Europe as Private Health Care Model? Not Again!
Strap in for another wish-fulfilling 'fact-finding' tour.
Frequent flyer: Dr. Robert Ouellet, president of Canadian Medical Association.
It's déjà-vu all over again: Dr. Robert Ouellet, president of the Canadian Medical Association, is setting out on a "fact-finding mission" to learn about European health-care systems, specifically their private insurance and their for-profit delivery systems. All of this to fulfil his wish for the private sector to provide "complementary support" to Canada's universal health-care system.
But if he really looks at European health-care systems, what is Dr. Ouellet going to find?
He will find that with few exceptions, European nations spend more on publicly funded care than Canada. In Canada, governments pay for 70.2 per cent of all health services compared to 83.6 per cent in Denmark, 79.9 per cent in France and 87.1 per cent in the United Kingdom. This is because many European systems cover more services, including medications, dental services, eye care and home care.
He will find systems with less emphasis on unproven high-tech diagnostics and specialty care and more emphasis on robust primary care networks and ensuring community-based access to family doctors, nurses and nurse practitioners. He will find that few countries in the world pay their physicians as much as Canada, which is why they can afford to have more doctors.
Are these the lessons the CMA is setting out to learn? Or are our medical leaders simply looking for another way to promote more commercialization in health care, by twisting the ways in which private insurance and corporate for-profit delivery would meet their own agendas?
Canada needs its own model
And where do the European models fall short in terms of helping Canadians with the problems we face?
Europe has little to teach us about improving access for geographically dispersed Canadians in a huge land, and even less about providing health care to First Nations people, who have among the worst health outcomes in the country for complex reasons, none of which would respond to health-care commercialization.
Furthermore, greater involvement of the private sector would do nothing for Canada's rural communities, nor for the 4 million Canadians, many of who are lower income, who do not have a family doctor.
Access to primary care is among the best means to promote healthy living and prevent diseases such as Type 2 diabetes and certain cancers. Community-based care can also reduce emergency-room queues and hospital wait times considerably. Last year, the Health Council of Canada reported that 41 per cent of people with chronic illness seen in Canadian emergency rooms had a problem that could have been addressed by a family physician, had one been available.
Introducing alternative networks of private for-profit care would further jeopardize those who do not have access to a family doctor. With roughly one family doctor for every 1,000 Canadians, how can any approach that encourages doctors to spend precious time providing boutique services to the wealthy possibly improve access for the vulnerable or even the middle class?
What's more, for-profit delivery costs more than non-profit delivery. Can we really expect Canadians or provincial health authorities to swallow higher billing costs from the private sector in the midst of an economic downturn?
Making our system better
What is needed instead is a made-in-Canada approach to training health professionals for communities in need. Our medical education system is beginning to re-orient itself towards social accountability rather than simply continuing to train more specialists for urban centres. Canadian medical schools are working to increase their enrolment, with UBC doubling its numbers in the past five years, and enormous work is being done to recognize the credentials of internationally trained physicians.
Initiatives at the Northern Ontario School of Medicine and elsewhere are designed to train doctors for rural communities, and to work in interprofessional teams. Changes to admissions policies that select students more likely to choose generalist careers can also help.
But the impact of commercialization on medical education can be extremely detrimental. Private corporations are interested in making profits, and learners slow down throughput. The Canadian Federation of Medical Students has stated that with increased privatization, "practices may face disincentives to provide the time and resources necessary to deliver quality training for future health-care practitioners. This would come at a cost not only to the quality of education achieved by Canadian health-care graduates, but would impact the quality of health care delivered in the future to Canadians."
We hope that the president of the CMA can appreciate that Canadians want solutions to problems like wait times and doctor shortages -- solutions that are consistent with Canadian values. Perhaps he will focus on the lessons he can learn from Europe that reinforce medicare rather than finding ways to advocate for more private-sector involvement, an option Canadians keep rejecting but that is offered to them over and over by those who have something to gain.
