledgeable patient would be less likely to call an absolutely exhausted doctor at 5 am. The idea of interviewing patients to establish boundaries is a brilliant proactive approach, in my opinion, because rested doctors make better decisions and can have more time for their families.

The savings incurred through this approach could be / should be redirected to purchasing new equipment and hiring more nurses/ doctors /labtechs etc. Also research is important, in that we really don't know where we are spending and where we could get a 'bigger bang for the buck'. Diagnostic equipment in this country is so outdated that some docs (I've heard) are greatly concerned about increased liability. In short, I think we need to reinvest in the health care system.

However, no matter how hard we try in this regard, there will still be those people that do not fit comfortably into the risk-reduction statistics. For them, it must seem very cruel that they, despite their best efforts and at no fault of their own, have a debilitating disease. We need a publically funded, accessible health care system precisely for these people, if for no other reason at all. Someone very close to me has a chronic illness that she is fighting with all her heart and I am enormously proud of her. The cost in financial terms to her and to several other friends of mine, one currently fighting cancer would be astronomical. If your interested, take a look at the cost of a treatment regimen of Taxol (anti-cancer) or Emberil (arthritis and other inflammatory disorders for example).

For me, it really comes down to what kind of a society we want. Afterall, much like this web page is a gathering place for the exchange of ideas between people with similar aspirations, 'we are all in it together' in this country as well.

 

Cheers,

Chochi

[Guest monkey]

so in the end, how does one answer such a large and complex issue to the medical interviewers if they ask: how would you solve the healthcare of today?

i know u choose whatever you feel is best and show its cons as well, but would that suffice?

[Guest Chochi]

To be honest with you Monkey, I think it is best to be honest above all else at all times during the interview, like you suggest. There are pros and cons to each side of this debate and it does come down to individual opinion in the end. As long as you can defend your position to show that you have thought it out, then you should be ok. Content is less important to interview committees compared to how you formulate your answers. I think they are looking to see if you are informed and how you think, not what you think. Looking at it from all sides is a safe bet, but I don't think it hurts to take a stand once in a while as well. I was asked the same question several times: How do you cope with stress? , for example. While the evidence I provided each time differed somewhat (actually this provided an opportunity to sell myself with new points each time) my central opinion did not change:that obviously I'd dealt well with stressful situations in the past as evidence of my future coping abilities. This is only one approach, but I felt it worked well for me. Strangely enough I prepared for all kinds of ethical/healthcare questions for a long time and received only 2 in total. Most of my questions came from the autobiographical essay, so I would suggest putting alot of time into that part of the equation.

 

Just a few suggestions,

[Guest monkey]

from someone who has an interview in a few days (UA), i thank u for your advice! i'll keep that in mind!!!!

[Guest Chochi]

No problem and best of luck, I'm sure you'll do a excellent job.

 

Cheers,

[Guest UWOMED2005]

Anyone here read any John Ralston Saul? I've read a couple of his works and seen him speak a couple of years back. Anyways, Liana - he made the same point you did. Personal income taxes in this country are too high. . . and part of the reason is that Corporations are paying a much smaller share than they did 40 years ago. I can't remember the exact numbers, but I think things have flip-flopped since the 1960s (ie in the 1960s 70% of government tax revenue was from corporations, 30% from personal income taxes. Now the exact opposite is true.)

 

On the other hand, increased funding is NOT the only problem. Healthcare costs themselves are spiralling up - partly due to the development of new therapies. New pharmaceuticals, while saving lives, cost a lot of money.

[Guest PeterHill0501]

UWOMED2005,

 

Great point:

 

<!--EZCODE QUOTE START--><blockquote>Quote:<hr> On the other hand, increased funding is NOT the only problem. Healthcare costs themselves are spiralling up - partly due to the development of new therapies. New pharmaceuticals, while saving lives, cost a lot of money.<hr></blockquote><!--EZCODE QUOTE END-->

 

This is one aspect of the problem that I've not really thought that much about. There are therapies and pharmacological interventions for more problems than ever...and people are much more open to accepting treatment. As technology improves within the healthcare sector so will the costs increase and the equipment will become more expensive (more likely than not), more complex and therefore less accessible to the public at large.

