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public and private health care
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| Wyndham |
I thought this was a good article, way too often i hear people bashing private health care cause they think its gonna be a free for all of doctors going private as soon as they're done their training.
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Ontario must offer incentives to stop MD exodus
Jan. 10, 2006. 01:00 AM
CHARLES SHAVER
Ontario is faced with a physician manpower crisis. This year, some 1.4 million Ontarians will have no family doctor. According to the Canadian Orthopedic Association, Canada is short 400 orthopedic surgeons and is nearly last among Western nations in the number of orthopods per capita.
Yet, at the same time, there is mounting pressure, especially in Quebec and Alberta, to allow more privatization. If permitted in Ontario, would this inexorably lead to further loss of access and increased wait times in the public system?
An increased private system across Canada seems inevitable. In June 2005, the Supreme Court paved the way to legalized health insurance in Quebec and similar court challenges will likely follow in other provinces.
Critics fail to understand a few principles. After all, a one-tier system within Canada has never really existed. Furthermore, a private system would not destroy the public one owing to several safeguards involving both patients and physicians.
The current system is really multi-tier, i.e. it covers people differently if, for example, they are prisoners, federal civil servants, professional athletes, over age 65, Members of Parliament or the military. Persons who are not members of one of these special groups can still access certain private diagnostic facilities, especially if they live near an interprovincial border.
Residents of west Quebec can purchase CT scans or ultrasound exams in Ottawa. Conversely, some eastern Ontarians pay out-of-pocket for MRI scans at a private facility in Gatineau, Que.
Even if an enhanced, expanded private system were legalized, most patients would not abandon the public health system. Some wealthy ones might be able to pay out of pocket for private services, but many would have difficulty qualifying for private insurance, even if it were legalized.
Baby boomers are aging and developing diabetes, malignancies, and cardiovascular disorders — all that make private insurance expensive or completely unobtainable. For example, a large insurance company in Britain requires a person under age 55 to wait five years before submitting a claim for a pre-existing condition. This increases to seven years for those age 55 to 59 and 10 years for those age 60 to 64.
An enhanced private system would probably concentrate on younger patients with fewer problems. Those who developed complications would gravitate to the public system.
Despite general physician manpower shortages, the bottleneck in most hospitals is a lack of operating room time. Fewer than half of orthopedic surgeons practise at full capacity. Most surgeons would be able to increase their productivity if extra hours were available in a private facility.
Sadly, half of orthopedic residents become so frustrated that they leave Canada at the end of their specialty training.
In Ontario, Bill 8 prevents physicians from charging patients a higher fee even if MDs have opted out of OHIP. If this legislation were repealed, a number of incentives already exist, or can be created, to ensure that most physicians would not abandon the public system.
In Canada, provincial medical associations have already negotiated a number of workplace benefits. All provincial governments help to defray the cost of malpractice insurance.
Most provinces offer maternity and paternity benefits. Manitoba and Saskatchewan have a "retention bonus," Alberta and British Columbia subsidize continuing medical education, and B.C. matches RRSP contributions.
The federal government should also amend tax regulations to permit self-employed physicians to receive pensions, a policy recently supported by the Canadian Medical Association. There is no need to demand that a physician work exclusively within the private or the public system.
Provinces could require each physician to work a certain number of hours in the public system or most, or all, of these benefits would be forfeited.
If the public hospitals cannot be funded sufficiently to keep new orthopods busy, is it not preferable to allow them to operate for a few hours per week in a private facility rather than to permanently leave Canada?
Ontario, at present, is competing poorly for doctors compared with other jurisdictions. Fees in Alberta, B.C., and in most of the United States are higher, and benefits tend to be more generous in the western provinces.
Expansion of a private health-care system in Ontario will likely not threaten the public one. Rather, it may provide the impetus to government to enhance and create new incentives.
These would attract and retain additional physicians and improve access to timely health care for all residents of this province.
Dr. Charles S. Shaver is former president of the Ottawa Academy of Medicine and of the Medical-Legal Society of Ottawa-Carleton.
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| rabbitjoker |
I heard Regina Herzlinger on a radio call in show and what she had to say about health care made a lot of sense. Here is part of an article that talks about her ideas:
Are you ready to own your health care?
Amy Feldman and Peter Carbonara, MONEY Magazine
Regina Herzlinger, 60, is a Harvard Business School professor of business administration and a senior fellow at the Manhattan Institute, a New York think tank.
