Patient-Centered Healthcare For British Columbia
- Put the needs of patients and their families first and protect charter rights in all legislative decisions
- Maintain existing multiple payer system for total health care costs
- Liberate Healthcare – Legalise Private Delivery Options
- Promote preventative, primary and long term care
BC already has a multiple-payer healthcare system in which workers injured on the job (WCB), those injured in accidents (ICBC), the RCMP, Armed Forces, federal employees, politicians, and even federal prisoners can access care from outside the public system and obtain procedures and surgeries very quickly. 65,000 surgeries are done annually in BC at the dozens of private surgery centres that have been operating for decades. Additionally, many medically necessary services like prescription medications, ambulance rides, dental care, and mental health counselling are excluded from our public system, despite their importance in health outcomes. Users pay for these services, or they purchase private insurance to pay for part or all of the costs. Our policy would not change this model, as the remaining 70% of the healthcare system is dictated by the Canada Health Act to be paid for directly by the provincial government.
Numerous consecutive provincial governments have attempted to tackle the increasing portion of their budgets going toward healthcare. Attempts have been made at increasing efficiencies in our current system, improving the overall health education of people, reducing wait times and many other well-intentioned reforms. What were repeatedly hyped as fix-alls have barely moved the needle. Health Care consumes 40% of the provincial budget. With aging demographics, rising populations, and increasing availability of new lifesaving treatments, health expenditures are expected to rise by 6% annually, outstripping economic growth, and increasing the portion of the budget directed toward healthcare (to 50% or higher, without significant new taxes). This will result in a budgetary crisis, necessitating more rationing of care.
Another approach is urgently required. It is our belief that the hidden efficiencies remaining to be found can only be uncovered by competitive forces in the delivery of health care services.
Patients are costing hospitals $1200/day taking up hospital beds, when they could be getting care better suited to them in a long-term facility that bills the government $300/day instead. Hospital admissions are costly, and serve as a bottleneck in the system which impacts the delivery of care in unanticipated ways, such as emergency rooms which are over capacity. This increases wait times, and results in patients even being seen in hallways as physicians struggle to cope with fewer available beds. An institutional diversity in delivery of care would allow for entrepreneurial doctors, nurses and nurse practitioners to group together and open their own specialty facilities that specifically target the needs of underserved hospital patients. Diverting these patients to more appropriate care facilities will free up hospital resources to improve outcomes in the areas they are best suited for.
Promises to improve outcomes in our current medical system without significant reform are not credible. We want to reform how public funds are allocated and how individuals are able to access medical care in British Columbia. Reforms should follow examples found outside North America. They are urgently needed to avoid a crisis with a majority of medical doctors in BC on the verge of retirement.
Canada’s System and global comparisons
Canada has unique factors such as vast expanses of land to cover, relatively small population, Indigenous health and mental-health related issues which make a direct comparison to other healthcare systems very difficult. We can look to other countries that have health outcomes on par or better than ours, which don’t have to spend as much money to achieve those outcomes, and then correct for factors that either make ours more difficult or easier. But it is not an exact science.
To a large extent, countries with better outcomes in many or most metrics than Canada include Sweden, Denmark, the Netherlands, Germany, France, Japan, Iceland and Switzerland. All of these countries have a primarily non-government system for the delivery of care.
Despite the amazing work done by healthcare professionals under trying circumstances, Canada’s medical system does not rank as the best in many categories despite recent high-profile proclamations of our superiority. Replicating the American system is explicitly not our objective. Their outcomes are some of the worst among developed countries, yet a larger share of total income is directed toward obtaining it than for any other country. However, systems that have superior health outcomes to Canada’s existing from Scandinavia to Asia can be emulated in their best features and applied to our system.
British Columbia’s system also differs from systems in other provinces like Quebec, where patients can obtain care privately if the public system cannot deliver in a reasonable period of time (See Chaouille v. Quebec 2005). The prohibition for British Columbians to seek out care when their government provider has failed them makes this one of the most restrictive places in the world for healthcare, and the only democracy with such a system. We believe, that if challenged at the Supreme Court, precedent from the Chaouille case would carry allowing British Columbians the right to access care when the government has failed them.
Attracting and retaining more Medical Doctors
We want British Columbia to be a haven for Canadian doctors struggling to find the kind of flexibility that multiple providers can offer employees or contractors. BC’s huge shortage of family doctors can be alleviated by market signals serving as the basis for fee schedules. This means that areas which are underserved would continuously increase compensation for doctors until the shortage was eliminated. Conversely, areas overserved would see compensation decreasing. With non-government delivery of services, compensation packages can become increasingly diverse and creative, rather than one-size-fits-all, a system that wastes the abilities of those who cannot or choose not to work under conditions set by government.
Competitive base salaries may be offered to some doctors as incentive to serve in more remote areas. Today doctors are limited by fee schedules that they and their groups negotiate with the Ministry. Fees are often outdated, and do not reflect the realities on the ground at any given time, creating permanent supply/demand mismatches. There is little reason to enter into lines of work that are not billable at favourable levels vs. the alternatives.
Complacency with the status-quo is wasting budgetary resources that could otherwise be directed toward further investments in patient-centred care. The cumulative effect is a system running far below its potential. It is time to address the structural causes of this waste.