 

Another few other things to think about re: controlling healthcare costs:

 

The husband of one of my first cousins was hired a few years ago to consolidate/reduce purchasing/expenditures of all hospitals in Toronto. In discussions I had with him, one of the things he found (among many things) was that every department...in fact...almost every doctor purchased the supplies they preferred from their preferred vendor...one of the efforts he made was to ensure, wherever possible, that common things like surgical gloves were purchased from the same vendor and from a single source for all hospitals within Toronto...you have to wonder if other redundant redundancies [sic] exist within the healthcare system.

 

Another example of redundant reduncies includes individuals who go to more than one doctor for the same problem to try to get the outcome they want (e.g., get a prescription). With the blossoming of walk-in clinics with, in many instances, no follow-up or communication with other healthcare providers associated with a particular patient...you have to wonder how many doctors/clinics are being visited for the same reason...and, by the way, all being charged to the healthcare system. One of the agreements my wife and her associates make with their patients is that after-hours care is offered on the condition that patients do not go to other walk-in clinics...is this enforceable? Probably not, but it does definitely get the message across to patients that abuse of the healthcare system is not acceptable and it ultimately affects the quality of care they receive (e.g., many walk-in clinics do not follow up with the person's regular physician for test results to be put in patients chart, etc.)

 

Peter

[Guest Liana]

Not necessarily as unquestionable as you might think, if it was a joint American/Canadian venture to raise big business taxes. When Mountain Equipment Co-op pays less in taxes (ie, $0) than I do, there's something amiss.

 

It's not right for hospitals to have to beg for funding as charities rather than getting funding handed to them with some dignity.

 

Someone answer this question for me, then. If not due to big business tax breaks, and only minimally due to an infrastructure not designed to bear the weight of the costs of technology needs for social spending these days, then how come in Canada's largest period of economic growth (ie, 1993-2000), we're still slashing spending left and right? Where did all the money come from in the 60s to erect all of these hideous concrete universities and city halls that mock us with their blatant costliness?

[Guest Liana]

I think we all recognize that technological improvement is a major contributor to the cost load of our medical system. Equipment like MRI (and the staff to run it), treatments like radiation and chemotherapy, and the extension of life expectancies for sufferers of chronic or long-term diseases are all adding to the costs.

 

However, as future medical practitioners, one thing that you can do to help is by not becoming reliant on advanced technology just because it's there. In some ways, it's great to ascertain a more definite diagnosis, but I've heard that many younger doctors are inadvertantly abusing these resources by using the most advanced tools when something simpler would suffice.

 

That said, there certainly must be many areas where advancing technology is also saving costs for healthcare. eg, telemedicine, plus more specific diagnosis through advanced techniques can lead to more appropriate treatment which can often save $$.

 

I definitely agree that patient misuse must constitute a major portion of unnecessary healthcare expenses. I haven't seen a lot in the way of education attempts in this area, but that's an excellent idea, Peter. I imagine if the government invested a small amount of money effectively, they could see a strong return in the form of saved healthcare costs. Perhaps it may boil down to having to implement some program where misuse will result in small fines, but hopefully an advertising campaign can be somewhat effective so that we don't need to treat hypochondriasis like a felony.

[Guest UWOMED2005]

I wish I had some facts & figures to back this up, but Ralston Saul at least argued that the difference is thatback in the 1960s most of the revenue was from corporations, whereas now it's mostly from private sources. And 1993-2000 saw a large increase in GDP and corporate profits, but not a substantial increase in personal incomes - which is now the primary source for government revenue.

 

Peter - wish I could find the facts & figures again, but I have seen in the last few months a chart demonstrating % of health care costs going to different services. The fastest growing portion of that cost was pharmaceuticals, though equipment (ie MRIs, other 'toys') was also increasing. Physician salaries as a portion of health care costs had significantly decreased, BTW.

 

Theoretically, as patents expire and mass production is brought in, costs on new therapies will come down. But it almost seems like the # of new therapies is exponentially increasing... leading to greater costs.

