Paying for long-term health care gain

In B.C., we pay MSP premiums, but people in the rest of Canada do not.

We may not always agree with the policies and the way our prime minister plots the future of our country, but I am happy with his approach to supporting the financing of our health care system, if you can call the mishmash of 13 different delivery approaches a system at all.

Different provinces pay for different benefits. In B.C., we pay MSP premiums, but people in the rest of Canada do not. The availability of MRI and CT scanners varies widely, as do wait lists for various procedures.

The premiers of our provinces are acting like the not-so-smart owners of 13 worn-out, rusty cars. Instead of junking the dilapidated vehicles, they keep on repairing and replacing various parts incurring big bill, not realizing that financially they would be far better off investing in new cars.

Stephen Harper has been watching how the federal monies of the current health care accord have been spent. A six-per-cent increase every year – twice the rate of inflation – has done very little to improve matters. If anything, things have gotten worse, just like fixing the worn-out cars will result in bigger and bigger bills, with worsening performance.

In our constitution, health care is clearly a provincial responsibility and the premiers are quick to point out to the federal government that it does not wish to be told how to spend money. The province just wants money, heaps of money, with no strings attached.

The main federal involvement rests with the provisions specified in the Canada Health Act, passed in 1984. Central to that legislation is promoting and enforcing the five principles of universality, accessibility, portability, comprehensiveness and public administration.

With the exception of the public administration, all the other principles are only partially implemented. The adherence to the principles of accessibility and comprehensiveness are woefully inadequate.

A year or more of waiting for a new knee hardly meets the standard of accessibility. To be unable to afford filling your prescription does not meet the criteria of comprehensiveness.

Reasons given: lack of money.

Mr. Harper says fine to the “no strings,” but no to heaps of money. And here is the deal:  after 2017, Ottawa will limit the increase in contributions to health care to a minimum of three per cent or maximally to the growth of our economy, and not a penny more.

Without the prospect of ever-increasing largesse from Ottawa, Mr. Harper hopes the provinces will get serious about being creative and come up with solutions and innovations that will make health care sustainable. Easier said than done without making fundamental changes, but they have five years notice.

During our last federal election, none of the parties wanted to address the looming crisis of how to pay for our health care without forcing unpalatable choices. Yes, we want the services, but, no, we do not want to pay for them. And if there is a bill to be paid, we want somebody else to pay.

And there is simply nobody else but the taxpayer.

Do I see ways to keep the main principle of making needed health care available to all Canadians regardless of ability to pay?

You bet I do.

1) There are lots of people willing and able to pay, but they are not allowed to do that. Queue jumping, you say? If you take a hard look at the issue of using your own hard earned money to pay for a service, the whole system benefits.

2) Cut down on administration. I do not have the figures for B.C., but the wage bill of managers in Quebec’s health system eclipsed the $1 billion mark in 2010-11, a 29 per cent increase in five years. The number of managers in the system has gone up by 51 per cent in the last decade to 14,374 currently. (Journal de Montréal, Jan. 9),

Do patients get better care and recover more quickly on account of all these warm bodies? I am sure we can do with a lot less management and get better value for money.

3) Fully implement electronic medical records. That will eliminate a lot of duplication of tests, speed up the process of looking after patients with better and legible documentation.

4) Use a system of rewards and disincentives to encourage people to adopt a healthy lifestyle.

5) That will drastically cut down on the admissions and the running of the most expensive component of our system: the hospital.

6) Billions of dollars are wasted on prescription drugs dispensed, but not used for a variety of reasons.

7) Consider a nominal fee when accessing the system. People will drive an extra 20 kilometres to avoid paying a toll on the Golden Ears Bridge. With that mentality, I expect the waiting rooms will be a lot less crowded and your doctor will have more time for you.

Some of these approaches and other ones not mentioned require political will and courage, but the initial pain will result in long-term gain and, as a result, the health care system will be there to serve you when you need it.


Dr. Marco Terwiel is a retired family physician who lives in Maple Ridge.


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