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Private Health Care

January 31st, 2006, 10:10 PM
Hi guys,

What do you think about the Chaoulli case and the private health care debate?

January 31st, 2006, 10:50 PM
Given that it only applies to Quebec, it does not matter much what I think. :) For some reason I fail to understand, there are some who think this case now applies to all of Canada. Bad reporting I suspect.

I believe we have one of the best medical systems in the world and wait times for some of these procedures are just as long in the US - a forum I modeate about scoliosis shows a wide variation in wait times for othopedic cases across North America. We need more orthopdeic suregons and more OR time. That case solves that problem not at all!!!! Interestingly, if you live n a riral area or a small town, you are more likely to have your surgery dine more quickly than if you live in the city. The most recent NS wait times for hip replacement wait times in NS was twice as long in the Capital District (Halifax) as it was in New Glasgow , a city of 10,000 in Pictou County - but covering say 40,000 patients. I think it was 2 months vs 1 month. But then Capital Health has a shortage of anestesiologists. I find it interesting and ironic that this fellow er man(ohhh boy, no pun intended there, lol) is not even board certified - meaning he probably was not even allowed tp practice at most of the Montreal hospitals and he did not want to go to one of the smaller places that might have taken him while he worked on his Boards. He's have to be supervised though because even the smaller hospitals in Canada require board certification. So it is hard to evaluate how good he is as a suregon.

Wait times are one of the worst determinants of whether one is getting good health care but for some reason, we have journalists who read a press release, see controversy and do not read what the real determinants of health are. And I am too tired to debate all of this tonite, I come here for fun, not work, lol We already do what this court ordered in the Maritimes in some cases anyway so it does not alarm me all that much. Mostly re cardiac cases.

February 2nd, 2006, 01:18 AM
I live in albert and the gov is trying hard to bring private health care in to this province slowly. I read that right now they are tyring to get the fedral gov to agree that doctors can be private and provincial which viloates the Canada Health Act, what I would like to know is how they know that Albertans want this...when most people I have spoken to are against this...and how can the provincial gov even think about going against the canada health act. I like our medical system..i mean it could be improved, but private isn't the way, I feel that is unfair to people without money. my rant...sorry

February 2nd, 2006, 03:55 AM
sorry for so many typos - it was late and I had taken a pain killer!!

I can't sleep so checked this thread and I agree with you divine - I know we have a tendancy to compare our system with the US and that is not a good comparison. One needs to examine medicine in the world and there is more to medicine than hospitals and surgery and wait times. We do have a really great system when you compare it with most of the industrialized countries. The US is unique in that it has a for profit system and that leaves it out of the loop as far as other countries with similar economic systems. There is some excellent health care and some great research - and I myself was educated there (ie my medical degree and other biochem grad degrees) but they are far too dependent on insurance systems. I just dislike a for profit system not because I think govt running any system is the solution but almost because of the opposite reason - the US system costs so much more to operate (pun intended) than ours. In essence, American taxpayers are paying for a system they do not have access to - they pay more per capita and even in general than we do yet so many needlessly suffer because they have to cope with HMO's or cannot afford health care coverage or they do not have insurance at all. Most of my friends who work there utterly HATE and loathe HMO's since they often have to consult someone working for the insurance company (usually a clerical person looking at the cost since the bottom line is more important for their purpsoes anyway - the insurance industry) before they can order certain procedures, say an MRI or even an echocardiogram. I do not beleive doctors whould order more tests than they need and run up costs - and most do not - but I am thankful that I can order whatever test I want and not have to worry abot anyone telling me my patient cannot have it.

