Health care wait times at 20 year high in Canada

[Argus]

19 hours ago, Michael Hardner said:

Canadians aren't good at managing services.  The government just provides worsening service and we accept it.  If we had two-tier, I expect most of us would end up paying more for marginally better services, and those who can't afford it would get terrible care.

What does that mean Canadians aren't good at managing services? Governments aren't good you mean.

France's health care system has been described as the best in the world. And poor people can get their fees subsidized.

[Topaz]

   I know we have debated many times, but in my opinion there is many facts that contribute to the problem and its on the government side as well as the patient side. Just look at North America citizen vs Europe.....how many 300 pounders up have u seen?  Some people can't help if they get a certain disease  like cancer if it in their family DNA.

[Michael Hardner]

52 minutes ago, Argus said:

What does that mean Canadians aren't good at managing services?

We do NOT pay attention to important things.

 

Wait Times have been deteriorating for years and have come up in perhaps one election 

Costs in general only come up when someone tries to control them.

[?Impact]

55 minutes ago, Argus said:

France's health care system has been described as the best in the world. And poor people can get their fees subsidized.

Ok, if you want to compare specifically to France then lets have the details. Don`t forget to include the higher education system in France that doesn`t leave health care professionals with huge debts to repay, and in exchange they get much cheaper wages for those professionals.

[Argus]

1 hour ago, Michael Hardner said:

We do NOT pay attention to important things.

 

Wait Times have been deteriorating for years and have come up in perhaps one election 

Costs in general only come up when someone tries to control them.

That's not because Canadians aren't concerned about it. It's because the major parties are too cowardly to address the issue. It's big and complicated and messy and long-term. They prefer quick sound-bites and short term answers which will get them elected.

[Michael Hardner]

Hmm.  You are saying that they all avoid the issue.  Interesting.  I have to think about that.

[eyeball]

They only avoid lousy management because we put up with lousy governance.

[dre]

23 hours ago, Michael Hardner said:

We need someone with vision to set up a new way for us to think of these services - allow competition and monitoring of the bottom line costs as well as service levels.  It's a massive rethink I'm asking for and I don't know who could do it, frankly.

They could start covering medical tourism under the Canada health act. Thats the only way our doctors and their medical associations will face real competition. 

You could make it so that the government splits the saving with the patient as long as they go to a JCI accredited hospital. For example... a triple bypass that costs the government 200k here could be done for 50k in India or Thailand. The government could split the saving with the patient, so the government saves 75k on the procedure, and the patient gets 75k to put in his pocket.

Then Canadian doctors and their unions (errr medical associations) would face real global competition. And we wouldnt waste money retooling our system for a glut of old and sick people that wont be here in 20 years.

The only real problem we have is the medical associations, and the fact that provincial governments have no cards to play during negotiations with them, and the fact that they control too much of the certification process. If we sourced procedures globally, there would be an abundance instead of a scarcity, and doctors here would be forced to compete with doctors countries where procedures cost much much much less. This has worked to bring down prices in every single sector its been applied to.

[?Impact]

30 minutes ago, dre said:

You could make it so that the government splits the saving with the patient as long as they go to a JCI accredited hospital.

Why should the patient get anything? What if something goes wrong, who ends up covering the additional costs? If the government is encouraging people by paying them, then the government will probably be held liable for anything that goes wrong. I can see massive lawsuits resulting from this.

[dre]

4 hours ago, Argus said:

What does that mean Canadians aren't good at managing services? Governments aren't good you mean.

France's health care system has been described as the best in the world. And poor people can get their fees subsidized.

Frances system has more government management than Canada's.

The entire population pays compulsory medical insurance fees, and the government sets "approved fees" for each procedure.

Like Canada, doctors run their own private practices unless they work in government run hospitals, and like Canada they draw almost their entire income from government funded insurance. Its also similar to Canada in that patients are forced to pay a little bit of the costs. They government often pays for 70 then there's a co-pay but for long lasting illnesses like Cancer or Diabetes they are covered 100%. In Canada we pay insurance premiums.

