Healthcare Quarterly

Healthcare Quarterly 8(1) January 2005 : 9-10.doi:10.12927/hcq.2005.17128
Departments

Quarterly Letters: A Response to Stories about Wait Times for Medical Procedures

Paul Faguy

Abstract

Many Canadians are waiting for life-benefiting surgery, for diagnostic tests that will inform and enable treatment, for access to human and physical healthcare resources. At a hospital level, the need for urgent care and diagnostic testing is being accomplished well. Canada should be deservedly proud of how all its citizens have access to public and life-saving healthcare. However, care and treatment that is not urgent but necessary to improve and sustain the quality of life, must always wait its turn. That turn seems to come later and later, with more cancellations and more limitations.

A recently published study by the Fraser Institute compared the healthcare systems of the leading countries in the world. All of the systems were publicly run and financed - socialized medicine. Every other country that provides a comprehensive publicly run and funded healthcare system has a mechanism for individuals to personally or privately purchase care.

There is much rhetoric about two-tiered healthcare from both sides of the debate. One side would have us believe that the private, for-profit provision of care coupled with the purchasing of the care is a business solution we cannot overlook. The other side would have us believe that any "private money" would water down the availability of essential healthcare professionals who would be naturally drawn - like moths to a flame - to the profits and concomitant higher pay - better working conditions resulting from the private money in the system.

The solution suggested here melds together the important parts of both of those arguments to form a different whole.

Hospitals could be permitted to provide privately paid for, non-urgent care and diagnostic testing based on the following simple rules. The new care being provided would be in addition to the current volume of care. The care would be performed by hospital staff as per the employment and compensation practice of the hospital. The physician(s) providing the care would bill the hospital based on their provincial re-imbursement plan. The cost of the care to the private individual or insurance company would be double or two times the pre-established actual costs as estimated by the hospital for all resources consumed including the physician's cost. For every paying patient, the hospital/physician must provide the same procedure to an individual who is not paying, but who is next on the wait list. Each hospital would sign an accountability agreement with their provincial ministry of health that outlines the types of services the hospital wishes to consider, the minimum volume levels for the procedures they wish to charge, the targeted extra volumes they believe they can do and the impact on shortening the wait list such volumes will have.

A simple example is access to CT scan. The hospital has a predicted volume of 50 scans a day working 10 hours a day, with only emergency service on weekends or paid holidays. This translates to about 11,000 scans a year. The hospital and its radiologists and the technologist get together and agree that by working Saturdays, three paid holidays and two more hours each night they can do an additional 6,000 scans. The total new cost for these scans, which includes wages, consumables, radiologists' fees and capital re-payment will be $1,800,000. The hospital contracts with its provincial ministry that they will maintain the 11,000 plus do another 6,000. Each paying customer (3,000) will be charged $600 to accelerate his or her particular access to the test. The actual wait list will be shortened by 6,000 with the next 3,000 waiting getting accelerated access. The queue is shortened by letting some jump it.

This model could be applied to full elective surgeries, to access non-approved and non-paid for pharmaceuticals, to access enhanced but not utilized medical devices, such as titanium knees and, of course, to access limited diagnostic testing including MRI, CT and PET scans.

The logic of this solution ought to stand on its own, no private poaching, more efficient use of existing resources, satisfying an established demand, local decision-making and effective provincial oversight. However, one more compelling point needs to be made.

The baby boom is entering the pre-retirement phase of their work and home life. These individuals, through their own work/life journey, have established one of the best standards of living anywhere on Earth. Homes have been paid for, weddings and tuition almost finished. Relaxation, retirement and quality of life purchases, such as cottages and vacation time-shares, dominate financial planning conversations. Add to this the significant inheritance of assets and estates from their parents, and Canada has a very large group of individuals with current and future access to cash for discretionary purposes. This same group is now focused not on building a life, but enjoying the one they have built. This group is not going to wait for that diagnostic test because the health issue is not life threatening. The quality of one's personal health will be at the top of the boomers' minds. The consumer giant to our south will be happy to take our money to provide the services and care we presently deny ourselves.

The demand for health services will only increase. If Canada fails to answer this demand by enabling the existing resources to produce the required supply, then the demand will go south and the economic value of those millions of dollars in expenditures will be lost forever to Canada and our provinces. Instead, the dogma of "two tiered healthcare" will compel increasing deficits and tax burdens for the next generations. The current personal wealth will be used to buy the services demanded from US providers with no benefit to Canada. Our economy loses an opportunity and our children inherit a debt.

There has to be a better way. We should all really think about this.

About the Author

Paul Faguy is a senior healthcare executive with 30 years of experience in hospital management at both academic health sciences centres and large community hospitals. This commentary reflects both his personal and professional views, as a private citizen

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