The paradox of Canadian health rationing
National Post – Full Comment – Brian Day: The paradox of Canadian health rationing
Posted: January 26, 2009, Brian Day
This year marks the 200th anniversary of Charles Darwin’s birth, and the 150th of the publication of his book On the Origin of Species. His theory of Natural Selection stressed that the ability to adapt encouraged favourable traits to prevail. This should be remembered as governments ponder an economic strategy that involves borrowing (from the next generation) and spending (on just about anything). Instinct suggests that an approach of spending more and saving less may have serious drawbacks. Can Canada, with a little Darwinian adaptation, do better?
There is a vital link between health care and the economy. Our government health scheme (it is not a “system”), wastes many billions of dollars by depriving sick Canadians of access to care. A study commissioned by the Canadian Medical Association in 2008 showed that the economic cost of waiting for care, based on only four of thousands of categories of illness and injury, was almost $15-billion in just one year. A StatsCan report revealed that waiting for mental health care imposed a $51-billion economic burden in just one year. Also in 2008, in a comparison with 29 European countries, the European Consumer Powerhouse group ranked Canada last in value for money. Canadians are actually paying to ration care and prevent patients from receiving early treatment — a process I called irrational rationing. It is time for change and adaptation.
Our provinces spend more on health care than on anything else, and spending continues to increase at well over twice the rate of inflation.
We should maintain sustainability by raising revenues to a level where they exceed expenses. When the famous bank robber, Willy Sutton, was asked why he repeatedly robbed banks, he reportedly replied, “Because that’s where the money is.” Well, in Canada, health care is where the money is (or rather goes).
International medical tourism is one of the fastest growing “businesses” on Earth. Patients travelling abroad for health care form part of a worldwide economy that is reputed to have doubled in each of the last three years, reaching $80-billion in 2008. The biggest exodus of patients seeking care in foreign countries is from the United States. According to a recent report by Deloitte, in 2007 an estimated 750,000 patients left the U. S. to access health care abroad. That number is estimated to reach six million by 2010 and a staggering 12 million by 2012. Already major U. S. insurers are negotiating contracts with foreign hospitals, and lost revenue to the U. S. is expected to reach US$162-billion within 3 years. So far, those medical tourists and that funding have been excluded from Canada, despite the fact that the U. S. is our biggest trading partner and our closest neighbour.
Singapore receives over a million patient visits a year and over half a million patients go to India and Thailand. In Europe, hospitals are clamouring for this revenue. The famous Royal Marsden cancer hospital in London generates 25% of its core revenue through the treatment of foreigners. Even in communist Cuba, the modest 100-bed Frank Pais orthopaedic hospital in Havana receives over US$20-million from treating visitors. The revenue is used to subsidize the care of Cubans.
Canada is excluded from this enterprise because our politically stymied monopolistic health care scheme is maintained through a policy of restriction of access. Rationing also prevents many highly skilled Canadian health workers from obtaining full-time work; the result is a peculiar paradox where, despite being in short supply, they are forced to leave. These policies have resulted in long wait lists at home, and explain why an estimated 300,000 Canadians travel abroad for care.
Because Canadians languish on waiting lists, allowing access for foreigners remains politically unacceptable. Yet, Canada could become the world’s leader in this field. The current dysfunctional economic model of health care funding and delivery in Canada must be revised in order to allow the emergence of a world-class international health care industry.
The potential benefits to Canada are enormous:
-An economic boost through the creation of a multi-billion dollar Canadian “export” industry;
-The retention and repatriation of Canadian health workers;
-The creation of new, well paying, long-term quality jobs;
-Investment in new hospital and medical school infrastructure;
-Investment in new training programs for new health workers;
-Investment in the new advanced medical technology;
-The development of related health and research industries;
-The elimination of rationed access and wait lists for Canadians
Are Canada’s state-operated hospitals up to this challenge? I believe they are. But, if not (and perhaps even if they are), the private sector must be authorized and encouraged to enter the field.
Dozens of countries are embracing and investing in medical tourism as part of their economic development. Canada could easily discount U. S. hospital rates by 60%-90%, yet we shun the opportunity to access an emerging market of 12 million U. S. patients who travel to foreign countries for care. Surely, if the option existed, they would prefer to be treated in Canada.
Medical tourism represents an enormous, low-risk opportunity for any political leader with vision and a pioneering spirit. Or are visionaries and pioneers an extinct species in Canadian politics?
Brian Day is medical director at Cambie Surgery Centre and immediate past president of the Canadian Medical Association.