That is just one minor example. Our system is far from perfect but every system in the world is coping with paying for high tech equipment and excessive drug costs - even in Canada where our meds are at least controlled. I would like to see a pharmacare program because that is one area I run into that worries me tho in most cases, pediatric meds are covered - and it is a rude awakaneing when the 19 year oilld ir 17 in some provinces becomes and "adult" and must then have Blue Cross or their parents' insurance plan cover meds. We do well in NB in covering cancer meds - but NS is good with children's meds but less so with adults. I have learned the system well tho - thx to involvement in politics - but most physicians I know have not the patience or time to lobby on behalf of their patients for drug coverage. (In some cases, you can get a Minister of Health to cover an exoensive drugs - and with osme of these new life saving drugs costing in excess of $20,000 a year, that is not pocket change - even for the govt actually.) Some doctors prescribe too much tho - they give in to patients demanding some med they saw advertised just to get the patient out of their office as fast as possible. There are still some good "veteran" meds that work just as well for treating the symptoms I have to treat and I am hesitant to use a new med when a tried and true one will work equally well or better. But I am bombarded daily by pharmacutical reps who offer me the moon and the sun to prescribe their meds - and this lobbyimng starts in med school and with Residents now. (They were less bold when I was in med school and in Residencies).

I am not totally opposed to private health care if only because I have to pratice what I preach and when I needed life saving spinal surgery at 17, I was in Boston and went there because thatr hopsital is one of the best in the world. If I had other issues, I would check into some Canadian facilities that have that distinction but that is my personal experience.

I do not want private clinics however to give us one system for those who will pay and another for those who cannot afford it so in thjat regard, we have to tread very carefully and ensure we safeguard the Canada ealthAct. I;d add pharmacuticals to the Act.

Health care consumers must do their part though too and I hate to sound critical but while this is rarely the case in my own pratice, I see other people who needlessly utilize hospiral services when a doctor's offiece visit or clinic would have sufficed and cost the goct 1/10 the cost. Or people who fo to an ER with a cold or minor ailments - if they complain about a 4 hour wait, they should think about why they did not call their family doctor. There is also this wanting everything now mentality - even when I had to have surgery in the US, I had to wait prob longer than if I had had it in Canada so that whole wait issues thing - which irks me to no end - is more of a myth perpetuated by an ill informed media - with the exception of reporting by Andre Picard of the Globe and Mail who has written some excellent accounts of health care and gives levctures at conferences across the country that are very knowledgable and thought provoking. I wish more journalists took his lead!! This is not to say there are some wait times that need to be improved but that has more to do with some less than brilliant govt bureaucrats decicifing to cut back on med school enrollments about 10-20 yrs ago.

I do not buy these dire predictions by such "think tanks" as the Fraser institutes - often written by some policy analyst who rarely sets foot in a hospital. People who lived before medicare will tell you what it was like before we had it and if anyone wants to introduce private health care - or an American style system here - they should think back to those days or ask someone who may have lost everything they had when a family member became ill. (Medicare was introduced in 1963 - and not easily - and we have Tommy Douglas and Justice Emmett Hall to thank!) Sask of course has it much earlier.

That said, in fact we have a multi tier system now and there is private involvement now - Most phsycians - tho that is changing to some extent - are private small business owners who contract with the govt and are paid according to a fee for service and accrding to specialty as well. But they also then must run that business and hire staff and do all the things associated with that fun (not the part of my work I enjoy). Some older physicians are already doing to work for clinics and working 9-5 and if I did something like family medicine, I might do that - but I doubt it, lol And younger grads do not want amily medicine because it involves too much work and overtime and they want a d better quality of life. They see counterparts they graduated high school with earning as much as them by working in IT or in some industry and not having overhead and being available 24/7 - and some actually leave medicine - I thought of doing it myself for awhile because it is not the easiest life for anyone to choose. A woman doctor with children usually has to choose a practice that will allow her to work part time or at least with certain hours. One year in the last 5, not one applicant sought a position in the Univ of Sask Family Medicine Residency program. (You cannot just be a doctor any more and hang out a shingle, you must be board certifed in family medicine to be a GP) and there is a trend of that across the country.

