Budget wonks are contributing to Canada’s expensive, inefficient health-care system, says the president of the Canadian Medical Association.
It’s not necessarily how much we’re spending, but how we’re spending it, says Dr. Brian Day.
If Canadians really want to have better access to health-care professionals, shorter wait times for surgical procedures and more bang for their health-care buck, the answer lies at the feet of government bean counters, said Day who spoke to the News on Thursday.
“We’re the only country in the Organization for Economic Co-operation and Development that funds its hospital on the global-budget basis.”
What that means is we’re the only country that gives our hospitals a block of funding once a year regardless of what happens and how many people need help, said Day.
As a result, hospitals view patients as a cost, not a source of revenue.
And so, to save money, they limit care, restricting physician access to operating rooms, which leaves them empty. That puts people on waiting lists, all so hospitals meet their annual budgets, he said.
“We give hospitals their money up front, so when you go to a hospital in Canada you are using up the hospital’s money.
“In every other country, a patient that goes to a hospital, even a government hospital, carries with them funding and revenue.”
In Canada, “the whole of the management, from the top down, is orientated to a situation where the patient is a cost and not a value.”
Other developed countries, including France, Germany, Belgium, Japan, Luxembourg and Austria, have abandoned that practice.
They bill the government on a per-person basis. That encourages more timely patient care, said Day.
Canada doesn’t do that.
Provincial and territorial governments are reluctant to change their respective funding systems because they are afraid of opening the floodgates as they’d have to help all of the people on wait lists in a timely fashion.
Governments also feel that if they fund per patient, they will loose control of their budgets because they won’t be able to predict health care costs, said Day.
But that would only be true in the short term.
Once the wait lists were eliminated, the system would cost less. That’s because people on wait lists actually cost more to treat, he said.
“Our wait lists actually cost a lot of money. Governments, by actually allowing people to wait and suffer on wait lists — perhaps a million Canadians right now — cost us money,” said Day.
“They deteriorate while they’re on wait lists, they’re not part of the economy, they’re not paying taxes, they may even be receiving wage-loss benefits from government or from an insurance company.
“This is costing taxpayers a lot of money.”
And with baby boomers and doctors aging, things are going to get worse before they get better, said Day.
“By 2011 the number of 80-year-olds in Canada will rise 43 per cent from where it is now,” he said. “That’s a massive increase.
“And we know, if you’re between 85 and 89, it costs $22,000 a year in health costs.
“If you are a one-year-old, two years old or a young adult it’s about $1,100.”
All governments and political parties know this, but not one of them is willing to touch the hot-button issue, said Day.
In fact, in the Harper government’s 30-minute throne speech recently, health care was mentioned one or two times.
That’s not going to fix things and it’s going to leave Canadians at the mercy of an ailing health care system that was broken in the early 1990s, said Day.
That’s when the government decided doctors were treating too many patients and started limiting access to hospital resources and cutting doctor numbers, he added.
“They diagnosed the causes as physicians treating too many patients.
“That was the wrong diagnosis.”
That led to an exodus of doctors to the United States and huge wait times for surgery, a problem we’re still dealing with, said Day.
The whole issue has led Canada’s health-care rating to drop internationally.
Canada used to be ranked fourth in the world in terms of doctors per population. Now we’re 24th.
The nation’s overall system is ranked 30th in the world — way, way behind France, at number one, and just a little ahead of the US at 37, said Day.
So, things need to change.
But for things to change, the debate needs to change. We need to get away from the two-tiered fear mongering and start talking about budgets, he said.
Scary stories about changes to the system, about moving it from a public to a private or two-tiered system are a bit of a red herring.
The fact is, with almost every doctor’s office in Canada acting as a private for-profit clinic, the nation is already a two-tiered system, said Day, one of the first doctors in Canada to start a private orthopedic surgery clinic.
“This polarization into private and public, I don’t think is serving the debate on reform well,” he said.
“There’s a lot of misinformation out there. I mean, first of all pretty well every doctor’s office in this country is a private, for-profit clinic.
“Thirty per cent of Canada’s health-care system is privatized already, it just happens that most of it is in drugs, dentistry and physio and so-called ancillary services and things like that.”
And privatized health care, which is not really talked about, has left a number of Canadians without insurance.
“Seventy per cent of the Canadian public has private insurance that covers them, and gives them a second tier of insurance, private insurance called extended health.
“Thirty per cent of the public doesn’t have it, by definition, so we have an underprivileged group in Canada that’s not talked about, and those are the people who don’t have coverage for many of their drugs.”
In the territory, Yukoners face a large number of problems due to delays and wait lists in larger centres, said Rao Tadepalli, president of the Yukon Medical Association.
“Our access to services is an issue; our wait times just to get access to services.
“If their system is backed up, we suffer as a result.”
Other problems include a lack of long-term care beds and mental-health facilities, patients who abuse drugs and alcohol and budget concerns, he said.
Whitehorse General Hospital would benefit from more secure long-term funding so it can plan ahead instead of having to plan year by year according to the government’s budget cycle, said Tadepalli.
“The issues haven’t changed. It’s frustrating to talk about the same thing, but really, we haven’t resolved those issues.
“And, certainly, we’ve made the government aware of those issues.”
Tadepalli and Day will both speak at the Yukon Medical Association’s annual general meeting, which takes place this weekend.