Imagine you're feeling sick. You have an inexplicable pain in your stomach. So you go to your doctor, and she sends you for a test. The test for your stomach pain is inconclusive.
"I think I know what the problem is. And I probably have something I could give you for it," says your doctor. "How about you pay me an extra $50, and then we can discuss it further?"
Most of us would think that's unacceptable. We already pay taxes to finance our universal health care. We would want our doctors to run more tests, give us a diagnosis and write us a prescription.
Sadly, asking Canadians for more money is exactly the kind of solution many economists and policymakers are suggesting as a fix for Canada's health care system. At this year's annual meeting of the Canadian Medical Association an independent advisory panel, including Don Drummond, former federal Finance assistant deputy minister and chief economist at TD Bank, suggested we look at more funding options, like user fees, and private funding.
This is the wrong way to go. Canadian Doctors for Medicare has a Top 10 list of positive ways to transform our health-care system, and a Bottom 10 of practices to avoid. User fees are number one on the Bottom 10, and private funding isn't far behind.
We know that user fees don't work. They put up barriers to health care, shifting the burden of payment from the healthy and wealthy to the sick and poor. People who can't afford the user fee will wait until a small health concern becomes a big one before they go to the doctor. And a full-blown disease will be far more expensive to treat than a common, curable infection. What's more, the revenues collected from user fees barely make a dent in the overall costs. We would expect a better suggestion from Drummond, the head of TD Economics.
And privately funded health care needs to operate where there are economies of scale, and people with money to spend, in order to turn a profit. This leaves out a lot of Canadians -- people in rural or remote communities, Aboriginal communities, marginalized urban populations, and people needing complex care, mental health care, and emergency care. Essentially, private funding benefits richer people in bigger cities. Our health-care system is supposed to be for everyone.
Canadian Doctors for Medicare has other ideas -- we think we ought to do the hard work and fix the problems in our system before we ask Canadians for more money, or bring in private corporations. We need to change, but we need to be smart and make our system more efficient.
So what does work? Here are just five of our Top 10 ideas for health-care transformation.
1) Primary and community health-care reform
We know that too many people are in expensive hospital beds when they should be in a long-term care home, or in community-based rehabilitation, or at home, receiving support. Expanding access to these kinds of community-based health care take the pressure off of overcrowded hospitals, and it's much more cost effective.
2) Electronic health records
In 2009, 94 per cent of the 322 million visits to the doctor by Canadians still resulted in a paper record. But we know that EHRs help prevent dangerous drug interactions, reducing the number of visits to the emergency room. EHRs help to ensure that you're getting the right kind of care and medicine you need, no matter if you're at your family doctor, a hospital or a clinic -- the health professional serving you will understand your history.
3) Wait times initiatives
There are a number of successful programs in Canada that reduce wait lists for surgical procedures. Strategies include having a single common wait list for a region instead of lists for each individual doctor, and implementing pre-surgical programs that prepare patients for surgery. Dr. Cy Frank, an orthopedic surgeon at the Alberta Bone and Joint Institute, led a team that reduced wait times for hip and knee surgery from 82 weeks to 11 weeks. We should be learning from Dr. Frank.
4) National pharmacare
Canada pays more for prescription drugs than any other OECD country except the United States, and yet we have one of the lowest rates of public drug coverage. A national program with competitive bulk-purchasing of drugs could save us a bundle -- one study pegs the number at $10 billion per year, a whopping 43 per cent of our current $25 billion drug bill.
5) Health promotion and prevention
Poverty, physical inactivity and poor nutrition are just some of the culprits that contribute to poor health status. We can do more to encourage better choices, and to provide assistance to our most marginalized citizens. Lower-income people tend to have worse health, and more complex conditions -- not only is that unfair, it creates a very expensive group of people to treat.
We can do better to build an efficient, cost-effective health-care system without sacrificing equity, universality and a patient-centred approach. We may need to invest more in health care in the coming years, but let's not rush to introduce methods of financing that create winners and losers, especially when there's no evidence to back it up.
Dr. Danielle Martin is a family physician and Board Chair of Canadian Doctors for Medicare. She is clinical staff at Women's College Hospital and lecturer in the Department of Family and Community Medicine at the University of Toronto. She served on The Health Council of Canada from 2005-2011. Dr. Martin helped launch Canadian Doctors for Medicare in May 2006.
Canadian Doctors for Medicare provide a voice for Canadian doctors who want to strengthen and improve Canada's universal publicly-funded health care system. We advocate for innovations in treatment and prevention services that are evidence-based and improve access, quality, equity and sustainability.
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