Premiers lack consensus plan to fix for soaring healthcare costs - Macleans.ca
 

Premiers lack consensus plan to fix for soaring healthcare costs

But they agreed that the ailing system needs to be improved


 

Canada’s 13 provincial and territorial premiers met in Winnipeg to address soaring healthcare costs and how to fix the healthcare system in Canada. But while they agreed the cost of healthcare is unsustainable, the way to go about fixing the ailing system is not so certain. “This is an elephant in the room for all of us,” said Quebec Premier Jean Charest. Some governments are currently spending around 40% or more of their total annual budget on health care, making it difficult to find money for education and other social programs. British Columbia Premier Gordon Campbell agreed healthcare costs remain “a significant issue” that must be addressed for future generations, and urged putting more money into preventive care, but also said adopting user fees to cover the costs of treatments and drugs is not acceptable. The premiers meetings come just after a new report from Canada’s doctors called for the country’s health system to be “massively transformed.” The policy document from the Canadian Medical Association said the principles of the Canada Health Act are not being met and must be updated.

National Post


 
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Premiers lack consensus plan to fix for soaring healthcare costs

  1. I find it odd that the premiers couldn't even reach a consensus for the federal government to cut them all a large cheque. That's usually an easy consensus for the premiers to reach.

    • For they all know that no amount of increasing health care budget will solve this problem. And as they all lack political courage to face the backlash if they put a solution that makes taxpayers and patients take a portion of responsibility on their health, they rather keep mum and just go on merrily along until we hit the bottom of the cliff (by then it is someone else's responsibility).

  2. Let's keep cruising along towards failure and bankruptcy until there's no choice about what we has to be done, that's so much easier than voting for politicians who will do something about it. None of these squishy liberal Premiers are willing to go against media-savvy special interests, so we'll all just open our wallets wider for them.

    • So which party will get your vote: the one that raises taxes or the one that cuts health care services?

      • Well, the one that cuts the bureaucratic waste within health care; there is more than plenty of it.

        • You figure there's enough to be gained through enhancing efficiency to offset both the currently monumental costs, and the projected cost growths that are potentially limitless? Where's the evidence of such excessive waste?

          There's always room for improvement, but it's a tired old neocon-type argument used to support promises of simultaneously holding and consuming one's cake.

          Cut services or raise taxes? What's it gonna be?

          • > Cut services or raise taxes? What's it gonna be?
            That is a false dichotomy.

            To see that there could be other ways than the two presented here as either-or, all one needs to do is talk to people who are employed in health care, and listen. It is not about "enhancing efficiency," but about cutting waste, bloat, and greed.

          • I'm listening – expand on that a bit…

          • Also interested to read more from Predneril……

            And I'll suggest that to "solve" the health care problem, we will need to:

            – pay a little more,
            – receive somewhat less, and
            – cut "waste, bloat and greed".

            The "receive somewhat less" action needs to focus on activities that are costly AND don't actually really affect outcomes; those will be very tough decisions.

            And I suspect the last part won't actually be so much about finding intentionally wasteful or greedy activities (errors of commission, so to speak), but more about changing the way activities are done and by what type of health care worker.

          • Also interested to read more from Predneril……

            And I'll suggest that to "solve" the health care problem, we will need to:

            – pay a little more,
            – receive somewhat less, and
            – cut "waste, bloat and greed".
            > The "receive somewhat less" action needs to focus on activities that are costly AND don't actually
            > really affect outcomes

            Agreed.

            > those will be very tough decisions.

            How to go about them, I wonder.

            > And I suspect the last part won't actually be so much about finding intentionally wasteful or greedy > activities (errors of commission, so to speak), but more about changing the way activities are done > and by what type of health care worker.

            Why speak we not of patients, orderlies, nurses, doctors and so on? "health care worker" is a newspeak term, and like a grey fog it is too; it hides the nature of things.

          • Just to lazy to type out "patients, orderlies, nurses, doctors and so on", but there, now I've done it. ;-)

            Do you have suggestions wrt going about the tough decisions associated with receiving less?

            I used to subsribe to a theory that 80% of health care costs are spent in the last x months of life, where x varied (dependant on source) from ~2 weeks to 4 months. That would make end of life care an (unavoidably) obvious target. But then I did some research and could find very little real info to support that claim. The closest I got was a study from The Netherlands that seemed to be suggestive of a slight skewing, but not anywhere near as significant as those older sources.

            What say you?

          • I say that the worth of a society is measured by how well it cares for its elders.