 

This is all well and good when research produces a useful new therapy/technology - insulin, MRIs, tPA, etc. But the pharmaceutical company also spends alot of money developing "new and improved" therapies which aren't that improved, but are mass-marketed to the public and doctors. I recently was exposed to a research project studying a new topical gel for treatment of Athlete's foot. There are already a number of effective therapies out there for Athlete's foot, and powders have traditionally been the most effective, but some pharmaceutical company decided it was worth spending $$ and putting patients through the agony of an RCT to seem if this new gel could cure Athlete's foot in 5 days instead of the regular 7 or something ridiculous like that. My guess is that they would then spend muchos $$ marketing that gel to doctors ("RCTs show "Expensivefungicide" gets rid of symptoms in 2 days** less than alternative treatments!!") hoping to make a profit. Considering there's already a fairly effective treatment for Athlete's feet, why is this company spending so much $$ on developing yet ANOTHER treatment? And where does this money come from?

 

(BTW-did anyone read that article in Time last week by Dr. Sanjay Gupta about the danger of new therapies? He was pointing out the dangers of new therapies that haven't had years of testing, but the article does point out that many "new & improved" therapies aren't much of an improvement.)

 

BTW-I don't mean to trash researchas worthwhile. Many great new therapies come out of research. But the idea of research as always good/beneficial and worth the funding shouldn't be assumed - the cost of developing new therapies is quite often absorbed by the Health Care system, in the form of in-hospital pharmaceutical costs.

[Guest medwant2b]

UWOMED2005 raised some interesting points about pharmaceuticals and their cost. I'd like to add a little bit to the discussion by talking about Australia, which has low drug prices and has a neat little strategy that keeps their drug prices low.

 

Australia has what they call the PBS (Pharmaceutical Benefits Scheme); it is essentially a list of drugs the government deems worthy of subsidization. If a new drug's benefit vis-a-vis its cost is outrageous and not essential for life or limb it doesn't make it on the PBS. A drug that is good and on the list physicians are more inclined to subscribe; less pricey drugs make the patient happy. Also, the physicians knows the drug has been evaluated by the government and deemed to be efficacious. Drugs that don't make the PBS have to compete with those on the list. If a drug's price is outrageous not many physicians are going to be inclined to subscribe it, so it has a downward pressure on the price of that drug. Also, PBS drugs are in a market that has low prices overall, so their cost can't be totally overinflated. Overall, the result is that drug prices are controlled in some sense, because the government in a way negotiates the prices with the pharmaceutical companies (for the whole country). If a pharmaceutical company prices a drug outrageously high it probably won't be on the PBS (--especially if alternative treatments exist) and as a result be subscribed less and therefore less profitable.

 

Some discussion about the scheme is given here (Consumer Project on Technology) and here (Pharmacy Guild of Australia). The explanation above is derived by reading a bit between the lines and may not be quite right (I'm not an economist). This link is what the second commentary is based on and takes the rational approach of 'What can we afford?'. In the end I think the health care debate is about 'How much do we want to spend (on health)?' and 'What is the most effective way to deliver care (private (multi-payer) or public (single-payer))?' I think many confuse the two questions or think they are really one.

 

<!--EZCODE QUOTE START--><blockquote>Quote:<hr> I wish I had some facts & figures to back this up, but Ralston Saul at least argued that the difference is that back in the 1960s most of the revenue was from corporations, whereas now it's mostly from private sources.<hr></blockquote><!--EZCODE QUOTE END-->I've heard that before from elsewhere; it was in a book I read about globalization by a couple of German academics. After searching the web for a while and being directed to the Cato Institute (Uck!) a kazillion times I found this site. It has corporate tax as a percent of GDP (it has declined over the past ~40 years in the US). This link has the goods (OECD Observer). It, however, obscures the picture a bit by separating 'social security contributions' from 'income tax'. I personally think the two should be considered together as 'income tax', because some countries pay for social programs with revenue from income tax, and the employees, more often than not, pay both.

 

Cheers, medwant2b