Reining in healthcare costs

Canada’s health ministers want you to reduce your salt daily intake to one teaspoon at the same time that the Organization for Economic Cooperation and Development (OECD) is advising that the Canadian government reduce spending on healthcare.

Our universal healthcare system is under threat as we seek to accommodate the growing cost to maintain it. Healthcare spending claims on average more than 40 per cent of provincial budgets. Over the years some services have been ‘de-listed’ in order to continue to afford the system. Also, to keep up with the growing cost in this province the McGuinty government instituted a “premium” of up to $900 from taxpayers towards healthcare. So never let it be said that healthcare is free. We all pay dearly for it. But many of us are in the dark about how much it costs to receive the services that come with an annual health checkup, for instance. Perhaps being better informed would influence how we use the service.

The OECD has noted that the spending on health this year is eight per cent over the previous period and that growth in spending on healthcare should move back to a rate increase of four per cent annually. Federal healthcare payments to the provinces account for 12 per cent of the Harper government’s 2010/11 $280.5-billion budget.

McGuinty has promised to contain healthcare costs with a “patient-based payment” system in which “money will follow the patient”. Previously, the practice was to provide billions in funding to hospitals with relatively few strings attached.

What “money will follow the patient” means in a nutshell is that individual hospitals will receive payments based on the number of patients they see rather than fixed payments.

That rather hurried visit you have from your family doctor, which may last less than 10 minutes after sitting patiently in the waiting room for more than an hour in some cases, can cost more than $50. And that’s just to start. A visit to a hospital emergency room can cost anywhere from $15 to more than $70 to just be seen by a physician, again after the lengthy wait of as much as 24 hours. The fee is higher during the evening hours, by the way.

If you are diabetic, fees start at $37 for an assessment and go up from there. Some doctors, themselves, don’t know at the end of the day what an itemized bill would be for treating a patient and all the tests that are requested. As it is now, doctors can bill the Ontario Health Insurance Plan (OHIP) without their patients knowing what is being billed for.

Would knowing the cost of services influence the behaviour of those who, for example, use emergency rooms when what they need is a pharmacist or to go to a clinic?

In the U.S., one of the initiatives of the George W. Bush administration was to present patients with information on the cost of health services and medical procedures so that they could make informed choices about insurance providers. To paraphrase former U.S. Health and Human Services Secretary Mike Leavitt, Canadians know the price of almost everything they pay for, except healthcare.

More transparency here will both serve the system and public awareness. An example of that would be if the patient, with each appointment, has to sign a ‘sales slip’ listing the cost of the visit and any additional services. This will ensure more accuracy in billing.

With emergency room visits by seniors in Ontario having increased by 100,000 a year over the past five years, the inefficiency of wait times in hospital emergency wards is also driving up cost. Add to that, ambulances having to line up and wait until their patients are handed over to emergency staff. Such a process has been known to take up to eight hours.

As with the new initiative on reduction of salt intake, reining in healthcare costs must include more focus on the preventive side. This means training more family doctors as well as improving the system for the certification of doctors coming here from other countries.

Canada’s universal healthcare is too vital to be allowed to drift due to negligence, de-listing or funding cuts.

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