Saturday, June 14, 2008

Birth of a New Industry

The Ottawa Business Journal is reporting on Wait Time Insurance.

"A new health-care insurance plan that sends Ontario residents waiting for public treatment to out-of-province private clinics". The intent of the plan is to "cover the cost of transportation and treatment costs for policyholders forced to wait more than 45 days for treatment in Ontario's public system"

Even though Canada is a combination of private and public funding, health care clinics and doctors are not allowed to operate in both for insured services. For instance, it would contravene the Canada Heath Act to see private patients in your clinic Mondays and Thursdays and public patients Tuesdays and Fridays (Wednesday is for golf). Physicians have to either opt in or out of the system for insurable services. A more relevant example is MRI clinics. In the same way, they either have to be completely private or public.

Where the wait time insurance kicks in is to cover the cost of people going outside of Ontario. Private MRI's and CT's are discouraged in Ontario because the current government views them as a threat to the public system and has vowed to shut them down. To this end, it is difficult to get a radiation safety certificate for a new CT or MRI machine and there are few (if any) private clinics left. But if you cross the border into neighboring Quebec, private MRI clinics are readily accessible.

Where things get complicated is in the regional differences. For instance the previous Ontario provincial government viewed private diagnostic imaging as the salvation of Ontario's system (shortly after they where thrown out and the new government began shut-downs) but Tony Clement, who was the provincial Minister of Health (and orchestrated the private clinics) moved to the Federal Minister of Health seat. Not surprisingly, life has gotten easier for private clinics across the country.

Similarly, certain provinces will allow private clinics (and register them) and others will not. Some provinces allow private insurance and others will not; you will notice that the firm providing the wait time insurance is based in Alberta, Canada where private insurance is legal.

So a seemingly innocuous story about some minor insurance turns into one major symptom of the problems in Canada's health system. The tenants of the Canada Health Act include portability, universality, accessibility and freedom from charges for insured services. Where one government demonizes private clinics another allows them which creates greater regional disparity. Those differences, are at odds with the concepts of the Canada Health Act.

In the end, most of Canadian Health Care, including hospitals, are private not-for-profit entities run by community boards but publicly funded. We are not truly socialized where physicians and nurses are employees of the government. I think that will be the loop-hole that facilitates greater private coverage through federal legislation. The writing is on the wall that exclusively publicly funded health care does not meet the demands of the public so funding will have to increase. Whether that funding happens through private or public means is at the discretion of the provincial governments but I think the federal government intends to make the choice between the two easier.

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