Hybrid systems in Europe show the option can cut costs, reduce wait lists
By Dr. Brian Day
Almost 2,500 years ago, Hippocrates wrote, "Healing is a matter of time." Canadian governments, with their strategy of rationing care as patients wait, suffer and deteriorate, have taken his statement too literally.
Back in the time of Hippocrates, treatments were often painful and ineffective. Many preferred to wait and see rather than experience, for example, the Hippocratic treatment for shoulder dislocations that involved the insertion of a red-hot iron poker into the shoulder --without an anesthetic--to create scar tissue and tighten the joint. Times have changed, and nowadays the denial of timely and effective care leads to costs, both medical and financial, to patients and governments.
Alberta has been known as the free enterprise province, but like others in Canada, when it comes to health care, it propagates a monopolistic government system that is inefficient, ineffective and unsustainable. Albertans on hospital wait lists must suffer, unless they have the resources to leave the province for care. Many seek treatment at private centres in British Columbia (I personally treat about three Albertans a week), which is completely acceptable under the Canada Health Act.
Annually, 300,000 Canadians seek care out of their home province, most commonly in the United States. This cross-border shopping for health care makes no sense.
Many Canadians have been persuaded that "medically necessary" services should be controlled, funded and delivered by government, as is the case for 98 per cent of all hospital and physician services. Yet proper nutrition, housing, and education are more important determinants of health than the health system itself. How would we respond to a government decision to exclude the private sector from, and enforce a single state provider of, such "essential" services as housing, food and restaurant outlets, not to mention schools?
The arguments on equality in health are not valid. The rich and famous don't wait. If necessary, they obtain treatment outside of the country. Politicians know that equal access in such a vast and sparsely populated country like Canada is impossible. Patients with severe heart attacks or serious head injuries in a large city have a better survival rate than they do in a small rural community.
Rational debate on health reform in Canada has been stifled by rhetoric and the "private-public" debate. We must ask ourselves a simple question: In a free and democratic society where we can freely spend our own money on smoking, gambling, cars, hunting or booze (and even worse things), how can it possibly be considered unethical, immoral or illegal to spend one's own after-tax dollars on the health care of oneself or a loved one? In Canada, we can legally insure against damage to our house or car, but not ourselves. We can buy insurance coverage for death, but not illness. A simple word-- "stupid"--accurately describes this scenario.
On the question of "queue jumping," we must accept that there are many countries around the world (such as Switzerland, Austria, the Netherlands, France, Belgium, Germany, etc.) with public-private systems that spend the same as, or less than, Canada, and offer universal care without queuing. Last year, a consumer group, which for the past seven years has ranked the health systems of 29 countries in Europe (including the above), added Canada to its study group. Canada finished 23rd in performance and last (30th) in value for money and wait lists.
Promoters of the status quo in Canada have focused--as a strategy--on the perils of privatization in the United States. Last week, in the Edmonton Journal, the Australian system was also given the thumbs-down by two Ontario hospital CEOs, Murray Martin and Cliff Nordal, after a trip to Sydney, Australia. While I would not advocate for the importation into Canada of either the U. S. or Australian health system, the latter's experience with private care was not accurately portrayed by Martin and Nordal. While below par compared with the better-performing European systems, Australia now outperforms us in many areas, and wait lists there are short by our standards.
A quick e-mail to my former high school buddy (a Methodist minister in Australia, who has no private coverage) confirmed the experience of my relatives down there. After polling some of his congregation, he described access to a specialist-- "Within a month usually, and it does not seem to make much difference whether the patient is public or private, unless it is a particular, named high-demand specialist. Public patients may sometimes experience long waits for non-urgent surgery--up to a few months on the waiting list. Waits for public MRI scans may be quite long--up to two weeks."
I suppose we all have our own perception of "long waits."
Although the private-public debate is unproductive( patients just want rapid access to excellent care), there is plenty of evidence that the private sector can outperform the public sector. French government data reveal that France's 1,000-plus private hospitals perform 60 per cent of all surgery, have lower mortality rates for comparable patients, and cost up to 40 per cent less than public hospitals. The French government funds care for public patients in private hospitals, and rich and poor alike benefit from a system where there is no waiting. A study this year in the Australian Medical Journal indicated that the private sector surpassed the public system in clinical outcomes. Closer to home, in British Columbia, figures from public hospitals reveal both significant cost savings (30 per cent) through contracted-out care to private facilities, and high rates of "superbug" and other infections compared with the rates in private facilities.
Canada has the unique distinction of being the only developed country in which citizens are prevented from using their own resources to avoid suffering on a wait list. In Canada, "public health care" is really a pseudonym for union-controlled care. Many have succumbed to well-orchestrated propaganda campaigns by groups such as Friends of Medicare and the Canadian Health Coalition. They imply that they act for patients when in reality they are simply union-supported advocacy groups.
The Canadian Health Coalition, for example, is housed in and funded by the Canadian Labour Congress in Ottawa. Public-sector unions, anxious to maintain the public trough and its potentially bottomless pit of taxpayer dollars, fear competition from the private sector. Yet, it is surely hypocritical that unionized workers have universally negotiated private "two-tier" insurance packages for themselves to cover such medically necessary services as prescription drugs, physiotherapy, ambulance services and dentistry. Equally hypocritical is the fact that the commonest demographic profile of a patient treated at our private centre in B. C. is a unionized health worker, many holding executive positions in the very unions that oppose our existence.
It is understandable that some in the public system should fear competition from the private sector. But, strong, talented and accomplished executives will benefit from expanded opportunities for growth and development. Unions should recognize that increased investment and new resources will benefit not only patients, but also health-care workers. With government spending on health care rising at an unsustainable rate, and draining resources from other essential services, new sources of revenue are desperately needed.
In his Sept. 9 speech to the joint session of the U. S. Senate and Congress, President Barack Obama said, "I will not accept the status quo as a solution."
Canadians' fears of a private option are as irrational as U. S. fears of a public option. The European hybrid systems confirm this fact. It is time for our leaders to step forward and acknowledge that the status quo in Canada is also unacceptable.
Brian Day is a Vancouver-based orthopedic surgeon and medical director of the Cambie Surgery Centre. He served as president of the Canadian Medical Association from 2007 to 2008.