According to the Canadian Institute for Health Information, total health care spending in Canada has nearly doubled in the past decade, falling just short of $150 billion in 2006. The rate at which health care expenditure is increasing is simply staggering and cannot possibly be maintained in any economically feasible future. To make matters worse, the problems that plagued health care in 1996 are the same problems that the system is facing 10 years later, despite all the extra funding. Many might argue that health care provider shortages, increasing wait times, and rural hospital closures are even more problematic now than a decade ago.
Considering the importance of the issue to all Canadians, there has been relatively little debate on the necessary course of action that will improve the provision of health care across the country while also curbing health care spending. Historically, the debate has had two main proponents: those in favour of revamping the system within the current framework set out by the Canada Health Act, and those in favour of revamping the Canada Health Act and establishing some type of privatized or for-profit health care system (commonly called two-tiered). More recently there have been proposals for a type of hybrid system that would combine aspects of private health care and aspects of public health care, and might look similar to systems that already exist in some European countries.
One of the factors that may be limiting this debate is the sentimentality that exists toward the universal system of health care that Canada was once so well known for. Universal health care has given Canadians a long-standing sense of moral superiority over our southern neighbors, who we consider barbaric for not affording all citizens an equal opportunity to health. In principle universal health care is a very noble concept, but if it is not accessible, timely and efficient, it is not beneficial to anyone, let alone everyone. An article in the National Post discussing the need to have an open debate about health care reform points out that “politicians will immediately cast any spokesperson for debate and discussion as pro-American, pro-private, two-tier health care.” The article’s author Kevin Libin also notes that “leaders are often reluctant to address growing problems for fear of being accused of trying to demolish universal health care.”
What many Canadians might not realize is that private health care is already a big part of Canada’s health care system. Private health care is loosely defined as anything beyond what the public system will cover. Of the nearly $150 billion spent in 2006, $43.2 billion was spent on private health care. Things like ambulance rides, private hospital rooms and many cosmetic procedures are not covered by the public system and either come out of extended medical insurance coverage, or the patient’s own pocket. It is also important to distinguish between publicly funded services and publicly delivered services. Most family doctors and specialists for example work out of the private sector, in practices that they themselves maintain and manage, and bill the public system for each patient that they see or treat. This service is therefore privately delivered but publicly funded. An increasing amount of long-term care facilities, and diagnostics labs are run privately and not-for-profit, again billing the public system for their work.
Private health care is not something that Canadians should fear, or be scared to talk about just because of our proud history of universal health care. In a democratic society, open debate is absolutely essential, especially when the issue is one that affects everyone, and one that so much of our taxes go towards. In part two of this blog I will delve further into the debate, and discuss the views and ideas of prominent health care policy researchers as well as the positions of politicians and the major political parties.
Sources:
CBC News In Depth: Health Care
Financial Post Article: Medicare Myths
National Post Article: People Should Speak Openly On Reform: NCC
Canadian Institue for Health Information
Monday, October 8, 2007
Tuesday, September 25, 2007
New HPV Vaccine Causing A Stir
Gardasil, a relatively new HPV vaccine, has been the focal point of much political and social controversy of late in Canadian media. Saskatchewan, however has to date been quiet on the subject, and currently has no plans as to whether or not it will be providing free immunization to school age girls.
Background: (All information comes from Health Canada website unless otherwise stated.)
Despite great results over 5 years of clinical trials involving 20,000 individuals, there have been a number of points of opposition to the vaccine. A CBC News article points out that some more socially conservative parents are worried that the vaccination may “encourage promiscuity and provide a false sense of invulnerability to sexual disease.” Others are concerned that there is not yet enough long term data to determine the true effectiveness of the vaccine or possible negative long term side-effects. Some parents are also questioning the motives of Merck Frosst Canada Ltd (the company that is marketing Gardasil) who stand to make huge profits, or the motives of politicians looking for votes. Catholic school boards, most notably in Toronto, have also shown opposition as their schools are trying to teach abstinence as the best protection against sexually transmitted disease.
