Changing of the guard — bringing timely food for thought

Both the outgoing and incoming presidents of the Canadian Medical Association held nothing back when they spoke at their annual meeting in Montreal this week. The passionate messages they delivered on behalf of doctors from across Canada brought some startling realities to what’s been happening behind the scenes in healthcare. Their experiences and statistics could be important for the United States, too, but mainstream media here has been nearly silent on this information.

Many Americans have a vision of Canada’s healthcare system formed from anecdotes and what we see and hear in the media, but rarely have an opportunity to learn what the overall picture looks like from the country’s doctors themselves. This annual meeting of the CMA provides a valuable chance to learn information that could be important as we debate healthcare reform here.

Canwest News Service reported on the valedictory address given yesterday by outgoing president, Dr. Brian Day, who they said blasted both national political parties for their continued failure to address the country’s pressing healthcare problems:

Brian Day bemoaned the fact that more than one million Canadians are on waiting lists for health care and that five million people don't have access to a family doctor. Yet neither the governing Conservatives nor the Liberal opposition seem to care, he charged. "Individually, most (politicians) have a deep understanding of the plight of our health-care system," Day told delegates at the CMA's annual meeting in Montreal. "Collectively, especially at the federal level, they are reluctant - even afraid - of engaging in a meaningful public policy discussion on health. For example... [full article here]

Day reiterated that Canada's public system must change and should embrace some private-sector initiatives. To that end, he suggested that public-private partnerships be set up to fund the education of medical students. "Despite the best efforts of medical schools to expand, we have actually dropped further in the OECD rankings this year," he said, referring to the Organization for Economic Co-operation and Development. Day said Canada now ranks 26th out of 28 countries in doctors per population. Adding to the pressure, he said, is the fact that 4,000 doctors are about to retire...

"In Canada we pay dearly to keep patients on waiting lists. This is illogical. Preventing patients from getting treatment is not my definition of preventive medicine," he said, adding that the cost to the economy in 2007 was $14.8 billion. This excluded the growing costs of waiting to see a GP or specialist. And it excluded the costs as patients deteriorate and develop chronic, severe irreversible damage, addiction to painkillers, or depression."

The incoming president, Dr. Robert Quellet, elected by the country’s doctors to represent them, spoke today. Here is a sampling from of the news stories of his speech:

Incoming CMA head says private health care can help ailing public system

The incoming head of the Canadian Medical Association says private health-care has a role to play in improving access to the public system... "We need to accommodate it in order for the public system to prosper." ...

He said Canadian health-care costs have quadrupled in the last 20 years and the country's doctor-to-patient ratio has plummeted. Ouellet called the overall state of Canadian health care “alarming”. “We have one of the most costly and least efficient health systems of any industrialized country,” he said...

Accept the reality of private health care: CMA chief

The natural next step for Canada's health system is allowing more private delivery, which will give patients more choice, and better access to care, the new president of the Canadian Medical Association says. "My whole career has been about resolving access issues. This is my battle horse," said Robert Ouellet, who takes over today as president of the CMA. "Private delivery is an accepted practice everywhere in the world and it's time Canada accepted this reality."

A radiologist by training, Dr. Ouellet, 62, owns and operates five medical imaging clinics in suburban Montreal. He is an unabashed promoter of private-sector delivery of medical care and keen to introduce more competition into Canada's health-care system, and he knows this will make him a lightning rod for criticism. "I've never hidden what I do. I'm not ashamed of it. In fact, I'm quite proud," he said in an interview in his spartan office in suburban Laval. "And let me remind you that the people who elected me know what I think and what I stand for."...

While largely unknown outside Quebec, Dr. Ouellet has been a pioneer in the health field and, more specifically, in the delivery of private care. In 1987, he and colleagues from Cité de la santé hospital opened Canada's first private computed tomography scan clinic. Long before the private-public debate, this was momentous, but sparked little outcry. "It was such a necessary service that there wasn't much debate," Dr. Ouellet recalled.

In fact, he stumbled into private practice. As head of radiology at the hospital, he was pushing for a CT scanner but was told that it would take between two and three years for the government to process the request. Outraged, Dr. Ouellet and others in the department bought the CT scanner and contracted their services to the hospital. The workers compensation board and provincial automobile insurance board also signed contracts. "Rather than wait six months for a scan at a hospital, we provided them in a couple of days," Dr. Ouellet said. It took five years for the hospital to get a CT scanner, which speaks volumes, he said. Later, Dr. Ouellet and colleagues opened an axial tomography clinic, an MRI clinic and two diagnostic radiology clinics, all private...

Dr. Ouellet said this is called consumer choice. "Patients want this, and they demand it," he said.... "I'm not touting privatization of the whole health system. Nobody wants an American-style health system, least of all the CMA," he said... "The system isn't perfect, but it's working. It shows the benefits of a good private-public mix."

Surprisingly, Canada has been debating the public-private delivery system for at least a decade as medical professionals seek to propose solutions. One concern that jumps out is if it would create a two-tiered system, one for the haves and one for the have nots, often used to describe our system in the United States. Rather than look just at ideas supporting what might feel intuitively or politically correct, this early article tried sort out facts from emotions and raised several interesting viewpoints. Canada already has a two-tier system, the author wrote, as those who’ve grown desperate for care simply head south across the border to the U.S.

Comparing just Canada to the U.S., however, overlooks the fact that there are government-funded care systems in other industrialized countries. This rather cutting, but interesting, article from the Edmonton Journal looked at a study comparing Canada to 18 other member nations of the QECD, all of whom had government-funded systems. Instead of a single-payer system automatically being cheaper, among all these countries, Canada was spending the most per capita on healthcare, without corresponding better health. This article warned Canadians not to confuse health care delivery with access.

It’s uncomfortable to challenge ourselves to question what might feel intuitively correct, but since healthcare reform is one of those life-altering decisions that will forever affect us and our children, it pays to look especially intently at the nays and try to get the full story and learn from our largest neighbors, and not simply let ourselves be swept up in the feel-goods and marketing.