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LETTER: Time to blend a little private with our public health care?

A blended public/private healthcare system could make our health-care system more fiscally sustainable, and yet still provide universal coverage, writes Dr. Charles Shaver.
A blended public/private healthcare system could make our health-care system more fiscally sustainable, and yet still provide universal coverage, writes Dr. Charles Shaver.

“..In 2018 we will continue to collaborate…to restore fiscal balance in a responsible, sustainable manner.” – Premier Dwight Ball

On Friday, Prime Minister Justin Trudeau will host a First Ministers’ Meeting in Montreal.

In his recent fall economic statement, Bill Morneau announced that the deficit for this year would be $18.1 billion – over three times what was initially promised. By 2013-24, the total debt would be $765 billion. Normally, in “good times” the government is expected to pay down debt. Now with the closure of General Motors in Oshawa, Ont., and the continued drop in oil prices, these numbers will be much worse.

Newfoundland and Labrador will have a deficit of $683 million for 2018-19 and a debt of $14.6 billion. Like Alberta, its revenues will be adversely impacted by the continued drop in oil prices. There is no sense “robbing Peter to pay Paul.”

All provinces need new sources of revenue to support health delivery and provide fair remuneration to physicians, nurses, and other health professionals. Health now consumes about half of most provincial budgets yet Ottawa contributes only slightly over 20 per cent.

One potential source of new revenue is medical tourism. At the First Ministers’ Meeting, a topic on the agenda is how to diversify international trade. One thing that Canada can do less expensively than the United States is to deliver health care. A knee or hip replacement costs US $60,000-$80,000 in Boston or New York City, but only about CAD $20,000 at a private clinic near Montreal.

A recent survey found that 165 recent residents and fellows in orthopedics were seeking full-time employment in Canada, and 73 were working outside the country. Encouraging expansion of hospitals across Canada with ORs devoted to elective surgery such as joint replacements on American, Chinese, and other foreign patients, would bring in much-needed revenue, and provide employment for orthopedic surgeons, and other health professionals; they would remain in this country to service their fellow Canadians and shorten wait lists.

Much more controversial is whether to amend the Canada Health Act so as to permit a limited amount of privatization for residents of Canada; yet Ottawa remains intransigent about doing so. Federal Health Minister Ginette Petitpas Taylor has criticized Quebec for allowing patients to pay out-of-pocket for care in their own province. Yet she turns a blind eye to the fact that this occurs when Quebec resident require medical care in another province.

Justin Trudeau recently stated, “I look forward to sitting down with Premiers to strengthen partnerships, find ways to eliminate barriers to trade between provinces and territories…”

If these barriers are to be improved so as to promote tourism and trade, all Canadians must be assured that if they visit another part of the country on business or vacation, they will have fully portable medical benefits. This is much more important than whether to establish a French university in Toronto!

New Premier Francois Legault should agree to sign the Reciprocal Medical Billing Agreement. If he still refuses, Ottawa should pay physicians directly for treating out-of-province patients.

In order to research possible limited privatization of health care, I suggest that each provincial medical association poll its members and ask persons to identify themselves if they ever were a patient in, or worked in Australia, New Zealand, Taiwan, or most of the European countries — all nations with blended public/private healthcare systems. Those with first-hand knowledge would be invited to participate in town hall meetings across each province. They would field questions concerning the pros and cons of health delivery in each country and educate the public, media, and politicians.

According to a poll by the WHO of healthcare systems, 8 of the best 10 and 19 of the best 25 nations had a blended public/private system. (Canada was ranked number 30!) We should be open-minded and be prepared to learn from other countries with efficient systems, shorter wait-times, and high rates of patient and physician satisfaction.

I urge the premiers and Justin Trudeau to translate these proposals into concrete action.

Charles S. Shaver, MD


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