31 Oct Oct. 31/12 – Op-ed: Stop the drift to private care by protecting public system

Published in the Chronicle Herald, October 31st, 2012
By Bill Swan, Board Member of the NS Citizen’s Health Care Network


“If we can’t afford public care, we sure as hell can’t afford pri­vate care,” Canadian health policy expert Raisa Deber quipped during a meeting some years ago in Toronto. It is one of the few truisms in health care.

The Oct. 24 editorial “Draft health bill: NDP rewrite puts system over patient” reveals biases toward a system that cares about profits over patients.

Clearly, the editorialist has bought into the mythos of private sector as saviour. Yet, there is no peer-reviewed research to sup­port such a strong position — it is simply ideology. These notions were termed “zombies” by B.C.

health economist Bob Evans 20 years ago as no matter how often you quash a nonsensical idea, it keeps coming back.

Those who follow the health­care debate know that “patient choice” is a euphemism in the U.S. used to perpetuate bloated private administrations — all the while ensuring that a population over twice the size of Canada is under-insured or uninsured.

So, rather than playing ideolo­gical games with Nova Scotia’s health care, we should look con­structively at what the draft legislation does and discuss how to improve it for the benefit of all users of the health-care system.

Enshrining the principles of the Canada Health Act: Health­care privatization is in direct conflict with the people’s will and has no legitimate empirical support. We waste time, energy and money pandering to for­profit proponents that could be used to find real solutions.

Nevertheless, the principles of the Canada Health Act must be in the actual legislation rather than the preamble, as recent court decisions successfully argued that preambles are not part of official legislation and therefore are unbinding.

Paying doctors : The draft goes far toward finally getting doctors off the fee-for-service treadmill.

Fee-for-service is why your doc­tor is always rushing or wasting your time by having you book another appointment. Many of the problems with our health care system can be directly tied to these built-in disincentives.

Opting out : Having pay rates for physicians who have opted out set at the same rate as the public system is a good start, as it elim­inates incentive for providers to switch to the private sector. Sim­ilarly, patients who receive in­sured services from these pro­viders will not be able to get reimbursed from provincial cof­f e rs.

However, there is no ban on private insurance for publicly insured services, nor does it explicitly prohibit co-mingling public and private services at individual clinics. These loop­holes should be closed.

Extra billing & direct billing : The draft reinforces the ban on extra billing and prohibits direct billing such as the “convenience charge” for blood collection outside of the Halifax peninsula.

Queue jumping : The draft is very strong against queue jump­ing, explicitly stating that this violates the Canada Health Act and is prohibited. This reinforces the crucial concept that access to care be based on need and not ability to pay.

The legislation should go fur­ther to protect patients by prohib­iting health-care providers from receiving kickbacks or making referrals to clinics where they have financial interest.

Accountability : The legislation creates an arm’s-length appeal board that would consist of pro­viders and “lay persons.” It would be restricted to reviewing a limited set of circumstances.

Accountability in this leg­islation must be more far-reach­ing, inclusive and transparent — from planning to delivery. The Provincial Health Council, for which legislation still exists, could be easily reconstituted to improve accountability.

We should ensure that the patient has direct access to their own personal health record, with amending rights, as a further step toward real accountability.

Moreover, the reporting of all uninsured services should be mandatory in order to under­stand the true magnitude of what people are being forced to pay out of pocket. Most importantly, as the move to “patient-oriented” health care accelerates, we must ensure that actual patients have a real role in the design, co-ordina­tion and delivery of care.

Collaborative care : Family doctors are just one of the many options that should be available for patients to have real “choice.”

We must use appropriate services for the appropriate person at the appropriate time. This can in­clude self-management of chron­ic care, better access to prescrip­tions, nurse practitioners, mid­wives, asthma educators, phar­macists, support groups, etc. This legislation should make it easier for the health care system to respond to the needs of the actual users of our system.

The proposed legislation has many important features that would stop the drift to private, for-profit care, but further chang­es are needed to protect, strengthen and extend public health care.

Bill Swan is deputy CEO, Interna­tional Health Economics Asso­ciation; co-chair, National Asthma Patient Alliance; and board mem­ber, Nova Scotia Citizens’ Health Care Network.