Radical Ideas to Modify our Health Care System
As a retired pharmacist and a 73 year-old senior, I take more than a cursory interest in the present state of Canada’s health care system and the plans for making the system function better. I have yet to see any useful information made public to indicate the extent of the debate to be addressed in the forthcoming conference of the premiers and the Prime Minister. I, of course, am completely ignoring the trial balloon released by the premiers asking the Canadian government to fund a national pharmacare program. As a former pharmacist I can categorically state that the plan, if implemented, as the provinces pay for drugs now, is a prescription for the bankruptcy of the health care system in its entirety. Drug costs are spiraling out of sight and must be arrested.
Roy Romanow, the savior appointed by Jean Chretian to revamp health care in Canada, is a shameful alarmist. Canada is not and never will be in danger of breaking up over the issue. Our health care system has a problem centered on the availability of professional services, but in total is functioning well, and in no real danger of imploding. The Romanow Report urged the government to spend more money to allow generic companies to certify drugs sooner for public use and to prevent the trade-name companies from extending their patents with minor variations. These ideas are not new.
Roy Romanow was and essentially still thinks as a politician, and had to come up with solutions that in the short term do not lose votes or create turmoil for the present sitting members of provincial and federal parliaments.
To make an omelet you have to break an egg. To correct a system to meet future health care needs, basic changes must be made, and certain laws governing the health professions must be modified to allow this to happen.
Everybody involved with our health care system abuses it. Some doctors milk it, as there is no limit as to how often you can see a patient and the decision is left entirely to the doctor. The public wants to get everything free, and frivolous visits are made to see physicians and demands are made to get drugs and tests as the patient desires. It is not in the interest of the physician to object, since it costs them nothing and their objection might lose the patient to another doctor. The politicians do nothing but take away and throw money at the system as their political priorities arise. Few significant changes have been made since the introduction of government-funded health care. It is time for change to avoid a real catastrophe in the future.
The problems lie in two directions. The aging of the baby-boomers who will soon become seniors and demand more and more services with fewer and fewer younger people to pay the bills. Also, the new technologies, services and drugs are much more expensive than in the past. We do have to provide more money to give better services but we have to look for ways to provide this money by saving in other areas.
Each doctor would be given a budget based on past performance. The budget would include prescriptions written, laboratory tests, patient visits, physiotherapy, etc. If the doctor goes below his budget, he or she retains the money saved. This is an incentive for doctors not to abuse the system. Of course, you must trust the integrity of the doctor to provide necessary services. Each patient’s history of medical and drug costs and services would be examined. If they came in below their previous medical expenditures, they also would receive part of the savings. Both parties would have an interest in saving money.
Starting in remote areas and after sufficient extra training, nurse and pharmacist practitioners would be allowed to see patients for simple ailments and to prescribe and recommend treatment. Many nurse practitioners and pharmacists are involved in providing this service now. The nurse practitioners and the pharmacists would be paid less than a doctor would for the same service. This would be a simple method of eliminating the shortage of general practitioners over the long run.
In the drug manufacturing field, drug companies launch a new drug at a much higher price that may, or may not, be better than the drug in use. If the doctor is on a budget, he or she may continue with the equal but less expensive old drug. Generic prices on drugs are based on the trade-name prices, so trade-name companies, when they lose their exclusivity, should be encouraged to compete against the generics in order to lower generic drug prices. Surprisingly, in Canada trade-name drugs are lower in price because of the Patent Medicine Review Board, but generic prices are lower in the U.S. because of competition.
Knee replacements, hip replacements, bi-pass operations, MRI’s, and timely service should be available to all, irrespective of wealth. That is the understood covenant between the people of Canada and the government. This can be accomplished if the government is open to new ideas to save money so that more can be spent on the areas required. Short term dissatisfaction and dislocation is inevitable. The process is complicated and all the parties involved should be consulted to bring about the necessary changes. Saving money is a priority in order to have the money for the ever-growing costs of modern health care.
