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Doctors can, and do, work in both public and private systems
From Thursday's Globe & Mail
August 2, 2007
by Gary Mason
VANCOUVER - So Tony Clement is against doctors working in both the public and private health care system. That's interesting. It wasn't that long ago that the federal Health Minister was whistling a different tune.
Back in 2002, when he was Ontario's health and long-term-care minister, Mr. Clement appeared before the Romanow Commission On the Future of Health Care. Then he was calling for a public health care system that was publicly funded but open to the delivery of services by private providers.
Mr. Clement said the Ontario government supported the Canada Health Act but believed more "flexibility" was needed to ensure its sustainability, which is exactly what the Canadian Medical Association called for this week.
Today, however, Mr. Clement no longer believes in a public health care system that is complemented by a private one. He questions how you improve access to doctors who are spending part of their time inside the public system and part of their time out of it. The fact is doctors in Canada already do work in both systems to the benefit of many of us.
People injured on the job and covered by Workers Compensation can go straight to a private clinic to be treated by a doctor who works in both systems. So can Mounties, members of the Armed Forces and federal inmates. The B.C. government, meantime, has contracted out thousands of operations to private clinics staffed by doctors who also, and mostly, work in the public system.
It's happening all around us.
Britain has recently reformed its health care system. While remaining committed to a healthy public program, it is using private clinics to make it better. It has contracted out thousands of operations to these clinics to eliminate waiting lists, which it hopes to do completely some time next year. More important, I think, is the business focus Britain's National Health Service has brought to the relationship between hospital and patient. We should be paying attention.
The patient in Britain is now viewed as a consumer whose business is sought by hospitals. Hospitals aren't given a set amount of money each year by government the way they are in Canada. Patients are their source of revenue. If hospitals want more money they have to do a good job of attracting patients. Or at least a better job than the hospital down the road offering the same services.
What a concept.
In Britain, if you are someone needing a knee replaced, you go see your doctor who is obliged to give you at least four different options in terms of hospitals where you can have the surgery performed. The patient is able to review how the hospital is performing, against its competitors, in a number of critical areas.
For instance, the patient can compare hospitals on their records for cleanliness, rates of hospital-acquired infections, fee schedule and probably most importantly, waiting times. They are even rated on things as mundane - but important to some - as parking availability.
Reforms to Britain's health care system have brought market forces to bear on the business of medicare. They haven't gutted the public health care system or made it more U.S.-style. What they have done is brought in a measure of accountability which, in turn, will make hospitals more efficient and help them - no, force them - to deliver better service.
Canada's system of funding hospitals is what has led to the severe rationing of surgery time for doctors. And that, in turn, has created an exodus of some of our finest surgeons to the United States and elsewhere.
According to Brian Day, the incoming president of the Canadian Medical Association, half of all newly trained orthopedic surgeons and neurosurgeons leave Canada within five years of graduation because they can't get enough work here. So we train them here and allow them to take their expertise elsewhere.
The federal Health Minister appears to believe that is preferable to allowing them to stay here and work in publicly funded private centres.
Apparently he thinks the health care system in this country is just fine the way it is.
© Copyright 2007 CTVglobemedia Publishing Inc. All Rights Reserved.
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