More power to the patient

Posted on December 13, 2010 in Health Debates

Source: — Authors: – FullComment/Canada
December 13, 2010.    Shaun Francis

The most recent statistics available tell us that 4.2 million Canadians still don’t have a regular doctor. That figure is troubling because fixing the doctor shortage represents the single most effective way available to us to improve our health care system.

To illustrate this, I’ll use an example drawn from this country’s health history. About a year ago, many of us were working to determine how we could best be vaccinated against the H1N1 flu virus. Despite the apparent urgency, many doctors elected not to provide the flu vaccines to their patients. They didn’t carry it because it was an inconvenience and it didn’t make financial sense from their standpoint. Unlike previous flu vaccines, this one needed to be mixed in a certain way, and refrigerated, and the Ministry of Health compensated doctors less than $10 per shot — despite the fact that a vaccine visit required a significant amount of time per patient, to allay client concerns. So why bother? From a business perspective, carrying the vaccine had no effect on demand for doctors’ services. Drs. Joe and Joan Smith of Wherever, Ont., wouldn’t lose any clients if they chose not to provide the vaccine. Those clients didn’t have any other options. They didn’t have anywhere else to go; because the supply of doctors in this country is smaller than the demand — as 4.2 million Canadians can attest.

In contrast, some private clinics did provide the H1N1 flu vaccination despite the inconvenience and the associated costs to handle the influx of demand, such as paying staff to work overtime and on weekends. Why? Because it was a smart business decision. In a private clinic setting, good client service is fundamental to the value proposition, and if clients aren’t happy with the service they are receiving, competitors are eager to take them on.

What if a similar dynamic of competiton existed for our family physicians? According to a report released December 2 by the Canadian Institute for Health Information, Canada is increasing its ranks of physicians. In 2009, Canada’s physician work force grew by 4.1%, the largest single-year bump this country has seen in more than 30 years. That’s an increase of 2,700 doctors in a single year, an inflow the Canadian Institute for Health Information attributes to greater capacity at medical schools and the return of Canadian physicians from the United States. Physician numbers have grown in per capita terms as well, from 150 per 100,000 in 1980 to 201 active physicians per 100,000 population in 2009.

Even with these increases, Canada still ranks near the bottom among developed countries when considering number of doctors per-capita. About 15% of Canadians older than 12 do not have access to a regular doctor. Interestingly, less than 15% of Americans don’t have access to health insurance, and this has touched off the largest debate and legislative social entitlement reform in a generation in the United States. Meanwhile, when a similar number of Canadians go without a family physician, there is nary a whisper from our legislators.

Reforms enacted by Ontario’s Ministry of Health aren’t what we need. The province is fiddling with physicians’ payment schemes, so that doctors bill according to the number of patients they see, rather than the sort of care they provide. This is wrongheaded because it encourages doctors to decrease the amount of time they spend with each patient — an even worse revolving-door scenario than what already exists. Nor will the province’s experiments with family health teams provide much help. These are groups of nurse practitioners, registered nurses and social workers, among others, who “provide more service and a wide range of health options, especially for people who don’t have a doctor,” according to the ministry’s official language. But even this terminology suggests it would be better for everyone to have a doctor. So rather than investing in family health teams, shouldn’t the province direct its scarce resources toward supplying us with more physicians?

And not just the incremental bumps we’ve been experiencing these past few years. Increasing the doctor supply enough to introduce competition into the market for family doctors would create a health care marketplace much different than the broken system we have now. It might lead to some things we’d now consider fairly unusual. Family physicians might have to advertise for clients, for example. One might sell herself as having the shortest waiting times, while another might champion the way he caters to those who require same-day appointments. Overall, competition among doctors would shift the power dynamic in this country’s provision of health care from the government and health care providers to the clients. For that reason alone, it should be done.

National Post

Shaun Francis is chairman and CEO of The Medcan Clinic, North America’s largest preventive health-care clinic.

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