Guest MDmobile Posted December 7, 2003 Report Share Posted December 7, 2003 Guys, Why Canada has one of the lowest ratio of doctors? It is 2.1 per 1000 population. A large number of patients do not have a family doctor. Is it just a matter of funding or something else? Any hypothesis? web.hhs.se/personal/suzuk.../he30.html Link to comment Share on other sites More sharing options...
Guest justanotherpremed Posted December 7, 2003 Report Share Posted December 7, 2003 although your data are slightly out of date (1999), I would think this data is still true today. WHY? Good question. Many people would hypothesize that it is due to an inflexible stance on medical care policy. If you have read the recent commission on health care, you will be well aware that the canadian government is absolutely opposed to any form of fee-for service medical care. Why would this have anything to do with the number of doctors. For one, it is possible that doctor's earn a lower wage in canada than in other countries. I am not sure about internationally, but this is certainly true with the United States. It is true that the u.s. has an equally messed up health care system, if not more messed up. Universal health care is a great idea. But shouldn't we be flexible and entertain possible avenues for privatizing non-elective services, etc?? Just a few ideas. Link to comment Share on other sites More sharing options...
Guest MDmobile Posted December 7, 2003 Report Share Posted December 7, 2003 Thanks for a prompt reaction... Well, I think that fee-for service payment mechanism is still the main one in Canada and I do not see anything wrong with it as far as funds remain public; and honestly, I do not think that the capitation formula will bring any significant change. It can slightly move doctor's incentives reducing number of visits but it won’t help to increase coverage and improve quality of care since there is no competition between doctors due to their relatively small number. Secondly, a small number of doctors makes care multifragmental when patients have to deal with nurses, public health staff, emergency rooms and so on… due to lack of doctors. About privatization – I am sure that market will drastically increase a cost of health care not necessarily improving its quality, a huge portion of funds will go to insurance companies and different intermediate organizations, like in US. But still, why Canada maintains such a low ratio of doctors? What is the rationale behind it? Link to comment Share on other sites More sharing options...
Guest cptn med Posted December 8, 2003 Report Share Posted December 8, 2003 Although I do not know all of the stats on the issue I think a few things are clear. The first being that Canada has become too corporate and thus programs like health care are shoved aside. Health care doesn't make Canada any money and so it is not as relevant as some other things. We see a similar lack of quality within the public education system and other social programs. I would submit that any type of privatization is not the answer. All this would do is entice doctors to leave the public sector in search of more money and allow the corporate agenda to further grow within our country. The truth is that the government needs to put some public money into public health care instead of making tax cutting deals with large corporations all the time. Sure we need business, but if we think about it healthy people make efficient work environments and therefore big business still wins (wins with average people not instead of average people). Wages were capped, hospitals were cut, beds were removed and so began the saga of the demise of the Canadian health care system. Now all we have is a society full of needy people to whom the government is propagating the idea that there is no money. We all know that thats a bunch of garbage. In a country like Canada, the rich should not be entitled to better treatment than the poor. If those with available funds want to get ahead in line, why don't they make a run for the nearest border and pay for it over there? I can't even imagine how a "fee-for service" type of system could keep the money public anyways. Or in the health care system. Ideas like that sound good in the beginning but don't usually end up that way. Someone always has their hand in the cookie jar. From what I understand, most new MD Students want to specialize not be GP's and sadly it has a lot to do with funds. Consider the number of med students that graduate/finish res each year and then ponder where they have all gone. Hmmm...maybe they flew south with the birds in search of better living conditions. Ok, I will stop there for now. Link to comment Share on other sites More sharing options...
Guest MDmobile Posted December 8, 2003 Report Share Posted December 8, 2003 "I can't even imagine how a "fee-for service" type of system could keep the money public anyways. Or in the health care system". - In my understanding, fee-for service is just a type of payment reflecting a measurement of doctor's work based on the number of visits. Every work (outcome) should be measured and paid off and a fee-for service mechanism provides a necessary tool. Another issue is the origin of funds. As far as it is public (collected from taxes) and distributed more or less equally according to the needs of patients – it is democratic since it covers everybody’s needs. If it is private (e.g. the USA) - it creates a huge exclusion of poor people from health care system. In this case it is not important how doctors are paid – fee-for service or salaries – if funds are private, health care system provides its services to people who can pay. Link to comment Share on other sites More sharing options...
