We need two-tiered medicine

NationalPost.com – FinancialPost/FPComment – We need to put the patient back into the centre of the debate
Apr 6, 2011.    By Keith Martin, Special to the Financial Post

A grey tsunami is hitting our shores and Canada is utterly unprepared to deal with it. Currently, there are four workers for every retiree. In the next 20 years, this ratio will shrink to two workers for every person over the age of 65.

The impact of our aging population on our economy and social programs will be enormous. Demand for programs will soar just as the workforce to pay for these benefits shrivels. Nowhere will this be more evident than in health care, where costs are increasing at a rate of 7% per year while revenues are rising at 3%.

As the Organization for Economic Co-operation and Development confirmed last year in a damning report, only one source of funds can bridge the gap between our health-care demands and the resources needed to for pay them: the private sector.

Even though health-care reform is the top concern for Canadians, this issue has been missing in action during the federal election campaign. Everyone is afraid of discussing it because the truth will run counter to what some have been feeding the public for some time. In short, we need to put the patient back into the centre of the debate.

To close the yawning gap between supply and demand, the Canada Health Act must be modernized to allow patients to pay for care if they wish in entirely separate, privately funded facilities. Individuals who go to these centres would be paying for care out of their own pockets or through privately purchased insurance. By doing this, patients will be leaving the public queues and thus shortening them. Physicians would work in both systems. Patients choosing to access private facilities would also be free to use the public system that their taxes pay for. Private facilities would act as a release valve, removing demand from the public system without removing resources. This would leave more money for the public system to use.

Seventeen of the top 20 health-care systems in the world are in Europe (Canada ranks 22nd) and all integrate public and private care. Surely we should adopt measures used by those countries that provide better care and improved health outcomes for their citizens.

In Canada, the sick are seen as a cost to the medical system. In Europe, they are seen as an asset, because hospitals are paid for treating the patient. Accordingly, we need to change the mechanism by which we fund our hospitals. Today, they receive a lump sum of money that doesn’t take into account the demands they face. Hospitals should receive payment for the services rendered to treat patients and not just a block of funds.

Canada also lags far behind most developed countries in e-health. We need to get into the 21st century and use the information technology tools that are available to reduce administrative burdens and provide better and more cost-effective care for the patient.

Our aging population means our caregivers are aging too. We need a national medical workforce plan so that we can train and retain the type of medical professionals we need in the places we need them the most.

With the Canada Health Accord set to expire in 2012, it is imperative that the federal and provincial governments immediately form a health-care modernization working group with ongoing input from professional medical associations and the public.

In the end, we cannot continue to wrap ourselves in the Canada Health Act, hold on to myths and demonize those who are trying to modernize our obsolete system. Our health-care system must be overhauled in order to fulfill its ultimate objective, which is to ensure that all Canadians, regardless of income, will have timely access to the quality care they need when they fall ill. During this election, political parties must not be allowed to hide from this, our citizens’ most urgent concern. Lives depend on it.

— Dr. Keith Martin, a physician, served as the Member of Parliament for Esquimalt-Juan de Fuca from 1993–2011. keithmartin.org

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