Tuesday, 25 March 2008
Public Sector Solutions – Not Private Sector Profits!
Nova Scotia’s publicly-funded and publicly delivered health care system is being threatened by proponents of for-profit health care and health insurance. To protect our health care system, we call upon the provincial government to demonstrate its commitment to public health care by introducing new legislation to stop privatization in its tracks.
This spring, the Nova Scotia Citizens’ Health Care Network is traveling across the province, with stops in communities from Yarmouth to Glace Bay. Our goal is to raise awareness about the dangers of private, for-profit health care and to push the provincial government to prepare and adopt new legislation to protect public health care.
To protect public health care the provincial government must:
Amend the Health Services and Insurance Act to:
1. Enshrine the principles of the Canada Health Act in provincial legislation – The five principles of the Canada Health Act – public administration, comprehensiveness, universality, portability and accessibility – are the cornerstone of Medicare. Enshrining them in provincial law requires the province to commit to public health care.
2. Prohibit the sale of private insurance for publicly insured services – For-profit advocates want private insurance so that those who can afford it can jump the queue in the hopes of getting faster care at private, for-profit clinics. By prohibiting the sale of private insurance as has been done in British Columbia, Alberta, Manitoba, Ontario and PEI, we deter private clinics from starting in the first place.
3. Prohibit the co-mingling of services at individual clinics – Legislation prohibits health care providers from charging MSI and private insurance or individuals for services they provide. However, current legislation permits a group of health care providers to work together in a practice, with some charging MSI and others charging privately. Preventing co-mingling means that patients cannot be bounced back and forth between the public system and the private system, so public funds stay in the public system.
4. Enforce the existing ban on extra billing and user fees and regulate block fees – User fees and extra billing are illegal, but some health care providers get away with charging patients out-of-pocket fees because the provincial government is not enforcing the law. Block fees for uninsured services are currently legal but are completely unregulated. This means that practitioners can charge whatever they want for uninsured services. We need to regulate block fees and enforce existing legislation to ensure that patients only pay for what they receive.
5. Prohibit queue jumping – Where private clinics exists, such as the private MRI in Halifax, we must ensure only one centralized wait list to receive care exists. By prohibiting queue jumping, we stop private clinics from enabling the rich to get care faster because they can afford to. Health care should be based on need, not ability to pay.
6. Prohibit health care providers from receiving kickbacks or making referrals to clinics they have financial interests in or own – Currently, health care providers may work in a hospital a few days a week and in a private, for-profit practice on the other days. These providers are allowed to refer patients they meet in the public system to his or her private practice, creating the potential conflicts of interest. Such conflict of interests may threaten the quality and appropriateness of care received by patients. We need to prevent such conflict of interests from arising in the first place by making them illegal.
7. Establish a transparent and accountable process, free from any taint of self-interest, for the listing and de-listing of publicly insured services – The provincial government can decide, with little or no public consultation, which services will be covered by public insurance and which services won’t. This means that the government can decided a service is no longer covered by MSI whenever it wants. We need a clear and transparent process that involves public consultation when services are being de-listed and to expand the list of currently covered services.
8. Require mandatory reporting of all uninsured services provided in the province – As it stands, there are no central records on the delivery of uninsured services in Nova Scotia. This means that we do not know how many or what kinds of uninsured services are being provided at a cost to patients. The provincial government must establish a mandatory registry of all uninsured services provided in Nova Scotia, with details on the type of services and the provider.
Amend the Health Authorities Act to:
9. Create elected District Health Authority Boards – The best way to ensure there is accountability and transparency within the District Health Authorities is to make these boards elected and responsible to the public. No more closed meetings – decisions about public health care should be on the public record and accessible with meaningful opportunities for public participation.
Amend the Hospitals Act to:
10. Implement a moratorium on P3s for health infrastructure – The provincial government has proposed that new health infrastructure be built using a Public-Private Partnership (P3) model. Evidence from other provinces and countries around the world shows P3s have no accountability, as most of the contracts are kept secret, and end up costing the public system more. For example, in Ontario, five P3 hospitals being built right now already have over $1 billion in cost overruns and will have fewer beds than promised. We need to stop these proposals – vital public infrastructure should be owned by the public.
Amend the Workers Compensation Act to:
11. Implement the Stanhope Manifesto on Workers’ Compensation – Workers who have been injured on the job are not covered by the Canada Health Act, which means workers’ compensation cases can be sent to private, forprofit clinics. Enthusiasts of privatization have used this to maintain the operation of private clinics while they challenge the laws protecting public health care. Closing this loophole and requiring workers’ compensation cases to be treated in the public system will stop the flow of public dollars to private clinics.
Finally, the government must:
12. Re-start the appointment process for the Provincial Health Council – Established in 1991 as an arms-length advisory body to the government on health policy, the Provincial Health Council was well known for its efforts to engage Nova Scotians on health policy, including the Provincial Health Goals and the determinants of health. It was dismantled in 1995 and again, in 2004 after it fell out of favour with the government of the day.