SASKATOON – While federal and provincial governments are fighting over what procedures they can afford to pay for under medicare, health academics agree it’s a controversial area.
Factors used by the health-care system to determine needs include the population’s age, gender, premature death rate and low birth weight. But these are no longer sufficient, said Glen Beck, a University of Saskatchewan economics professor.
Needs aren’t simple and today’s system can’t analyze them to determine which should be addressed and how. Also the system is still cumbersome and “can’t follow the germ around” fast enough to deal with an emerging problem.
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“We have very lumpy health resources distributed around the province and we move people to them,” Beck told a health forum sponsored by the university’s medical college.
He suggested Saskatchewan be a leader in policy debates since medicare began here. But Beck said he was told by one health bureaucrat that keeping the department out of the newspapers is the goal.
Keep problems quiet
“You don’t need a health evaluation institute in the province speaking out about problems,” seems to be the government view, said Beck.
Federal health minister Diane Marleau, speaking in the House of Commons in April, said “for the most part in Canada, we have left the definition of medical necessity to professionals, not to bureaucrats.”
And health analyst Stephen Lewis agrees with that, saying the definition is “doctor-based.” He said medically necessary procedures are those services delivered in a hospital or elsewhere by a doctor. And there is nothing that will change that in the near future, said Lewis who heads the Health Services Utilization and Research Commission, an independent health study group set up by the Saskatchewan government.
Forced to change
Alberta’s Tory caucus had to back off when it declared that all abortions are not necessary. It ended up in a spat with the province’s doctors who don’t want to be making political decisions about medicare. Meanwhile, Ottawa has also ordered Alberta to stop its experiments with two-tiered health care – those willing to pay extra can get into the quick line for procedures at private clinics.
Beck said as services are removed from the insured list, individuals pick up the costs. A study he did found Canadians now pay 28 percent of the total health-care bill out of their pockets.
However federal attempts to force a national health-care standard carry less weight as Ottawa withdraws the millions of dollars it used to send the provinces for health costs.
Marleau set an Oct. 15 deadline for Alberta to stop its particular health cost-cutting. Two days before the deadline passed, Alberta agreed to develop a new policy to deal with private clinics that charge patients extra.
Newfoundland, Nova Scotia and Manitoba also allow extra charges at private clinics and Marleau said Ottawa is calculating the financial penalties they will have to pay.
Lewis said most people would say it’s doubtful if the federal government can enforce standards when it doesn’t fund the system.
“Recent noise from Ottawa is that cash transfers won’t go to zero. … (They realize) they have to stay in the game.”
But Ottawa isn’t the only player in determining medicare’s future.
“Citizens have to declare whether they want a one-tiered or two-tiered system,” said Lewis.
