Canada's costs of waiting for healthcare

Kate Jaimet wrote in "Top doctor admits to queue-jump", (National Post, Dec.4, 2007):

"Hospital funding model broken, CMA head argues.

OTTAWA -- When his five-year-old daughter's bone scan revealed a tumour that might be cancerous, the man who is now president of the Canadian Medical Association decided to jump the queue.
His wife, also a doctor, had taken their daughter into the emergency room of a Vancouver hospital after the little girl experienced a sudden pain in her leg, Dr. Brian Day recalled. The initial bone scan indicated a tumour, but couldn't reveal whether or not it was cancerous.
"The hospital said: 'We'll do a CT scan, bring her back next week,' " Dr. Day said. "To me, it's completely unacceptable, sending a mother home for six days not knowing whether her daughter has a malignant or a benign bone tumour. I made the phone call ... I made them do it that day."
Dr. Day's experience is one example of what he calls the "parallel public system," a system of social connections that make it easier for people in a certain class of society to get quick access to medical treatment.
He admits he himself used the system when he needed knee surgery, jumping a long queue to get the procedure done within a week by a surgeon who was also his friend.
It's not realistic, Dr. Day believes, to expect people not to use their connections to jump the queue when their own or their family's health is at stake.
What is realistic, he said, is to eradicate medical wait times, so there's no queue to jump and everyone -- no matter what their social class -- can get quick access to medical care.
"There shouldn't be wait times in a country that's a rich country, that's got a booming economy, that's got taxes going down," Dr. Day said in a meeting Monday with the Ottawa Citizen's editorial board.
And while he acknowledged there would be an up-front cost to eliminating wait times, he said patients on waiting lists actually end up costing the system more money because their condition deteriorates by the time they get to the front of the line.
"At all levels, waiting costs money," said Dr. Day. "If it costs $7-, $10-billion dollars to get rid of wait lists, it's worth it."
An orthopedic surgeon, Dr. Day worked in the public health care system for 20 years. He opened a private clinic in Vancouver, the Cambie Surgery Centre, in 1995.
He has proven an outspoken and controversial figure since taking over as president of the CMA in August.
Dr. Day said Monday he wants to open up a public debate on health care, because politicians are too afraid to speak frankly about the subject.
"Politicians of all stripes want to sweep health care under the carpet," he said. "Any call for change in the system is targeted as attacking the 'national identity' of Canada."
He said the first step toward eliminating wait times would be to change the way hospitals are funded.
In the current system, he said, each hospital is given a lump sum of funding. Any treatment given to patients is then taken out of that lump sum, creating a negative entry on the balance sheets. Instead, he said, hospitals should be given money for each time they treat a patient. That would give them an incentive to treat more patients, and keep their operating rooms busy instead of letting them lie idle.
"Fifty per cent of newly trained orthopedic surgeons leave the country within five years because they can't get operating time ... [It's] our system, the way the hospital is funded, where the patient is a cost, not a value," Dr. Day said.
"The instant you tell hospitals you're going to get revenue for treating patients, they're going to start treating patients."
The change would result in more specialists staying in Canada, and even coming to Canada from abroad, he said. And with no wait times, Canada could begin attracting U.S. medical tourists, a multi-billion dollar industry, Dr. Day said.
He added the pay-per-procedure model has been successful in Britain, where wait times have gone down to zero since it was introduced in 2004.
But in an open letter to Dr. Day in August, a group of British doctors argued this model of funding, combined with more contracting out of publicly funded services to private clinics, have led to "a destabilized and damaged public service" in the U.K.
The doctors in Britain's National Health Service Consultants Association argued in their letter policy reform such as those advocated by Dr. Day has led to unnecessary hospital admissions and private clinics scooping up contracts for quick, lucrative surgical procedures while leaving public hospitals to provide low-paid, day-to-day care to the chronically ill.
"Money has been lavished on politically sensitive wait lists for elective surgery through expensive and unsustainable deals with the private sector. This has been to the detriment of many patients with more long-term needs," the letter stated.
But Dr. Day said it was the government's fault if it signed bad deals with private-sector clinics, and examples of bungled contracts don't disprove the value of the funding model.
Besides the issue of wait lists, Dr. Day said a public debate is needed over what medical procedures should and shouldn't be funded by medicare.
He pointed out there are many medically necessary treatments -- such as physiotherapy, dental care, and drugs -- not covered by the current public health care system.
This leaves about 30% of the population, who have no private health benefits, in the underclass of what is de facto a two-tier system.
That raises questions about whether the current system is fair, or whether public funding should be allocated differently, he said.
As well, with an ageing population demanding more high-tech medical interventions -- and with new, and more expensive, medical procedures being developed such as gene therapy, stem-cell treatments and nanotechnology -- Canadians will have to make hard ethical decisions about what will and won't be publicly funded in the future.
"You can't give everyone robotic heart surgery. It's impossible," he said.
However, Dr. Day wouldn't give an opinion as to what criteria should be used to decide which procedures receive public funding.
"We need to give [the public] the facts. You can't have everything, so what do you want?," he said. "Those questions need to be asked of Canadians. It's not our role to dictate to them." "

*

How dare someone have the temerity to demand that they or their family should receive immediate medical treatment?
A true Canadian would obediently do as they were told, by those who know best: to go wait in line, and die if necessary, while bowing gratefully at the altar of Tommy Douglas’s grand healthcare Utopia.