Rationing Health Care

[sumdumguy]

Foreign trained doctors vie for residency positions in Canada. They don’t get it, the government limits health care expenses by limiting the gate-keepers - general practitioners. Open wide the gates and our country would be broke in no-time.

[AlbertaFarmer5]

Foreign trained doctors vie for residency positions in Canada. They don’t get it, the government limits health care expenses by limiting the gate-keepers - general practitioners. Open wide the gates and our country would be broke in no-time.

The reality is, that the only way socialism can work is by rationing the products or services. Not just health care.
When there is no market mechanism to keep supply and demand in balance, of course demand for a free product will inevitably exceed supply.

[Hamloc]

The reality is, that the only way socialism can work is by rationing the products or services. Not just health care.
When there is no market mechanism to keep supply and demand in balance, of course demand for a free product will inevitably exceed supply.

Yes even the Communist Broadcasting Corporation(CBC) can see there is a problem.

[chuckChuck]

And the solution is not to let for profit clinics drain away resources and staff from the public system when the biggest issue is a shortage of staff.

There are examples of more efficiency being developed within the public system by having specialized operating rooms for knee or hip operations. If they do only hip and knees for example, they don't have to be prepped for every other type of operation. This increases efficiency.

The other question is where does the profit come from in the delivery of healthcare? Are they going to pay workers less or give less service or quality of care than the public system? Most likely.

One of the biggest problems we have is many Canadians don't have a family doctor for a variety of reasons. So they clog up ERs with conditions that can easily be treated by a family doctor or other health care providers.

We also have a lot of seniors waiting for long term care beds in hospitals because there is a shortage of long term care and now where to go.

The solution is not privatization for profit health care.

In Ontario and Quebec the for profit private long term care homes performed very poorly and caused a lot of misery and deaths during the covid crisis compared to public long term care.

[blackpowder]

This issue is large and I don't have any answers. Neither public nor private in their pure form will function. We need both for efficiency.
We already have a slight mix, for which I'm grateful. No government seems to get it right. Our largest cost is overhead. It's never the amount of the budget, it's how it's spent.

[chuckChuck]

Here is another good reason to not let private clinics take over. Just what vulnerable and desperate patients need. Upselling and unnecessary procedures so private clinics can make a profit? Its very unethical and yet Conservative leaders are saying it's the solution! Yeah right!

Medical upselling in Canada can cost patients thousands of dollars
LinkedIn
'I don't know if it's illegal, but it's unethical,’ says one Ontario patient
Marcy Cuttler · CBC News · Posted: Apr 02, 2023 3:00 AM CDT | Last Updated: April 2

Lois Cooper says she was upsold thousands of dollars in extra services at a private, for-profit clinic, and when she started to ask questions, the doctor told her to leave. She's not the only Canadian who's gone through the questionable practice.

It's the pile of bills that sums up her medical journey.

"This is the note that I made when I got the phone call in January," said the 75-year-old from Gravenhurst, Ont. "And I was told there'd be a $150 fee.... That was the beginning of starting to pay for stuff."

Cooper had a macular hole in her right eye and needed medically necessary surgery called a vitrectomy, a procedure where the surgeon removes the gel-like substance around the eye called the vitreous and replaces it with another solution.

Cooper was referred to a private, for-profit clinic north of Toronto, but before the operation started, she was asked to sign off on optional tests, services and procedures.

In later appointments following the surgery, the doctor told her that she would need to keep her face down for two weeks — and that would require the rental of a special wedge type of pillow. He also recommended glasses that would refract her vision. Months later, he recommended laser surgery for eye floaters, which Cooper said didn't work. He even said he detected a mass behind her other eye that would require further surgery.

A second opinion from a doctor in Toronto revealed there was no mass in her eye.

Health Canada reports show private, for-profit clinics are upselling patients on extra services they don’t need. One Ontario patient says a private clinic had her sign off on additional services that cost her thousands and even tried to get her to have another surgery that she didn’t need.

When Cooper asked questions, she was shown the door — but not before she was on the hook for close to $8,000 for appointments, equipment rentals and procedures.

