Part One: Definitely NOT the Romanow report; AIMS offers Health Care Alternative

Roy Romanow, head of the Royal Commission on the future of health care, has made it clear that he will recommend not only retaining, but even expanding the centrally planned, government monopoly model of health care in Canada. He will also recommend major new infusions on tax dollars, without making a convincing case that lack of money is the true culprit behind medicare’s woes, as opposed to poor incentives, lack of competition and choice, and inadequate accountability within the system. Virtually every other major inquiry into health care, including Kirby and Mazankowski, identified sustainability of the health care system as the challenge we face. Mr. Romanow’s own former Minister of Finance in Saskatchewan, underlined this when she appeared to testify before his commission. Mr. Romanow’s only real response to these challenges is to throw more money at them.

In place of Mr. Romanow’s complacent defence of the status quo, AIMS’ newest paper: Definitely Not the Romanow Report: Achieving Equity, Sustainability, Accountability and Consumer Empowerment in Canadian Health Care proposes a system that concentrates scarce public health care dollars where they’ll do the most good, and gives users of the system incentives to be prudent about how they spend them. The authors make a detailed case as to where and how to introduce competition between public and private health care providers. They also recommend focusing on health outcomes for Canadians (rather than what we spend on health). Finally, they suggest that strengthened accountability for consumers, providers and governments can have real and immediate benefits for everyone, while maintaining the integrity of the goals of medicare and a central role for government.


Part Two: Ideology blinds Romanow – National Post explores alternative solutions being offered by AIMS

AIMS latest study, “Definitely Not the Romanow Report: Achieving Equity, Sustainability, Accountability and Consumer Empowerment in Canadian Health Care,” released today, was reported on the front page of the National Post this morning. The study, an alternative to this Thursday’s widely anticipated Romanow report, concludes that Canadians must take more responsibility for their health and pay more for services in a smaller, more competitive public system. With the national debate increasingly focused on only two alternatives: increased taxes or reduced services, Definitely Not the Romanow Report will supply a broader and more innovative list of solutions to widen the debate and encourage thoughtful reform.


Part Three: AIMS releases six of twelve background reports in the Health Care Reform Background Series.

The Atlantic Institute for Market Studies (AIMS) continues to challenge assumptions underlying national debate. Recently, AIMS released six of the twelve papers in its Health Care Reform Background Series. According to AIMS President Brian Lee Crowley, “The national debate on health reform can not afford to ignore alternatives that can make a difference to the long-term sustainability of the health services Canadians cherish. The national debate around the Kirby and Romanow reports is becoming very narrowly focused on expanding services and raising taxes – we hope this series, and the alternative perspectives it is laying out, will change that.”

Below are brief descriptions and hyperlinks to each of the six papers:

Doctors Have to Make a Living Too: The Microeconomcs of Physician Practice delves into the misconceptions about cost drivers in the health care field. Looking at the arguments supporting two common cost cutting and service expanding ideas – the introduction of non-physician practitioners (NPP) or the introduction of doctor’s salaries in place of fee for service – the author finds these ideas ignore fundamental economic realities and, have exactly the opposite impact to what was intended.

Issues in the Demand for Medical Care: Can Consumers and Doctors be Trusted to Make the Right Choices? explores the concept of physician induced demand, one of the fundamental underpinnings of the policy where government limits enrolment in medical schools and artificially limits the number of Canadian physicians. Correlating high demand for health care services with the number of doctors practising in an area does not in itself confirm physician-induced demand. In fact, it is far more likely that the demand for medical services in an area induces physicians to practise there.

How Should We Decide What to Cover Under Medicare? looks at the Oregon approach to health care coverage decision-making, and demonstrates how an improved version of the Oregon model would result in a truer reflection of the collective values of society’s members in deciding what medical services should have first claim on the scarce public health care dollars available. Says author and health economist Julia Witt, “We need to generate a healthy and constructive public debate about what our priorities are in health care, removing decisions about listing and delisting from the bureaucratic and unaccountable process where they are now taken.”

