Dr. Brian Day @DrBrianDay Twitter

  • Past President Canadian Medical Association
  • Past President Arthroscopy Association of North America
  • Honourary Associate Professor University of British Columbia
  • 2014 Doctors of BC Don Rix Leadership Award

Health Care Hampered by Red Tape

Jan 20, 2016

By Dr. Brian Day, Vancouver Sun

Over 60,000 BC residents have signed a petition against rising MSP premiums. Organizers report that the wealthy pay the same fees as those earning $30,000. Their point is valid. Their anger would probably be tempered if the funds garnished from wage earners were being used efficiently.

Few are probably aware of the Medical Services Commission (MSC), an unelected body responsible for spending the $4 billion plus in MSP premiums and other taxes. Their mandate is “to facilitate reasonable access throughout B.C. to quality medical care, health care and diagnostic facility services for B.C. residents under MSP”. Hundreds of thousands of patients on BC waiting lists know that role is not being fulfilled. The Health Minister and Premier recently admitted that patients were waiting inappropriately long times, and a health region spokesperson reported some “life-saving” procedures were being delayed.

Provincial health commissions were the brainchild of Tommy Douglas, who believed they should be chaired by a doctor and never subject to political influence. The MSC is always chaired by a politically appointed civil servant. Douglas supported premiums and felt they made the public cost conscious, creating a sense of individual responsibility. He would never have condoned the current practices of raising premiums to compensate for fiscal failures, nor reporting low income earners, delinquent with their payments, to aggressive collection agencies.

Cheques from BC MSP

Bureaucrats at the Medical Services Commission sent Dr. Brian Day
cheques totalling hundreds of thousands of dollars for services
on patients he had never seen.

The Commission is wasting health care funds as it displays contempt, in terms of its fiscal and social accountability, toward taxpayers. Funds targeted for patient care are spent recklessly. In one example of carelessness and incompetence, I received cheques from them totaling hundreds of thousands of dollars, for services on patients that I had never seen (figure). I also received confidential personal information on hundreds of patients unrelated to me or our clinic. When informed of their error, they responded, “Just mail them back”. They were not inclined to investigate.

In Canada, health providers are compelled by law to share confidential patient files with government employees (the “Medical KGB”) armed with the right to inspect and copy patients’ files. Your health record is considered public property; you cannot block government access. Consent is not needed and you are not notified when “Big Brother” is looking. Privacy rights have been legislated away. I witnessed a defeated provincial cabinet minister’s medical file being reviewed by a newly elected government. In the 1989 tainted blood inquiry, Justice Krever was “shocked by the inadequate laws, the abuses of confidentiality, and the fact that so many people—except the patient—had access to medical records.” Little has changed.

The MSC is also charged with defining what services are “medically necessary” – and therefore publicly insured. They have never created a definition, but have arbitrarily designated clearly essential services such as ambulance, drugs, physiotherapy, artificial limbs, and dentistry as unnecessary, creating a true 2-tier structure of care for patients.

The government’s last action in delaying our constitutional challenge on patient rights resulted from a “last minute” discovery of 300,000 documents they were legally bound to provide. After more than seven years delay, the plaintiffs in the coming June trial will confirm that the Supreme Court of Canada’s 2005 finding - that patients are suffering and dying on wait lists - applies in BC. Supporters of a system that limits timely access are complicit in such outcomes.

Our public sector health system (MSC included), is grossly overstaffed with non-clinical workers. A 2011 study revealed Canada has 11 times as many public health bureaucrats per capita as Germany, where there are no wait lists. Canada has 14 ministries of health, each with bloated bureaucracies and commissions scavenging dollars that should go to patient care. The mentality that cost inefficiencies can be balanced by increased taxes or “premiums” is responsible for our escalating premiums and taxes.

Independent health groups in Europe rated Canada as last in value for money compared to hybrid public-private systems that have accessible public systems. The Commonwealth Fund, a non-profit foundation focused on issues affecting low income groups, ranked Canada 10th of 11 health systems in developed nations.

What specific changes would I incorporate if I were Minister of Health? Apart from incorporating the best practices of other hybrid systems (including private sector competition), I would dismantle the Ministry of Health and its committees and commissions. Then I would resign. The Finance Ministry could fund patients directly (thus empowering them), and also assign budgets to the newly emancipated, self-regulated health organizations, allowing them to cater directly to patient needs. Maybe our June 2016 constitutional court challenge will point us in that direction.