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?

Tuesday, January 24, 2006

Designing a Healthcare System

The idea of coming up with a health care system that works for Canadians is no small task. I’m hoping as I struggle along there will be suggestions, questions and criticisms. Although it is something that I have thought about for years I have no clear easy answer. In my experience, the more choices people have the happier they are and the “one size fits all” is an idea that simply cannot be applied to humans as many socialist countries have found out. We often use the term “rights” to justify social programs, but I believe at the root of every democratic society must be the right to be “different”. So I will start with my first premise: 1) A workable health-care system in a free democratic society must have many options for its citizens.
My second premise is that:
2) There must be a basic safety net of coverage that can be applied to all citizens (with specific attention to the most vulnerable) and the coverage must be clearly defined. It is not good enough to use terms such as “medically necessary” when that term has not been defined and there is no federally designated body that is recognized to define the term in keeping with the Canada Health Act. Can you imagine any other insuring body that would allow an open policy that did not spell-out your coverage?
3) The system must be patient centered, not cost driven. In the event of any funding change or system change the question must always be asked “how will this affect the most vulnerable in our society” and provision made to deal with the consequence in an acceptable manner PRIOR to the action occurring.
The economic vitality of a country and competing priorities will determine to a large degree what is spent on healthcare funding. Therefore:
4) One of the most important criteria for a universal health care system is that it must have “sustainability. For this to happen, along with criterion (2), a body or system needs to be devised to look at, on a regular basis, the appropriation of money in an environment of competing interests and fluctuations in government’s capabilities. Another option would be to have an agreed proportion of the total budget that should go to health care and then the system devised would adjust the items covered as to capabilities.
5) If the federal government is involved, which I feel is desirable, the responsibilities and jurisdictions of each government must be clearly spelled out as well as its financial obligations (e.g. a federal drug plan).
I put these initial items out and invite input and criticism. To my mind, the major problem with the present system is its monopolistic nature and inability to be sustainable and therefore instead of being patient driven it is cost driven. Large companies are criticized for being driven by the bottom line but governments are equally pressed to control and justify expenditures by the competing priorities of education, social services, infrastructure, etc.


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