I say multi tier because people who can afford exactly what they want will go to the doctor they want - in whatever country (and even in Canada, it is not illegal to opt out of the Medicare system and some very good doctors do so so if you want their services, have good insurance or a lot of money). My own dad went for yThe goct itselfears to the Mayo Clinic because they had a contract with his company for their executive health care priogram and many people in the Maritimes go to the Lahey Cliniic in Boston. Some prov govts place people seeking money n the Workers Comepnsation Program ahead of the curve by using private clinics so they have these people back in the workforce faster and are not paying out money to them. Same goes for the military tho there one must choose doctors who work for the military and that is rather like an HMO - and they tend to get young docs starting out rather than someone who has done procedures many times which is how one become sproificient, Once they have done their time (if they've had an ROTC scholsrhsip), they go into practice for themselves and use what they have learned. They will tho refer outside for something like my own specailty.
Then there are folks who for whatever reason - they are on a hosptal board, they know how to lobby, they work in the halth care system and know the right doctor who manage to get in faster. It is only natural for a doctor who has a long waiting list and a nurse (for ex.) she or he works with informs him.her that she (or he) or a their child or family member or best friend needs to see someone of their specialty to ask their manager to work them in - same goes for friends and family members of physicians. That is just human nature and is nothing different than any other profession.

Then there is everyone else who either do not know anyone in medicine or do not lobby or are notr assertive enough and one oif the thingsd I learned in Boston was in health care, - as a patient, you have to assertive! Bernie Segal who does all those lectures for cancer patients recommends people become "a character" to stand out and they will get the care they need as fast as they need it. I saw that with my grandfather who already was a "character" - an Irish story teller. All the volunteers fought to be with him,. lol He was over 80 when he developed Hodgkin;s Disease and many oncologists prefer not to treat people over that age with that illness but his family doctor said "wait tll you meet him!" Of course, I would made sure he got help but he was on hisd way from his home in NB to the Moncton Hospital as soon as the diagnosis was made - wrong one at the time and I recall the oncologist in question - forgetting thios patient was my grandfather who I loved more than life itself showing me the slides and comme nting on the curious cells - his family doc had thought leukemia but we knew it was H D as soon as we saw the cells but they were quite unique but even as I had to agree with him about these unusual cytological structures and interesting "case" - I had tears in my eyes. So I turned to him and said, please remember this is my grandfather we are talking about" - he Has forgot in his exciitement about this unusual neoplasm, sigh!

Anyway - my grandfather never paid a cent for his care - other than his taxes - and I could do his chemo at home so the 3 years he fought the illness did not hirt him finacially! (My grandmother was so impressed with his care tho that she donated megabucks to the Moncton Hospital so I don't know - the amt may well have paid for his care, lol) Now, thx to her gernerous largesse, I get invited to every &^%$ reception their fund raising arm have - as if I did not have enough to do!! Still, her money helped them buy an MRI so why should I argue - lots more ppl get help!! (except me who cannot be given an MRI, lol ) Ironically, she herself died a few yrs later from breat cancer, sigh!

Anyway - we do have a great system, it is better than that of some European countries in some respects, below in others, and cpomparing those with the US does not really work because it is apples and oranges. For profit care is never as good as non profit because the goals are quite different - excpt for the truly great places like Sloan Kettering, Children;s in Boston, Mayo, Lahey, Vanderbilt, etc, etc. Those better centers have lots of great nefactors while the small for profit hospitals in the US have a tougher time so have to reject too many patients, not necly by choice but they cannot afford people who have no insurance or cannot pay. So that leaves the "charity" hospitals in the US or those who accept Medicxare (a declining numver) in a desperate state almost all the time. I am sure the US - if they got rid of some of those insurance plans - and some politicians - could have a system like the rest of the indutrialized world, where people who cannot afford care actually get the care they need and deserve.

Anyway - my rant of the night, er early morning now!

heeler's rock!
February 2nd, 2006, 07:51 PM
If it were possible to facilitate a public and private system in harmony, I'd be all for it. Bad thing is, if you start privatizing, eventually all health care becomes private.

To me, if it could be done two tiered, I'm all for it! It'd reduce public waiting times, and if people with money wanna pay for their health, I say let 'em. We'd all benefit.

Again, this is *IF* it could work. Too many doctors would go private because there's more money to be made there......