In Canada,a move toward private healthcare option

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Dec 16, 2002
Huntington Beach, CA
In Canada, a move toward a private healthcare option In British Columbia, private clinics and surgical centers are capitalizing on patients who might otherwise pay for faster treatment in the U.S. The courts will consider their legality next month. By Kim Murphy September 26, 2009 | 6:31 p.m. Reporting from Vancouver, Canada - When the pain in Christina Woodkey's legs became so severe that she could no long hike or cross-country ski, she went to her local health clinic. The Calgary resident was told she'd need to see a hip specialist. Because the problem was not life-threatening, however, she'd have to wait about a year. So wait she did. In January, the hip doctor told her that a narrowing of the spine was compressing her nerves and causing the pain. She needed a back specialist. The appointment was scheduled for Sept. 30. "When I was given that date, I asked when could I expect to have surgery," said Woodkey, 72. "They said it would be a year and a half after I had seen this doctor." So earlier this month, she drove across the border into Montana and got the $50,000 surgery done in two days. "I don't have insurance. We're not allowed to have private health insurance in Canada," Woodkey said. "It's not going to be easy to come up with the money. But I'm happy to say the pain is almost all gone." While U.S. healthcare is provided predominantly by private doctors and paid for by private insurers, things here in Canada are just the opposite: The universal public health system is only beginning to flirt with private-sector medicine. Hoping to capitalize on patients who might otherwise travel to the U.S. for speedier healthcare, a network of technically illegal private clinics and surgical centers has sprung up in British Columbia, echoing a trend in Quebec. In October, the courts will be asked to decide whether the budding system should be sanctioned. More than 70 private health providers in British Columbia now schedule simple surgeries and tests like MRIs with waits as short as a week or two, compared with the months it takes for a public surgical suite to become available for nonessential operations. "What we have in Canada is access to a government, state-mandated wait list," said Brian Day, a former Canadian Medical Assn. director who runs a private surgical center in Vancouver. "You cannot force a citizen in a free and democratic society to simply wait for healthcare, and outlaw their ability to extricate themselves from a wait list." Yet the move into privatized care threatens to make the delays even longer, public healthcare advocates say, as doctors and nurses are lured out of government hospitals and into better-paying private jobs. "What it means is that people who have no money, who are chronically ill, disabled, who require medical attention frequently, are going to suffer dramatically," said Leslie Dickout of the B.C. Health Coalition, which is involved in the lawsuit to determine whether the Canadian constitution guarantees citizens the right to choose their own care. "There's so much money to be made by the insurance industry," Dickout said. "If this [legal] case succeeds, what we would have is a system of U.S.-style healthcare -- along with a public system that is decimated." Indeed, an investment group backed by Arizona businessman Melvin J. Howard earlier this year filed a $160-million challenge under the North American Free Trade Agreement, demanding that U.S. healthcare companies gain access into Canada. The consortium hopes to build Canada's largest privately owned health center in Vancouver, offering orthopedics, plastic surgery, general surgery and other services. In many ways, the prospect of private investment is alluring in British Columbia, where the provincial government -- like those all across Canada -- is responsible for funding the healthcare system. Officials recently announced a $360-million shortfall in British Columbia's $15.7-billion budget for healthcare for the fiscal year that ends in March. The shortage will mean fewer surgeries and longer waits. The Vancouver Island Health Authority has said it would reduce the number of nonemergency MRIs by 20%; nonemergency patients now are being booked for scans next March. The Vancouver Coastal Health Authority, which serves a quarter of the province's population, said it would eliminate 450 elective surgeries -- about 30% of the schedule -- during the four weeks of the 2010 Winter Olympic Games. And in the rapidly growing suburbs east of Vancouver, the Fraser Health Authority plans to close its spending gap by, among other things, holding the number of MRIs to last year's total, ending $550,000 in service programs for senior citizens and reducing elective surgeries by about 14%. The authorities also are making administrative cost cuts and looking to pool resources for things like computers and laboratories. "We need to be crystal clear. . . . I'm not denying anybody access here to urgent or acute or immediate care," Nigel Murray, the Fraser authority's chief executive, said in an interview. "If our surgeons feel people need access to urgent care, they get it." The government across Canada has invested a large amount of money in a successful effort to reduce wait times, especially for life-threatening conditions like cardiac disease and tumors, and for procedures like knee replacements and cataract surgery. Under Canada's health system, most doctors run private practices but are paid uniform rates by a government-funded network. (Many Canadians have private or employer-paid insurance that covers things such as dental and eye care, which are not part of the national plan.) Murray, a proponent of the system, conceded that the growing number of private clinics and public-private partnership hospitals could serve to strengthen government healthcare. "You can lose staff to the private systems. . . . But the other side of the coin is that you may be keeping nurses in your communities by providing other employment options for them, so that you're adding to the pool of overall healthcare professionals," Murray said. "Additionally, the private system can take some of the strain off the public system." The heart of the legal case is the 1984 Canada Health Act, which established the framework for the national insurance system known as Medicare. It outlawed most private insurance for essential healthcare and provided the vast majority of Canadians with free medical services. Canada spends about $172 billion a year on healthcare, which is one reason the nation's taxes are higher than those in the U.S. (Canadians pay about 33% of GDP as taxes, compared with 28% in the U.S.) British Columbia is the only province that still charges residents an extra health premium of $54 a month, subsidized for those who can't afford to pay it. The first foot in the door for private medicine came in 2005, when the Supreme Court of Canada struck down the laws in Quebec that banned private insurance. The court found that having people die while on wait lists violated the