Canadian Hospitals and the Political Circus of Public Health Care
Overflowing emergency rooms, bed shortages, and hallway nursing are the norm in Canadian hospitals. Patients unable to avoid getting sick or injured are now being advised to wait at home. Another way for hospitals to make their statistics look more favorable is to change the reporting of them. The minutes of a public meeting held by the Saskatoon Regional Health Authority notes, “As the wait times in the Emergency Department (ED) are not appropriate, ‘emergency’ might have to be redefined and there could possibly be a different entry point for those with ‘non-emergency’ issues.”
This political circus has been going on for years with the same old acts appearing over and over again. Politicians shoot cannons stuffed with public money that falls from the air like confetti. The regional health authorities juggle consulting contracts and so-called health care improvement programs while running million dollar deficits. Bureaucrats manipulate supply and demand by opening and closing hospital beds, limiting operating room hours, cancelling surgeries, and extending wait lists. Academics collect data and systematize the practice of medicine while spinning its culture upside down. Unions train their members to perform on demand for various treats. Patients walk tightropes and make death-defying leaps high above the center ring.
The Only Show in Town
Provincial legislation prohibiting doctors from charging fees above or below the prices set under Medicare effectively squashes entrepreneurial opportunities for doctors wanting to run their own show. Likewise, patients are legally prohibited from paying directly for any publicly-insured services which means even those willing and able to pay for their own health care are forced to depend on government for access and payment. This sets the stage for vote-seeking politicians and ravenous bureaucrats to take full advantage of what has become a very lucrative public health care industry.
The Price of Admission
Public hospitals consume the lion’s share of health spending in Canada devouring an estimated $63.5 billion in 2014. Efforts to contain these costs aim to align government regulation and price controls with hospital policies and procedures. This can be seen in ever-expanding scopes of practice for various health professionals and the use of hospital-owned group purchasing organizations (GPOs).
Hospitals claim their GPOs save money by negotiating volume purchases and long-term single source contracts on pharmaceuticals and other medical supplies. They receive millions of dollars in rebates for providing corporations with access to these exclusive hospital contracts. Even politicians admit to getting lost when trying to follow the public money flowing back and forth through these GPOs.
Another cost-containment measure is service alignment or cuts whereby hospitals are designated to provide certain services. Patients and ambulances can no longer choose the nearest hospital expecting to find a full range of services, nor can they choose one with a reputation for better care but must travel to a designated hospital.
Do these cost-containment measures really benefit patient care or do they just add another layer of complexity to it? Politicians tell us it’s about getting value for money. How can patients judge whether or not they’re getting value for their money when they’re not the ones spending it? The ability of hospitals to cover their losses with public money is made easier by the fact that patients receive no information on the costs of their individual care, nor do they have any alternative options for accessing it.
Complaints about the quality of hospital care are handled by their risk management department. Information obtained during investigations of complaints by quality assurance committees is privileged and therefore exempt from legal proceedings. The Healthcare Insurance Reciprocal of Canada (HIROC) is one of the leading hospital-owned insurance companies providing liability coverage for hospitals. It has amassed over $1 billion in assets with premiums and investments from public money. In addition to their liability insurance, hospitals also retain the top legal firms in every province. Risk management for hospitals has become big business for the network of publicly-funded corporations and organizations tasked with improving quality of care and patient safety.
Despite continuous cutbacks, the shifting of care to out-patient facilities, and millions of dollars injected annually by public hospital foundations, Canadian hospitals are still failing to provide patients with timely access to high quality care.
It’s time to let politicians know that patients will no longer be putting their lives on the line for this political circus. The show is over.