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Time to let those who can pay for health care: Tremayne-Lloyd

A new report on the high cost to Canadians of queuing for health care underscores the need for public-private partnerships to take pressure off the system, says Toronto health lawyer Tracey Tremayne-Lloyd.

“If you want to get some private money in the public system, which is very badly needed, you need a partnership,” says Tremayne-Lloyd, principal of TTL Health Law.

The cost in time lost to Canadian patients waiting for treatment in 2017 is conservatively estimated to be $1.9 billion, according to a Fraser Research Bulletin published in May 2018.

That works out to an average of $1,822 for each of the 1 million Canadians who queued for medical services over the year, according to report authors Bacchus Barua and Sazid Hasan.

“The report is clearly accurate,” Tremayne-Lloyd tells AdvocateDaily.com. “There’s no question that wait times in Canada have been a problem for many years now and, in spite of the government in every province’s attempt to throw money at them, they don’t get better. They just get longer.”

Provincial governments earmarked money to try and shorten wait times for medical conditions in which delays cause harm. Those include cancer, cardiac cases, cataract problems that can lead to blindness, orthopaedic hip and knee surgeries, and others where it’s a complete quality of life issue, she says.

But the problem, though nobody wants to admit it, Tremayne-Lloyd says, is the biggest chunk of this money goes to middle management.

“It doesn’t open up any more operating rooms. It doesn’t hire more nurses. It doesn’t give surgeons more time. It gets eaten up on more middle management running budgets and punching numbers,” she says.

Wait times aren’t as long in other countries with universal public health care in large part because they have some form of co-pay for patients, she says. They are forbidden in Canada. But allowing those who can afford to pay for treatment in private facilities could dramatically reduce wait times, she says.

 “You can’t get even $2 for a visit to deter people from making unnecessary visits. It’s not allowed,” says Tremayne-Lloyd. “That in and of itself, in my view, is just putting blinders on.”

Some people wrongly blame the Canada Health Act (CHA) for blocking innovation, she says.

“It’s not the Canada Health Act because it expects every province to make timely, accessible health care available,” she says. “We know it’s not timely. We know it’s not accessible because the wait lists are horrendous.”

Provincial governments have the power, without offending the Act, to pass legislation allowing private investment and innovation, she says.

Instead, they close their eyes and pretend the problem can be cured with more money or that people can wait for treatment, she adds.

“Why? Because Canadians are just so sold on having every single penny of their health care covered (by government), whether they need it or not.”

So provincial governments are afraid of losing votes if they introduce even small co-payments, she says.

As the law now stands, any medically necessary service must be fully covered by a government health plan and Canadians can’t buy their own private insurance for such procedures, Tremayne-Lloyd says.

 She suggests a process where “You let health-care providers put their own facilities in place, all licensed, all properly done, but not on the government’s paycheque, on their own paycheque, with their own investment and then you let people pay something toward the overhead of that facility.

 “Allow orthopaedic surgeons to spend a few million dollars to open up their own surgical centre, and let people pay — not for the surgery — but as an overhead fee,”Tremayne-Lloyd says. “They get their surgery done there so that they get out of the queue in the public hospital.”

Hospitals could also outsource selected services to these private facilities on a per-case basis, she suggests.

Tremayne-Lloyd uses the example of a hip replacement.

“Let’s say the surgeon is getting $200 for the surgery, but the cost of the hip to the hospital and the government is something in the range of $8,000 to $10,000,” she says. The hospital tells surgeons if they can do it cheaper and faster, they’ll get paid $6,000 or $7,000 a patient, she adds.

Public-private partnerships make sense, Tremayne-Lloyd says.

“Otherwise people who can afford to pay something toward getting that surgery by having it done in a private surgical facility, they’ll just take their money to the United States, which they do every single day,” she says. “If you want to cut the queue down, then take out the people who don’t need to be in the queue.” 

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