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, August 30, 2006

Public and Private Medical Systems Can Be Synergistic

Now we get into the fun part!!! Today we will discuss: B) Areas of health care change and innovation that may well contravene the Canada Health Act. These are the areas that probably never get explored in the MSNM because very vocal lobby groups raise the negative side of the equation to public awareness, but little discussion occurs as to the positives.
1) Doctors being able to work in both the public and private systems. Probably the public doesn’t know that in some provinces there is a “cap” put on doctor’s earnings. This means that effectively some doctors (even family doctors) who work hard are penalized for their productivity; the more patients they see, the less they get paid for their additional work. This is a definite disincentive to work to capacity. If they were allowed to spend additional time in a parallel private system, they would be fairly remunerated for there additional work, and more community needs would be addressed. The more patient needs that are addressed in the community, the fewer patients show up in the emergency departments for treatment.
2) Surgical waiting lists comprise an “at risk” group of patients, and at risk patients are more likely to end up in the emergency department. This is true of cancer patients waiting for investigation and/or treatment, joint replacement patients who are more prone to falls, etc, or patients waiting for coronary by-pass surgery. Many presently practicing surgeons in Calgary have limited operating room time, and many surgeons who possibly would come to the Calgary region do not do so because of lack of operating room time. Allowing surgeons to work in both a private and public system would make full use of the existing highly trained physicians, would entice surgeons to come to this area despite restricted access to public funded operating rooms, would shorten wait times, and by doing so, reduce visits to the emergency departments by these high risk patients.
3) Allow insurance for “covered” investigative procedures and treatments (in a private parallel system).
a) People waiting for investigations such as C.T. scans, MRI’s, and other investigative procedures, are usually getting these procedures done for medical reasons. They comprise a community group of patients at risk, who are more likely to attend the emergency departments of our hospitals than the average patient who does not have medical concerns. The faster these patients are dealt with and their medical issues addressed, the less likely they will frequent the emergency departments.
b) As in “(#2), access of treatment, through insurance, takes patients off treatment lists in the public system, and by shortening the “wait” times, reduces emergency department visits.
4) Allowing a private, parallel, health care system.
a) This could entice thousands of doctors and other health care providers who have left Canada over the years, back to Canada. More care providers in the community will decrease the need to visit the emergency departments.
b) Insurance for various “services” of health care, that are in short supply at present, will be taken up by the people who can afford to do so. This will take these patients off of the wait lists in the public system with benefits to both the private and public patients. Further, the care of the insured patients will not be coming from the tax-payer funded public system. As the waiting lists shorten in the public system in various areas of service, the patients will decide whether they wish to carry insurance for a particular service. As an example, if waiting times for joint replacements are two years, I would probably take out private insurance coverage. If the wait times for joint replacements are six months, I likely would not take out private insurance coverage. At all times this system will give options to the average Canadian (right now only the very wealthy have options), and at the same time have an ongoing effect on shortening the waiting times for many procedures in the public system. Keep in mind, the public system will still be there as it is today, with appropriate emergent and urgent care (and should be more accessible).
c) Privately owned and operated facilities could be established in this environment, but the finances for these operations are completely paid for by the insurance carriers. If, on the other hand, it is expedient (by virtue of cost benefit or demand) for the public system to “farm out” certain procedures, the private system acts as a resource and a possible safety valve at times of critical demand (disasters, epidemics, etc). On the other hand, the public system may be able to compete very effectively in providing certain privately insured patient’s services. This could be a financial benefit to the public (tax payer funded) system. After all, the proponents of the public system continually state that they provide services more cost effectively than private systems.
5) An interesting thought is for the government to actually be one of the insuring companies. They already have a premium system in place. People could either take out separate policies with them that would give them access to private facilities or simply “beef up” the existing universal health care system in such a way that it complements their individual needs. I personally don’t need abortion coverage, but I would like better “portability” coverage.
All in all, significant and major changes are necessary in our health care system (we are running out of band aids). In spite of ever increasing proportional cost to our governments disposable, tax payer funded budgets; huge new money is needed within the system. We need to make a decision; do we increase government’s taxation significantly, or do we devise a system where, in return for slightly better access to elective and non-urgent care, those that can afford it will take some of the pressure off the system. I personally, always opt for systems that provide personal options, consumer input and control. And I see no reason why the public and private systems can’t work synergistically.


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