          • the worth of a society is measured by how well it cares for its elders.

            So are you also saying that end of life care is the one area where you wouldn't propose any service reductions?

            Are there no opportunities to shift to better palliative care and away from "interventions"?

            Does it sound plausible that end of life care consumes "more than its share" of the health care dollars?

            If so, are you aware of some studies that have quantified the magnitude of the imbalance?

            If so, can you provide a link or two?

            Thanks muchly.

          • There might be a good argument to be made on families taking care of their elders. If tax credit and monetary support will be provided for those who take care of their elders, it will free more resources and spaces in senior's home and long term care institution for those who most need them.

          • Which will be funded by.. what? Remember, tax credit and monetary support isn't just magically created by the government.. it has to come from somewhere.. either debt with associated interest, or by the government raising taxes or cutting other programs.

          • Predneril is absolutely correct. Costa Rica, for example, plays hosts to some of the longest living people in the world as well as the happiest people. These are not mutually exclusive concepts. "Retirement homes" do not exist in Costa Rica. When parents become elderly, they move back in with their children — they are family oriented people, and do have children as a general rule. They do not lounge about awaiting death — they participate in the household, family life, and family decisions. They are not shipped out of sight left to die in the company of strangers. I'm speaking in generalities, but I hope you understand my point.

            Retirement homes serve their purpose in terms of the mentally insolvent or invalid. I don't expect regular folks to take care of their parents who have debilitating health issues. But that is where it should end.

          • I agree with you. In many countries like Costa Rica, Japan, and others, respect for elders is taught and ingrained since childhood.

          • Gotcha. So.. you folks have a plan for changing our entire culture in the next 10-15 years?

          • If the study of countries which are among the top of the list when it comes to efficiency in delivering health care, is accurate, then we Canadian have been paying way more for way less. Just a few among the many reasons, which my myopic eyes could see, why this is:

            1) Ignorance among us all in how much tax payers are on the hook for each visit made to
            Doctors and hospitals.
            2) More emphasis on expensive diagnostic tools but less on treatments/cure.
            3) Less education on Preventative measures
            4) Pushing unnecessary drugs wich causes many side effects which are worse than the original illness (Aspirin is an example among many). I have seen many seniors and to lesser extent younger people carrying many prescription drugs (a walking pharmacy).
            5) Procedural complexities which cause more money spent on administration than on patient
            care.
            6) Patients' irresponsibility. As people think that hospitalization is free, taking care of one's health is not a priority. People are more concern about the health of their car and properties than their own body. If a yearly cap is made on "free" physician's visit, then people might start thinking in taking care of themselves and save those visits for when it is actually necessary. If a yearly cap has been reached/used then patient needs to pay his/her own way to the doctor. As for hospitalization, there should be a limit on number of expensive diagnosis (like MRI, CT Scan) a patient can have in a year. After the patient reached it's yearly limit, then he/she will pay portion of the cost. And like Car Insurance, if one has not used one's limit per year, this can be carried over to the years when one will need it the most.

            Patients, responsibilty and awareness has to be part of the equation when making changes for health care, otherwise health care will be a bottomless pit.

          • People are giving you thumbs down for your intelligent, frankly worldly comment. Sometimes I don't understand this website.

            Canada spends more money on healthcare in comparison to other countries with "universal healthcare" and isn't doing so efficiently. Is this in contention? I would add to the list the fact that healthcare is accessible to people who have never and will never put money into the system as a whole as a huge problem as well. When 19% of all immigrants are skilled workers and the rest are part of "family reunification," there is a question as to whether these family members are working — or are even expected to work within their cultural framework.

          • It is quite understable when the truth is too painful to swallow.

          • Go see yourself, do the legwork.

            If you'd like to start from the iceberg tip, try this, for example: http://www.cbc.ca/canada/calgary/story/2008/07/17

            If you'd prefer to start from the bottom, begin with how much (electronic) paperwork are nurses required to do instead of nursing. Then look at the various, numerous levels of "leaders" providing "leadership."

          • Too many economists and other business-trained bureaucrats infesting the administration of health care; not enough health professionals doing the real work:
            http://torontoemerg.wordpress.com/2010/08/02/thre

          • If we keep labeling and excluding people's idea because of their election choices, no serious resolution will reach the table. Can we discuss things and welcome each other's idea and concerns as valid no matter which party one voted?

          • Giving us 2 choices only? Are we that mentally deficient? Can we think outside that so small a box?

