Health care: Quebec's hollow reform proposals

Why the proposals are essentially a sham (full text not online). At some point the Conservative government much face up to reality: "one-tier" health care is not the solution and cannot remain sacrosanct.

We might as well laugh. It's cheap, usually effective, and will do us no harm. Exactly unlike Quebec Health Minister Philippe Couillard's proposed "reform" of the province's health-care system. Humourist Stephane Laporte had the best line last week, commenting that Mr. Couillard's proposals "will give us something to read while we wait in the emergency room."..

...what's it going to take to make politicians and -- I'm afraid -- the majority of Canadians understand that there is no way (repeat: no way) (repeat again: no way) to "fix" the health-care system by tinkering at the margins? Nothing short of repealing the Canada Health Act will do, because the problem is the state's monopoly on financing. Every single part of the health-care system that's outside the state monopoly works fine and every single part that's inside doesn't...

...patients suffer. Worse, they are prevented from buying private health insurance by their benevolent state. Wouldn't want some folks getting ahead, eh? Un-Canadian, that. Whereas letting people suffer at home, unheard and unseen, now that's compassion...

The Citizen, in an editorial last Friday, said "Quebec is moving in the right direction, albeit slowly." Most commentators agreed. It's not false to say Quebec is moving in the right direction. But even "slowly" is too generous...

There are several serious problems with Mr. Couillard's proposals. First, even if they are speedily accepted by the legislature, they won't be implemented before mid-2007. Second, private insurance will be restricted to hip, knee and cataract procedures, which will all but guarantee no decent market for insurers and deny patients relief on the most vital procedures. So of course Quebecers will be disappointed with private insurance. You'd be forgiven for believing that's exactly what Mr. Couillard wants. Especially as only doctors who have left medicare will be allowed to operate on privately insured hips, knees and cataracts. Doctors will not be allowed to work both private and public systems, which will make the switch to the private sector less appealing...

...as La Presse's Lysiane Gagnon noted, the guaranteed wait times (after six months, you go to a private clinic; after nine months, you go outside the province -- in both cases the government foots the bill) are counted not from when you need a new hip but from the moment you get a diagnosis from a specialist. Which can easily mean up to a year more than the guaranteed nine months. But there's worse.

By instituting those guaranteed wait times, the Quebec government will make citizens consider a six-to-nine-month delay between a specialist's diagnosis and surgery normal, when it is anything but. Now I hear Stephen Harper is calling Mr. Couillard's proposed reform "a model" for the rest of the country, and all I can do is laugh...

And the sham that Ms Pellerin identifies about waiting times "guarantees" is nation-wide. The recommended (and that's all they are) waiting times for various procedures that provincial governments are agreeing on only cover the time between a specialist's recommending treatment and the treatment itself. They do not include the time--which can be exrcuciatingly lengthy--it takes to see a specialist after referral from a family doctor.

That is the dirty little secret our politicians are hoping we won't notice.

Dec. 12, 2005:
...
A wait time begins with the booking of a service, when the patient and the appropriate physician agree to a service and the patient is ready to receive it. The appropriate physician [i.e. the specialist] is one with the authority to determine the needed service. A wait time ends with the commencement of the service...

See also: Private health care delivery: one-tier vs. two-tier (Jan. 31).

Posted by markc at February 23, 2006 10:04 AM | TrackBack