November 05, 2010

Liar, Liar The Government of Canada’s Pants Are On Fire

No Private Health Care In Canada What A Load of Bull-X#&*!

BY Melvin J. Howard

In my NAFTA dispute with Canada one of the things I wanted to bring out to the world is the hypocrisy of Canada's Universal Health Care System. On the one hand it claims for the social good of its citizens its health care system is free and you will not be charged for medical care. On the other hand if you want the really speedy and better service health care system. We take all major credit cards, cash, personal cheques, money orders, bank drafts, and company cheques, wire transfers, the barter system (I’ll do your scan if you build my sun Deck) etc. Meanwhile enter Centurion Health Corporation an American firm that wants to build a 100+ Million Dollar plus health care facility providing the same services. Guess what in effect they said YANKEE GO HOME American Health Care Companies Need Not Apply. So much for free trade and all the NAFTA promises I demand redress my resolve on this issue remains strong or should America in kind shut the door on Canadian Health Care Companies that have opened up shop in the great U.S of A. To make my point just read the following head lines in Canada and this is after my tribunal disbanded it really insults my intelligence that the Government of Canada can continue to defend their position with a straight face.

Tom Blackwell, National Post
Thursday, Nov. 4, 2010

Major Canadian hospitals are hosting for-profit services that sell speedy MRIs and CT scans to fee-paying patients, part of a surprising, parallel private health system that appears to stretch countrywide.

The businesses — at Mount Sinai and St. Michael’s hospitals in Toronto and many others like them — say they are not violating laws that bar Canadians from buying medically necessary treatment, but taking advantage of a little-known quirk in medicare rules that allows “third parties” to seek care outside the public system.

The concept has long applied to workers’ compensation clients, RCMP officers, military personnel and even prison inmates - all of whom are effectively excluded from provincial health plans - but recent interviews reveal that the third-party exemption now stretches much further.

Private auto and health insurers, law firms, sports clubs and individual employers and corporations are also being allowed to purchase expedited care for patients who normally would be prohibited from doing so.

An Alberta-based insurance company is selling policies to employers and individuals in the West, Ontario and Atlantic Canada that will provide patients expedited MRIs and CT scans and even speedy visits to a range of specialists if they face lengthy wait times in the public system.

Acure Health’s service is possible because the bill is paid for by an insurer - a third party - but Jim Viccars, Acure’s president, said his company is not stealing from the public system, only tapping into unused capacity.

“The reality is that the system right now is faltering under incredible burdens of demand, versus the ability to meet that with provincial revenue,” he said. “This kind of program can alleviate a lot of that ... No one needs to wait in pain.”

One Toronto man says he turned over $850 recently to get the MRI scan his doctor had recommended within two days, versus waits of up to two months for a taxpayer-funded scan on the same machine. Staff at the Mount Sinai third-party service told Greg Martin he just had to make sure it was paid for by a corporation, which happened to be his own computer-consulting business.

“The clinic questioned me ... to make sure I had pre-printed company cheques and to make sure it was a legitimate company,” said Mr. Martin, who would actually like to see more private medicine. “We obviously need to support the public system, but if people can afford to pay for it, then let them.”

Some of the third-party diagnostic imaging services are offered by private companies that use publicly owned equipment within hospitals part-time, some by the hospitals themselves and at least one in Ontario is a privately owned MRI suite within a public hospital, St. Michael’s.

At Mississauga’s Trillium Health Centre, a representative for the hospital’s service told an anonymous caller that a patient can get an MRI or CT scan in three days or faster, and have it paid for by a corporation.

“Even if it’s your own company and your own money in a sense, if it’s the company that’s making the decision for your wife, that’s the way we need to do it, so it looks like it’s a legitimate sort of expense for the company,” said the employee.

It all adds another twist to the continuing debate about Canada’s single-tier system and the seemingly expanded role being played by private medicine. The phenomenon is particularly striking in Ontario, where the Liberal government actually converted several private imaging clinics to non-profit facilities in 2004, saying “MRI services will be driven by community need, not by profit.”

David Jensen, a spokesman for the Ontario Health Ministry, said Thursday the province funds hospitals and clinics to provide a certain number of hours of medicare scanning service; outside those hours, they are free to use the machines to provide “uninsured” services, those that do not fall under the provincial health plan.

It would seem, though, that third-party customers are often funding care that would normally be covered by medicare. And some critics argue that is a potential threat to the integrity of universal health care.

“It’s relentless: medical entrepreneurs trying to exploit the system for money.... it easily escalates out of control, so you lose single-payer, universal access,” said Michael McBane, spokesman for the union-backed Canadian Healthcare Coalition. “It’s the thin edge of the wedge ... If they don’t get beaten back, they will grow like a cancer.”

One diagnostic-imaging entrepreneur catering to third parties, however, said the exemption makes perfect sense, allowing employers to get sick or injured staff back in the saddle sooner

“I don’t think it’s a loophole; this is well considered,” said Bruce Bronfman of Ontario MRI Centres, which operates the services at Mount Sinai and at Toronto’s Humber River Regional Hospital. “It’s important for the Ontario economy.”