Guest justanotherpremed Posted December 8, 2003 Report Share Posted December 8, 2003 Interestingly, I just received a copy of the new Maclean's issue that has a cover story about the shortage and plight of the family physician in Canada..... you guys should check that out. Not very encouraging for someone considering a career as a family physician in canada. Link to comment Share on other sites More sharing options...
Guest RageoftheDragon Posted December 8, 2003 Report Share Posted December 8, 2003 "Canada has become too corporate and thus programs like health care are shoved aside" -Do you not look at the political situation in Canada at all? Health Care is the most prevalent issue in essentially any political/societal setting. More people identify with our Health Care system than they do with the Canadian flag. Canada continually pours money into this, and yes, from the public purse of taxation. -In regards to privatization, there are currently very functional parallel systems running. Doctors have the choice now to exempt themselves from provincial payments. It works fine, and in an idealic economic system, would drop costs. Yes, while it doesn't exist ideally now, we don't have the drastic and painful system of insurance that rapes the USA of a good medical care system. Also, consider that privatized clinics could lessen the burden on the public system by distributing waiting lists, they provide additional training centers for new meds, and there's no way a huge privatization could overtake the public system as the capital costs would be to great to be individually surpassed. -Your comment about big business only applies to Bombardier contracts. Increasing health care will help big businesses? Colds/flu take up the most work days in terms of sickness, and trust me, boosting the health system is not going to prevent spread of cold and flu viruses, unless you have some formula for clairvoyance. -Wages were capped? Update your history of Canadian Health Care. Yeah, through the sixties there were no increases in fee schedules, then come 68-mid 70's, there was a boost almost every year. When there was another surplus of doctors come late 70's, bargaining power was lost, and fewer increases. Come the early 90's up until now, another physician shortage has given the bargaining power back to physicians, and we've seen rediculous fee schedule increases, such as 22% over 2 years from the Klein gov't, or 25% over 3 years from Sk. Doctors are not hurting. Other medical care personnel? Nurse strikes have given unprecedented and undeserved increases in wages to the entire nursing profession. CUPE and other overactive and underneeded unions have helped keep the other personnel into a good S.O.L. -Thanks to all the social programs and Canada's noble undying effort towards keeping an entirely public health care system,one of the top systems on earth by many standards, yeah, the government is a bit short on coin. And most tax breaks have been for the lower tax brackets. So instead of increasing business taxes, the proper increase would be in personal taxes. -The rich aren't entitled to better treatment than the poor. Studies show that the 'poor' are not more sick or unhealthy than the 'rich'. And people do go across the border to pay for procedures. It would be foolish not to, that just helps the system and the person in general. -Learn what "Fee For Service" means before you try to deride it. -If you are so righteous, then when the company from the states offers you triple what you would get payed here, turn them down. That is your choice, and everyone elses to make. You cannot blame people for recognizing that while it is sad, green makes the world go 'round. I know alot of doctors going into this for the money. Free Will is a beautiful thing. -Specialization is also a choice. With the advancement of science, many feel they could make a greater donation to medical science by being more focused. Others go for the money, refer to above point. I'm glad you stopped where you did. Go cure your ignorance of the system before making another bunch of unbased claims. There is plenty of real health economics information out there that doesn't come from the back of an NDP pamphlet. RotD Link to comment Share on other sites More sharing options...
Guest moo Posted December 8, 2003 Report Share Posted December 8, 2003 I agree with rageofthedragon. Although in the US there are 44 million people who are uninsured, this is not mostly "poor people" as someone above stated. Poor people in the US are covered by medicaid, and seniors are covered by medicare. Most everyone else has health insurance through private companies or offered by their employer. The 44 million refers to mostly people in the middle class who are out of work, or work for a company that does not cover their health insurance. While it is a problem in the US, when Americans need health care, they get it right away. You also can't deny emergency care to someone who is uninsured. And with drug benefits finally being offered to seniors in medicare, things are finally starting to turn around. Despite the typical attitude of the arrogant Canadian, Canada does not have the greatest health care system in the world. We're not even close. Link to comment Share on other sites More sharing options...