"I wouldn't have spoken out if I hadn't heard Premier [Doug] Ford say that these private clinics won't charge you money, won't charge extra," she told CBC News. "It feels like it's my public duty to say that's not true."

What is upselling?

Upselling, according to Dr. Danyaal Raza, a family doctor at St. Michael's Hospital in Toronto, occurs when a patient is asked to pay for extra services that are uninsured when they're undergoing a procedure that should be publicly covered.

It's different from extra billing. That's when a private, for-profit clinic would bill the province for a procedure that's covered by government health insurance while also billing the patient.

Health Canada reports show that between April 2019 and March 2020, private, for-profit clinics upsold and illegally charged Canadians to the tune of tens of millions of dollars.
A man with dark hair and glasses smiles.
Dr. Danyaal Raza, a family doctor at St. Michael's Hospital in Toronto, says he worries that private, for-profit clinics will lead to what he calls 'the slow creep,' where patients grow accustomed to spending money on additional tests and procedures. (St. Michael's Hospital Communications Department)

In early March, the federal government announced that it was going to cut more than $82 million in transfer payments to the provinces in cases where patients were asked to pay out of pocket for care that should have been covered in 2020-21.

"You're paying out of pocket for health care you should not be paying for and clinics are prohibited from charging you," said Andrew Longhurst, a health policy researcher at Simon Fraser University in Vancouver.

Raza said it's a slippery slope between extra billing and upselling.

"I think we need to be concerned about upselling because it's the thin edge of the wedge towards extra billing, where patients are told they can only get something that's publicly covered if they pay out of pocket."
How does upselling work?

Upselling can start with the power dynamic that often exists between patients and health-care professionals. Cooper said it certainly started that way for her.

"I was sent there by my medical professional. So that would mean to me that this is where you should be and this is how it's done, and this is what's expected and you do it."

Once she got to what she described as a "large warehouse with no ceiling" that was packed with people, she had to sign documents before she was seen by anyone.

With a recent poll showing Canadians are divided over privatizing health care, CBC’s Christine Birak looks into common questions about it, including patient outcomes and its impact on the public health care system.

It's a situation, according to Raza, that's filled with subtle pressure.

"You're not a doctor, you're not a nurse. You don't have 10 years of medical training under your belt. So you're at a huge disadvantage when you're presented with information," he said.

Cooper signed the documents, which she showed to CBC News, and had her vitrectomy. During the surgery, she said, her retina was torn and she was told cataracts were removed, even though Cooper had never been aware that she had cataracts.

She said she got her vision back in her right eye. However, in subsequent visits that cost her $150 for each appointment, the surgeon said he found a cataract in her other eye, told her she had dry eye disease and convinced Cooper to get laser surgery for floaters.

What's more, that equipment Cooper's doctor told her to rent after the initial surgery, such as the special glasses and pillow, should have been covered by the government since it was deemed to be a medically necessary procedure.

The bills have eroded Cooper's trust in a medical system that should be protecting patients.

"I don't know if it's illegal, but it's unethical. I think that the behaviour is unethical," she said.

Cooper did not want to publicly name the clinic. CBC News reached out to the clinic for comment but did not receive a response.

Why should we be concerned about upselling?

Dr. David Urbach, surgeon-in-chief at Women's College Hospital in Toronto, said upselling is baked into the business model of public money going to private, for-profit clinics.

"I don't believe they can be a viable business unless they're going to be paid in excess of what the government is already paying public hospitals, or they're going to be levying all these unnecessary charges," he said.

What worries Raza is what he calls "the slow creep": As more patients are persuaded to spend money on additional tests and procedures, they may grow accustomed to the practice.

"If you're already used to paying for services that are uninsured out of pocket, suddenly paying for this insured service feels normal," he said.
What can the public do?

Ultimately, Cooper started asking questions when she was told there was a mass in her eye that would require another vitrectomy.

"I asked him to explain the mass to me, and he looked at me like I had three heads," she recalled.