Reducing waiting times
Waiting times for orthopedic surgery (joints), ophthalmology (eyes), and otolaryngology (ears, nose, throat) are particularly unreasonable even according to a majority of surgeons themselves. Waiting times in emergency rooms are also beyond reasonable by any standard. There are additional non-surgical procedures for which waiting times also exceed the amount of time needed to prevent the advancement of conditions to stages that require more costly and invasive interventions. While increasing tax dollars have been pouring into reducing these wait times, the needs of an aging and growing population is overwhelming any gains made. The waits for some specific surgeries are so long that careers can be cut short or earning potential and quality of life permanently affected. Policies of the Canadian Medical Association imply that people should have a right to prompt treatment. We agree.
With waiting times that are on average over 30 weeks, people in need of routine surgeries are often sitting idle, not earning their full wages and creating losses for their employer who has had to suddenly do without an employee. In more extreme cases than should be necessary, a multi-year absence can lead to the loss of a career path, an assortment of health complications related to pain management or even suicide. This constitutes a waste of human potential and violates the spirit of the Canada Health Act while diminishing the importance of patient-centered care. It can be avoided: with immediate treatment and rehabilitation.
The drain on our economy by having tens of thousands of people on waiting lists is acknowledged by the use of private medical services by WCB and ICBC, the RCMP and others. Where workers have recourse to immediate treatment to mitigate wage and career losses, they can get it. Where someone else injures themselves off the job, they should be able to similarly seek out the same care, get multiple opinions easily, and select the provider that offers them the best combination of timely care and comfort with the medical personnel they have chosen themselves for their care. There is no logical or ethical reason for excluding one person but not the other.
Responsible governance and economic reality dictates that only a certain portion of government revenue can be used on the medical system. However, medical advances over the decades have made it possible for British Columbians to positively affect their quality of life with more spending on preventative care and risk reduction. Our reforms should result in more health care being delivered in British Columbia by more doctors, more nurses and more allied health professionals at more medical facilities. Our wealth as a society would be better served if our excess income was able to be directed toward our own health – far better than credit fuelled consumerism or asset speculation. There is no virtue in clinging to a system that forbids this. Basing our health care budget as a proportion of GDP on the political ability to tax and fund its growth is unnecessarily restrictive and virtually guarantees permanent shortages of funding. Health care is simply too important to be subjected to artificial scarcity.
In addition to minimizing wasted lives and broken dreams, we hope our reforms will introduce the proper incentives into our medical system that will drive the public system toward greatly improved service through optimization of efficiency that will be able to handle a growing and aging population.
Channel more patients to long-term care
In terms of the percentage of patients accessing long-term care institutions other than hospitals, Canada ranks far behind countries like Sweden, Switzerland, the Netherlands, Australia. When home-care is included, countries like New Zealand, Norway and Israel also serve far larger portions of their populations with similar levels of funding than does Canada.
Floating fee schedules and market prices
A single-payer system for the $19 Billion dollars that is the 70% of total health spending still leaves the problem of non-market prices being dictated by a central authority that does not have the knowledge nor the data to make informed decisions. Non-government delivery would be motivated to collect and disperse more and better data that is needed to improve efficiencies.
The BC Libertarian Party proposes a floating public fee schedule system that naturally reacts in real-time to the supply/demand signals that private delivery would provide. We will encourage the use of outcome-based compensation models, rewarding medical professionals partly based on the results of their interventions on patient outcomes measured by quality-adjusted life years (QALY), disability-adjusted life years (DALY), and/or years lost to disease (YLD).
Apply Chaoulli v. Quebec ruling in BC
The Canada Health Act is being interpreted in a manner that we believe violates the individual’s Charter Rights (Section 7: Security of Person). Since delays in medical treatment could have physical and stressful consequences for individuals, the Supreme Court agreed in 2005 that preventing individuals from procuring their own care was a violation of their charter rights. This ruling, however, was only applied in Quebec. A BC Libertarian government would take precedent from this ruling (Chaoulli v. Quebec), remove any existing legal opposition to it by consecutive Liberal and NDP/Green governments (Cambie Surgeries Corporation et al v. Attorney General of B.C. et al), promote it moving through the courts, and defend that interpretation against any federal protestations.
This case is important for patient-centered health in British Columbia. It will allow for elevating the needs of the patient being the primary determinant of how health resources are directed, demoting political and budgetary motivations to the secondary considerations they should be.
Powerful special interest groups and unions spend an extraordinary amount of money on lobbying for favourable fee schedules. The ministry administration budget is reflective of the kind of bureaucracy this arrangement necessitates.
One of the main inefficiencies in the medical system is created by political pressure and specialist groups that attempt to fix the procedure rates physicians charge their employer at artificially high rates, despite technological advances that have made the procedure cheaper and faster to complete. Rather than more procedures done for the same price, or savings for the system at large, the fees remain expensive and entry into that specialty is instead rationed to prevent increasing demand from cratering the health budget. Conversely, when the demand for certain procedures goes up (orthopedic surgery, for example, because people are living longer), prices on the fee schedule are slow to reflect the increase in demand. There is no signal to medical students choosing a specialty that there is an opportunity for higher wages in that field. The result is a shortage of specialists. Both are non-market prices that lead to increased waiting times, and a misallocation of health resources.