The Future of Health Care in Canada

[Visionseeker]

With health expenditures accounting for 10% of GDP (15% in the US) and representing the ultimate ever-growing area of provincial spending (e.g. 42% of the Ontario budget 2007), there is tremendous reason to be concerned that our system is becoming unsustainable. Within 5 to 10 years, the largest bulk of baby-boomers will enter the acute care demand window (i.e. the age group that exhibits the largest growth in acute care demand).

Systems across the country are already under significant strain. While some localities have made great strides in reducing wait-times for both urgent and less-urgent procedures, the general consensus within the medical community is that much more needs to be done. Doctors are in short supply, necessary tests are the subject of long queues, and both critical and elective surgeries remain plagued by almost inhumane waiting lists.

And while these dragons have yet to be slain, our population’s demographics move ever more towards placing unprecedented demand on a system that is almost defined by its scarcity. Taking the Ontario example where 42 cents of ever tax dollar is consumed by health care, it is clear that Ontario is running out of fiscal room to boost health spending while continuing to meet its other obligations. The system, as it stands, is bound to collapse.

What can be done to avoid this collapse or, more importantly, to address the wider challenges facing our health care infrastructure? Furthermore, what are the potential social implications?

Edited October 8, 2007 by Visionseeker

[bush_cheney2004]

We already know that part of the short term solution involves sending patients to the United States. Unable to staff and fund additional infrastructure, this is the only option for acute cases in the near term. Pressure will build for additional private care and health insurance products to grow infrastructure for designated procedures demanded by an aging population. Two tier care, already a reality, will be acknowledged as part of the solution, instead of political grist for the mill.

[margrace]

The biggest problem we face is the baby boomers but remember, in a country that already has 40 million people without health care, there are a lot more boomers than us. It would behove Americans to quit trying to ruin ours and look to their own problem.

[trex]

i cant vote in the poll here because the options are too limited. none of them is acceptable to me, least of all privatization. sending people away is totally unnecesary as we have plenty of wealth to fix the problem, without making it a commercial enterprise. we have a 15 billion surplus but there are hospitals lacking equipment and trained personnel... and the lack of accountability in those hospitals means the best decisions are not being made, questionable choices are being made, vast sums of public money wasted with no repurcussions to the administration. or government for that matter. it seems to me that this crisis is artificially created, theres no need to be sending people anywhere else if the system is properly managed and funded.

fix the public system.

Edited October 8, 2007 by tbud

[Topaz]

A border city radio station has a topic on this every weekend and the topic is that a US company has set up shop in the border city and is telling Canadians if you really need treatment and have to wait, calls us and we'll get you an appointment to see a doctor. Alot of the hospitals along the border in the US has hospitals that specializes in one of two things and so they can take any extras patiences coming their way. The only problem is you have to pay for the treatments yourself, so I guess its really for the well-do, but doing so, I would think that the waiting lists would get smaller and the people who couldn't pay for would get treatment sooner. If we are to have a two-tired system, then maybe this is the way to go. They also explained why Canada is having problems. There's too many babyboomers, not even doctors because of retirement, and more people coming to this country. So, perhaps it will all work out in a generation, where we could have too many doctors, am I dreaming???

[old_bold&cold]

I see our healthcare problem as one of not having the doctors more then not having the hospitals. we here in Canada educate doctors and as soon as they get their license to practice they leave. What we need is a contrat that is binding on all doctors we educate, that if say the subsidized part of their education is $500,000.00, and if you practice in Canada for ten years, we will forgive that subsidy. But if you leave Canada before ten years of practice then we will assess that amount plus interest for the education that they will leave with. It would only be fair because we as the people do subside these peoples education immensely. If we are not going to benefit from this subsidy, then we should be paid back for it. Then maybe we will see the doctor shortage ease up and then can work on other supporting figures like nurses and and staff. The federal government should find a committee that will come up with a formula for for any given population there must be one hospital, or in rural areas a set distance for every hospital. This shoudl be Canada wide and so it shoulkd be a federal issue, and if necessary subsidies from federal accounts for this. Then maybe we will in time get back our balanced approach to health care.

[Keepitsimple]

There are so many great ways to upgrade our healthcare system but I'm afraid it will take some innovative Private involvement - and it's really not that scary. Canada has an advantage in that we already have a government healthcare system with all the billing and administration that goes with that. Introducing a dollup of Private help is easier than in the states for example where it's almost all Private and introducing broad government involvement is like turning around the Queen Mary....because doctors and HMO's will fight it. Here's two examples that could greatly help our healthcare:

1) The intoduction of Private Clinics

Staffed by doctors, registered nurses, physiotherapists and perhaps other specialists, these clinics would provide access to 24 hour care. They would function as your General Practitioner but provide immediate access to complimentary care. This would greatly ease the pressure on ER's. The Private element is only related to the Infrastructure and Billing. A Private company would supply the facilities and equipment, be responsible for cleaning and upkeep, and do all the billing, paperwork, and patient record keeping. In exchange, they get a percentage of the regular OHIP/Medicare fee. Only services that are covered by our Healthcare card would be offered and the Healthcare card would be the only method of payment. The Doctors and other Professionals would get less of the Healthcare fee because they would have to give up a percentage to the Private company.....but they don't have to pay all the overhead and do the paperwork - they do what they do best - look after patients.

2) Assembly Line Surguries

Many people do not know that almost all heart surgeons are not able to fill their day with surguries because there are not enough beds and supporting services. I'm pretty sure that many other surgeons face the same problem. So again, we get the Private Sector to provide the infrastructure, support services, and billing and paperwork. Perhaps each major city gets one of two Private facilities for hip & knee replacements. Again - everything is paid for with our healthcare card and the doctors give up a portion of that to the Private facility.

Summary

That's where I see the Private sector helping out - investment in infrastructure and support services where there can be a scale of economy that allows them to operate more efficiently than a bureaucratic hospital that tries to be all things to all people. That's the key, if they can do it for less because of the sdcales of economy, then they can make a profit without charging any more - and everybody pays with their Healthcare Card. It's not so scary.

[old_bold&cold]

Private clinics and testing facilities are a great way to ease the wait times on the regular system, as long as they charge and bill exacly the same as the Ohip or Qhip will pay. This way you get all the services just by presening the card. We also need smart user cards for all health cards. This is where your whole medical history is on that card, and it can only be used by the person the card was meant for. No more of the old cards, where the same person has had his appendix removed 3 or 4 times, and all photo ID updated every 5 years. If we put these controls in place we will stop the fraud, and that alone will shorten wait times.

Many investors would gladly buy shares in any private clinic for test equipment, making better and quicker machines available that will not cost the system more, but will be more efficient. By again we will need the doctors and the nurses and that is still going to be a long term investment. As I said earlier we need to stop our grduating doctors from leaving Canada to practice else where, when we have subsidized their education by as much as $500,000.00.