two-tier health care?

[electricland]

Top court strikes down law forbidding private clinics

I'm not sure how I feel about this.

On the one hand, I don't think that allowing private clinics is going to spell The Grisly End Of Public Health Care As We Know It. (As the product of a private high school who believes passionately in public education, it would be fairly hypocritical of me to claim this, anyway.) I think there's a finite market for private care, and I don't think that it will necessarily siphon all the best doctors out of the public system. Nor do I think it's inherently wrong for people who can afford it to take themselves off the waiting list and get faster care. (If they were paying to go to the head of the line and bumping everyone else down, that would definitely be wrong.) That said, I don't know as much about the parallel public/private health care system in, say, Britain as I would like (blame the obsessive U.S.-Canada mutual navel-gazing tunnel vision that our media and commentators seem to suffer from on this issue). Can any Brits enlighten me? Has the NHS gone to hell in a handbasket because of private health care?

On the other hand, I am depressed that it's come to this. I don't believe that there are any inherent problems with the public system that make it unworkable and doomed to failure and years-long waiting lists. I believe that it should be possible to fix the system and shorten the waiting lists and get everybody the care they need without having to resort to private clinics. Lots of people have studied the issue and made recommendations; I wish the powers that be would lighten up a little and try some of them.

Comments

[briasoleil.livejournal.com]

Klein is going to have a field day with this. *headdesk*

[mrs-cake.livejournal.com]

I'm not a Brit, of course, and I haven't had to see any specialists or even dentists yet (*touches wood*), but the impression I get is that, with the chance to go private, many doctors do. Simply because it's more lucrative. Consider that some people drive 2 hours to see their NHS dentist, just because no NHS dental practice closer to home can take them on. Do you remember the pictures of 300 people queueing (spelling?) outside a newly opened NHS dent. pract.? Desperate because private care is so expensive.

I don't think there are any qualification issues, and I honestly believe that NHS doctors are "better" (simply because I don't really trust doctors who "do it for the money"). However, private care does have the advantage of shorter waiting lists, and if I ever had something serious going on I'd want seen to, I'd be at a private practice like a shot.

The worst bit in Britain is that some specialist areas aren't even represented in the NHS. Like osteopaths. Or even gynaecologists! Well, the latter are there, but only when you're half dead, have cancer, or are pregnant.

For most things here, you see your GP. If it's urgent, you go to A&E. If it's something specific, you pay. Loads. But then...private care is supposed to be excellent over here. But so is the national service, as far as I know.

This inane blabber brought to you by a tired German. Any questions? ;)

[electricland.livejournal.com]

oyyy. he is, isn't he? ouch.

[electricland.livejournal.com]

Oh dear. This does not sound like a situation we'd want to find ourselves in.

[raithen.livejournal.com]

well, osteopathy isn't in the public system, here, either. You pay for it out of pocket, and osteopaths aren't always easy to find. And getting to see a specialist - like a gynaecologist requires a referral from your GP, and a sound reason for the referral. And often, a fairly long wait. So the GPs still handle as much as possible. But the system, with all its flaws, has some great features. It'll be interesting to see the impact of this change.

[lilactime.livejournal.com]

I don't think that it will necessarily siphon all the best doctors out of the public system.,

It's not about quality but quantity. Most areas of medicine in this country are understaffed, which means you've got to take doctors out of the public system to work the private system, Then the public system is going to suffer until you ensure there are enough doctors and nurses to treat the people in that system in a timely manner. Until the provinces bring staffing levels up to reduce wait times, it sort of *is* like the private clinic patients get to bump everyone else to the back of the line.

In fields where there are plenty of doctors to treat the patients, I don't have a problem with it. But that's a rare occurrence.

[electricland.livejournal.com]

Excellent point. (Although, if they're that understaffed, perhaps there wouldn't be enough people able/willing to pay for private care in the area either? It would partly depend on whether doctors are allowed to be part of both systems or have to choose one or the other, I guess.)

Either way, I do think the system could use better organization.

What ticked me off about the CBC's report this morning was the reporter going on about how nice the waiting room was and how there were free granola bars for patients and... come on, people. That has NOTHING to do with who's reimbursing the doctors for care.

[life-on-queen.livejournal.com]

What concerns me is the reaction of groups like the Canadian Taxpayers Federation:

"This is the end of medicare as we know it," said the federation's John Williamson. "This is a breach in government monopoly health care in this country."