In spite of the opposition, many groups (especially in the medical field) are supporting the vaccine, even highly encouraging it for all young girls. The Canadian Pediatric Society representing 2,500 pediatricians across Canada officially endorsed the vaccine in a position paper released yesterday according to a Leader Post article. Other supporters of the Gardasil vaccination include the Society of Obstetricians and Gynecologists of Canada, and the Federation of Medical Women of Canada.
The key in administering the vaccination is making sure it happens before girls become sexually active. This is really the underlying cause of the controversy in my opinion, because parents don’t want to think of their kids having sex at such a young age. Vaccinating 9 year olds against a sexually transmitted infection is going to lead to a conversation that some parents might not yet be ready to even think about. The fact is that Gardasil is statistically shown to be a very safe and effective vaccine and is the only one of its kind. The only important question should be is this going to save lives, and is this going to lead to improved public health? Ultimately parents and their children will have the final say, so if a large portion of the funding has already been made available for the vaccination, what objection should parents or policymakers in Saskatchewan really have?
Background: (All information comes from Health Canada website unless otherwise stated.)
- Health Canada estimates HPV to be the most common STI nationally and around the world.
- Some types of HPV lead to cervical cancer, and some others to genital warts.
- Cervical cancer kills about 400 women a year in Canada. (CBC News Article)
- Health Canada estimates 75% of sexually active people will have at least one HPV infection in their lifetime, although only a small proportion would potentially develop cancer.
- Gardasil protects against two HPV strains that cause about 70% of cervical cancer, and two other strains that cause about 90% of genital warts.
- Use of Gardasil is recommended by the National Advisory Committee on Immunization for:
Females between 9 and 13 years of age, before the onset of sexual intercourse;
Females between the ages of 14 and 26 years of age, even if they are already sexually active, have had previous pap abnormalities, or have had a previous HPV infection. - The federal government allocated $300 million in the last budget to help provinces with HPV vaccination programs. (CBC News Article)
- Ontario, PEI, Nova Scotia and Newfoundland have already begun programs giving free vaccinations to school age girls with parental consent. (GlobeandMail Article)
Despite great results over 5 years of clinical trials involving 20,000 individuals, there have been a number of points of opposition to the vaccine. A CBC News article points out that some more socially conservative parents are worried that the vaccination may “encourage promiscuity and provide a false sense of invulnerability to sexual disease.” Others are concerned that there is not yet enough long term data to determine the true effectiveness of the vaccine or possible negative long term side-effects. Some parents are also questioning the motives of Merck Frosst Canada Ltd (the company that is marketing Gardasil) who stand to make huge profits, or the motives of politicians looking for votes. Catholic school boards, most notably in Toronto, have also shown opposition as their schools are trying to teach abstinence as the best protection against sexually transmitted disease.
In spite of the opposition, many groups (especially in the medical field) are supporting the vaccine, even highly encouraging it for all young girls. The Canadian Pediatric Society representing 2,500 pediatricians across Canada officially endorsed the vaccine in a position paper released yesterday according to a Leader Post article. Other supporters of the Gardasil vaccination include the Society of Obstetricians and Gynecologists of Canada, and the Federation of Medical Women of Canada.
The key in administering the vaccination is making sure it happens before girls become sexually active. This is really the underlying cause of the controversy in my opinion, because parents don’t want to think of their kids having sex at such a young age. Vaccinating 9 year olds against a sexually transmitted infection is going to lead to a conversation that some parents might not yet be ready to even think about. The fact is that Gardasil is statistically shown to be a very safe and effective vaccine and is the only one of its kind. The only important question should be is this going to save lives, and is this going to lead to improved public health? Ultimately parents and their children will have the final say, so if a large portion of the funding has already been made available for the vaccination, what objection should parents or policymakers in Saskatchewan really have?
Sunday, September 16, 2007
Pre-Election Promises
Surgery cancellations due to faulty air conditioning systems… a record breaking number of West Nile cases… leaked memos claiming the Regina-Qu'Appelle Health Region is in a state of crisis… and just a pinch of striking unions in various health sectors have all contributed to creating an exciting summer for health care in Saskatchewan. Add to that the ever problematic shortage of doctors and nurses, rural hospital closures, increasing waiting times, and it seems as though health care (in the home of Medicare itself) has nearly flat-lined. Yes, it does appear that measures must soon be taken to revitalize health care in Saskatchewan, and what divine intelligence that there should be an upcoming provincial election. This of course guarantees that even if measures aren’t taken, you can rest assured measures will be promised. Enter Brad Wall, and his defibrillation team that is the Saskatchewan Party... CLEAR!!