When she asked further questions, the ophthalmologist told her to leave. "And then he turned to his assistant and said, 'Charge this to OHIP.'"

In spite of her ordeal, Cooper is happy that the original surgery to fix the hole in her eye was successful. Her vision isn't perfect, but she can read and drive. But her story is a cautionary tale, and she wants others to learn from it.

"I just want people to be aware that when they go to a private clinic, make sure you ask questions, don't sign any papers. Go there first and get all the information on what they're going to want from you and then maybe go talk to somebody else," Cooper said.

"If you're in a medical appointment and you're being asked to pay for a medical service, you should always ask whether or not you need to pay that fee to actually get the care that you came there for," Raza said.

He added that if a patient feels they were unfairly charged for a medical service performed at a hospital, they should contact the hospital's patient relations department.

Unfortunately, Raza said, too much is put on the patient to process at a time when they are most vulnerable.

"If I ask, 'Am I going to be denied care, am I going to be put at the back of the line?' – it's overwhelming, and frankly we shouldn't really be expecting or asking patients to be able to decode federal and provincial legislation."
ABOUT THE AUTHOR

[Taiga]

We need both here, it is obvious. Anyone who knows someone in healthcare would say the same thing. Anyone who has experience first class private care would say the same thing.

Also - I don’t read posts that are copy and pastes. Should be a 100 max word limit per post, or something.

[chuckChuck]

Sorry the complex issue of healthcare can't be explained in a 100 words or less.

The key message is some unethical for profit clinics will try to upsell you additional uneeded services and claim there was another mass in your other eye that needs surgery as well. A second opinion said there was nothing.

What more do you need to know to make you go wholly crap that's terrible!

And buyer beware isn't good enough. Some these clinics are crooks. And the business model is based on upselling and added fees to make profit!

[chuckChuck]

Do private, for-profit clinics save taxpayers money and reduce wait times? The data says no

Do private procedures cost less?

For example, data obtained from the Canadian Institute for Health Information (CIHI) shows that knee replacement surgery in a public hospital, paid by the province, costs about $10,000. The same surgery in a private clinic can reportedly cost patients up to $28,000.

When the province pays for the knee replacement surgery in a for-profit clinic, the amount is kept secret, due to confidentiality agreements.

Andrew Longhust, a health policy researcher at Simon Fraser University in B.C., says the lack of transparency makes it challenging to understand the real costs.

"Governments are often reluctant or will actively fight the disclosure of that information and so will the clinics themselves," he said. Clinics, Longhurst added, often provide contracts with unspecific additional costs that are not easily visible or broken down, so the profit margin remains a mystery to patients and taxpayers.

However, sitting recently in a closed operating theatre – the result of budget cuts — Dr. David Urbach, surgical chief at Women's College Hospital in Toronto, says Ontario doesn't need more clinics.

"You can do operations in this operating room. You don't need to open those new facilities."

Public hospitals, according to Urbach, are funded to do a specific number of surgeries per year, and provincial governments could pay to schedule more surgeries at night or on the weekends. But when there are two parallel and competing systems, a bigger problem emerges: staffing.

"We need people," said Urbach. "The bottleneck right now is particularly nursing care."

Both for-profit centres and hospitals recruit from the same limited pool of health-care professionals, but three years of pandemic fatigue and limited salary increases has led to an exodus from the public system.

A doctor or nurse that leaves a hospital to work at a for-profit facility for more money, can, in fact, worsen the broader problems plaguing our health-care system, says Urbach.
https://www.cbc.ca/news/health/private-health-care-taxpayer-money-1.6777470

[AlbertaFarmer5]

And what do you propose as a solution? Given the exponential growth in medical interventions and procedures, an aging population, an increasingly overweight and unhealthy population, and increasing costs of nearly every input, how do we fund a medical system without it consuming the entire economy?
And personally, in spite of the obvious impossibility of actually funding all the potential medical services, I still believe that investing in healthcare by whatever means should be all of our's highest priority.
Unfortunately, most of us don't see it that way until it is too late.

