This article originally appeared in the Chronicle Herald.
A costly and harmful impasse between doctors and the health-insuring government could be resolved with citizen participation.
Recently, a government source shrieked fearfully that doctor fees might escalate and health care become unaffordable, while doctors cried that government proposals would leave Nova Scotians without necessary and important medical services.
It is considered crass to speak about health care and money in the same breath. However, how care is organized in Nova Scotia is problematic, leading to excessive costs for medical and non-medical health services.
Janet Knox, CEO of the Nova Scotia health authority, remarked that among Canadian provinces, Nova Scotia pays the second-highest amount per person but buys worse health results than most other provinces.
Despite the high cost per person, many Nova Scotians do not have timely access to hospital services and suffer while waiting for essential services like hip or knee surgery. According to the Canadian Institute for Health Information, Nova Scotians are also more likely to die in hospital, compared with Canadians admitted elsewhere with similar conditions.
Family practice is one example of inefficient organization.
While government complains about medical costs, they happily pay someone about twice as much to answer an 811 phone advice line, on average $70, as they pay your doctor to see you in person. Your doctor additionally pays all the costs of running a medical practice.
Government insurance makes it financially more attractive for family doctors to provide walk-in clinic services rather than comprehensive continuing care. Not only are the hourly earnings higher for doctors who provide walk-in services, but also the overhead is lower because doctors spend less unpaid time communicating with specialists, reviewing and interpreting the results of laboratory tests and interpreting results for patients. As a consequence, many Nova Scotians cannot find a family doctor to deliver comprehensive continuing care and advice.
Automobile drivers would not be indifferent if auto insurers tried to control costs by rationing access to quality repair shops and by refusing to pay mechanics more than a token amount for each repair. Nor would drivers be happy if lengthy repairs were delayed because the insurer, trying to save money, would not pay the garage to keep the car overnight. Indeed, in its capacity as regulator, government would probably insist that insurers meet their obligations and not control costs by rationing quality and access.
The services for which health insurance pays and the amounts paid define the limits on quality and the scope of practice Nova Scotians enjoy. Since how government allocates financial resources limits the scope and quality of health care, it is especially important that Nova Scotians have a say. Citizen participation could resolve the impasse.
Do people prefer government pay adequate amounts for excellent care, or token amounts for unnecessary visits? Do people prefer government insurance pay for timely access to important and expensive services that we rarely need, or that government use limited resources to pay for the minor and inexpensive problems that we all suffer from on occasion?
Would community health-care co-operatives provide more effective and efficient management, or should the insurer continue to influence how health care is provided?
When government shrieks that $35 is too much to pay for a visit to a doctor, they should announce the amount they believe is appropriate and what they are buying.
Recently, ordinary citizens and health-care experts at an Atlantic Institute for Market Studies forum in Halifax examined the barriers to patient participation in their own care and citizen participation in governance. Two barriers were lack of information about health system performance and the inability of Nova Scotians to have timely and direct access to their own health information, including results of laboratory tests.
For citizens to decide, governments need to make some basic medical information available. It would be helpful to learn which health-care activities are useful, which harmful and which are a waste of time and money.
Some Nova Scotians would like government insurance to pay for everything; most would be happy if insurers stopped paying for harmful and wasteful care. Let’s give people the choice.
