What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Friday, January 27, 2006

A Basic Health Care Package.

I think the Oregon Project must have shut down any incentive to come up with a basic health care safety net. The project of course gets its name from an attempt to arrive at a basic package the government would cover. As I recall there was so much infighting by self interest and special interest groups that the top 100 priorities could not be established. In Canada I think the process could be simplified and would work. A federal body would look at what is at present covered by the various provinces, and put together a basic package that is a composite of the various plans. This package would be covered by all provincial governments and recognized by the federal government. These procedures would be considered “medically necessary” and meet the stipulation of the Canada Health Act. It would also be reviewed by an expert body on a regular basis for inclusions and deletions.
I believe that another category would be needed----a grey area. These procedures would be comprised of medical treatments and procedures that had not yet been shown to be warranted and old procedures that may be falling into disrepute, but the public may still wish them. It may also included procedures that the designated federal body did not deem to be “medically necessary” according to the terms of the Canada Health Act. It may include chiropractic, naturopathic, and other treatments, and would be optional. If patients wished some or all of these optional treatments, they could be covered through various packages paid for by premiums. This could be government covered and/or insurance company covered. The important thing is that each one of us would have a menu of coverage to choose from above the basic plan. An empiric exemption could be made for people below a certain income i.e. they would be given $150.oo a month credit (as a premium) to choose their specific needs. This would not be unlike packages offered by some companies in which one can pick certain perks up to a set value.
There would need to be a federal body similar to Canada Food and Drug that reviews the basic package every two to three years to ensure that it meets the criteria of the Canada health Act. Treatments would move into the premium side and out of the premium side from year to year or on some other timely basis and people would review their coverage accordingly.
Probably, there should be exempted groups of people. We already have dozens of people within our society who require physicians statements to advocate on their behalf for special consideration e.g. workman’s compensation, palliative care pharmacy program, notes for school athletic programs, sick notes, handicapped parking---- the list goes on and on. Why not have physician-designated authorizations for premium coverage for our chronically ill and frail elderly?
I’m not saying the above scenario is the only scenario, but it does involve participation on the part of patients to some degree (cost and choice), and it deals with the issue of what should be covered in a taxpayer funded universal health care system. To my mind there must be involvement of the people most impacted by any government program. The federal government long gun registry ---billions, and still dysfunctional, the cattleman’s cow registry------1% of the gun registry cost, and it is working smoothly.
Before I leave today I must take note of the comments of Mr. Jack Davis, our Calgary Health Region C.E.O. While commenting in today’s herald on bed shortages, he stated something to the effect that the Holy Cross and General Hospitals were costly to maintain and therefore needed to be replaced with new hospitals. But how many of us blow up the home we are living in today without having arranged, in advance, someplace for us to live tomorrow? This leads into the next point for discussion, “when considering cost effectiveness, look at the impact of the change on our most vulnerable before enacting the change”.


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