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THE FOLLOWING ARTICLE HAS APPEARED IN THE RECORD December 18, 2002

Coming to grips with our
health-care costs

Part III: The verdict

In 2001 health care costs in Canada broke the $100 billion mark for the very first time. This year the total will exceed $102.5 billion or the equivalent of $3,300 per person. Yet these figures hardly mean that we are receiving high quality health care. Not by a long shot, particularly in light of the grave shortage of doctors, nurses, technicians, hospital beds, modern diagnostic technology and the resulting long waiting lists for medical services.

As for the future, there is little reason to be optimistic. Due to our aging population the demands on our health care are expected to increase by 300 percent during the next 25 years. Millions of dollars have been spent on public inquiries, forums and think tanks in the hopes of finding the right solutions, yet the only conclusion we seem to agree upon is that our health care system is lacking massive financial resources. Even assuming the federal government would be in a position to inject the extra $15-billion by 2006 from budget surpluses recommended by Roy Romanow, in 10 years that amount will represent a mere token.

Time has come to consider major reforms

It is becoming increasingly obvious that failing major structural reforms the odds of ever receiving prompt quality health services at an affordable price are practically nil. Whether we like it or not, we have little choice but to seek constructive ways to increase the role of the private sector which this year contributed $ 27.5 billion to health care through private insurance and out-of -pocket-expenditures. Common sense suggests that the more we allow the wealthy to pay for their own care the more the we could liberate tax dollars to help the less prosperous. Granted, the real challenge would be to prevent those who provide such care from profiting at the expense of public health care. The question is whether such an objective can be reasonably achieved.

Education is two tier

The answer may reside in our education system, which supports the coexistence of both public and private schools. According to the most recent data available from Statistics Canada, in 1998/99, 1 out of every 18 children in Canada, or 5.6 per cent, attended a private school for a total of 298,000. Contrary to health care, parents have the right to choose the quality of education for their children. Many prefer to rely on private schools even if it means paying annual tuition fees of up to $14,000. Nevertheless, when choosing the " private tier", parents continue to pay their school taxes, which benefit those children who attend public schools.

One of the most frequently invoked arguments against allowing the private sector to play a greater role in our health care is the concern that it will open the doors to a two-tier system and thereby challenge the principle of universality. The wealthy would be allowed to jump the queue and thereby receive priority in diagnosis and treatment. The reality is that we already have a two-tier system and many do jump the queue. Patients who can afford to pay for their medical services have at least three alternatives; two are perfectly legal, the other is questionable. One way or another they continue paying their "health-care " taxes, which benefit the public tier.

Patients are entitled to purchase medical services from doctors who have opted out of their provincial health program and who practice private medicine. Albeit, less than one per cent of physicians have done so, they are remunerated by patients who are willing to pay the entire costs of their medical services. The right to jump the queue also applies to sick and injured workers all across the country. Workers Compensation Boards purchase preferential treatment for workers even when their medical treatments fall within the definition of "medically necessary". Allowing them to jump the queue is deemed justifiable in order to get them back to gainful employment as soon as possible.

As I pointed out in last week's column, the practice of jumping the queue occurs at various for-profit private clinics. By paying for supplementary services out of their pocket or through their insurance, patients occasionally succeed in jumping the queue for medically necessary services. In other instances, patients can purchase medically necessary services simply because they are labeled as non-medically necessary.

Studies have demonstrated that high profile public individuals also jump the queue thanks to their close connections with those working within the health care system .The fact is that anyone who happens to be a close friend or relative of a medical specialist has a much better chance in obtaining an early appointment. The repercussions are predictable: The earlier the appointment, the earlier a diagnosis, the earlier the treatment. Such opportunities will always exist no matter how hard any government tries to police the system.

Contrary to the education system, the private sector never gained a strong foothold in our health care system due to the lack of any meaningful public demand. Much has changed over the last ten years, not the least being the fact that the demand for private medical services has grown in proportion to the decline of our public health system.

Another significant factor to consider is that there will always be newer and more efficient technologies that the public sector will not be able to afford to purchase, much less operate on an extended basis. On the other hand, there will always be patients ready to pay the price out of their own pockets.

Considering the sad state of our health care there is no longer any justification in preventing patients from obtaining access to private high quality medical services. The equitable solution would be to transform their willingness and capacity to pay the costs into a source of revenue for the benefit of those who are less fortunate. That way, everyone would stand to benefit.