[blackpowder]

I had two separate responses written for this. Aren't going to bother. I have my beliefs and experiences supporting my opinion. Even if Chuck had similar he would see it differently.
Just getting bitter contemplating.
Gonna take a break.

[chuckChuck]

And what do you propose as a solution? Given the exponential growth in medical interventions and procedures, an aging population, an increasingly overweight and unhealthy population, and increasing costs of nearly every input, how do we fund a medical system without it consuming the entire economy?
And personally, in spite of the obvious impossibility of actually funding all the potential medical services, I still believe that investing in healthcare by whatever means should be all of our's highest priority.
Unfortunately, most of us don't see it that way until it is too late.

Fair enough its a really complex issue and no one on Agriville can propose a single solution because there are many solutions and improvements needed.

But for profit private clinics are not the solution because where does the profit come from?

And where do the resources and staff come from?

We don't need to let anybody make extra profit off of healthcare. Improve the system we have. Train more people.

As mentioned in the article above the provinces are not funding enough surgeries. So why would a private clinic make more sense if the province doesn't fund enough extra surgeries?

Unless you want a two tier system where the rich pay for quicker access?

It seems like provincial governments are holding back resources for surgeries when the need is bigger than their budget.

[AlbertaFarmer5]

Do you extend this rationale to other industries where public and private are both competing for staff and resources?
For example, road construction. The government would be the largest player in this industry, and some levels of government do have their own equipment and perform their own work. But most is performed with private for profit contractors, who compete amongst each other to perform the work at the lowest cost, but they are competing for the same skilled staff and resources as the public works.
But competing with those government projects are also private road building projects such as exist in the logging, energy, recreationand mining industries. By your logic, they are competing for the same limited resources and staff as the government projects.
This seems to be the exact same situation as exists in public health care and the parallel private system.
Does the same solution apply?

[chuckChuck]

Do you extend this rationale to other industries where public and private are both competing for staff and resources?
For example, road construction. The government would be the largest player in this industry, and some levels of government do have their own equipment and perform their own work. But most is performed with private for profit contractors, who compete amongst each other to perform the work at the lowest cost, but they are competing for the same skilled staff and resources as the public works.
But competing with those government projects are also private road building projects such as exist in the logging, energy, recreationand mining industries. By your logic, they are competing for the same limited resources and staff as the government projects.
This seems to be the exact same situation as exists in public health care and the parallel private system.
Does the same solution apply?

Typically road building contractors submit competing tenders so that local and provincial governments can choose the lowest price tender that meets their contract requirement.

One of the articles I posted talks about governments who are reluctant to even release the details of the contracts they have with existing private health care providers.

Were the contracts publicly tendered in a competitive process? Doesn't sound like it.

So how do we know if there was even a competition?

And how can we compare whether the private or public system is lower cost without that information?

So the analogy with road building doesn't fit.

So if it is cheaper why isn't the private clinic and government releasing that information? Read below from the article:

"For example, data obtained from the Canadian Institute for Health Information (CIHI) shows that knee replacement surgery in a public hospital, paid by the province, costs about $10,000. The same surgery in a private clinic can reportedly cost patients up to $28,000.

When the province pays for the knee replacement surgery in a for-profit clinic, the amount is kept secret, due to confidentiality agreements.

Andrew Longhust, a health policy researcher at Simon Fraser University in B.C., says the lack of transparency makes it challenging to understand the real costs.

"Governments are often reluctant or will actively fight the disclosure of that information and so will the clinics themselves," he said. Clinics, Longhurst added, often provide contracts with unspecific additional costs that are not easily visible or broken down, so the profit margin remains a mystery to patients and taxpayers.

[chuckChuck]

So A5 if you were paying for the knee surgery would you rather pay $10,000 in the public system or up to $28,000 in a private clinic all things being equal?

Let us know whether you would still prefer the private clinic? Maybe they will give you a deal on a hip and a knee for 20% off? Or throwin some extra surgery during a slow week? Nothing like the profit motive to upsell you something you don't really need! LOL

In the public system they just want to get you done and on to next patient. No extra profit required.