Thursday, March 3, 2011

qOtd: Private Health Delivery

qOtd: Should Alberta further explore the option of allowing private, for-profit delivery of health services?

Nation, it's no secret that our current healthcare system in this province is seriously over-taxed. We have too many people, making too many visits, to too few doctors and too few facilities. Once they get there, they have too few beds and too many patients to deal with. Wait times are improving, but still an issue of major concern. Throwing more money at the system doesn't seem to be helping, and isn't fiscally sustainable even if it WAS helping.

One proposed solution that keeps coming up is to allow private, for-profit delivery. In essence, allow "Enlightened Savage Health Services" to open its doors and perform neuro-surgical procedures, as an example (I'd recommend against it, as I had to check the spelling of "neuro"). Alberta Health would then cut a cheque to the clinic, rather than to itself.

The benefits, we're told, are that it would provide more options for care. More beds. More surgical bays. More facilities, closer to more Albertans. The risks, critics claim, is that it will take the most qualified doctors and nurses out of the clinics and hospitals we have, and put them in the for-profit clinics where they can afford to pay more, or offer better perks. Also, we're reminded, it doesn't address the issue of a lack of trained health personnel - we'll just be spreading a limited number of doctors and nurses even further.


I think we're foolish if we don't at least explore this option. If we have more facilities offering care, then the demand for trained health professionals will rise. When demand rises, the supply will increase to meet it (in theory). More students will pursue nursing or medicine, because they'll know there will be jobs. If they're exceptionally good, there will also be opportunities in the "for profit" health system.

There IS, of course, the "slippery slope" argument to be made: That once we allow this to take root, before too long we'll have a second tier of health care, available only to the super-rich.

I'd point out that we already HAVE a second tier of health care, hidden in plain sight. We see the results of that second tier every Saturday night.  When Jarome Iginla loses an edge and twists his knee on Monday, he's getting an MRI on Tuesday, and (if necessary) surgery by Friday. If the same thing happened to you or me on Monday, I'd get an MRI by Labour Day, and surgery by this time next year (maybe).  
Would these "for-profit" clinics allow for queue jumping? I suppose it's possible - it would depend on the legislation and the regulations. Even if it DID, though, consider: If I'm #3 on the list for a hip replacement, and Brett Wilson (who is #2) pays an extra $50,000 to get his done right now at the "Golden Hips OsteoSurgical Spa" in Nanton, then I - the poor plebe that I am - move to #2 on the list. And I'm getting mine sooner. Provided there are doctors to do it, and they aren't all working on Brett's hip because Golden Hips pays better than the Rockyview General Hospital.

I don't know if private, for-profit delivery can work for health services. I know that's how we get dental, vision and chiropractic care in this province - some dental clinics are better than others, and the rates we pay vary from chiropractor to chiropractor. If we're told that it can't work, then fine - it can't. This isn't something I want to explore due to ideological dogma. I'm not interested in this idea at ALL if it means anyone, anywhere, is waiting LONGER tomorrow than they are today. Or receiving worse care tomorrow than they are today.

But we owe it to our parents - and to ourselves, and our kids - to at least TALK about it. Because nobody gets hurt by TALKING about it, right?

That's MY take...  what's yours?


Art Hornbie said...

Alberta Health would then cut a cheque to the clinic, rather than to itself.
No. This in no way address efficiency. Fixed dollars are fixed dollars.

Instead, cut a pro-rated annual cheque to Savage, the individual. Savage then selects from the slathering medico masses a service.

Perhaps the services will develop a B.B.B. system from which Savage may judge them; or, Savage may select from something in the neighborhood. It doesn't matter. Savage spends Savage's pay cheque in a similar manner and market efficiencies provide consumer-appropriate product.

I suppose we could let the government spend Savage's pay cheque in Savage's best interest. Then we would all be wearing, for example, blue Mao shirts, driving American-brand cars and receive generic health care.

Enlightened Savage said...

Herbinator: Thanks for your colourful example. Are you suggesting a fully private system, then - with tax savings passed back to the taxpayers? Or a dedicated personal "health account" for Albertans, as was bandied about several years ago?

James said...

Whether we agree to private care or not, the fact is that over 20,000 canadians leave our country every single year to purchase medical services. Just imagine the revenue and economic development opportunities should our province develop a facility that could attract just a small portion of those medical tourists.

It is obvious that some people are willing to pay out of their pockets for medical services, so at the very least why must we make it difficult on them? For ideology? It simply boggles the mind.

The other issue I deal with is where do the decisions get made? For example, when my wife gave birh we had an incredible nurse the first afternoon shift, and then we had a terrible, cruel, rude and difficult nurse for the night shift. Why shouldn;t I be allowed to select my own nurse, who I would gladly pay out of my own pocket, just to give my wife and baby the care I think they deserve? Health care may not be considered a "business" to some idealogues, but this taxpayer sure things that our current system could learn a lot from some customer service businesses.

Enlightened Savage said...

James: I firmly believe that decisions made based on ideology rather than on fact are always the wrong decision - even when they end up correct.

Regarding your unfortunate experience, I wonder if we don't already have SOME semblence of "market choice" in this particular area - friends of mine have researched and contracted midwives and dhoulas (sp?) who served as the primary birthing assistant during their pregnancy and delivery. I don't know to what extent, if any, those services were covered by the healthcare system... but as long as we're considering "all options on the table", isn't that route something that bears closer examination?

I'm a big fan of competition - in a world where people can hire their medical practitioners directly, the night shift nurse you described would either shape up, or ship out. However, I'll leave you with this scary thought:

Somewhere in Alberta, right now, there are people sitting in a waiting room to see a immensely popular and experienced family doctor who finished at the bottom of his class 35 years ago. Somewhere, a cardiac surgeon with a great bedside manner and a 100% success rate is "scrubbing up" for surgery, and her patient is totally unaware that the surgeon graduated med school by the skin of her teeth.

In a fully competitive system, those 2 incredibly valuable medical professionals would likely never have been given a chance to practice. And in a "parallel system", they'd have been hired by the "2nd tier, public" system, to howls of protest from lower-middle-class Albertans upset at the notion that they were being denied the best practitioners and getting stuck with the dregs of the meical community.

I don't know what the solution is... but I'm open to suggestions...

Anonymous said...

Ongoing discussion on matters such as these is healthy (no pun intended!).

What you have laid out is the essence of The Third Way isn't it? That initiative of Ralph Klein was trashed severely when it was floated. But, times have changed. It has become more and more apparent that the rising cost of public health care cannot be sustained by the public purse. Delivery need be different. Should ideas be dismissed because they don't fit the current payment model? The current delivery model? Absolutely not!

Lets be open minded in our considering on how our overall governance may be improved and not locked into what has become Canadian dogma.

Art Hornbie said...

"Personal health account."
Paying the consumer in no way contravenes the Canada Heath Act.

And the idea is so enticingly efficient and democratic that I would also contemplate adding an education account.