Do we need to rethink healthcare delivery?

I know today is budget day but the Globe and Mail published this editorial on private delivery of health care in Ontario (Ontario's dismissal of privately provided care). With all of the talk in reducing wait times and the growing concern for providing quality care for a population that is rapidly aging, it's disconcerting to see governments (in this case the Ontario Liberals) dismissing delivery options that will solve these pressing issues.

In this case Health Minister George Smitherman rejected the possibility of a private clinic, Don Mills Surgical Unit Ltd., providing knee replacement services to reduce wait times. This seems odd given the stated commitment to reduce wait times and the fact that other procedures are outsourced to the same company.

The environment has dominated the national agenda over the course of the past few months, but health care is the monster that's still under the bed waiting to jump out and scare us all. We need to rethink our entire health care system and relatively quickly. Alternative delivery mechanisms under medicare are option that should be considered where it makes sense. Allowing private companies to specialize in niche areas may not only shore up gaps in the current system but make it more cost effective and efficient. The Shouldice Hernia Centre in Markham, ON. is one example. It's been operating since the late 1940's and is so good it attracts patients from around the world. The operation is efficient and most patients are discharged within a couple of days of surgery.

And best of all, the entire cost, except for the semi-private room is paid for by OHIP. When I was there the rooms were about $125 and I was there for a total of 3 nights, so the cost was by no means prohibitive. Why shouldn't we consider this type of delivery? Just because it's private? In reality, as long as mechanisms are put in place to rate providers as is done by for profit payers in the U.S. it seems an excellent way to improve the system as a whole.

Governments should also looking to innovate in other areas. Implementing or expanding funding for community clinics and the role of nurse practitioners, as the Ontario government has done in several communities (I went to one in Toronto when I lived there) provides excellent service and reduces emergency room visits.

Where the Ontario Liberals have fallen short is in supporting preventive health care such as nutritionists and physiotherapists which were delisted over a year ago. And what about making individuals more responsible for their own health care? If we are going to reduce health care costs then individuals must be made to bear some responsibility when they have been negligent. After all, why should I pay for someone who eats fried food every day and doesn't exercise and then develops diabetes and chronic heart disease? At risk patients should be put on a program by their doctor and then made to pay increasing deductibles if they don't adhere to the regimen set by their physician. This has been done to good effect by some private payers in the United States. As long as we maintain these programs under medicare I don't see why we should do some of these things. They will save us substantial health care costs down the road.

Then there's a national pharmacare program which could rationalize the drug industry in this country and make many more drugs affordable. Again, we can see in the U.S. that scale means lower costs.

Whatever we do we need to begin to explore new delivery models if we are going to save medicare in this country. And, as difficult as it may be, it also means that minimizing political pandering even in an election year as Mr. Smitherman has done here.