    • Any workable solution will not be popular among the voters, that is why primiers breath a sigh of relief for not reaching a concensus on health care solutions. They will be voted out if they do, no one is brave enough to lose their future pensions and popularity to do that. What they are doing right now, is just tinkering, hoping they will appease the voters for at least having shown the appearance of doing something. A year from now we are back to discussing the same worsening problem

  3. Everyone paying 5-10% of costs – no exceptions – capping out at $500 or $1000 bucks would instantly produce efficiencies and save the health care system.

    • Is there a study or two that you can point to to back up this claim, or is it more of a gut feel?

      I ask in an effort to become better informed…thanks.

      • I think it's pretty simple. There are many Canadians who don't put into the system because they do not work, are not legally in the country but still subject to health benefits, or are family members of sponsors who cannot work (ie. elderly) or will not work for cultural reasons (ie. women). If everyone was paying $20 for every visit to the doctor's, it would decrease abuses of the system (doctor note fraud) as well as ensure the generation of healthcare costs.

        • Health care fraud is just one among many problems facing the system. Our health care cards do not have a picture. Any visitor who is staying with a family/friend here can visit a doctor using someone else's card. If like the drivers license card or passport, we each one pays for health care card application/processing and renewals, we might probably avoid adding to administrative costs and solve identification problem as well.

        • Like you, I suspect that there are Canadians who are not earning an income and therefore not paying taxes. And I'm also confident that many or most of those people will use the health care system at some time.

          But I would still be very interested to see some actual figures to confirm those suspicions. I do wonder if this is another one of those 80:20 rule situations; if it is then reducing the number of visits to the doctor to deal with a "runny nose" won't be as effective as we hope.

          Have you seen some studies or other hard numbers that show how many non-contributors make use of the health care system? More importantly, how many visits to a family doctor are truly without value? If we introduced a user fee of $20 per visit, do we know about how many no-value visits would be eliminated? On the other hand, about how many needed visits might be delayed, resulting in higher costs later on?

          I'm asking because at this stage I only have suspicions, and I wouldn't be comfortable implementing a $20 user fee without some hard evidence to show the magnitude of the net benefits.

          • I really do not know about user fees, whether it is enough to solve problems. In BC, residents (except those whose income are below the cap) are paying monthly health premiums and yet it is still facing problems. There might be those who have serious concerns and might be discouraged to visit the doctor until it is too late, if user fees are introduced, specially among those with low income or none. This is just a suggestion , you and others may have better ideas than what I am suggesting,and we would like to hear those too. As for me, I thought why not have a yearly cap on doctor's visits. If the yearly cap has been reached, then patient pays his/her own way. However, if patient has not used the yearly cap, then those unused visits will be transferrable to future years when he/she needed it most. As for health care delivery we should study those countries that do better and spend less than us, and apply those solutions where it is applicable. No one solution is enough, I think a multi pronged approached will have to be looked at in order to slow down this crisis.

          • Sorry the above posting is in response to Phil.

          • So you're saying that people with long-term or chronic diseases should be S.O.L? That a poor person with cancer has less of a right to live than a rich person? Interesting.

            There are no countries which both do better *and* spend less than us — not if you include the private expenditures as well. There are some that do better. There are some that spend less.

          • Where do you get that generalization from my comment? Are you just trying to score a point or do you really have some suggestions to put on the table? Why not suggest it ? Caustic remarks do not really help resolving problems. What I am suggesting is a yearly cap that is still to be determined and has to be researched as to how many per year. Probably if they could increase the cap for older people and exempt those with terminal illness… there is nothing written in stone. Reading your comment, it seems you are suggesting a business as usual? And believe me, people do not realize what crisis our health care is facing right now. You probably are one of those people who believe that it is still there, so it might be doing okay, so why not leave it as is?

          • I'm sorry, I was unaware one needed to have a correct answer in order to point out an error.

          • You are just being obtuse. I do not need nor interested on as you say "correct answer", but would appreciate for your suggestion as how you go about solving the problem.

      • Generally we value more the things we paid dearly, and take for granted what can be freely had.

        • Do you have any evidence for that?

  4. a lot of people already look up all their symptoms online ..why don't they leverage technology to save money ..also one way they will save money is directing you to a nurse rather than a doctor for less serious problems ..similarly pharmasists will also do things doctors used to do .. in the united states some companies even outsource some of the work to other countries ..like somebody in india can read the x-rays .. that wouldn't fly in canada's provincial systems due to the ideology of the system

    • We already lost so many jobs to other coutnries. I believe there are a lot of ways to save money without outsourcing it to other countries.