And like Canada.... you can purchase additional private medical insurance (I have Manulife) to augment your government funded plan.

Doctors there make less money in wages, but they get to go to medical school for free. That's a good idea but I don't see it happening in Canada because tuition costs are increasing as fast as healthcare costs. The government would have to raise taxes. Malpractice insurance is also cheaper in France because all doctors prescribe to the same public malpractice insurance fund.  The French National Insurance system also pays for a part of social security taxes owed by doctors that agree to charge the government-approved fees to keep wages lower, which appears to be nothing more than a shell game.

The main differences are.. 

1. There's more public funding and control.
2. The education and certification processes are government controlled and almost completely subsidized. A student Faculte de Medecine Pierre et Marie Curie in Paris will pay $264 for the entire year.
3. They have managed to avoid massive unionization.
4. The government in France funds a much larger portion of the total cost, and spends more as a percentage of GDP.

Healthcare as a percentage of GDP
Canada:  10.45%
France: 11.54%

Government expenditures as a percentage of total  healthcare expenditures
Canada: 70.93
France: 78.21

Private expenditures as a percentage of total  healthcare expenditures
Canada: 29.07
France: 21.79

 

 

 

 

[dre]

1 hour ago, ?Impact said:

Why should the patient get anything? 

Because he is saving the government a pile of money and taking pressure off the current system and it would create an incentive. It would also help the patient pay for the non medical costs like his flights, accommodations, a nice little post-op holiday, etc.

 

[Michael Hardner]

Some good ideas and interesting points here.

Overall, the system is also laden with so many stakeholders as to make change impossible.  Buckminster Fuller had some quote about making change, which said something like it's better to build something new and let the old system die.  I think that would be the best approach.  Create a new system, and with it a new culture that has a smaller number of governors representing patients first, taxpayers and healthcare workers second.  

And... I have a bit of a bias here... but ultimately I would want to get doctors out of management altogether.  I have only anecdotal reasons for that goal but I worked with doctors before and I'm sorry but they are terrible managers.  Yet they are the ones who ascend to the top levels of management... not good.  I accept that this is just my personal experience.

Good management can weigh out costs and benefits and create simplified approaches.  The system we have now is laden with special interests and worst of all is owned by many levels of government.  Why not build something new, and see what happens ?  I don't care if it's public or private - as long as quality is there.

[Michael Hardner]

Quote

“In order to change an existing paradigm you do not struggle to try and change the problematic model. You create a new model and make the old one obsolete.”

http://www.goodreads.com/quotes/35623-in-order-to-change-an-existing-paradigm-you-do-not

[dre]

17 hours ago, Michael Hardner said:

  Why not build something new, and see what happens ?  I don't care if it's public or private - as long as quality is there.

ANY system would be stretched thin by an aging population. The answer here isn't to throw the baby out with the bath water and start again from scratch. The answer is to leverage global resources to get us through what is a temporary crunch. And that is the ONLY way to give provinces more bargaining power during negotiations with Medical Unions here at home. We need to address artificial scarcity, certify more doctors, and fund procedures done in accredited foreign hospitals.

Our system used to work really well... we should restore federal funding levels, and use foreign hospitals for overflow until the babyboomers are all dead.

Quote

 

A survey of 12,000 doctors shows they are having a hard time dealing with aging baby boomers and their increasing caseload of chronic illness.

It's the second national report in the space of a week warning that chronic illness is pushing Canada's health-care system to the brink.

The National Physician Survey is conducted every few years by the College of Family Physicians of Canada and other doctors' groups.

 

 

[Argus]

On 11/24/2016 at 8:23 PM, dre said:

Frances system has more government management than Canada's.

The entire population pays compulsory medical insurance fees, and the government sets "approved fees" for each procedure.

I'm fine with this. 

On 11/24/2016 at 8:23 PM, dre said:

Doctors there make less money in wages, but they get to go to medical school for free.

I'm fine with this, as well, so long as they agree to practice in Canada and not take their skillset south.

The French might pay a little more than us but the services they get are dramatically better and more timely than we do. I'd be willing to pay more for better services. 

