Health Care
Poll after poll has shown that health care is the number one issue for Canadians. Yet despite several increases in funding for health care at all levels of government, long wait times continue. In fact waiting times have become so bad that the Supreme Court of Canada ruled in the Chaoulli case that the ban on private health insurance was unconstitutional. Below I will summarize my views in three sections: Federal, Provincial, and Private sector
Federal
Although health care is primarily a provincial jurisdiction matter, I believe the federal government has a role to play here beyond First Nations health care, RCMP, and military. Regardless of what province one lives in, they should all have access to similiar services therefore I support the federal government continuing to transfer money to the provinces. The federal government also has the right to set standards that provinces must meet if they wish to receive funding. Now provinces should be free to ignore those if they wish to forgo the funding. However, there are a few other things I believe the federal government could do. In coordination with the provinces, they should set up a database of wait times for surgeries that normally have long waiting times so patients can see whenver there is an opening in other provinces. They should amend the Canada Health Act to allow provinces to establish a parallel private system so long as the doctors working in the private system operate in separate facilities and work either exclusively in the private system or do a minimum of 40 hours a week in the public system before working in the private system. Punishments on the Canada Health Act should be results based as opposed to legislative based. Otherwise if a province institutes a system that undermines accessibility then they should be punished, but if a parallel private system emerges that doesn't undermine accesibility or any of the five principles, they shouldn't be punished. The federal government should also work with other countries to establish a standard criteria for medical schools, so that foreign trained doctors won't have to go back to training again when they immigrate to Canada and they can begin practicing immediately. We also need to increase the number of doctors by providing more funding to universities for medical school, but also accepting more immigrants who wish to go into medicine. This should be done in tight coordination with the provinces.
Provincial
Provinces should decentralize hospital planning decisions to local health authorities which cover a geographic area that is similiar in its features but of significant size. Here in BC, having 30 regional health authorities was costly and unnecessary, but having everything done by one province wide health authority prevents there from being adequate responses to local needs. Doctors should continue to remain funded on a fee for service basis. Provinces who currently ban the sale of the private health insurance for medically necessary services should repeal this while, like Quebec introduce strict measures to ensure private health insurance doesn't undermine medicare. There should be a wait times guarantee and if a patient goes above this, the province will pay for them to go outside the province, outside the country, and even to a private clinic. Contracting out of laundry and food should be considered if the wages the unions demand are unrealistic, however to keep labour peace, this should be done as a last resort as it had to be in BC, but not necessarily in other provinces. Also more funding should be put into medical schools to increase the number of spaces. All licencing requirements should be harmonized nationally to ensure all medical professionals can freely move between all provinces.
Private Sector
The private sector contrary to myth already plays a large role in health care. Around 30% of health care spending is in the private sector. This is about where I think it should be, but with some adjustments. There should be better coverage of prescription drugs which would reduce the role of the private sector, but individuals should not be prevented from paying for private health care or taking out private health insurance for medically necessary services. Many complain a parallel private system would undermine our public system, but this has not been the case elsewhere. In fact Canada is virtually alone in the developed world in not allowing a parallel private system yet our health care ranks 30th by the WHO. We obviously shouldn't copy the American system which doesn't work, but countries such as Sweden, Netherlands, Germany, and France all allow private and public systems to co-exist and have overall better outcomes in health care. Some may say this is morally wrong, but the reality is our system has never been 100% equal. Those with money have always had the option of going south of the border, while third party payers such as the WCB have frequently used private clinics to get faster services for their clients. The important thing here is that there are limits on how many doctors can practice in the private system so as to ensure that we are taking people out of the queue and shortening for everyone, not shortening it for the rich while lenghthening it for the poor. I also believe the private system for medically necessary services should only be about 5-10%, which is already what it is for diagnostic services. In terms of delivery, I believe this should be left to local health authorities to judge on a case by case basis. I have neither a preference for private or public delivery, rather whichever works the best in each scenario should be used.
My next topic will be Childcare.