  5. There are many procedures which include diagnostic protocols and treatments done in hospitals that are not necessary. No matter how public our system is, you can not rule it out as partly business. Doctors are paid for each procedure, reports, prescription, refills, and patients/ visits. It is one of Canada's biggest private enterprise inside a public funded program.

  6. Others say we spend less on public health care than most countries. Where are the facts?

    "…The CMA's apparent shift away from privatization, and toward a more constructive dialogue with Canadians about how to improve medicare, will be welcomed by many physicians and our patients. Now that the CMA has recognized that the principles and values of the Canada Health Act provide the most efficient framework for delivering accessible and quality health care, on to the hard work of improving medicare!…"
    http://www.thestar.com/article/844530–cma-s-welc

    • You could see the study done most recently about countries that excell in delivering health care, Canada is lagging behind many countries that spend lesser ( According to "The World Health Organization's ranking of the world's health systems in 2000" We are actually number 30 in ranking not even in the top ten. In 2008 Reuters' issue, Canada is number 6, ahead of us is France, Japan, Australia, Spain, and Italy. Among those top 6 countries, Canada spend more than those top five countries.

  7. Healthcare is like any other industry. Competition is the only thing that can save the system. In the age of demographic decline, which some say is caused by our nanny state healthcare system, and the baby boomers our current system is not just "unsustainable" it goes against the natural laws of the universe. We need a system that is almost completely private with maybe some subsidies here and there. If our society is to last, we seriously need to get real. Survival of the fittest, its natures law… why is it not ours?

    • Healthcare is not like any other industry. There is no regular supply and demand curve. You're not going to stock up on heart surgeries no matter how cheap they are if you don't need one, and if you need one, you're not going to hold off on getting one just because the price seems high.

      Nature's law isn't ours because we've got enough brains that we don't have to let it be that way, and if we're smart, we won't.. because nature doesn't give a crap if we survive or not, and evolution tends to direct us toward the short-term benefit, which can doom us over the long term.

  8. A small deductible to be paid at the time of your visit to the clinic would be a good start.

    • I am afraid that any solution that involves patient responsibility will not be popular. Knowing this, can we really blame the primiers for backing out and opt out for status quo?

    • Dumb move. Health care is a public good for very simple reasons:

      Disease doesn't care if you have insurance.
      It's cheaper to cure diseases they earlier they are caught.

      If your neighbor gets sick and doesn't treat it because he can't afford the deductible, that increases your chances of getting ill. And if you get ill, then that will affect you even if you do have insurance — lost productive time and higher insurance premiums are generally a result. It also increases the total amount that needs to be paid to cure the person — something which, if the system has a public funding component, affects all of us.

      • So, what is your suggestion?

        • Fund our health care system on par with other countries.

          • Studies after studies from World Health Organization to studies on Health care system for industrialized countries, Canada is one among the top ten in health care spending, but when it comes to efficiency and delivery, we lagged behind other nations that spend way lesser than us. In short, we are already spending more than other countries. It would really be dumb to ask for reduction of funding just as you say " to be on par of those countries".

          • Here's some real stats: http://www.who.int/entity/whr/2000/en/whr00_annex
            So yes, what you say is technically true — we're one among the top ten in health care spending.. barely. We're number 10.

            However, we only lagged behind 6 other nations in overall goal attainment. And of them, only 2 spend less per capita than we do.

            Japan was number one in overall goal attainment but 13th in spending per capita, and Norway was 3rd place in goal attainment while being 16th in spending per capita. Meanwhile, Canada is 7th in goal attainment and 10th in spending per capita.

            Remember when you look at the single number ranking, where Canada comes in 30th, that ranking includes the WHO weighting system where they compare where they are with where they think we should be given our resources.

            Of the other countries that rank higher than us in goal attainment:
            France: 6th in attainment, 4th in per capita. More money = better attainment. Go figure.
            Luxembourg: 5th in attainment, 5th in per capita. More money = better attainment. Go figure.
            Sweden: 4th in attainment, 7th in per capita. More money = better attainment. Go figure.
            Switzerland: 2nd in attainment, 2nd in per capita. More money = better attainment. Go figure.

            So hey.. unless we're willing to change our system wholesale (as the Japan and Norwegian systems are considerably different) perhaps we ought to try the easy way first and put more money into the system we have.. who knows, maybe economies of scale will push our system beyond those of even Japan and Norway.