Principles to Guide a Unified Funding Model For Non-Medicare (Non-insured) Health and Social Services argues that Canada’s sustained health care debate has tended to focus primarily on insured Medicare-hospital and medical services. While there is an increasing interest in non-insured health and social services, such as continuing/long-term care, drugs, home care, and social supports, analysis has often overlooked the fragmented funding arrangements in these sectors, in particular the financial impact for some people.

In Canadian Health Care Insurance: An Unregulated Monopoly Dr. Zitner outlines how the government has abandoned their regulatory authority to ensure people receive the care they need. The government’s ability to play that regulatory role effectively is hampered because, as the ultimate provider of health care services, government is actually being asked to regulate itself – an impossible conflict of interest. “For health care in Canada, avoiding compliance with standards for access, comprehensiveness, portability and universality becomes a focus because compliance represents a cost and revenue is allocated based on political negotiation, not results,” says Dr. Zitner.

Profits and the Hospital Sector: What does the Literature Really Say? explores the anti-for-profit bias in the public debate on health reform and concludes that there is, in fact, a considerable amount of evidence to show that there is no systematic differences in efficiency between for-profit and not-for-profit hospitals. The role that for-profit health care providers can play in the health care system should therefore concentrate on those areas where such providers enjoy comparative advantages over public sector providers, not on irrelevant ideological preferences for not-for-profit provision of health care.


Part Four: AIMS in La Presse on Health Care

In his newest role as a contributing author to La Presse, a French language daily in Montreal, AIMS’ President Brian Lee Crowley has started off with this article looking at why Roy Romanow, the head of the federal commission into the future of health care is part of the problem, not the solution.

Administrators of our health-care system suffer no direct consequences from poor customer service. They aren’t even answerable to a demanding regulatory agency, other than the vague federal power to withhold funding for violations of the equally vague principles of the Canada Health Act. Other than notoriously ineffective channels of complaints to politicians, letters to the editor, and calls to open-line shows, dissatisfied consumers have little power to influence the system. This translates into excessive waiting times, error tolerance, and the growing use of health services outside “official” channels.

Says Crowley, “Roy Romanow thinks this unresponsive monopoly is just fine and only needs more money – a lot more. That’s why he’s part of the problem, not the solution.”


Part Five: Shed no tiers for medicare; “one-tier” health care a myth and a distraction

The head of Canada’s health care commission, Roy Romanow, has made it clear that his forthcoming report will continue to ensure that “two-tier” health care is forbidden in Canada. In this piece from the National Post, AIMS’ President Brian Lee Crowley explains that many of Mr. Romanow’s concerns are ideological, and have little to do with the quality of care delivered within the public system.

“Romanow clings to a system that outlaws private spending on publicly insured services, in the mistaken belief that parallel systems rob the public system of resources, while both objective and subjective international rankings show that multiple tiers of access are fully compatible with high quality public systems, high levels of care overall, high levels of patient satisfaction and public health outcomes as good or better than Canada’s,” says Crowley.


Part Six: We’re headed the wrong way.

In this piece from the Globe & Mail, Brian Crowley, AIMS President and co-author of the “Definitely Not the Romanow Report: Achieving Equity, Sustainability, Accountability and Consumer Empowerment in Canadian Health Care,” explains why any health-care system that makes visits to a family doctor freely available but rations high-cost treatments for life-threatening ailments has it backward. He then takes aim at the soon to be released Romanow Report: “Mr. Romanow is wedded to an old paternalistic model — one that’s been overtaken by technology and by rising public expectations. It suggests experts know best which services we should get, how much they should cost, and how long we should wait. Let’s tell Canadians the truth about medicare’s unsustainability and involve them in making the tough choices to ensure that medicare’s best features are there when we need them.”


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