Federal
Although health care is primarily a provincial jurisdiction matter, I believe the federal government has a role to play here beyond First Nations health care, RCMP, and military. Regardless of what province one lives in, they should all have access to similiar services therefore I support the federal government continuing to transfer money to the provinces. The federal government also has the right to set standards that provinces must meet if they wish to receive funding. Now provinces should be free to ignore those if they wish to forgo the funding. However, there are a few other things I believe the federal government could do. In coordination with the provinces, they should set up a database of wait times for surgeries that normally have long waiting times so patients can see whenver there is an opening in other provinces. They should amend the Canada Health Act to allow provinces to establish a parallel private system so long as the doctors working in the private system operate in separate facilities and work either exclusively in the private system or do a minimum of 40 hours a week in the public system before working in the private system. Punishments on the Canada Health Act should be results based as opposed to legislative based. Otherwise if a province institutes a system that undermines accessibility then they should be punished, but if a parallel private system emerges that doesn't undermine accesibility or any of the five principles, they shouldn't be punished. The federal government should also work with other countries to establish a standard criteria for medical schools, so that foreign trained doctors won't have to go back to training again when they immigrate to Canada and they can begin practicing immediately. We also need to increase the number of doctors by providing more funding to universities for medical school, but also accepting more immigrants who wish to go into medicine. This should be done in tight coordination with the provinces.
Provincial
Provinces should decentralize hospital planning decisions to local health authorities which cover a geographic area that is similiar in its features but of significant size. Here in BC, having 30 regional health authorities was costly and unnecessary, but having everything done by one province wide health authority prevents there from being adequate responses to local needs. Doctors should continue to remain funded on a fee for service basis. Provinces who currently ban the sale of the private health insurance for medically necessary services should repeal this while, like Quebec introduce strict measures to ensure private health insurance doesn't undermine medicare. There should be a wait times guarantee and if a patient goes above this, the province will pay for them to go outside the province, outside the country, and even to a private clinic. Contracting out of laundry and food should be considered if the wages the unions demand are unrealistic, however to keep labour peace, this should be done as a last resort as it had to be in BC, but not necessarily in other provinces. Also more funding should be put into medical schools to increase the number of spaces. All licencing requirements should be harmonized nationally to ensure all medical professionals can freely move between all provinces.
Private Sector
The private sector contrary to myth already plays a large role in health care. Around 30% of health care spending is in the private sector. This is about where I think it should be, but with some adjustments. There should be better coverage of prescription drugs which would reduce the role of the private sector, but individuals should not be prevented from paying for private health care or taking out private health insurance for medically necessary services. Many complain a parallel private system would undermine our public system, but this has not been the case elsewhere. In fact Canada is virtually alone in the developed world in not allowing a parallel private system yet our health care ranks 30th by the WHO. We obviously shouldn't copy the American system which doesn't work, but countries such as Sweden, Netherlands, Germany, and France all allow private and public systems to co-exist and have overall better outcomes in health care. Some may say this is morally wrong, but the reality is our system has never been 100% equal. Those with money have always had the option of going south of the border, while third party payers such as the WCB have frequently used private clinics to get faster services for their clients. The important thing here is that there are limits on how many doctors can practice in the private system so as to ensure that we are taking people out of the queue and shortening for everyone, not shortening it for the rich while lenghthening it for the poor. I also believe the private system for medically necessary services should only be about 5-10%, which is already what it is for diagnostic services. In terms of delivery, I believe this should be left to local health authorities to judge on a case by case basis. I have neither a preference for private or public delivery, rather whichever works the best in each scenario should be used.
My next topic will be Childcare.
posted by Monkey Loves to Fight | 7:05 PM
2 Comments:
Miles, do you think there could be a correlation between there currently being approx. 30% involvement of the private sector, so you cite, and the fact that additional monies into the system have not significantly improved the problems. Perhaps all of the increases in funding are being funnelled off as profit.
I think there is a weak correlation, however most of that 30% comes from services that are not covered by the public system. About half of that comes from the cost of prescription drugs, which I think the government should cover more of, however, the cost here is rising too fast to be sustainable, so a parallel private system would balance this out. It would mean a more comprehensive system in terms of more services being covered in the public system, but those who wish to buy their own health care could do so taking off some of the load. By restricting the number of doctors who can opt out and requiring them to work either exclusively in the private system or at the very least work a minimum of 40 hours in the public system, this will ensure the private system is small 5-10% and acts as a safety valve. What we would have would be no different than what we already have for diagnostic services, but instead expand this to other surgeries.
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