Guest aneliz Posted December 8, 2003 Report Share Posted December 8, 2003 Keep in mind that the number of people in medical school and the number of residency positions in Canada that allow both Canadian grads and IMG's to become practicing Canadian physicians are both strictly regulated in terms of quantity and specialty by the government.... this is radically different than in the states where there are many private medical schools and residency positions sponsored by HMO's.... The Canadian provincial governments are directly controlling the supply...and the 'supply' is not keeping up with the number of retirements from existing doctors....(average age of physicians in Ontario as of Sept is 56)....given that it takes a minimum for of 6 years from the time someone enters med school until they can practice and may take up to 9 or 10 years...it is not a quick problem to fix.... At the same time, the governments are not doing a lot from either financial or working condition perspective to retain doctors in Canada either.... Link to comment Share on other sites More sharing options...
Guest cptn med Posted December 8, 2003 Report Share Posted December 8, 2003 Rageofthedragon: First I would like to congratulate you on your ability to rant. My intent was not to start a big argument, but rather share my own thoughts on some of the issuse in play. We need to notice what is wrong with the system so we can improve it. Nothing is perfect, and this one will take a long time to fix...nonetheless, it is worth debate. -You ask if I ever even look at the political situation in Canada. The answer is of course...don't you? I am sorry but if you believe for one minute that the government is doing its best, or all it can than you are sadly mistaken my friend. Yes health care is on everyone's mind these days, but is it better? No, not very much...if at all. What is better to you? What specifically has improved so dramatically in the last decade that would make you think that the government is pouring so much money into the system? Do we so quickly forget who took SOOOO much money out in the first place? Its a sham...its a gov't who has taken billions out, than adds a bit back and expects applause. We should not give it to them. Have you ever seen a sick baby wait for a bed in emerg for hours on end because there are only two infant beds in the entire emerge dept? -Yes, more people identify with health care than anything else but so what? That doesn't mean that it is the issue being looked at properly. Remember the commission that was established not so long ago to tell the PM how to fix health care? What happened to that? Oh thats right, not much. -As far as your view on privatization working aside a public system...would you be so kind as to name the successful one? I have to say that it does not work...doctors exempting themselves from provincial payments only allows for crappier care for the poor and lower middle class. I don't see how you could think it doesn't. Think about it. If there is a private sector and then a public, many good MD's will go to the private because the public is sooo underfunded, thus not giving equal benefit to everyone who is in need. -MONEY SHOULDN'T TALK IN MEDICINE. What you are saying is that the rich should be able to skip ahead of the poor for treatment. I see this as sad an unethical. And if you think the poor will be better off for it, you may want to rethink your ideals from the position of the underprivileged. -It is narrow-minded to assume that a two tier system works equally for all. The Ontario Liberal gov't wouldn't keep the PC agenda for this type of system simply because there is a lack of proof that it works. (and no, I am not a Liberal) -As far as "the wage cap" I mentioned and my need to update my history;) . My info is not so out dated. I will say read this if you wish and leave it at that. The info is there (there is much more), try searching for it on your nearest search engine, or checking out some newspaper archives. www.nga.sk.ca/medicare.html (here's a tiny excerpt) since the 80's..."This has included the reduction of the number of doctors and nurses, the reduction and even closing of medical and nursing schools, limiting the access to billing numbers by doctors, lowering the number of acute care beds, restricting admitting privileges of doctors, and capping payments to physicians.", -By the way, who told you that doctors and nurses aren't hurting? The government? ALTA and SASK are nice examples, but only a portion of Canada. Has everyone gotten fair treatment? Perhaps now, they are starting to get their butts in gear...but the issue is far from being solved. My own GP told me a couple of weeks ago that after her overhead, she makes less than a Chrysler lineman...there is something wrong with that. -Next, it is the governments responsibility to ensure that all social programs run properly and they and their supporters shouldn't hide behind health care as a ' big financial burden that bogs down the whole system' (or whatever). -If I have the idea of "fee for service" wrong...explain it to me. It seems to me that combined with taxation policies, fee for service caps doctors at a notably lower wage than that of their US counterparts. Maybe it could be improved a bit. -I didn't blame people for leaving for money but rather said that the gov't should sell out a bit more to keep them...and no, I wouldn't go just for the money...would you? -Again, nobody said anything bad about specialists, but rather that there are reasons (some of them monetary) for the decline in GP's...I don't think all of it is for the sake of science. -Just to clarify, I am not an NDP follower by any means, but I am not an elitist either. As far as the rest of your nonsense...You are way too upset about way too many things! Relax a little eh...its the holidays. Try and learn the meaning of a friendly debate. By the way this is a very interesting perspective and some stats if you care to look. www.robarts.yorku.ca/pdf/mendelson1.pdf Link to comment Share on other sites More sharing options...