Herzlinger wrote her first book on consumer-driven health care, "Market-Driven Health Care," seven years ago. In 1999 she organized a conference at Harvard that gave the movement its name.
Herzlinger likes to view herself as an outsider and an iconoclast, and in some ways she is. Neither Republican nor Democrat, she's a market-oriented business professor in the highly regulated world of health care and a woman competing in male-dominated arenas.
Her interest in medicine dates to her graduate thesis on the productivity of physicians at Massachusetts General Hospital. She wanted to see how they would perform if they knew how productive they were compared with their peers. The doctors she dealt with didn't like being measured and resisted her efforts to show them how they stacked up.
"It was so foreign, so different from the rest of the economy," she says.
The basic problem, Herzlinger says, is that the American health-care system is shielded from the discipline of the market. Instead, bureaucrats set the economic incentives, a process that typically starts with good intentions and ends with absurdity.
Hospitals, for instance, are paid (usually by insurers or by government in the form of Medicare or Medicaid) for individual acts of care. The unintended result is that providers have ample incentive to do more tests, more procedures and more hospitalizations, and little reason to actually make people better.
Herzlinger likes to cite as examples hospitals that have bundled under one roof all the specialized services needed to treat a specific disease. These programs tend to work well, in that they make patients better and keep them out of the hospital. But, of course, that means less money for the hospital. The strategy makes medical sense but not business sense.
Herzlinger's goal is to make those two things the same. Provide better care, make more money. The best way to realize that ideal, Herzlinger says, is to give patients real choice.
"Right now the health industry is so devoid of choice, it's laughable," she says. In her vision, patients would be free to decide which insurers and which providers they wanted and to shop around for the best deal. The information to make an intelligent decision would be readily available. (Insurers and health-plan administrators, along with new outfits like HealthGrades and the Leapfrog Group, are already scrambling to provide the data.)
Eventually, insurers and health-care providers would have to tailor their offerings to what consumers needed and could afford. One new business Herzlinger sees arising from this process is what she calls the "focused factory" -- a highly efficient medial center that treats only one particular disease.
For now, the consumer-driven idea attracting the most attention is the health savings account. (Herzlinger regards HSAs as only a small step in the right direction.)
HSAs are tax-free accounts offered in conjunction with low-cost, high-deductible insurance plans. Either you or your employer (or both) puts a certain amount of money into the account each year and, to oversimplify somewhat, you are free to spend that money on any health treatment or medication you wish. Whatever you don't spend each year is yours to keep.
The purpose is twofold. If you spend your own money, you will be a more frugal consumer of health care, thinking twice, say, before running to a specialist for a minor complaint.
The other reason is more subtle: If you are knowledgeable about treatment risks and prices (something few patients have any idea of today), you will take your business to providers who give better care at lower cost. Those who don't keep up will fold. The "creative destruction" of the free market will reform the system.
Herzlinger believes that corporations, which bear the brunt of soaring health insurance costs, will be eager to adopt consumer-driven reform.
"The CEOs are thinking, 'Health-care costs are killing me,'" she says, "and consumer-driven care offers them a way out." |
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| DigiNut |
The HSA sounds like a brilliant idea to me. If there is truly a belief that people are incapable of saving money for health, then give them tax incentives to do it. Sort of like RRSPs.
I wonder if the Republicans would have the balls to follow through with such a plan - to date they've been really left-leaning on the medicare front and domestic policy in general. Here's to hoping, though... |
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| rabbitjoker |
Apparently Switzerland has a healthcare system similar to what Herzlinger advocates.
Swiss healthcare is considered to be very, very good - perhaps afree-market (market-driven) system is what Canada will require when our current system colapses (which will be within a decade, I predict). |
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| DigiNut |
| Germany also - they have a two-tiered system there that works very well. |
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| Wyndham |
so there are a few countries where a two tierd system works really well then.
is no one on here opposed to this? lol i hear so many people saying say bye bye to public health care if harper's elected...wheres the arguements?? |
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| jon jon |
| quote: | Originally posted by rabbitjoker
when our current system colapses (which will be within a decade, I predict). |
optimistic prediction, I give it 6-7 years. But as we discussed on Sunday, a lot can happen between now and then. I say ride the bitch and learn what we can from a brilliant experiment.
<- still quite proud to be Canadian. |
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| DigiNut |
| quote: | Originally posted by Wyndham
so there are a few countries where a two tierd system works really well then.
is no one on here opposed to this? lol i hear so many people saying say bye bye to public health care if harper's elected...wheres the arguements?? |
Australia too, but I'm not sure where their system ranks. Australians don't seem overly unhappy about it though.
