...as in: :canada:
"Quoting JLM That is partly true- I'd change the "excellent" rating to a "C+". "
Huh? :-?
HEALTH CARE - User fees
- Thread starter JLM
- Start date
...as in: :canada:
"Quoting JLM That is partly true- I'd change the "excellent" rating to a "C+". "
Huh? :-?
"20 years ago" you say? That I believe. How about the here and now?? My son recently got hurt at work. Hospital staff attended to him really fast. It's called WCB. Staff jump then. I recently hurt my back at home, spent 6 hours waiting to see doctor in emerg. I hurt so bad I could hardly breathe, but had to 'wait my turn'. Behind people sneezing and wiping runny noses...
Yeah that's bad enough Chev, but at least you didn't end up like the guy in Winnipeg a few months ago. He died, just sitting there being ignored completely. Had he lived, he probably would have felt a lot better knowing the hospital boss apologized for the incident later on.
I will admit that my most recent run-in with ER was about 6 years ago; my daughter (then 7) was stung by a wasp, and we discovered she was allergic...we drove to the ER (2km drive), she was rushed in, they got 4 docs/nurses/orderlies to try to hold her down to give her an IV, which they couldn't do (couldn't hold her still enough)...spent about 3 hrs there getting her stable, but the wait time to be seen and treated was about 60 seconds.
Fast, efficient, and effective.
Mind you, this was a life-and-death issue, not a sore back or a cold.
Fast, efficient, and effective.
Mind you, this was a life-and-death issue, not a sore back or a cold.
Not a chance. I don't think American doctors will be comfortable practicing in Canadian style health care system.
Wait time depends upon the severity of the situation. In your case the patient clearly needed to be attended to right away, so it was done.
Emergency is never on first come first serve basis. If you have a life threatening problem, you will be attended to right away. On the other hand, if all you have is a fracture etc. and are experiencing some pain, nothing more, nothing life threatening, you may sit in the emergency for hours.
I'm of two minds on the whole healthcare debate.
a) there is a LOT of waste in the Canadian system that needs to be addressed somehow, and the SirJP's of the country seem to be against anything that would be done on that path, because they claim all change leads to an American style system. In a perfect world I would like to see clinics/hospitals/provincial health plans able to bill the hypochondriacs and other abusers of the system to recoup the costs they incur, and I would like to see a streamlining of the bureaucracy. One way the Canadian system fails is when you have people on social assistance calling for an ambulance, faking illness to get a ride because the hospital is close to where they want to be (and I have talked to a couple paramedic/ambulance attendee friends and acquaintances who have repeated the same type of story). How can we address this type of behaviour? In some places it creates a lot strain on the system but what can be done, charge people and put more strain on a heavily laden court and correctional system?
b) I am amazed at the way Americans accept the inherent conflict of interest in their system. Its run by private insurance companies whose primary obligation is not to their customers but to their shareholders. Yes, keeping the customer happy (and in this case healthy) is good business sense whenever possible, but if its a choice between profitability and custmomer (patient) welfare, executives can make the company the priority... and that means people can die or end up brankrupt.
a) there is a LOT of waste in the Canadian system that needs to be addressed somehow, and the SirJP's of the country seem to be against anything that would be done on that path, because they claim all change leads to an American style system. In a perfect world I would like to see clinics/hospitals/provincial health plans able to bill the hypochondriacs and other abusers of the system to recoup the costs they incur, and I would like to see a streamlining of the bureaucracy. One way the Canadian system fails is when you have people on social assistance calling for an ambulance, faking illness to get a ride because the hospital is close to where they want to be (and I have talked to a couple paramedic/ambulance attendee friends and acquaintances who have repeated the same type of story). How can we address this type of behaviour? In some places it creates a lot strain on the system but what can be done, charge people and put more strain on a heavily laden court and correctional system?
b) I am amazed at the way Americans accept the inherent conflict of interest in their system. Its run by private insurance companies whose primary obligation is not to their customers but to their shareholders. Yes, keeping the customer happy (and in this case healthy) is good business sense whenever possible, but if its a choice between profitability and custmomer (patient) welfare, executives can make the company the priority... and that means people can die or end up brankrupt.
I never said that, Wulfie. But my point is that user fees will lead to American type health case system, since it will punish unnecessary visit to doctor's office (for cold, sniffles etc.) as well as the necessary ones (for real illnesses, for preventive care etc.).
Exactly, and how do you do that without also penalizing the genuine visits to the doctor's office? User fee is a blunt instrument, which will discourage the unnecessary as well as the necessary visits.
I am open to sensible suggestions (e.g. putting doctors on a salary would be a sensible suggestion), but user fees will do more harm than good.