Guest driedcaribou Posted December 8, 2003 Report Share Posted December 8, 2003 cptn med wrote: "MONEY SHOULDN'T TALK IN MEDICINE. What you are saying is that the rich should be able to skip ahead of the poor for treatment. I see this as sad an unethical. And if you think the poor will be better off for it, you may want to rethink your ideals from the position of the underprivileged." Correct me if I'm wrong but don't athletes and other members of our society deemed 'special' (i.e. politicians) skip ahead of people for treatment already? The way I see it, if people choose to spend their money on private healthcare, it's actually an advantage to the poor because they would no longer be on the same waitlist as them. The 'poor' would not be subsidizing for healthcare for the rich. They don't really jump ahead in treatment, rather, they are in a completely different standard and system of health care. No, it wouldn't be fair but is it fair that we allow people who can afford private schools for their children? And is it always the rich that can afford private schools and private healthcare? I'd say a large section of the middleclass does and can. If you argue that healthcare and schools are apples and oranges then consider the fact that the BC gov't has made it a law to consider teaching an essential service. I am under the impression that the healthcare system in Australia is a mixture of private and public at the moment. The current system is not working and this is not an issue of morality here. If you want to argue morals, I think it's immoral that people have to wait so long to get treatment because they have illnesses that are considered non-emergency... thus their illnesses get worse until it does reach an emergency situation. When you say 'MONEY SHOULDN'T TALK IN MEDICINE' my reply is what jobs does money not talk in? None. We live in a capitalistic society. Money always talks. Are we going to tell the police they shouldn't be paid so much because it's their duty to protect us from criminals? Are we going to stop paying firefighters because it would be negligent if they weren't putting out fires? Maybe accountants should never get paid for calculating income taxes for the government because their work is an essential service to fund everything in our country. With the link you provided here: www.nga.sk.ca/medicare.html All it consists of is a bunch of statistics with a concluding slide that mentions a progressive change and a regressive change. I don't see how it is an interesting perspective at all because it offers no solutions on how to increase the funding to healthcare. Where is the money going to come from? The only place to go is to cut services from other sectors, increase taxes or find an alternative source of revenue. Link to comment Share on other sites More sharing options...
