Now, I'm all for introducing private health-care delivery into Canada's system (I think it's pretty ridiculous not to do that), but I don't think Dr. Ouellet quite hits the mark.
The pitch for change at the conference is to start with a presentation from Dr. Robert Ouellet, the current president of the CMA, who has said there's a critical need to make Canada's health-care system patient-centred. He will present details from his fact-finding trip to Europe in January, where he met with health groups in England, Denmark, Belgium, Netherlands and France.
His thoughts on the issue are already clear. Ouellet has been saying since his return that "a health-care revolution has passed us by," that it's possible to make wait lists disappear while maintaining universal coverage and "that competition should be welcomed, not feared."
In other words, Ouellet believes there could be a role for private health-care delivery within the public system.
He has also said the Canadian system could be restructured to focus on patients if hospitals and other health-care institutions received funding based on the patients they treat, instead of an annual, lump-sum budget. This "activity-based funding" would be an incentive to provide more efficient care, he has said.
He's absolutely correct that annual lump-sum budgets are a poor method of payment. Further, I agree that switching to "activity-based funding" would be an improvement - but it is no panacea. We will be switching from one set of problems to another. One of the biggest obstacles to an efficient health care system is doctors, and, specifically, the phenomenon, "supplier-induced demand". Basically, this means that if a doctor suggests a course of treatment to a patient, the patient will probably follow suit. If we tell doctors that they will be paid on a basis of the activities/services they actually provide to patients, they will have an incentive to provide more services, more treatments. They will have a stake in the amount of intervention that they proscribe.
(Think doctors don't respond to economic incentives? According to Steven Levitt they do. In Freakonomics he notes that obstetricians will conduct more c-sections when they don't have as many patients.)
So, if we can't pay them by treatment, what about by patient, then they have no incentive to suggest unnecessary procedures. Well, the obvious problem with that is that they now have an incentive to see as many patients as possible. Anyone who has been ushered in and out of a doctor's office as fast as humanly possible can guess what the result of that will be.
Okay, I realize I've just crapped on three different payment systems, so, you may ask, what do I recommend. Well, I think an activity based model is the way to go, but we have shift some of the responsibility back to patients - the consumers, if you will. One way to achieve this is through Health Savings Accounts. This will put some of the onus on patients to avoid costly and inefficient procedures. If doctors are going to respond to financial incentives, you can bet patients will as well. (Logistically, there are some issues with these accounts, and a nuanced implementation is probably best.)
This solution, though, is only one aspect of a larger solution. Unfortunately, this larger solution is far more difficult. Empowering patients to make proper decisions will take more than just shifting economic incentives. We will need a cultural shift, as well. People need to learn not to unconditionally trust doctors. Even the best doctor can have an unfortunate response to a perverted incentive. It is up to us to determine what advice we take from doctors.
We need to learn to rely on ourselves rather than just relying on experts. We need to seek out information, weigh options and do our best to make a rational choice about our health care. We cannot merely trust experts and politicians to tell us what is best, what is appropriate and what information is relevant when making these decisions. Sure, doctors are generally going to know more about health care than the rest of us, but that doesn't mean we don't have a role to play.
Further, we need to re-assert our personal sovereignty. It matters not what doctors want to do your body. It matters not what treatments they think are best. It matters not what study they just read. We are the arbiters of what is done to our bodies. If I demit, and merely do whatever the doctor tells me to do, then I am responsible for all that is done to me. (Granted, when health care workers lie, bully or otherwise coerce me into doing something, the blame gets shifted.)
Sadly, this is not easy to do. Doctors and nurses will bully you, and they will lie to you. Hospitals can be intimidating, and the practitioners can exert undue influence on patients. Hell, sometimes they'll just try to do stuff without even consulting the patient or guardian (I've experienced this with my daughter). Standing up for yourself, your rights and your personal dignity is difficult in such a situation (I admit it; I didn't do enough to protect my daughter from these assaults... and assaults they were, no matter how minor others may view them).
Choice, responsibility, personal sovereignty - so many things really do come down to liberty.