Quality always suffers in government-run health care systems where price controls wreak havoc on the basic economic principles of supply and demand. Recent news articles concerning the National Health Service in Britain reveal a much different picture of the patient experience than what is portrayed in its June 2008 report titled “High Quality Care for All: NHS Next Stage Review final report”.

The Ontario government claims its new act is putting patients first by requiring hospitals to conduct satisfaction surveys, publicize a “patient declaration of values” and a “patient relations” process. Their government health care executive salaries will be tied to performance measures and issues with quality of care will be addressed by ensuring every hospital has a quality of care committee and develops yearly quality improvement plans. However, the term quality can mean different things to different people depending on where you stand in the hospital spectrum. What does quality mean to the hospital CEO who must contain costs in order to present a balanced budget annually? What does quality mean to doctors allocated limited operating time and space or to nurses and other health care providers in understaffed, overworked environments? What does quality mean to patients waiting on lists for care and whose care may be compromised by reduced time with doctors and nurses, outdated technology and equipment, a lack of cleanliness and hospital acquired infections?

A majority of Canadians have not experienced medical care outside of Canada and therefore have nothing to serve as a comparison when it comes to assessing the quality of our hospital care. Tools for assisting patients and the public in this endeavor are limited. The Fraser Institute, a non-profit research and educational organization in Canada, provides a website with Hospital Report Cards for 2009 to assist the public in assessing hospital performance. Ontario is one of only three provinces for which a report card is available. The Fraser Institute notes that a majority of the hospital administrators in Ontario refused to allow their hospitals to be identified in the report thereby keeping valuable information regarding the quality and safety of their care from patients and the public. It will be interesting to see the quality measures and information revealed by hospitals under the Excellent Care for All Act.

With each passing year, the number of Canadians forced to seek medical care outside the country is increasing and their experiences are adding to the rising public expectations regarding access to high quality care. We all heard about the excellent medical care Newfoundland Premier Danny Williams received outside of Canada earlier this year.

In their attempts to quell public demands over public health care, our politicians continue to quickly introduce and pass various legislative acts. Canadians are keeping a watchful eye on our promise-making politicians who will soon come to realize that fancy titles no longer fool us. We know that Excellent Care for All is just an act.

Then, during a few blinks of the eye and with the subtleness of an unskilled magician, the fabric of medicine was pulled from the table along with all of the delicate pieces adorning it. It was the disappearance of private health care’s true meaning.

In Canada, legislation prohibits patients from directly paying for any publicly insured “medically necessary” hospital and physician services. The Canada Health Act of 1984 includes two conditions prohibiting “extra billing” and “user charges” for these health services. Provinces and territories that do not abide by the conditions are penalized by the withholding of federal funds equal to the amounts received through these practices.

Each province and territory has enacted legislation which either bans or effectively deters “extra billing” and “user charges”. Depending on the province or territory, doctors wishing to “opt-out” or practice outside of the public plan are either 1) prohibited from charging the public plan anything for their services or 2) prohibited from charging any amount above what the public plan will pay for their services. Patients of doctors practicing outside of the public plan would receive no public funds towards their private purchase of publicly insured services. They would essentially be opted-out of the public plan despite contributing to it through taxation.

All provinces and territories have legislation that either bans the purchase of private insurance for publically insured services or deters patients and doctors from opting-out of the public plan so that there is effectively no market for private insurance.

As of March 31, 2008 there were approximately 49 doctors in Canada (excluding Quebec) practicing outside of the public plan. Forty of them are located in Ontario.

Government remains the single-payer for all “medically necessary” services for Canadians. In this role they alone decide the value of these services, the provision of these services as well as measure and assess their quality.

Provincial and territorial laws can be changed and the health care insurance industry is not yet firmly entrenched in every aspect of our health care system. Canada is in a unique position to return the true meaning of private health care to its rightful owners – patients and their doctors.

You can find out more about provincial and territorial health care by reading the most recent Canada Health Act Annual report.

Who really determines a patient’s medical needs in the Canadian health care system? The federal government takes the tax revenues from its citizens and distributes money for health care to the provinces and territories through a global or block funding arrangement. The provincial/territorial governments perceive their patients’ needs in relation to their health care budget. They then provide block funding to their local health regions, networks or service boards who in turn allocate specific amounts to their hospitals. The hospitals perceive the needs of their patients in relation to the money received from their provincial/territorial government and the amounts they have budgeted for specific “medically necessary” services. This helps them determine equipment and supply purchases, the number of procedures and surgeries that will be performed annually, the number of operating hours allotted to doctors and the number of beds available for patients. Doctors then perceive the needs of a patient in relation to the needs of all of the other patients they are treating. Patient names are then added to various waiting lists for medical care.

Does this Medicare system sound frightening? It is deadly. There are patients who die while on waiting lists for medical care. In most of Canada it is illegal for a patient to financially contribute to meeting their own “medically necessary” needs covered under Medicare. The province of Quebec is the only exception due to a 2005 Supreme Court ruling that opened the door for its residents to purchase private insurance for medical care when the province fails to provide timely access. However, the Quebec government only legalized private insurance for three procedures with the longest waiting lists including knee, hip and cataract surgery. Our government often tells us that a shortage of health care providers is a contributing factor for waiting lists. In many cases the shortage of health care providers is due to governments capping the number of employees because of funding restraints.

How is our system fair to its citizens? Is it fair that an individual is prohibited from making financial contributions towards accessing medical care for their own “medically necessary” needs? Is it fair that foreigners can come to Canada and pay for private medical care provided by our best doctors while our own citizens continue to wait on government imposed waiting lists? Is it fair that our government has designated a number of groups, including politicians and prisoners, as falling outside of Medicare and therefore not subject to the same waiting lists as the rest of us?

Our government attempts to meet the “medically necessary” needs of all of the people all of the time through its nationalized health care system called Medicare. It is an altruistic goal and one that, despite the lion’s roars, cannot be met by government.

During the writing of this report 27,598 patients waited for surgery, the Saskatoon Health Region created “hallway nursing” procedures to provide guidance to nurses for treating patients in the hallways of our hospitals and the provincial kidney transplant program was put on hold after a member of the surgical team became ill. These are common provincial symptoms indicative of the larger Canadian health system problems.

In the Speech from the Throne opening the fall session of the Saskatchewan legislature on October 21st we heard the government say that they will reduce waiting lists and recruit more health care providers. If the words describing the promise for better health care sound familiar it’s because they are the same words used a decade ago by another government making similar promises.

The good news is that the desire for change in Saskatchewan, though bound and gagged by red tape, is alive and well. If the premise is a “Patient First” health care system then it is only fitting that patients take the first step towards driving change.

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