Guest cptn med Posted December 8, 2003 Report Share Posted December 8, 2003 first: The YorkU site was the one I said was interesting...try that one not the sask one. SK was only intended to show one example of why I said Dr.'s have been capped. The reason I said it was an interesting perspective was because it shows something that many don't really aknowledge...that is that there is still a major decline in health services and not really much relief. Now, as far as my ideal that money shouldn't talk in health care, I stand firm in my belief. Your examples of athletes, private schools etc combined with the "capitalism" and whatnot do not make my belief smaller, but rather show an attitude that reminds me somewhat of the saying "if you cant beat em, join em". The idea of athletes as an example of someone who gets special treatment isn't really fair considering that it is their profession and not likely that they pay for their own doctors. You say that if people want to spend their money on health care than they should, I agree. However, I do not think that they should necessarily be able to do it here. Canada used to be of a higher standard. And the capitalism you speak of is exactly the reason for all of the problems. If we would stop worrying about our excess bank roles for a minute and pay attention to the needs of everyone (not just the few) we would be a lot better off. As for cutting services from other sectors...I don't really think that it has to be that way, but rather the funds should be reprioratized. I realize I may sound like some sort of hippie, but trust me I am not. I just honestly believe that with the given information and available money that is in our great country, Canada could change her attitude a bit and really help everyone. I doubt it would hurt much. Money talks in Capitalism as you say, but it shouldn't be the biggest issue...care should be. If you are trying to give me a dose of reality, don't worry I get it already, but I think it can change...how do you think universal health care came about in the first place? The need for change. Canada is loosing her standing on things like health care and education. Its not a pretty picture. What if the rich and middle class were the ones who were allowed to have kids or have day care? Would this be ok? Why not right, after all, money talks and those poor folk cant really afford them anyways...at least not as well as the rich. By the way, the middle class in Canada is shrinking quickly. The following figures are used just for example: If you were a doctor who made $400,000 each year gross, but had to pay half (or close to half) in taxes, than another $60,000 in insurance wouldn't you want your tax dollars to go back into science, health care or some sort of social program. I was under the impression that most MD's were not all about the money, but mostly about the people. The world doesn't need another reality check, I think most of us are already too well aware of the corporate agenda. You ask when money should talk? Maybe your right, it should talk in health care. It should be saying something worthwhile and something helpful. The gov't makes the health care dollars talk, that is why it is a universal system. Why do so many people act like there is nothing that can be done by the gov't? Last time I checked the gov't was supposed to be for the people and by the people. Not by the people (sort of) and for the bank role. If two tier care came into effect there would be no real way for the gov't to regulate. Therefore, people would not be realistically ensured equal care. I am not saying that I have all the answers, but rather that this is not it. Link to comment Share on other sites More sharing options...
Guest justanotherpremed Posted December 8, 2003 Report Share Posted December 8, 2003 The interesting thing is that in a way, we already have privatized health care in Canada, although we don't know it. Why do I say this? Consider this: I live in saskatchewan, which is a province entirely opposed to any fee-for-service medical care. Does that mean that the rich cannot get better medical care than the poor?? NO, of course it does not. My cousin is a perfect example. For her medical problem, she simply flew herself to the Mayo clinic and got preferential treatment by paying for it in the u.s. The thing is that Canada gets screwed two ways by our inflexible stance on fee-for service medical care. The people go elsewhere to pay for it. Therefore, the system gets none of the money. The doctors do not reap the high salaries and thus, go elsewhere. You may have a situation where a Canadian med school grad goes to the U.S. for high salaries, only to provide fee-for-service medical care to someone that he went to high school with in small town saskatchewan.. This is a paradox, but needless to say that fee-for-service is NOT The magic key to unlock it. I'm just saying that people should be tolerant...... because our system is NOT perfect Link to comment Share on other sites More sharing options...
Guest MDmobile Posted December 8, 2003 Report Share Posted December 8, 2003 Guys, But in Canada now we got a situation when obviously good and fair policy (equity) simply does not work because there are not enough doctors at primary health care level to implement it. What is the value of such a policy (which is indeed, good) that can not be iput in practice? Two million of Canadians are staying without family doctor (I think this is the latest figure that I saw recently). The state can not ensure primary health services not only for the poor but for many other vulnerable groups. Secondly, the structure of health care at primary level became poor - doctors are providing just a minimal package of curative services. Look at how many other health players are involved in primary activities that normally should be performed by a family doctor - prophylaxy, vaccination, tuberculosis, sexual transmitted diseases, etc... that are done by other health staff. I do not even speak here about home visits, continuous care, patient-centered care, etc... There is no space for such elements, there is no time to do it due to lack of physicians. How many patients are compelled to go to emergency rooms, public health units instead of going to see their family physician? Unfortunately, these issues are not properly addressed and latest reforms try to modify just the payment method - from the fee-for service to capitation-based. But it looks so cosmetic! You can say - it is expensive to get another few thousand doctors trained and paid. OK, but nobody calculated the costs of keeping running a huge staff of public health units, emergency rooms, walking clinics... In addition, if a patient is facing many different health agents (that, by the way, do not communicate), it is impossible to have a good care focused on patient. Just to summarize - without addressing the issue of sufficient number of doctors it is absolutely ridiculous to speak about care quality improvement. Link to comment Share on other sites More sharing options...