I'm not sure where people are getting the idea that Harper will make public health care disappear. He's already told us that he won't touch health care and Conservatives have a pretty good history of keeping promises like that.
Frankly, I would love to see health care expanded into private enterprise (that is, other than dental exams, eye exams, psychologists, psychiatrists, dermatologists, certain HIV treatment, certain lab tests, drugs, and all the other things that are already private). It just isn't going to happen though - not in the next term at least. |
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| Wyndham |
| quote: | Originally posted by DigiNut
Australia too, but I'm not sure where their system ranks. Australians don't seem overly unhappy about it though.
I'm not sure where people are getting the idea that Harper will make public health care disappear. He's already told us that he won't touch health care and Conservatives have a pretty good history of keeping promises like that.
Frankly, I would love to see health care expanded into private enterprise (that is, other than dental exams, eye exams, psychologists, psychiatrists, dermatologists, certain HIV treatment, certain lab tests, drugs, and all the other things that are already private). It just isn't going to happen though - not in the next term at least. |
i think its just knee jerk reaction, people hear private health care and think that means the end of prublic health care and that they're gonna have to pay, they dont understand that its a private system complimenting the public system. |
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| Wyndham |
so it begins
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Private health clinics to open in Ontario
By MIKE OLIVEIRA
TORONTO (CP) - A private health-care company is moving into Ontario this summer with plans to set up clinics in every major Canadian city by 2007.
The announcement by Copeman Healthcare on Wednesday raised immediate criticism from observers who warned such moves would erode the public system by redirecting resources and expertise to wealthier patients. Copeman Healthcare said patients in Toronto, Ottawa and London, Ont. could be paying for private health-care as soon as this summer when it opens three new clinics.
For a $1,200 enrolment fee and $2,300 a year, Copeman Healthcare will offer access to a general practitioner plus specialists in the fields of cardiology, urology, orthopedics, neurology, oncology, gynecology, sports injury and pain management.
"It's time for action not further debate," said company president Don Copeman.
"We have very real solutions that can help Canada avert a crisis in primary care, and we believe that solving the problems in primary care is the key to the overall sustainability of our health-care system."
The company said its work would actually benefit the entire population by saving governments money by keeping more people healthier. Healthier people would stave off demand for costly medical treatment down the road, Copeman said.
Each of the Ontario clinics will have eight physicians and take up to 4,000 patients.
Copeman Healthcare opened its first clinic in Vancouver last fall. By 2007, the company plans to open others in Halifax, Montreal, Winnipeg, Regina, Saskatoon, Edmonton, Calgary and Victoria.
The company said it is acting within the guidelines of the Canada Health Act and expects to get the blessing of Ontario's premier and ministers of health and health promotion.
But critics said the clinics will take away resources from public health-care and lure doctors away from the public system.
NDP health critic Michael Prue said allowing the plan to go ahead would be a broken promise by Premier Dalton McGuinty, who campaigned on a promise to end the creeping privatization of health care.
"Dalton McGuinty is letting down ordinary families," Prue said. "Instead of guaranteeing all Ontarians access to public medicare, he is standing by doing nothing while private, for-profit firms Americanize our health-care system."
Prof. Brian Golden of the University of Toronto said the rollout of private clinics was a move every provincial government should have seen coming.
"Particularly because they seem to be doing OK in Vancouver - and by that I mean no one's locked their doors yet - there is apparently an appetite among consumers (for private clinics), at least their entrepreneurs think so," Golden said.
"There will always be some relatively affluent people who are willing to pay more to jump the queue."
While such clinics could intensify pressure on governments to improve health-care, it's more likely that they could weaken the public system, he said.
"Where it can be detrimental to Canadians is if we start to lose our most scarce resources and those are physicians, nurses, radiologists," Golden said.
"It takes a considerable amount of time to train (them) and (with private clinics) we're simply reallocating those resources."
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| DigiNut |
| quote: | Originally posted by Wyndham
i think its just knee jerk reaction, people hear private health care and think that means the end of prublic health care and that they're gonna have to pay, they dont understand that its a private system complimenting the public system. |
Even so, Harper has mentioned nothing about introducing private health care.
Must be part of that "hidden agenda" that only Liberal supporters can see. |
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| Wyndham |
| quote: | Originally posted by DigiNut
Even so, Harper has mentioned nothing about introducing private health care.
Must be part of that "hidden agenda" that only Liberal supporters can see. |
haha yea |
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