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?

Wednesday, April 12, 2006

Care Brokers, An NDP Necessary Evil

In the Nov/05 issue of the National Review of Medicine Newspaper, Jean Crowder, the Health Critic for the Federal NDP, is quoted as saying: “What it does point to is a need to take a look at what’s wrong with our public health care in this country. The question is, why are we putting people in the position that they have to use them?”
What she was referring to as “them” are care brokers. Now some of you have not heard of care brokers but they have been around and active for at least the last twenty years. Like an insurance or mortgage broker, they will find you whatever medical service you wish----OUTSIDE of our Universal health care system (unlike the insurance and mortgage brokers, what they find for you may be a matter of life or death). So it would seem that although the NDP are adamantly opposed to doctors working in both the private and public systems, Ms. Crowder (according to the article), sees these brokers as a necessary evil in a health care system as overwhelmed as Canada’s.
Now I have never heard any of the political parties outline the solutions to our health care dilemma. Yes, I know, innovation, increasing efficiencies, technology, etc; I’ve heard them all for the last 15 to 20 years, while waiting times (risk times) have grown longer and health care providers have become a scarce resource. Annual increases in health care spending routinely exceed our GDP, and in today’s Calgary Herald, Jack Davis, Calgary Health Region’s C.E.O. states health care needs a further major infusion of money. It would seem this province’s 9+% increases annually won’t do the job. Can anybody say “not sustainable?”
So let us look at this care brokering business that Ms. Crowder states is “a necessary evil”. They will find you medical services if you wish, and, if you can afford to “jump”, one of our many queues. If the best price you are quoted exceeds the price they can find for you, they will take a percentage of the money you have saved. So if a surgery is proposed to you by the Mayo Clinic at a price of $40,000.oo and they find a place that will do the same procedure for $30,000.oo you have saved $10,000.oo minus their commission. In this scenario, it seems to me, the incentive for the “care broker” is to find the cheapest price, not the best place. That insures them of the largest commission.
The article states that these brokers (in B.C. and Montreal) are doing an ever increasing booming business. And the NDP health critic considers this conflict of interest a “necessary evil”.
Recently, in Mr. Harper’s letter to Mr. Klein, Mr. Harper felt that if physicians were to work in both systems, they would be in a conflict of interest. For some reason (he suggested financial), physicians would encourage their patients to access the private system instead of using the public system. I have news for Mr. Harper and any other similar thinking politicians, we are already doing it and have been for years; and it has nothing to do with remuneration, it has to do with acting in the patient’s best interest.
If I had a patient that I felt needed surgical intervention for a disc protrusion/extrusion, I would suggest that the patient get a private MRI. This could be done within two days in the private system and two to three months in the public system. Without the MRI result included with my referral to the Neurosurgeon, the neurosurgical consultation may take months and the surgeon would still have to wait to make a decision pending the public MRI. With the MRI enclosed with my referral, the surgeon could better assess the urgency of the situation. The result was the patient was seen and operated on more quickly because he/she needed to be operated on more quickly than the system allowed (but effectively queue jumped). Doing this did not put a penny in my pocket, but it helped me sleep better at night knowing I had done what I could for my patient. This type of activity by the medical profession facilitates queue jumping and could be called a “necessary evil” in a health system as overwhelmed as Canada’s.
But let’s consider the “care broker” scenario. They will arrange to get the private service faster but their revenue is directly proportional to how cheap it can be done. The incentive is to find the “cheapest” care, not the “best” care. In fact the “best” care may not provide any commission. This is conflict of interest at its worst, and possibly a detriment to the patient. Where are our governing bodies? At least a flat fee for finding a private provider may include concern about quality care and risk management without financial disincentive.
The whole system sounds a little bit like: “hey, Mister, you wanna buy a watch?” or in Cuba where if you need something the response is “I no got, but I gotta friend” or in Soviet Russia where the “blatnoi” (fixers) would look to the needs of the politically well connected. But what does one expect from a monopolistic socialist system that would brand all its doctors as being enemies of the state, who would flee to the private system for financial gain. From where I sit and from what I’ve seen, most of us practicing physicians use the private system through concern for our patients and their safety. If only the same attitude prevailed for the die-hard supporters of the system.


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