Don’t blame our doctors

NationalPost.com – Opinion/Editorial
Tuesday, Sept. 28, 2010

According to a new federal-provincial report released yesterday, Canada’s family doctors may be over-prescribing medications and ordering more expensive diagnostic tests than are actually needed or useful. That should not come as a shock. Under the current system, physicians have no incentive to rein in health care spending, but plenty of incentives to err on the side of intervention — including persuasive pharmaceutical reps and patients with the human desire to feel that something concrete is being done to address their problems.

What’s the solution? The Health Council of Canada (which issued the report) suggests better independent tutoring of family doctors on the use of medication and extra help from radiologists about which tests to order and when. We don’t see how a bit of added guidance in these areas could hurt. However, as long as our health-care system remains a government-run and -financed monopoly, there will remain a powerful dearth of motivation for family doctors to minimize costs.

As it happens, though, the report does serve as a timely rebuttal to recent and rising calls for a universal pharmacare program, in which all Canadians would have their drug costs paid by the government. Right now, the one small safety-valve the system maintains is that some patients have to pay for their own medications — either directly out of pocket, or through private insurance plans that they pay for, or receive through employment.

As things stand, then, these patients — or the private insurance companies that cover them–still have good reason to keep an eye on drug costs, and to balk at paying for prescriptions that seem unnecessary or obscenely expensive (or some combination thereof ). Introduce a government-funded pharmacare program and we lose even that last healthy, if small, bit of consumer caution and restraint.

Ultimately, we get the optimum use of drugs when it’s the suffering individuals bearing the costs, since only they can know how much trying or continuing a particular treatment is truly worth to them given their situations and conditions.

One further note of caution: While over-prescribing is a legitimate concern, it’s important to be mindful of the fact that even the widespread and expensive use of medication can actually be a hidden cost-saver, reducing even more expensive treatments such as hospitalizations and emergency room visits.

It’s important that family doctors not start undertreating simply to meet new guidelines aimed at bringing down overall prescription costs. Again, the best barometer would be a paying patient in a system without price controls. In our current reality, we have to settle for a price-controlled system with some paying patients. But that’s still better than none.

Finally, it’s worth noting the irony that many family physicians may be ordering diagnostic tests because it’s the only way they can get their patients in to see specialists — and/or because they want to make sure these patients are safe while they wait the months it ofen takes for that specialist appointment. If patients didn’t need referrals and could proceed directly to specialists on their own dime, then we’d have far more of these decisions about testing being made by the doctors with the expertise to know when and which tests are actually warranted.

Ultimately, the problem lies not with family physicians, but with Canada’s rigid health-care system and the perverse incentives it provides everyone concerned.

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