The only way to bill the abusers would be to enable the doctors to classify a visit as non-legitimate and most probably never would for fear of discouraging patients, so its a non-starter, IMO.
I honestly don't see how "putting doctors on salary" does anything: it flattens their wage earning potential (in cases where they don't own a part of the clinic they work out of) and encourages them to say "OK I've done my shift, I'm done and to hell with the X number of people in the waiting room". With doctors who own a part of their practice, its about the number of patients they can get through and bill the provincial plan for: if you "nationalize" (for lack of a better term) their clinics, you take away most of the incentive for them to stay in Canada vs practicing in other countries, unless that salary is huge.
I honestly don't see how "putting doctors on salary" does anything: it flattens their wage earning potential (in cases where they don't own a part of the clinic they work out of) and encourages them to say "OK I've done my shift, I'm done and to hell with the X number of people in the waiting room". With doctors who own a part of their practice, its about the number of patients they can get through and bill the provincial plan for: if you "nationalize" (for lack of a better term) their clinics, you take away most of the incentive for them to stay in Canada vs practicing in other countries, unless that salary is huge.
IIRC, user fees of $5.00 applied to hospital visits in Alberta in the 1960s, shortly after the introduction of universal coverage. As I was very young at the time, I cannot remember exactly, but they were eliminated around 1970. Extra billing by physicians was allowed as late as 1986, to my personal knowledge.
Also, another poster earlier suggested that health club memberships should be tax deductible. They have been since 2007 or thereabouts.
That is not exactly news, they have a rating system from 1-6 and you're a six you could still be sitting there a week from now. Of course the man who is bleeding at a quart a minute with his foot stuck in his pocket is going to get fairly snappy service.
"In a perfect world I would like to see clinics/hospitals/provincial health plans able to bill the hypochondriacs and other abusers of the system to recoup the costs they incur"
That's exactly what the $20 charge would partially accomplish.
That's exactly what the $20 charge would partially accomplish.
In Ontario more and more doctors are going on salary, Wulfie. Well, not exactly salary, but on capitation, where they get so much per patient per year. This regardless of how many times the patient visits the doctor.
As to "OK I've done my shift, I'm done and to hell with the X number of people in the waiting room", that is easily taken care of. If the doctor is not available and his patient has to visit another doctor, the fee for the other doctor comes out of the first doctor’s payment.
The doctor is obliged to provide after hour service to the patients (that also cuts down on costs). Most doctors work as a group, so it is OK for one doctor to see another doctor’s patient from the same group, nobody gets penalized for that. But let the patient go outside the group and the doctor does get penalized for it. So doctor cannot just abandon his patients, now that he has got the payment. If the patient goes to another doctor as a result and that doctor charges OHIP 100 $, that comes out of first doctor’s income.
So that problem doesn’t really arise. But there is a big advantage to salary. Since doctor’s payment does not depend upon individual visits, the doctor usually gives patient prescriptions for one year (without salary, he may give prescription for any period between one month and one year). That leaves him with more time to look after really sick patients, preventive care etc. He gets extra bonus for preventive care, so there is incentive for him to do preventive care.
Salary is a win win situation, doctor does not lose out, the salary is set at sufficiently high level for that not to happen. Ontario is encouraging doctors to go on salary, offering incentives etc. and more and more doctors are going on salary. My wife is considering it, her group may switch over to salary in the next few months.
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In the short time I worked in a hospital and the 5 years I worked at Health Canada, I can truly say I believe a lot more is wasted in poor management and corporate misuse of funds then by abusers of the system..
Those who abuse the system can easily be discouraged from seeing doctors by savvy nurses and receptionist but corporate mismanagement and waste is rarely never seen and or reported..
When you think about it, the people you will hurt the most are the working poor.. Those who are always at the doctors and are on social assistance will get waivers due to financial aid requirements..
So again, people with barely enough to get by, seniors on tight pensions and the working class that don't qualify, will get hit by repeated fees.. And these fees might start at $20.00 but will soon get boosted as medical costs rise and government look at new places to find funding..
You make a good point, Francis. Doctor usually knows who are the frivolous patients, who come to see the doctor for trivial complaints. There are not very many of them. Doctor simply has to tell the receptionist not to give the appointment for a while, if the patient phones today, give him the appointment for next week rather than the next day.
In the worst scenario, the doctor may even tell the patient to take a hike, to find another doctor. In these days of doctor shortages, it is not easy to find another doctor.
Incidentally, if a doctor is on salary, he is more likely to tell such a patient to take a hike. Putting doctors on salary may well solve the problem of frivolous patient to some extent.