Guest cptn med Posted December 8, 2003 Report Share Posted December 8, 2003 Hey, You made very valid points. How can people be provided adequate health services when the money is being spread so thin and not enough doctors to treat or even know about the issues. The main need is more doctors, not more methods. Training doctors is great, but we also have to keep them in Canada. Link to comment Share on other sites More sharing options...
Guest MDmobile Posted December 9, 2003 Report Share Posted December 9, 2003 Thanks cptn med. ) Justanotherpremed - I think that "fee-for service" payment method does not authomatically mean private or privatized care because money still remain public. This formula - "public funds and private delivery" proved to be very effective since it respects equity on one side (public component) and maintain a certain level of efficiency (private one). So I want to repeat that there is nothing wrong with this formula. For example you can have a fee-for service mechanism in Canada bringing to a physician $160 K and a huge salary of another physician $400K in the US. But still in Canada it is public money, and in US -private. What would be dangerous and unacceptable in Canada - to bring the private component to funding policies. Again, look at the US - a competition of private sector in the field of medical insurance drastically raised health expenditures (e.g. HMO) - money that are going not only to health actors , but also to numerous business actors. Do patients benefit from it? Not obviously. Since we do not have private sector in health funding policy in Canada - we have to cherish it as is (IMHO). Link to comment Share on other sites More sharing options...
Guest strider2004 Posted December 9, 2003 Report Share Posted December 9, 2003 I think I need to clarify a few things: 1) fee for service: this literally means "getting paid to do something" like when you see your family doc and he/she gets $20. This happens throughout Canada, whether in Saskatchewan or Ontario. The only other systems are AFP where everyone gets a set salary and Family Health Network which never really got off the ground. It's a terrible argument to say that one group is against fee-for-service and anotehr group is for it. The simple facts is that when you're rewarded for doing more work, you are MOTIVATED to do more work. This is why FFP has worked for so long. I think you guys are arguing about not-for-profit which is a totally different issue. 2) Royal Commission on Health Care - this was completed last year by Roy Romanow and the ball is rolling on improvements. Just recently most provinces approved an accord to set up a national council on health care. The Federal government has agreed to increase health care spending equal to what was recommended in the report. Who said the commission hasn't done anything? Have you been watching the news?? 3) two tiered health care - some love it, some hate it. It exists in many other countries including the US, Australia, Singapore, malaysia, Hong Kong, etc etc. It also exists in Canada to some extent. Ever tried to get a private room in a hospital? It doesn't come free. Private MRI clinics are popping up all over even though most people don't need one. 4) Income - most docs don't bill for $400k, and they certainly don't get taxed on $400k. They usually pay 30% overhead and then get taxed. They will take home $100-150k. That's why every med student and doc around has been telling you not to go into medicine for the money. You get comfortable, but not rich. I'm actually leaning more on the side of RotD, also a bit cynical Link to comment Share on other sites More sharing options...
