The weird world of health economics

When politicians make gaffes, they are usually speaking off the cuff or unaware the microphone is on. Only rarely does one of our leaders think up a gaffe, print it out on government letterhead and e-mail it to the newspapers.

When politicians make gaffes, they are usually speaking off the cuff or unaware the microphone is on.

Only rarely does one of our leaders think up a gaffe, print it out on government letterhead and e-mail it to the newspapers.

I am talking about the letter our Minister of Health, Doug Graham, sent to the Yukon News last week. I have read plenty of ministerial letters over the years, and this one was one of the most puzzling.

The background is that – here in the land of universal health care – there are a lot of people who can’t get a family doctor. The government has been studying the issue for years, and even set up a registry in 2012 for Yukoners without a family doctor. Some Yukon doctors recently proposed a solution to the problem that involved the government paying more for doctors to take on new patients..

The first weird thing is that the minister makes a big deal in his letter of the fact that the registry “was never intended as a matching service or to allow for the active management” of the problem. The web survey has now been purged from the YTG website.

Consider it this way: the government spends money setting up a special web survey for people who don’t have a family doctor, then shuts it down and writes a letter to the papers saying it never intended to use the survey to help people get doctors?

It’s as if the government kept measuring the unemployment rate, but shut down the job matching websites it funds. Or like a nurse in Emergency coming into the waiting room, noting the number of bleeding people on a clipboard, then walking out the front door to go to Tim Horton’s while saying “this clipboard is for information gathering purposes only and was never intended to help with your injuries.”

Over 1,800 Yukoners signed up via the registry. This is likely only a fraction of doctor-less Yukoners. To sign up you had to hear about the survey, go online, find the web page and fill it out. I am guessing the real number is several thousand people higher.

The next weird thing is that after telling us the registry wasn’t meant to help the people on it, the minister went on to insult the then president of the doctors’ association, Rao Tadepalli. The minister says “confusion” over the registry was “aggravated” by Tadepalli when he (imagine this!) encouraged people to register with the doctor-less patient registry so they could get a doctor.

The minister went on to insinuate that doctors are over-paid. He listed all the financial support given to doctors and added that the “pay” for general practitioners averages $317,000. But he didn’t say that this is before each doctor has to rent an office, hire a receptionist and billing clerk, pay an accountant, install a computer system, buy malpractice insurance and pay for all those machines that go “beep.”

Plus, they have to buy those vintage magazines off e-Bay to put in the waiting room.

It is well-known that the headline fees of $317,000 are not the same as the take-home pay of a doctor, so one is left with the impression that the minister is trying to portray doctors as greedy and overpaid.

He mentions the Yukon’s top billing doctor, who billed $959,000 in one year. Assuming $47.90 per visit and 250 working days a year, that works out to about 80 patients a day. In an eight-hour work day, that’s a patient every six minutes. The doctor may have billed for other services, so perhaps the real minutes per patient was a bit higher.

Which brings us to the next weirdness. Is the minister saying that he approved paying a doctor who saw 80 patients day? Does he consider the six-minute checkup to be sound medical practice? Could he be the minister who approved that doctor’s permit to practice in the Yukon?

The minister seems steamed that the doctors suggested a scheme where the Yukon government would pay “thousands of extra dollars” for doctors to take on new patients. I suppose it’s his job to say no to ideas he doesn’t agree with, but does he really think writing cranky letters in the paper will make the doctors work harder and take more patients than they are now?

And why didn’t he publish his analysis of why the doctors’ proposal didn’t make sense? Is it really more cost effective for the government to serve people via the Emergency Room, which is where a lot of doctor-less people go when they need help?

As for doctor-less Yukoners, the minister says more doctors are moving to the Yukon and that this will be “adequate to serve the needs of Yukon residents.” He also mentions that, instead of the online registry, the government will pay for a “free ad” to let citizens know the new doctors are here.

He might be right. But we will never know because there won’t be a doctor-less patient registry to keep track of people without doctors. Could this be the real reason he is shutting down the registry?

The minister says he will also “examine new service delivery models.” His letter doesn’t say what this means, but it may be government code for steering more Yukoners to nurse practitioners, call centres and online health options instead of expensive doctors.

Depending on the details, these new models may make sense. But until he gets around to implementing them, he remains totally dependent on the doctors. He may regret publishing such a gaffe-filled letter. Doctor-less Yukoners might too.

Correction: in my last column I wrote that Minister Currie Dixon said that Yukon government lawyers were not as good as Chevron’s lawyers. It was actually Minister Brad Cathers. My apologies to both.

Keith Halliday is a Yukon economist and author of the MacBride Museum’s Aurore of the Yukon series of historical children’s adventure novels. You can follow him on Twitter @hallidaykeith

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