Why would you want to breach Medicare? I have always gotten excellent healthcare, which afforded me reasonably prompt access to specialists and tests when I had a serious health crisis. Admittedly, I live in Toronto, which does improve my access to healthcare. But from my admittedly lay perspective, the two major crises facing Canadian healthcare are a shortage of doctors, particularly doctors willing to practice a) outside of major metropolitan areas and b) willing to go into general practice and less 'glamorous' specialties like anestheseology (I don't think I spelt that right). The second is major inefficiencies in the current funding formula and healthcare delivery model. We need more clinics, more operating rooms, and more innovation.

Private care might take the weight off the public system in some cases but, from what I know of the British experience, private hospitals don't reduce wait times because they complicate rather than ameliorate staffing shortages. There's not going to be any reduction in the wait time for average patient A in the public system if the public system still doesn't have enough anesthesiologists to operate enough operating rooms to do the surgery. So average patient A either has to pony up for a hip replacement now, or buy what is likely to be prohibitively expensive private insurance.

I say situations like this is why we have the notwithstanding clause.

[raithen.livejournal.com]

That has NOTHING to do with who's reimbursing the doctors for care.

well, actually, yes, it kinda does, because private practitioners set their own rates, and therefore can factor in the cost of nicer premises and "free" granola bars. The patients pay for these things. With a public system and prescribed fees, doctors may WANT to offer things like this, but can't factor the costs back to the patients and so must pay for them out of pocket, and greed being a fairly common motivator, they don't want to.

As well, the private system, to attract patients, needs to show some "value added" from a marketing perspective. They offer nice premises and granola bars because these things encourage patients to come to them and part with their money, instead of going to the doctor down the hall who is free, but who doesn't have the granola bars or the comfy chairs....

[texaslawchick.livejournal.com]

The specialty hosptial moritorium is a nice parallel in the US. General hospitals have to deal with all patients that show up, and physicians end up being undercut to some extent, especially in the surgery departments, when they have to write off unreimbursed care. So physicians have been building specialty hospitals all over the country, which siphons off a lot of the cash revenue from the hospitals (since surgery actually makes money) and leaves the general hospitals with the non-profitable services, thereby making the general hospitals even less profitable than they were before. The hospital association plead their case to Congress when they were arguing the Medicare drug act two years ago, and Congress imposed an 18 month moritorium on building specialty hosptials. That moritorium is ending soon, and it's unlikely that Congress will be able to extend it, even though a lot of organizations, including the Medicare Payment Advisory Commission, think that it harms patient care in the US by weakening general hospitals. Last I heard, there are at least six or seven hospitals here in Houston that are just waiting for the moritorium to end. Some are acting as ambulatory surgery centers until the moritorium is lifted.

Hear more about it http://www.npr.org/templates/story/story.php?storyId=4224831

I'm torn, because I understand why we should keep general hospitals going, but I also understand physicians' frustration with dealing with the hosptials.

(Note: all physicians aren't on the same side on this one. Emergency room and family physicians are definitely interested in keeping the general hosptials strong. Surgeons and anesthesologists are more interested in heading the specialty hospital route. I think that the larger hospitals should assist the physicians in building the specialty hospitals, go into joint ventures and everyone comes out ahead.)

[monkeycommando.livejournal.com]

The standard counter argument is that some privatization will solve the shortages more quickly because there will be a greater incentive to stay working in Canada, instead of moving to the States.

I don't see why there's any need (theorhetically) for public medicine, as long as there is universal public health insurance--which is why the Quebec court case is so confusing to me.

[electricland.livejournal.com]

v.v. good point.

but not one that the reporter was making, alas. :(

[electricland.livejournal.com]

Interesting -- I didn't know about this issue.

Sort of the flip side of something that came up earlier this year, where a surgeon in Ontario was upset because cosmetic surgeons were doing private operations in his hospital and paying the hospital a pittance for room and equipment rental, staff time etc., while other patients who NEEDED operations were kept waiting because of shortages.

Again, I always feel quite strongly that there SHOULD be a way to make the system fast, efficient, and equitable for everyone. I don't see why we have such a hard time implementing this...

[electricland.livejournal.com]

Amen.

One other point to consider is that a certain amount of waiting time is actually desirable sometimes -- it shows the system doesn't have huge amounts of wasteful excess capacity. I'm not sure we're at that point at the moment, unfortunately, but I always try to keep it in mind when commentators compare U.S. and Canadian waiting lists -- I gather the U.S. has a lot of overcapacity in the system and its facilities sit idle a lot of the time. Which you'd think would lower the prices, but it seems not.

[electricland.livejournal.com]

yes, I'm not quite clear on what the Quebec clinic is trying to achieve, either.