Guest cptn med Posted December 9, 2003 Report Share Posted December 9, 2003 Thanks for clearing up the fee pay thing, but isn't the amount one can be paid as "fee for service" still capped at a certain amount? If so, what really is the difference? Just wondering. Just to clarify: If you read the Romanow report it says that federal funding is to be increased by 3.5 billion in 2003-2004 and another 5 in the next and so on ( capcollegefa.ca/clc_on_ro...report.htm ). As far as I know (from the latest budget I watched in the house), the feds have only committed to 2 billion, split betwn provinces and territories and the funds are only guaranteed if the surplus is over three (not sure of exact numbers but I think that is it). So not exactly 100% of what was needed...but nonetheless the ball is rolling as you say. I think it rubs some people the wrong way that this is the gov't that cut all of the funding that we are talking about in the first place. Now with a pending election, some is being put back in all the while forgetting where it went to begin with. The nice thing about the minimal privatization in Canada that you mentioned is that although you can pay for a private or semi-private room through insurance or whatever, if the beds get filled and more beds are needed to be put in your room...they will be. One quick question for anyone who knows... I heard stated from a med pro that the gov't "wanted" to tax MD's on "net worth" not yearly earnings. Any ideas? Link to comment Share on other sites More sharing options...
Guest MDmobile Posted December 9, 2003 Report Share Posted December 9, 2003 "isn't the amount one can be paid as "fee for service" still capped at a certain amount? " - No. In fact, theoretically yes, but then it will loose sence. The main objective of the "fee-for service" mechanism is to motivate doctors to get more patients visiting them, since doctors are paid as, let's say, $40 per patient. After each patient's visit doctor sends a bill with patient's OHIP number to the OHIP. One of the "coping strategies" of doctors in this case is to implisitely increase a number of visits. And often doctors ask patients to come again to pick up a report, to show the result of analysis, to sign a document ... etc... This system sets doctor's incentives to increase a number of visits (since they are paid per visit) and to deal with non-complicated cases (to have less work). Another system is based on capitation, meaning that doctors assume a responsibility over a certain amount of population, lets say - 2,000 potential patients. Assuming this responsibility they get a fixed salary, lets say $160K a year. Doctor's responsibility is to ensure a proper health status of his target group, regardless the number of visits, disease incidence etc... In this case doctors are motivated to decrease a number of visits (to work less for the same money) and, consequently to do more prophylaxis to prevent diseases in order to decrease a number of visits. This is in theory, but in practice this system also has some disadvantages. You see, in both cases health system uses public money and there is no inequity in treating patients - it is just a difference of payment methods. Link to comment Share on other sites More sharing options...
Guest strider2004 Posted December 10, 2003 Report Share Posted December 10, 2003 but isn't the amount one can be paid as "fee for service" still capped at a certain amount? There is a maximum amount. I think it's somewhere around $330k for family docs and $400-470k for specialists. It's difficult for most specialties to reach the cap. As for capitation: it hasn't really been welcomed by physicians. Family health groups have worked much beter. This system is the same as fee-for-service but a group of family physicians guarantees that one of their offices will be open until 8pm every weekday and the morning of every weekend. For this, they will get an extra 10-20% on top of their fee schedule for any service rendered in the 'overtime' (typically any service from 5pm-8pm). This has been much more accepted by physicians. Link to comment Share on other sites More sharing options...
Guest macapplicant Posted December 17, 2003 Report Share Posted December 17, 2003 "Guys, Why Canada has one of the lowest ratio of doctors? It is 2.1 per 1000 population. A large number of patients do not have a family doctor. Is it just a matter of funding or something else? Any hypothesis?" ------------------------------------ I think I heard that ratio too on the t.v. somewhere....what I don't understand it that if the number of doctors is soo low....why do they(government/medical council) have to regulate admission to a medical school so much?...I mean as a government your main prerogative is to make sure that all the people get sufficient medical attention and not whether you produce 1000 or 5000 doctors(just an example) in a year.....Ofcourse the more doctors you have, their average salary would go down, but atleast people get proper and timely medical attention....Its simple logic.....am I missing something here?....I get ticked off when I have to wait for a month to get an ENT specialist's appointment or to get an MRI..... Link to comment Share on other sites More sharing options...
Guest Kirsteen Posted December 17, 2003 Report Share Posted December 17, 2003 Hi there, One influencing factor is that the body that must provide funding for Canadian health care must also provide funding for national debt, and defense, and culture, and roads, and research and development, and foreign affairs... There are many competing interests for a pot of money that is not bottomless. Politicians presumably are trying to do the best thing while ticking off the fewest Canadians as possible. Not an enviable task. Cheers, Kirsteen Link to comment Share on other sites More sharing options...
