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?

Saturday, February 04, 2006

Governments Need To Take Ownership

Where is the dividing line between suffering and comfort? I think we agree that suffering should be covered by a Universal Health care system, but as tax payers we do not wish to be saddled with another person’s comfort cost. The answer to this is simple: the Federal Government has to take ownership of the Canada Health Act. A federal body with authority, appointed by the provinces, must specify the exact services that are covered under the Canada Health Act. This would, of course involve negotiations, consultations, and input from health care providers to various levels of government. The federal government would have to take “ownership” of that package (defined by the Canada Health Act and arrived at by the aforementioned process), and all provincial governments would agree to abide by it.
Would this satisfy all of us? I would think not. That is why the provinces could offer augmentation through government “health care menus with premiums” and would invite private enterprise to compete in the menu category. If private suppliers could provide services that are within the federal mandate, at a cheaper rate than the province could provide them, contracting out should be permissible. This would bring market forces into play, both within the federal government owned (provincially paid) system as well as those services outside of the universal package.
Although there will always be some variance on interpretations by practitioners, judgments as to what is covered or not covered should, for the most part, be taken out of the hands of individual physicians. My experience has been that most physicians will simply give patients what they want e.g. handicap parking, sickness notes, requests for massage etc. Patients are human, and for the most part will try to get whatever they can for nothing. I recall years ago a patient asked me for a letter stating that she needed to have a Jacuzzi bath tub. She had problems with a sore back and various other aches and pain which she stated felt better when she used a whirl pool at the physiotherapy place. She informed me that her insurance would cover it with a” doctor’s letter”.
In a somewhat incredulous state of mind, I stated: “very expensive chairs and sofa would also feel much better to sit on”, to which she replied she would like a letter for those things as well!
Insurance companies have been using physicians in this way for years but many have come to realize (at last) that for the most part physicians will oblige the patient. More recently many contracts will limit the amount to be spent on chiropractic, physiotherapy, massage, etc to a maximum dollar amount, in spite of the “Dr’s note”.
On the other hand (and more frightening), some physicians have totally bought in to the “cost effective” dogma and practice medicine as though the costs of care were coming directly out of their pockets. As pointed out previously, that is in fact what was happening in some of the contracts agreed upon by the provincial medical bodies and provincial governments. This clearly comprised a conflict of interest. The physician that practices in a mind set that protection of our publicly funded health care system must be sustained at all cost, is clearly in conflict with the patients best interests and is not fulfilling their role as the patient’s advocate.
Because governments over the years have erroneously suggested all health needs of Canadians (but have not defined health care needs) are looked after, patients are frustrated and often lay blame for deficiencies in their care on the doctors doorstep. Many times during my years of practice I would inform my patients that the Canadian Health Care System is not the “doctors health care system” but was “the Canadian public’s health care system” and that they should convey their displeasure to their M.L.A. There is no question that this obfuscation of responsibility has been, and is, intentional, as evidenced by the appointment of Regional Health Authorities to further the electorate from those that should take responsibility. Administration of the “ownership” on the other hand, is likely to be most appropriate at the community level.
The conclusion drawn must be that this is the “peoples” universal health care system, not the doctors. Representatives of the medical profession, other care giver groups, and the public, can and should be used as consultants, but our elected representatives (both provincial and federal governments) must take ownership. Within their fiscal capabilities and competing interests, they must design a system that serves the majority of the people’s health care needs, not necessarily all their needs. The system must enable the people to be responsible for those needs not being met by government, and government has a responsibility to provide the information and a system that enables people to assume that responsibility. Governments, as representatives of the population at large, have the responsibility of applying their resources to the areas that will do the most good but must never close the door to enabling its citizens to look after themselves. There must be a refocusing on the poor, the frail elderly, and the chronically ill. But to do all these things effectively, they must take ownership and the responsibilities that go with it!


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