In a Saskatchewan Party Caucus news release from September 5, Brad Wall announced a plan that lays out the first steps his party will take to address health care in Saskatchewan. The plan involves investing $275 million (in their first term of government) to add 300 registered nurse training seats, and also involves bringing the number of physician training seats to 100 (currently there are 60). It sounds pretty great. We spend a bit of money and out come 300 more nurses and almost double the amount of doctors every year. Sort of like a vending machine when you think about it. But could it really be that simple?
An article by Murray Mandryk in the Sept 7th Leader Post titled “Sask Party’s Faulty Diagnoses” raises a number of doubts, not least of which is who is going to train these people? Mandryk points out that “nurse educators are retiring at a faster rate than the general nursing complement.” Another concern will be finding the resources to hire these 300 extra nurses once their training is complete. Just how many I-Owe-Yous is the province willing to write?
Mr. Wall might also want to take into consideration that the University of Saskatchewan’s College of Medicine was put on probation for three years and risked losing their accreditation beginning in February of 2003. According to their website, deficiencies identified included library assets and number of faculty members compared to number of students. So, while it may be easy to accept 40 more students every year, Mr. Wall may want to consider who will teach them, and which library they will be loaning books from. The even bigger question for Mr. Wall to consider is… how many doctors with MD’s from non-accredited medical schools does it take to thread an IV?
The bottom line is that with an approaching election, promises are flying. Parties are going to fix all of the problems that plague Saskatchewan. They are going to do it better than their opponents, and for less money. No promise is too ridiculous if it will court at least a few votes. I’m not saying there’s anything wrong with unveiling big plans so close to an election, or firming up positions on issues important to the province. But why not add a little substance to these plans. Mr. Wall’s announcement is little more than a summary of the end result he would like to see, and an estimated dollar amount. I find it offending that politicians believe voters opinions will be swayed by such superficial announcements.
In a Saskatchewan Party Caucus news release from September 5, Brad Wall announced a plan that lays out the first steps his party will take to address health care in Saskatchewan. The plan involves investing $275 million (in their first term of government) to add 300 registered nurse training seats, and also involves bringing the number of physician training seats to 100 (currently there are 60). It sounds pretty great. We spend a bit of money and out come 300 more nurses and almost double the amount of doctors every year. Sort of like a vending machine when you think about it. But could it really be that simple?
An article by Murray Mandryk in the Sept 7th Leader Post titled “Sask Party’s Faulty Diagnoses” raises a number of doubts, not least of which is who is going to train these people? Mandryk points out that “nurse educators are retiring at a faster rate than the general nursing complement.” Another concern will be finding the resources to hire these 300 extra nurses once their training is complete. Just how many I-Owe-Yous is the province willing to write?
Mr. Wall might also want to take into consideration that the University of Saskatchewan’s College of Medicine was put on probation for three years and risked losing their accreditation beginning in February of 2003. According to their website, deficiencies identified included library assets and number of faculty members compared to number of students. So, while it may be easy to accept 40 more students every year, Mr. Wall may want to consider who will teach them, and which library they will be loaning books from. The even bigger question for Mr. Wall to consider is… how many doctors with MD’s from non-accredited medical schools does it take to thread an IV?
The bottom line is that with an approaching election, promises are flying. Parties are going to fix all of the problems that plague Saskatchewan. They are going to do it better than their opponents, and for less money. No promise is too ridiculous if it will court at least a few votes. I’m not saying there’s anything wrong with unveiling big plans so close to an election, or firming up positions on issues important to the province. But why not add a little substance to these plans. Mr. Wall’s announcement is little more than a summary of the end result he would like to see, and an estimated dollar amount. I find it offending that politicians believe voters opinions will be swayed by such superficial announcements.
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