Guest DonaldKaufman Posted December 17, 2003 Report Share Posted December 17, 2003 I completely agree with you Kirsteen - there is a limited amount of resources, and a large number of interests to take care of. A government's main prerogative isn't 'to ensure that all of the people get sufficient medical attention', it is to get RE-elected! That might be one reason that increasing med-school class sizes isn't always the first method dealing with the doctor shortage. By the time that the changes are implemented and the additional students work their way through the system, a new government could be in place, and they'd be the beneficiaries of another government's actions (well, maybe not in Canada, right now). That's one of the biggest problems with democracies - they are often short-sighted. The same reasoning could explain why environmental legislation is a tough sell - it's not a problem that can be solved in 4 years. Link to comment Share on other sites More sharing options...
Guest MDmobile Posted December 17, 2003 Report Share Posted December 17, 2003 there is a limited amount of resources - - this is a most common explanation that can be often heard through the mass-media etc... But do we know that already existing resources are being used in a rational way? Are we sure that the current organizational set-up is the most practical? For example do we really need a lot of auxiliary staff in health? In this regard I would like to give you an example from Belgium where I used to live and study though it is from the area of dental care, but still relevant, I believe. Usually dentists in Europe work alone. When you call a dentist to make an appointment, it is a dentist himself/herself who makes a registration; when you come to a clinic - it is again a dentist who meets you and greets you at the entrance; dentist performs all operations including taking X-ray, sterilizing instruments etc... . This is a kind of very RATIONAL and ECONOMIC model. Total price of one feeling is 51 Euro (about $75) and is quite affordable even if people do not have an insurance. Compare it now with Canadian model - when you come to see a dentist - you are being greeted by a charming dental receptionist, there is a friendly dental assistant who holds instruments and makes an X-Ray, there is a dental hygienist somewhere in a room who is waiting for his turn etc... etc... As a result, the price of the feeling is around $200-250! Is a Canadian dental care quality better than European? Probably, no - it is rather at the same level. You can easily find similar situations in curative care though they would be not so illustrative. As you see, it is not so simple just to focus everything on funds shortage, I think the problem is more serious than that going to health care organizational set-up and rational use of resources. May be it would be better to find money to get more doctors rather than to spend these money on other different medical professionals (care attendants, public health, some technicians) or other medical priorities? Anyway, non of them can replace a family doctor and, nothing can be worse than not to have a family doctor at primary care level. Link to comment Share on other sites More sharing options...
Guest Ian Wong Posted December 18, 2003 Report Share Posted December 18, 2003 Compare it now with Canadian model - when you come to see a dentist - you are being greeted by a charming dental receptionist, there is a friendly dental assistant who holds instruments and makes an X-Ray, there is a dental hygienist somewhere in a room who is waiting for his turn etc... etc... As a result, the price of the feeling is around $200-250! I'll be honest, I really can't agree with what you're suggesting. People invariably become more efficient when they specialize down their number of tasks. It's the reason why you have line cooks at a busy restaurant (one guy concentrates on grilling the steaks, someone else prepares the veggies, and someone else prepares the potatoes). In your proposed system, the doctor/dentist should be the guy responsible for: -reordering all supplies -handling all medical/dental billings -hiring new staff and scheduling staff for hours/vacations, etc -phoning all patients the day before to "remind" them of their appointment -cleaning the office -trouble-shooting any malfunctioning equipment -contacting specialists for all referrals -following up on all laboratory and radiology tests -seeing patients The thing is, if the doctor/dentist had to do all of the above, how much time would be left in the day to see the patients? Anything you can delegate to someone else frees up more of your time to see your patients, or to see more patients. The high cost of dental care in North America has a lot more to do with the expectation of high reimbursements from dentists; if the insurance companies tried to slash their payments to the dentists, the dentists would all en masse stop taking patients with that insurance, and those patients would then abandon that insurance company in favour of another. Ian Link to comment Share on other sites More sharing options...
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