Related Tyee stories:
- Europe's Health Reforms: Hard Lessons (series)
An investigation into health care reform issues in European countries Premier Campbell visited in 2006. - Gordo's 'Conversation' Takes Surprising Twist
Public health care endorsed at Vancouver Board of Trade event. - BC Health Spending Exploding? Don't Believe It
The real story is a provincial budget skewed by deep cuts to welfare, local government and transportation.
![[Tyee]](http://thetyee.cachefly.net/ui/img/ico_fishie.png){kind=small}
Van Isle
10-11-2008
Back a number of months ago
Back a number of months ago PBS had a program on health care in Great Britian, Germany, Switzerland, Japan, on Taiwan. The whole theme of the program was about how those countries changed from a system that was failing and on how they fixed it. Taiwan was the one that got my attention; they sent out their wise and learned people to the world and were told to come back with a medical system that would work for them. Just guess what country was the model that those wise and learned people wanted to adopt, of course with some variations? Why Canada, of course. Taiwan implemented the new system and is working alot better than what they had before. Now the thing that stuns me is that we had a very expensive study and report done a number of years ago on how to fix our system for Canada and it's being ignored; Why?
BC Mary
10-11-2008
Canadians do it better so stay home Dr Ouellet
One of my rels, with a Canadian Ph.D. in Public Health Policy, is constantly on speaking assignments to every corner of the world on the subject of Public Health policy.
Why do you suppose that is ... because Canada is so bad at what it does? Nope, I don't think so.
Dr Ouellet is fooling nobody with his European junket. He should be embarrassed, to be taking money from the Health Care system and throwing it away on his ill-considered voyage of discovery. What a negative message for the doctors and nurses working here.
I would think better of the silly man if he changes his mind and decides to tour within Canada , determined to build up confidence, teamwork and efficiencies within the system we have.
SharingIsGood
10-11-2008
Romanov report
Van Isle, you asked why the expensive [Royally Commissioned] report is being ignorred.
For those who cannot remember its name, it is: "Building on Values: The Future of Health Care in Canada – Final Report"
Published in 20002, it can be found by cutting and pasting the above title into your search engine or by going to:
www.cbc.ca/healthcare/final_report.pdf
Personally, I think Romanov was such a popular guy that this was a way to keep him occupied thus giving the public the impression the government wanted to improve health care. It is my hunch that those involved in Federal politics did not want Romanov to throw his hat into the Federal ring - they could kill two birds with one stone! I have never heard a government comment upon it since it was published. The report (like Romanov) has been left to wither by both, the Liberals and the Conservatives!
canuck
10-11-2008
shuffling off into expensive
shuffling off into expensive institutional care.
What's needed for Canadian seniors to stay healthy is be in their homes with community care access centres (CCACs) attending to their needs. However, the problem currently with CCACs is they're top heavy with administration and don't pay caregivers a reasonable wage. Nor are the same caregivers sent to the same home. Caregivers aren't trained and often don't speak English. CCAC cheats seniors from quality care just as the system understaffs long-term care facilities that are dirty. Hire fewer administrators and more attendants!
Most seniors want to stay in their homes, if possible, cook their own meals or at a minimum have access to Meals On Wheels. Seniors with higher needs do need attendants to come to bathe them and tidy up their living quarters. It's much cheaper for governments to provide services that allow them to stay in their homes than have seniors wasting away in long-term care facilities. Why is the most expensive solution always sought?
canuck
10-11-2008
Oops ...
beginning paragraph should read, "And Canadian seniors don't want shuffling off into expensive institutional care."
margot
10-11-2008
unproven high-tech diagnostics
Martin and Huish mention my pet misgiving about health care in Canada: far too much use of woowoo machinery, often when an educated glance would suffice.
Their claim, that Robert Ouillet "will find systems with less emphasis on unproven high-tech diagnostics", is worth a piece on its own. I think we over-use gamma cameras, we have far too many, and I have yet to read anything credible about what happens when Tc-99m's six hours are up and it is Tc-99 with a half life of hundreds of thousands of years. It does not go away. It can lodge, emitting beta-particles, in patients' bodies for far longer than six hours, and then it's in sewage, where treatment does nothing to alter it all. And then? How long can this process be used before certain lakes etc. are in trouble.