Canada Health Act Annual Report 2011-2012 Number of participating physicians: 1,618 Number of opted-out physicians:0 Number of private for-profit facilities providing insured health services: 0 Payments to private for-profit facilities for insured health services:0.
The Story Health Care’s spending not “out of control” Aging population won’t break the bank Affordable public solutions to all healthcare problems – the 2nd Stage of Medicare Focus on primary health care and prevention and other community based services like home care.
Medicare’s Second Stage “Those of us who talked about Medicare back in the 1940’s, the 1950’s and the 1960’s kept reminding the public there were two phases to Medicare. The first was to remove the financial barrier between those who provide health care services and those who need them. … The second phase would be the much more difficult one - to alter our delivery system to reduce costs and put and emphasis on preventative medicine.... - Tommy Douglas 1979
Imagine if all physicians were part of the health care team… “Canada’s system of independent physician private practice is the biggest elephant in the room.” -Michael Rachlis, MD
New Brunswick Extra-mural program Comprehensive home health care services Providers: nurses, licensed practical nurses, registered dietitians, respiratory therapists, occupational therapists, physiotherapists, speech language pathologists, rehabilitation aides and social workers. Services: acute care, palliative care, home oxygen program, long term care assessment and rehabilitation services.
It’s Time for Pharmacare 1. Universal & Equitable Access 2. Safe & Appropriate Use 3. Cost-controls & Affordable
Privatization drives up spending Encourages overuse of high-cost tests, procedures, and inappropriate medication to increase income and profit. Fraudulent billing by physicians and facilities adds at least 5 % to the total cost of care in U.S. Profit-seeking physicians and facilities will abandon rural and remote communities
This is what for-profit health ‘care’ looks like: 1. For-Profit nursing homes 2. For-profit surgical clinics & hospitals 3. For-profit pharmaceuticals 4. For-profit health insurance HealthCoalition.ca
1. For-Profit Nursing Homes Abuse & Neglect On The Rise At For-Profit Nursing Homes Q. How do you make money in a nursing home? A.Divert funds and focus away from clinical care. “ It is unwise to entrust the sick and the frail elderly in the hands of profit-seeking firms.” -- American Journal of Public Health (Vol. 91, No.9) HealthCoalition.ca
2. For-Profit Clinics & Hospitals Prevented public audit Charges Illegal user fees Unlawful billings Patients must sign false statements An extra 2200 deaths a year in Canada if we converted to investor-owned private for-profit hospitals HealthCoalition.ca
3. For-Profit Pharmaceuticals Millions of Canadians can’t afford access; Rx costs are 30% above international average; 4 th to 6 th leading cause of death; * Prescription use driven by advertising not evidence. * Lazarou, J., JAMA, 1998 HealthCoalition.ca
4. For-Profit Health Insurance Is more expensive and drives up costs Denies access for the sick (pre-existing conditions) Denies access to those who can’t afford to pay Not new – Canada had private insurance and rejected it for Medicare! -CIHI, 2012 HealthCoalition.ca
Ethics + Evidence + Economics = Public Support The federal government should ensure that all Canadians, no matter where they live or their ability to pay, get access to healthcare. HealthCoalition.ca
21 What the few want: Open up the delivery of health services to market rules and divert public funds to the profit seeking private enterprise. Segmentation of ‘markets’, access, coverage. Cherry-pick and provide only the profitable services in the profitable ‘markets’ HealthCoalition.ca
22 More private means less public Draws off resources from the public system Increases costs overall Introduces the inequities of the U.S. system Gives too much care for those who don’t need it and not enough for those who do. Source: Marcia Angell, MD, “Privatizing health care is not the answer”, Canadian Medical Association Journal, 2009. HealthCoalition.ca
Public Solutions To avoid all these problems you have to: 1) Keep services out of the hands of for-profits; 2) Replace fee-for-service payments to MDs; 3) Organize delivery with teams in community health centres; 4) Encourage quality of care over quantity; 5) Keep people healthy (food, housing, income…).
Solving Medicare’s Problems Misuse of prescriptions - prescription drugs (ADR a leading cause of death) - patients in acute beds, inappropriate referral to specialists Overuse from over-diagnosis - average of 16 prescriptions per Canadian in 2011 - MRIs: 4 million inappropriate (10-20% of referrals) Underuse of prevention - prevention and public health - non-therapeutic treatments + TLC - common sense: diet, home & community supports 24
Our values Health as Public Good Keep people healthy Integration & Teamwork Protect the vulnerable
Values in conflict Health as Public GoodHealth as Commodity Keep people healthyProfit from illness Integration & TeamworkFragmentation & Competition Protect the vulnerableExploit vulnerability
…and Canadians want more of it! Universal public drug plan Home Care and Long-term care standards Adequate and stable federal funding “The price of Medicare is eternal vigilance.” -- Tommy Douglas HealthCoalition.ca
Conclusion Canadians want a stronger public health care system; Medicare won’t survive without federal leadership: What stands between Medicare and its destruction are the peoples of Canada! Think about Medicare before you vote in 2015