Posted on 11/28/2002 4:27:59 PM PST by jodorowsky
OTTAWA (CP) - In a properly funded public health system, there should be no need for private clinics offering MRI scans or minor surgery, the Romanow commission said Thursday.
Growing reliance on private diagnostic services "is eroding the equal access principle at the heart of medicare," said the report, which urged governments to reconsider the practice of sending workers' compensation cases to private orthopedic clinics for fast-track surgery.
"Rather than subsidize private facilities with public dollars, governments should choose to ensure that the public system has sufficient capacity and is universally accessible," the report argued.
Private delivery of some medical services has been around for some time, said Sharon Sholzberg-Gray of the Canadian Healthcare Association.
"In the province of Ontario for instance, there's been private X-ray and ultra sound clinics and blood testing clinics for years," she said.
These areas are expanding, with private MRI clinics opening in Alberta and Ontario set to approve 25 more.
There are other experiments in Alberta - private clinics specializing in cataract surgery and hip and knee replacements. British Columbia has also approved a clinic for hips and knees .
Romanow called these grey areas. He said diagnostics should be explicitly included in the Canada Health Act, adding there's no evidence that private clinics are any better or cheaper than not-for-profit facilities.
People who live close to the American border have long been able to go south for a quick MRI, if they can pay the freight.
In private Canadian clinics, provinces are supposed to pay for medically neccessary MRI scans, Sholzberg-Gray said. But non-medically necessary scans - say a pro athlete checking the status of an injury - are paid for out-of-pocket.
This isn't common, Romanow said, but Canadians worry that well-heeled queue jumpers will become routine.
Are these private services a threat to the universality of the health system? Or are they just a way of easing the pressure on an overtaxed public program?
Romanow sees them as eroding the principles of medicare.
And Michael McBane of the Canadian Health Coalition, a group affiliated with the Canadian Labour Congress, says they're dangerous.
"There's no way that the commercialization of delivery cannot jeopardize equity, affordability and quality," he said.
The Ontario Public Service Employees Union sees private diagnostic clinics as a threat because they'll lure scarce technicians away from mainstream hospitals.
And Alberta's health department suggests private clinics haven't cut waiting times for things like hip surgery. Waits for hospital surgeries in run 24 to 48 days compared with 79 days for a private clinic in Calgary.
Access and long lines can be a key problem.
Take Bill, an Ottawa-based TV cameraman who has a deteriorating hip because of arthritis and needs a replacement
"The waiting list here is 11 months," said Bill, who asked that his real name not be used. "I'm on the emergency list, too, but who knows?"
His hip gets worse as time passes, the problem aggravated by the heavy camera he lugs on his shoulder.
"My doctor says I shouldn't carry more than five pounds or stand for more than half an hour, but that's my job."
Last summer, Bill travelled to his European homeland on vacation. While there, he spoke to a prominent orthopedic surgeon.
"He said he could do it next week, no problem ."
The problem is the cost, 5,500 Euros or about $9,000 Canadian.
Bill is asking the provincial health plan to pay and is in the middle of his paperwork.
For him, access is key. He fears that an 11-month wait might lead to such deterioration in his hip that he'll end up in a wheelchair.
Sholzberg-Gray agrees that access has to be improved.
"The real issue is how to create access in an efficient and effective way," she said.
Romanow proposed beefing up spending to make the public system more robust.
Devidas Menon of the Calgary-based Institute of Health Economics, said he doesn't see how private health care could make money while still meeting standards of care. There just isn't that much slack in the public system that could be ironed out by private business.
"I just can't in my own mind see how it could be cheaper in the long run."
Sholzberg-Gray agrees, saying that even in the United States - the land of private health care - only 20 per cent of hospitals run on a for-profit basis.
"There's a lesson there," she said. "Why aren't more owned by corporations? There's not a lot of money to be made in complex care because you can't always predict the complications."
Romanow is unequivocal: "Direct health care services should be delivered in public and not-for-profit health care facilities."
"Universality" indeed. I am surrounded by idiots.
What an incredibly ignorant -- and revealing -- statement.
Spoken like a Marxist true believer...
the United States - the land of private health care
This is a lie, what with Medicare and Medicaid messing up the economics of medicine, but EVERYWHERE except North Korea and Cuba is the land of private health care compared to Canada. You can be imprisoned for trying to pay a doctor yourself.
If you're country gets worse, you are always welcome to emigrate to the US.
Thank you... It may come to that one day...
Hey, everybody in the US is a line jumper.
Line jumping is good!
BTW: We'd love to have you here.
Thanks Louisiana!
My colleagues at Nortel back in the corn years often joked that I ought to be at the Texas plant instead of Ottawa ;)
Or, Canada can petition for admission to the United States, officially.
You really don't want that! You think your parties are left wing now... 30.000.000 more potential socialist voters in the U.S. would have us all back in the caves wearing animal skins by 2100 A.D.
1. "There's no way that the commercialization of delivery cannot jeopardize equity, affordability and quality," he said.
There it is, just lay it out there without any shred of evidence to support the statement and claim it has to be true simply because you are so much smarter than anyone else. Or is he simply attempting to admit, without admitting, that commercialization will harm the public delivery system because it is better at providing equity, affordability, and quality?
2. Alberta's health department suggests private clinics haven't cut waiting times for things like hip surgery
Could it be that the ratio of private providers to public providers is kept so low by the government that numerically private providers couldn't possibly overcome the inertia in the public system? If the pool of inefficient public providers is 10 times the size of the private providers how could the privates ever hope to make a dent in the poor performance of the public sector?
3. The real issue is how to create access in an efficient and effective way," she said
The access problem would be solved by a private provider being compensated on a "productivity" basis. Doctors on a flat salary with no incentives for work performance will never be interested in solving access problems. Why see 40 patients daily if you get paid the same as if you see 10? The govenmentalists will always suggest that they cannot afford paying for private health care but who knows what the actual cost of restricting care is on worker productivity and medical complications that ultimately cost more to take care of unless they are shortcircuited by death?
4. Sholzberg-Gray agrees, saying that even in the United States - the land of private health care - only 20 per cent of hospitals run on a for-profit basis
Intentionally misleading statement by this government apologist. She is attempting to lead people to believe that 80 percent of US hospitals operate at a loss. In reality, the statement attempts to obfuscate the fact that 80 percent of hospitals are operated on a "non-profit" basis as outlined in our US tax law. "Not-for-profit" does not mean "for loss". Most of the hospitals in the "not-for-profit" (mine included) operate at a profit. The fact that private business may not be interested in hospitals is only partly due to the lower rate of return than other businesses. It is also due to the fact that many hospitals in the US have historically been private charitable institutions and "not for profits".
Ay, yi, yi. These people are so invested in the absolute infallibility of their governmental system that they are not able to even consider alternatives.
I have no idea what "standards of care" this fool is talking about when a Canadian women traveled across the border to have me do her breast biopsy last month so that she would not have to wait in line in Canada.
Maybe the "standard" is that all Canadians have to be treated equally........equally poorly, that is.
There's no getting rid of access to private medical care when it will be only a short drive from most Canucks across an easily-crossed border...
I don't. That makes me a rank heretic, something less than a true Canadian, indeed, a quisling for the Americans.
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