For Trillium, the third-party service uses machines when they would otherwise be idle, while providing crucial funding for public care, more work for radiologists, and added job security for technologists, said Larry Roberts, a spokesman for the Ontario hospital.

Private companies and others catering to third parties say the bulk of their business comes from workers compensation, car-accident victims funded by insurers and federal police and military.

At Halifax’s Healthview Medical Imaging, which owns its own private MRI clinic, about 20% of patients have their scan paid for by others, such as workplace health plans, or actually pay out of their own pockets.

For $800, patients get a scan within three to five business days, compared to waits of up to six months in Nova Scotia’s public system, said Dr. Derrick McPhee, a radiologist who works full-time on the public side and after hours for Healthview.

Dr. McPhee argues the company actually helps medicare by taking thousands of patients out of it annually.

National Post editorial board, National Post
Monday, Oct. 11, 2010

Monday marked the start of “Family Doctor Week” in Canada. It provides an occasion to celebrate the contributions and hard work of Canada’s general practitioners, but also to take stock of the serious challenges facing these doctors and their patients across the country.

According to a report released by the Canadian Medical Association (CMA) and the College of Family Physicians of Canada (CFPC), in Dec. 2009, 4.1 million Canadians — 14% of the population — did not have a family physician. A series of focus groups conducted for the CMA by Ipsos-Reid in 2007 further revealed that some people had been unsuccessfully searching for a family physician for as long as several years.

And those Canadians with family doctors enjoy less timely access to them than citizens of other industrialized nations. According to a Commonwealth Fund survey conducted in 2007, and cited by the CMA, Canada had the lowest rate of same-day physician appointments: Only 22% of respondents, versus 30% in the United States and 41% or better in the other five countries surveyed, reported being able to see their doctor within the day. Canada also had the highest rate of respondents who waited six or more days to see their doctor, at 30%, as opposed to 20% for Germany and the United States, and lower for the other four nations surveyed.

What causes our shortage of family doctors? The perception that family medicine is not as “prestigious” as highly specialized disciplines is one problem, as is the difficulty in attracting family physicians to remote or outlying communities. But according to a 2005 report from the CFPC, the main reason is money: “[A] lack of remuneration is the leading cause of a decline in medical students choosing to take up family practice. It is also the prevailing reason why family doctors are forced to close their practices.” A 2008 report by the same organization found that family doctors earn an average of 33% less than physicians in other specialties.

Yet when searching for a solution to the shortage, discussion more often centres on increasing the supply of doctors, instead of their remuneration. Some observers claim Canada should attract and accredit more foreign doctors. But two recent studies found that between 2001 and 2008, only half of international medical graduates (IMG) passed their accreditation in Canada, versus over 93% of Canadians.

Other critics would like to increase the number of medical students in Canada. But if these students continue to prefer specialization over general medicine, this will not improve the situation.

If the paycheque is the problem, the answer is not to increase the supply of family physicians, but to increase the reward they receive. In a state-run, monopoly-payer system, this would mean having government pay higher fees for service. But public health budgets are stretched to the limit — and they already fail to deliver enough bang for the taxpayer’s buck.

According to Nadeem Esmail, former director of health policy at the Fraser Institute, Canadians currently underwrite the developed world’s second most expensive universal public health system. In an article published in 2009, he notes, “Only Iceland spent more on universal access health insurance system than Canada as a share of GDP, while Switzerland spent as much as Canada… Twenty-five developed nations who maintain universal health insurance programs spent less than we did; as much as 38% less as a percentage of GDP in the case of Japan.”

Instead of fighting market forces, through a rationed, monopoly-payer system, Canada should allow family doctors to practise both public and private medicine. This would allow them to diversify the sources of their revenues, and exert better control over their working hours and the quality of care they deliver.

A trend to private family medicine is happening already in parts of the country. Leading the charge is Quebec, where between 2007 and 2009, the number of private family doctors nearly doubled, from 61 to 113. An estimated 20-25 physicians leave the public system each year. According to the Quebec Family Doctors Federation, as of 2009, Quebec had a shortage of 800 general practitioners (there were 8,000 in practice that year). Doctors cite the desire for higher pay and lower stress as their chief motivations for going private.

Some provinces, such as Ontario, expressly forbid physicians from setting up general practices which bill patients instead of the medicare system. The fear is that “going private” will further diminish the number of doctors available to treat patients “for free.” But the reality is that such edicts only encourage physicians to vote with their feet, and move to jurisdictions which allow them choice in how they earn their living, and their patients choice in how to pay for medical services.

The answer is not more public money, but a more efficient allocation of resources from both the public and private sector that will increase compensation for family doctors, allow them to achieve greater work-life balance and thereby make the practise of family medicine more attractive. Now that would be something for “Family Doctor Week” to celebrate.