 

 

[dre]

53 minutes ago, Argus said:

I'm fine with this. 

I'm fine with this, as well, so long as they agree to practice in Canada and not take their skillset south.

The French might pay a little more than us but the services they get are dramatically better and more timely than we do. I'd be willing to pay more for better services. 

 

 

 

I'm fine with those things too... Throw these in too...

1. A non-profit national malpractice fund. 

2. Get rid of provincial medical associations, especially their role in the certification process. At the very least pass right to work legislation so that certified doctors can practice without being a member.

3. Fast track certification for foreign doctors that have practiced in JCI accredited hospitals in other countries.

4. Replace the residency system with an apprenticeship system, so that any practicing doctor can train another new doctor, whether its a doctor that immigrated to here, or a new student out of our own program. 

5. Create a panel of doctors to set fees for different procedures.

6. Cover procedures done in JCI accredited foreign hospitals under the Canada health act as long as the government saves money on the procedure. Not only would this be of help to Canadians travelling abroad but it would put our own doctors into global competition, and make them more likely to accept the fees set by the previously mentioned panel.

7. End all forms of medical protectionism. For example a radiology scan could be electronically sent to doctors in any accredited hospital in the world, but the college of radiologists have successfully lobbied not only to prevent THAT, but to prevent scans being sent to other Canadian or American cities, and in many cases they cant even be sent to another hospital in the SAME CITY.

The problem is...
Its pretty easy to have good ideas, and learn what we can from the most successful systems. But Canadian doctors will fight tooth and nail to prevent Canadians from receiving affordable timely care. They don't want to get paid like French doctors, and they are smart and very well organized, and have a tremendous amount of clout and bargaining power, and the government has almost none. Imagine a government faced with a threat by doctors to walk off the job?

That's why you start with number 6, 3, and 4. Erode their bargaining power, and weaken them... then maybe we could get some of the other things done.

[overthere]

On 11/24/2016 at 11:41 AM, Argus said:

What does that mean Canadians aren't good at managing services? Governments aren't good you mean.

France's health care system has been described as the best in the world. And poor people can get their fees subsidized.

The walkin fee is not large to discourage sick people from visiting a doctor, but it is enough to discourage the many people in Canada that have hypochondria as a no-cost hobby.  

 

But this is all hypothtetical, millions of people just lose their sh** in a pique of mild insanity when any kind of reform or user-pay model is mentioned.  We spend all our time arguing left and right wing irrelevancies while our system gets less and less sustainable.   The culprit is not ideology, it is an aging and unhealthy population, much longer life spans, and enchaned drugs/technology.  All of these conspire to vastly increase end-of-life costs.

 

We are so far unable to have a grownup conversation about reality.

 

 

[?Impact]

4 minutes ago, overthere said:

millions of people just lose their sh** in a pique of mild insanity when any kind of reform or user-pay model is mentioned

Many more millions of people are full of sh** when they make outright false claims like healthcare taking 70% of our tax dollars when it is more like 15%. We can start having a grownup conversation about reality when real data is discussed and not the falsehoods that are propagated by the children.

[overthere]

I reckon we have to start that discussion with some premises:

 

1. none of us are going to live forever, even with publicly funded heroic intervention

2. the amount of our GDP that we can and will spend on health care via government must have a % limit.

3. If we choose to have govt pay for most of our health care, then we cede the power to limit or deny some  procedures and practices.

[Bonam]

1 hour ago, dre said:

The problem is...
Its pretty easy to have good ideas, and learn what we can from the most successful systems. But Canadian doctors will fight tooth and nail to prevent Canadians from receiving affordable timely care. They don't want to get paid like French doctors, and they are smart and very well organized, and have a tremendous amount of clout and bargaining power, and the government has almost none. Imagine a government faced with a threat by doctors to walk off the job?

That's why you start with number 6, 3, and 4. Erode their bargaining power, and weaken them... then maybe we could get some of the other things done.

Have doctors ever threatened to walk off the job en masse?

[dre]

1 hour ago, Bonam said:

Have doctors ever threatened to walk off the job en masse?

