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?

Sunday, February 25, 2007

Healthcare Savings Accounts

Last week, Mark Milke provided an opinion in the Calgary Herald entitled “A small reform that would work”. Basically he suggested that Alberta’s health care premiums be put into government “owned” health savings accounts instead of into general revenues, and that patients could access them as a deductible for a range of health services (not just ministry designated services). Am I missing something here? Since this money is now going into the government’s coffers and would be the government’s “owned” health savings account with his proposal, expanding the services covered would only increase the cost of health care to the government (i.e. the taxpayer). Isn’t the present problem one of unsustainability? How does increased spending on “new” services address that issue?
The only way this could work is if the government actually de-insured many of the services that are now provided e.g. visits to the family doctor, chiropractor, ophthalmologist, the first $100.oo of a specialist visit, the first $100.oo of diagnostic imaging, laboratory investigations, etc. Can you imagine the uproar by Joe Public over something like that? The bottom line is that the government “bean counters” would have to de-insure more than 900,000,000 dollars of annual healthcare spending in order to come close to making Mr. Milke’s proposal cost effective, and still not address the unsustainability of our healthcare system.
Now don’t misunderstand me; health savings accounts, as done by some companies can have merit; but it does not do so by increasing the coverage of a variety of health services funded by the Canadian taxpayer.
The area that still needs intensive scrutiny in a health savings account system is the area of preventive medicine. Since most of these systems still carry “insurance” (either private or government) for major health expenditures, the participants may decide to spend their “annual allotted moneys” on eye laser corrective surgery instead of medication for their hypertension and not have to be concerned about the cost of their choice. As a taxpayer and a physician, I believe there needs to be justification for, and a shown benefit to, any tax funded health service. Ideally, the system should have significant “built in” incentives for disease prevention. Mark Milke had best get back to the drawing board on this one.

3 Comments:

Blogger David MacLean said...

I haven't read the article, but is your main objection to de-listing services the predicted "uproar by joe public"?

If we measure all policy proposals against what's "popular" most reforms aimed at sustainability would be dismissed before they even hit the drawing board.

In the interest of sustainability, we must introduce a "price" function in health care. Introductory economics tells us we can't allocate resources effectively in the absence of price.

That's why they had to wait in line for bread in the Soviet Union.

De-listing services and allowing private clinics to deliver those services and charge them to health accounts is something that needs to be considered, and not dismissed just because it doesn't play well in the polls.

26/2/07 1:42 PM  
Anonymous Someone Special said...

I commented just using the Other choice instead of the GoogleBlogger choice or Anonymous choice. I put whatever name I wanted in the name field and pasted my URL in the Your Webpage field. No need to sign in at all or worry about your password when commenting. Love ya

26/2/07 5:23 PM  
Blogger Al said...

I agree. If you have read other entries on my blog site you will see that I am a strong supporter of a private system, a public system, and an ongoing delisting process. The problem with the article was twofold:
1) No mention was made of any kind of delisting process, merely using existing government premiums (government revenue) to expand coverage. This simply exacerbates the existing shortfalls in healthcare funding.
2) No process was in place, with the writer's proposal, to encourage decreasing risk (preventative medicine). At least in a private insurance system premiums decrease with decreased risk; and the public system is still there for the aged, the chronically ill and the poor (those that society should cover). A health savings account that is structured from personal or company contributions(personally owned and tax deductible) could be used by the individual to seek the lowest premiums based on their individual risk for covered services, or used for "choice" as to caregiver.
Thank you for your comments.

26/2/07 7:16 PM  

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