province's Charter of Human Rights and Freedoms. The ruling does not apply outside the province, because only a minority on the court found that the laws also violated Canada's basic human rights charter. The case to throw out the law in British Columbia was launched when authorities attempted to audit some clinics that were collecting government payments for surgeries in addition to fees they charged patients for use of their private operating rooms and nursing staff. Day's Cambie Surgery Center refused to open its books and filed suit along with other private clinic operators, saying citizens deserved a choice. "In Canada, the rights of the individual patient are trumped by the welfare of the system," said Richard Baker, who runs a Vancouver-based consulting group that helps patients find quick access to care in private clinics or in the U.S. "We have patients come from all over Canada, because B.C. has the most liberal rules on private surgical centers, other than Quebec," he said. "They complain, 'They're all jumping the queue!' Well, it's not jumping the queue at all. It's leaving the queue." In fact, the government here has been slow to crack down on private clinics. Health Minister Kevin Falcon in June told the Vancouver Sun: "I don't have an objection to people using their own money to buy private services, just as they do with dentists, just as they do with . . . sending their kids to private school or what have you. I think choice is a good thing, actually." The outcome of the legal case, most analysts say, likely will determine the future of private healthcare in Canada. Not all Canadian doctors have flocked to the defense of private clinics; indeed, many see the public health system, for all its strains, as a gem that ought to be protected from the out-of-control expenditures and huge inequities that are part of the U.S. healthcare system. "We can and need to improve [healthcare]. . . . But it's always going to be more effective, and it's certainly going to be more equitable, if it's done within the public system," said Robert Woollard, a longtime family practitioner and member of the Canadian Doctors for Medicare, which has applied to join the lawsuit in British Columbia. Woollard said the public system has the nimbleness to provide speedy, quality care to those who truly need it. "Just six or eight weeks ago, I had a patient come in who needed urgent attention to her knee. She was in severe pain," he said. "She was seen by a [reviewing] team within a week, and she was slated for surgery that will probably happen in the next two to three months." [email protected] Copyright © 2009, The Los Angeles Times
so there are too many patients to a specialist, who would take govt insurance? maybe all the specialists took a boat down are in Cali scamming the medi-cal system. also sounds like the dilemma with Medicare in US, few PCP take Medicare so people who are actually on Medicare are not able to see one. Human Greed has no boundaries, shame!
just means that the Canadians are smart. Everyone gets single payer, and well off people can purchase additional insurance to cover non life threatening conditions. This is exactly the same as in France - another "socialist" country, where people live longer and better than USA, there is more upward mobility, and no one needs to pay a penny for health problems. Canadians are wisely moving toward the option. British Columbia is a well off province, with many very well off retirees who get tons of health problems, overwhelm the system, and if they want something extra that their taxes didn't cover, then by all means, let's scoop up some of their retirement funds!!! Human greed has no boundaries.
Government, especially in the US, cannot do anything right let alone handle my health. I agree, something has to be done but not a government option forced upon us.
What a coincidence, I live in BC. I don't mind setting up a public + private system, so long as the public system remains reasonably functional for those who don't have the means to resort to the private system. If you want to pay $50K to get surgery now instead of free surgery next year, power to you.
Canada is one public system of many. A decent system, probably. But it also leaves much to be desired. Yes, waiting years for elective surgeries stinks. But just because one aspect of the American system (very low waiting times) is good doesn't mean the rest of the system isn't broken. Health care will continue to stink until people realize there's no free lunch. Pay the price (through high taxes/upfront cost or long waiting times) or receive substandard care.
Originally Posted By: Vilan
What a coincidence, I live in BC. I don't mind setting up a public + private system, so long as the public system remains reasonably functional for those who don't have the means to resort to the private system. If you want to pay $50K to get surgery now instead of free surgery next year, power to you.
In the quote, she said it won't be easy to come up with the $50k. Hope she pays up. wink2
I'm not going to get into the debates again over health care in Canada but I will say this... Don't believe everything you hear in the news. It is their job to promote fear because it drives their bottom line so of course they are going to paint a bleak picture. I have had some bad health problems over the last year and needed to see my doctor, Emergency Doctors, Specialists and a Neurologist. I have also gone for countless tests of every sort. All of this happened very quickly and within days or up to a 1 week wait time, not months/weeks/years but DAYS!!!! I even had an MRI the same day it was ordered and we supposedly have limited MRI machines up here. (I wasn't on my death bed but needed this testing done.) I'm leaving it here... Canada
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If a small group of people are doing something illegal in the realms of health care, you could just as easily say "In the US, Pharmacists are moving towards independent, unlicensed distribution." That would of course mean drug dealers on street corners. The examples in that piece were anecdotal in size and scope. Serious movement would be debate in their government, bills introduced, etc.
I have felt for some time that Nurse Practitioners should play a stronger roll in Healthcare. More than once I have been to Emergency with little more than a cut finger, needing a stitch or two. I would have been happy to be passed on to a NP (perhaps after a brief inspection by a Doc). Especially if it cuts my wait time. Sometimes it feels like Doctors are operating like an 'old time' Gild, protective of their quasi monopoly on administering health care.
Originally Posted By: stockrex
so there are too many patients to a specialist, who would take govt insurance? maybe all the specialists took a boat down are in Cali scamming the medi-cal system. also sounds like the dilemma with Medicare in US, few PCP take Medicare so people who are actually on Medicare are not able to see one. Human Greed has no boundaries, shame!
Not Medicare but Medicaid. Providers like Medicare.
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