Not that I know of. When you make 350k and get a big raise every year why would you.

But if the government tried to bust the unions with right to work legislation (like they should), or open the market up to foreign competition then we would have a fight on our hands. Like I said the last thing on earth they want is for Canadians to have affordable care. 

And for us to have a system like France, doctors wages would need to be driven down by almost 50%. The average French doctor makes just over 100k.

Edited November 26, 2016 by dre

[Bonam]

44 minutes ago, dre said:

Not that I know of. When you make 350k and get a big raise every year why would you.

But if the government tried to bust the unions with right to work legislation (like they should), or open the market up to foreign competition then we would have a fight on our hands. Like I said the last thing on earth they want is for Canadians to have affordable care.

As much as you like to equate the two, professional associations are not unions. Doctors and other professionals are independent minded people and their organizations have no authority or precedent to compel them to stop working.

There is good reason to have people with a deep understanding of the field to be in charge of certification in the field. Even if you made it a separate organization that had to control who can practice as a doctor, that organization would still have to be staffed by doctors (or former doctors), because the absolute last thing I would ever want is a politician or bureaucrat with no medical knowledge deciding who is fit/unfit to practice as a doctor.

By the way, the average doctor salary in France is $95k USD, $166k USD in Canada, and $186k USD in the US. Doctor salaries in Canada could likely not be reduced substantially without large numbers of them being tempted to go work in the US instead.

 

[?Impact]

14 minutes ago, Bonam said:

By the way, the average doctor salary in France is $95k USD, $166k USD in Canada, and $186k USD in the US.

I'm not sure what source you are citing, but it is important to understand that in Canada many (probably most) doctors are not salaried. Doctors bill for services, and then run their small business paying for staff, supplies, rent, etc. Their take home pay is far less than what they bill. Family physicians bill about $275k on average, and specialists generally bill more (eg. surgeons about $450k). 

[Bonam]

1 hour ago, ?Impact said:

I'm not sure what source you are citing, but it is important to understand that in Canada many (probably most) doctors are not salaried. Doctors bill for services, and then run their small business paying for staff, supplies, rent, etc. Their take home pay is far less than what they bill. Family physicians bill about $275k on average, and specialists generally bill more (eg. surgeons about $450k). 

https://www.google.com/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=canada average doctor salary

I believe the source takes the expenses into account. 

Edited November 27, 2016 by Bonam

[dre]

2 hours ago, Bonam said:

As much as you like to equate the two, professional associations are not unions. 

There is good reason to have people with a deep understanding of the field to be in charge of certification in the field.

The problem is the medical associations are not just trade associations. They hold a monopoly in each province and they negotiate pay on behalf of their members, and their members are not allowed to negotiate pay outside of that process. So they are unions and they collectively bargain. Certification and collective bargaining should not be the responsibility of the same body. There's a blatant incentive to create scarcity of services. A blatant conflict of interest that is harming both patients and taxpayers.

Think about... If you and 10 other mechanics controlled who could run an auto repair shop, would you want to license a whole bunch of new mechanics to compete with you? Obviously not. You would just reduce what you can charge in the market. You are better off keeping the services scarce. The problem with you and your group of mechanics creating that artificial scarcity is that it now costs 100k to get your transmission fixed.

And yes... a group of doctors SHOULD play a part in designing the certification process, along side representatives of the patients.

Quote

By the way, the average doctor salary in France is $95k USD, $166k USD in Canada, and $186k USD in the US. Doctor salaries in Canada could likely not be reduced substantially without large numbers of them being tempted to go work in the US instead.

That's why you streamline the certification process. There are hundreds of thousands of good doctors in the world that would happily practice in Canada for 100k. We need to create a glut of medical services and medical professionals. Flood the market... and allow doctors who are not part of provincial medical associations to work for the fees set by the panel of doctors and stakeholder representatives.  Yes... doctors that refuse to work for those fees will leave. Good riddance. But as long as we can source doctors globally there's easily enough talent out there.

 

Edited November 27, 2016 by dre