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Difficult times ahead in health care

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There is a significant challenge facing the health departments of every province.

The time is coming when doctors will begin refusing to take older patients, primarily because the fee system, for some doctors, discriminates against the elderly in many provinces.

Family doctors can be paid the same amount for the care of any patient, but elderly patients take up a lot more time as they have much more complex issues.

This particular issue is currently taking place in Ontario, while across the country, fewer new doctors are specializing in geriatric medicine.

This, despite the obvious aging changes in the population that will necessitate more medical support for the elderly.

In Canada, there are three options for payments to doctors.

The first is fee for service, which means that doctors can charge a set fee for services provided.

If this is the only payment method used, it creates a problem for governments that have no idea how much doctors will be charging to the system in any given period of time.

The second method is called capitation, in which doctors are paid a set fee each month for the patients they serve, regardless of the services provided for each patient. In other words, if a patient visits once a year or once a week, the doctor is paid the same amount for that patient.

Obviously, this method causes the most complications for a doctor whose practice may serve a large proportion of elderly people.

The third method is a straight salary, where doctors are paid to work a certain number of hours and to serve a certain number of patients. This fixes the cost of health care to a particular area, but creates problems when doctors act more as employees than as concerned professionals.  In essence, it limits the flexibility of health care by fixing hours and services.

Most provinces in Canada utilize a blended form of these payment methods to try and deal with different regional needs.

Rural doctors and urban doctors do not practice the same kind of medicine, nor do obstetricians or geriatric doctors.

But if we are going to ensure a high quality of medical care at all levels, we have to ensure that a formula for compensation is worked out that gives all doctors a fair compensation opportunity.

Without that, we risk losing our best doctors to other countries or we risk being in a position where some provinces are ‘have’ and some are ‘have not’ when it comes to services or quality of services.

Between the provincial governments and the doctors, a reasonable solution to this problem needs to be negotiated, and soon.

There are difficult times ahead in the health care business.

As the elderly population increases, there will be a natural rise in demands on the medical system and if we are going to attract enough people to employment in the medical sector, and work to ensure there are enough practitioners to serve all segments of the population that need service, then we have to put the right policies and pay schedules in place.

The worse-case scenario would be a growing elderly population combined with a shrinking number of doctors who either can, or will, serve that population.

 

Graham Hookey writes about education, and eldercare (ghookey@yahoo.com).

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