What's ailing our healthcare system

Our great monolithic, single-payer system—a tribute to ultimate socialism—is in trouble. The edifice is cracking and its foundation on sand is tottering. The whole basis from the Canada Health Act which states, “no provider shall ask or receive more than the government schedule of benefits for any medically necessary acts,” needs to be challenged. 1. Do we cover all things to all people? What is a medically necessary act? Do we fund every expensive cancer-fighting drug? 2. Remuneration and morale of physicians. Do we continue on the traditional fee for service mode with its assembly-line, quantity-inducing incentives? Pay the physicians a salary, capitation, pensions, sick time and benefits and maybe they may look upon patients holistically rather than a procedure and a fee. 3. Patient fiscal responsibility. A simple user charge or co-payment may suffice. To the idealist if that is not acceptable, healthcare accounts can be introduced and depending on your spending, a tax benefit or tax deduction be applied. Many other solutions can be applied, all to the end so that there is some incentive to save some of our finite healthcare dollars. More bureaucracy? Read: Negative, unintended consequences of Ontario’s spring fee deal 4. Flexible planning. Get away from Soviet-style central planning where all directives are applied across this vast land. Communities in Newfoundland and urban centres like Toronto have vastly different needs and solutions. Allow the provinces and regions some flexibility. Allow different ideas and regionalization where practical and needed. 5. Primary Care Reform. Careful assessment needs to be made whether we need and are prepared to fund family physicians. They are currently the frontline of primary care. Can we afford them? I sincerely think we would be worse off without them. Use of "Physician Extenders," such as nurse practitioners, chiropractors, physiotherapists, naturopaths, midwives etc. could all be used. There is place for them all. Primary care teams are an obvious answer. Headed by a physician, there could be specialized teams for hypertension, arthritis, headaches, vertigo, geriatrics, dementia, immunisation, obesity, nutrition and so on. These could be attached to local Family Health Teams . 6. Privatization. Private physicians, private facilities, even private hospitals should all be allowed and indeed be encouraged. You should be allowed to purchase insurance individually for these services if you so choose. Medicare and government subsidy are essential but add-on privatization would be an asset to our tax-based Medicare system. This would decrease the load on our overburdened public funded service. It would also serve as counter balance and a measure of comparison regarding quality control on our government system. This operates in all other Western Countries. Read: Alberta to pilot fast-track program for international medical graduates 7. Leadership. This has been sadly lacking from our provincial associations and physicians. In the current crisis, there has been no word from our leaders. This has been left to the politicians. Morale is at an all-time low. We have fallen further behind in our remuneration. We give no collective input on where our health care is heading. What do we want? We would like to practise good medicine with sound incentives for good individual patient care without undue bureaucratic stifling. We would like reasonable remuneration in keeping with our years of education, responsibility, benefits, pensions, sick time. All this to ensure some balance and quality of life. The ministries and associations are all busy building their own empires without regards to the grassroots and their needs. The whole system has to be appraised and overhauled. Do we want to be all things to all people and to cover all things from cradle to grave? To leave things as is and band-aid the cracks is to allow the whole system to ultimately implode. These are my thoughts as an old GP. Dr. Bertram Wing King is a family physician based part-time at Polyclinic in Toronto, ON. Read: What's really ailing docs these days?

What's ailing our healthcare system

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