In the wake of the Supreme Court decision "Chaoulli v. Quebec" opening the door to two-tier health care in the province of Quebec the BC government must put in place the steps needed to ensure public health care delivered by public facilities as soon as is possible.
The first steps will be needed to shore up the Canada Health Act by enforcing its principles. BC has been fined three years in a row for violations of the Canada Health Act. These moves will assist in making our public system in BC stronger.
The ever growing waitlists (34% higher since 2001) need to be addressed. The Vancouver province recently printed a report detailing 15,000 hours of operating room capacity not used in BC each month over the last three years. This at a time when government has seen growing waitlists and health authorities are pushing some surgical procedures out to private clinics.
A provincial government investment in innovative solutions such as specialized public clincs could see the waitlists lowered substantially in a short period of time. In an example of simple but important surgeries not being done in a timely fashion, residents in Kelowna BC can expect a waiting period of over one year for cataract surgery. This waitlist is not required. It provides for a lower quality of life for the person requiring the surgery.
There is a theory behind growing waitlists. It is that the longer the lists become, the more apt proponents of publicly funded and delivered care, will see the need for private care. The current BC Government is a strong proponent of expanding the use of private services for health care. The primary reasoning being that private clinics save taxpayers money.
Looking at private care and how it is delivered and paid for it is no different than a Public private partnership or a 3P project. The value of these partnerships has always been touted that the government does not have to borrow the money to build them. In the case of private clinics, they would build a clinic, staff it and provide all the equipment to operate it. The government then would pay a fee for use of the clinic, often guaranteeing the clinic a certain number of procedures each year.
Lets look at the math. The owners of the clinic borrow the money to build and equip the clinic. This cost is amortized over 20 or 30 years, something that government would do if it was building the clinic or has done already with vacant hospital operating facilities. The clinic then provides for surgeons, nurses and staffing to operate.
The government pays the clinic for each service it provides. The fees paid by government go to paying for the cost of operating including any debt servicing, staffing and surgical staff and a profit for the people that own the facility.
One argument used by the BC Liberal government is that the province saves in not paying the up front costs of building and equipping these surgical facilities. The provincial books look better as there is no debt added. What the government is not so forthcoming with is the contract they sign with the private clinic. This contract is usually calculated to ensure the clinic can pay all its bills and make a profit. Essentially we are leasing a service much like someone leases a car.
The lease has a small up front cost, guaranteed payments to the person who owns the car, and additional penalties if you use the car for more than you contracted it for, you also pay for wear and tear on the car. In the circumstance of a private clinic an escalator clause is usually included to cover unforeseen costs. All the time we are in this agreement the clinic makes a profit for its shareholders, meaning we as taxpayers are paying out an additional cost not required in public or not for profit health care.
If the government were to use exsisting facilities (we have over 15,000 hours of unused operating capacity each month in BC), we would not need to pay for private clinics saving construction and or equipment costs, we would not be paying a dividend or profit to the clinics shareholders. These saving can be significant over the course of a 20 or 30 year contract. Imagine shareholders investing in a company that does not provide a good return on their investment. Its not going to happen.
Look at who is interested in expanding private health care in our province and country, insurance companies. These companies see a large opportunity given fewer government decreed medically required services to collect millions of dollars in premiums and user fees. Private clinics would benefit by charging back to the government an agreed to fee for the cost of an operation and charge an additional fee to the patient for the convienance of quicker access to care.
This scenario would lead to wealthier people receiving better care and treatment. At the same time the cost of public run institutions would go up as they would be dealing with more complicated procedures driving up the over all cost as private clinics creamed the easy less complicated surgeries. Waitlists could grow again for those that could not access private care directly as a result of fewer dollars coming into the public system.
Governments in Canada have generally failed Canadians over the last 12 years. The federal government slashed funding to health care from 50% to 14%. Most provinces dealing with deficit's of their own, slashed health care funding and waitlists started to grow. The exception was in BC where the government through out the 1990's continued to fund health care despite federal government cuts.
Despite the maintaining funding and even increasing funding levels in BC, healthcare costs continued to rise. The time has come to look at innovative solutions that maintain costs and provides timely provision of care. No person should be waiting a year or more for any surgery. There are costs involved in long waitlists including lost productivity, prolonged use of prescription drugs to stabilize some patients while the wait for surgery and a substantially reduced quality of life that not only affects the patient but the family and friends as well.
The one good thing to come out of the "Chaoulli v. Quebec" Supreme Court decision is a renewed urgency it commands of our governments to find a solution. Governments have three ways to choose to go, maintain the status quo and see court challenges that will provide an avenue for private care to expand, actively provide more room now for private care or reinvigorate the public health care system with innovative solutions and adequate funding.
Tax money should go to Healthcare and not profits for investors. I choose the Public health care system.