Get creative for health-care revenues

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This article was published 10/7/2017 (649 days ago), so information in it may no longer be current.

Premier Brian Pallister continues to refuse to sign a federal health-care deal, terming it "dangerous, reckless, and risky for the sustainability of health care. Right now, I don’t mind standing alone." I agree, but believe that he should collaborate with new Conservative leader Andrew Scheer. There are four areas needing attention.

National pharmacare program: According to Steven Morgan at the University of British Columbia in a recent study from the Canadian Medical Association Journal, Canada had the second-highest medication costs for conditions such as hypertension compared with nine other countries. Some 10 per cent of Canadians cannot afford to fill their prescriptions. If Ottawa spent $1.2 billion annually to provide universal coverage for 117 medications (accounting for 44 per cent of prescriptions), individuals and private plans would save $4.3 billion per year.

Binding arbitration for physicians: Justice Emmet Hall rejected the notion that government could unilaterally reduce or determine payment to physicians. He termed it "wrongful conscription" of physician services. He added that if legislation prevents doctors from opting out of medicare, it must provide that "when negotiations fail and an impasse occurs, the issues in dispute must be sent to binding arbitration." In British Columbia, Nova Scotia and recently Manitoba, governments have rejected arbitration decisions and neutralized them by subsequent legislation.

If mobile physicians are to be recruited and retained in Manitoba or any province, they must be treated fairly. The Canadian Medical Association in 2013 proposed amending section 12 of the Canada Health Act so as to mandate binding arbitration. In fairness to doctors across Canada, the health act needs to be amended now.

Portability of payments to physicians: Quebec residents enjoy portability of hospital but not physician services, a violation of section 11 of the health act. As no federal health minister has enforced the law, a solution would be for Ottawa to pay physicians directly for all patients treated outside of their home province, just as it does for federal prisoners, refugees (until signed up with a provincial health plan), and, until recently, members of the RCMP. This would cost about $175 million per year — an affordable amount.

Limited privatization of health-care delivery: Unlike Americans, we are fortunate to have a universal public system that covers all Canadian patients, regardless of previous illnesses or recent changes in medications. Surgical and procedural fees are lower, as are administrative and malpractice costs.

However, as provincial deficits rise, hospital global budgets are frozen, forcing them to close operating rooms for weeks at a time over Christmas and during the summer. This lengthens wait times for elective surgery and accelerates the permanent loss to other provinces and countries of skilled physicians, nurses and technicians, who become frustrated with underemployment.

How can we better fund our health system? Certainly provincial governments should not increase their debt; Manitoba predicts a total net debt of $24.8 billion, Alberta expects to double its $45 billion debt over the next three years and Ontario already has a debt of $312 billion. Despite Pallister’s position, an inadequate solution is just to demand increased federal transfers from a Trudeau government already committed to annual deficits of nearly $30 billion.

We should also not simply raise federal or provincial taxes. As Scheer said, "What the prime minister is failing to realize is that when you tax Canadians, they have less money to save for their university education, their first home or for their retirement."

We should be creative. New sources of revenue must be found. If federal and provincial legislation were changed, operating rooms in major cities such as Winnipeg could expand and provide elective surgery 24/7 to American, Chinese and other foreign patients. When a joint replacement in New York or Boston costs more than US$70,000, but only C$18,000 in Laval, Que., and with a 77-cent Canadian dollar, the less-expensive care in Canada should be attractive to U.S. insurance companies and for medicare patients.

Moreover, according to New York Times, mainland Chinese patients took 500,000 outbound medical trips last year — a fivefold increase from a year ago. Most were to U.S. hospitals for surgery and, occasionally, cancer therapy. These patients could come to Canada for less expensive treatment.

We can take pride in a universal health-care system that Americans — due to powerful lobby groups — will likely never enjoy. Yet it desperately needs reform.

Ottawa physician Dr. Charles Shaver is chair of the section on general internal medicine of the Ontario Medical Association.