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Gray C. Visions of our health care future: Is a parallel private system the answer? CMAJ 1996;154:1084-1087. Study Questions. Lisa Weger and Sandy Widder. SPHA 511. Gray C. Visions of our health care future: Is a parallel private system the answer? CMAJ 1996;154:1084-1087.

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Study Questions

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  1. Gray C. Visions of our health care future: Is a parallel private system the answer? CMAJ 1996;154:1084-1087. Study Questions Lisa Weger and Sandy Widder SPHA 511

  2. Gray C. Visions of our health care future: Is a parallel private system the answer? CMAJ 1996;154:1084-1087. • What is a parallel private system? • A system whereby two levels of care are available for consumers • One that is publicly funded via tax dollars • One that is funded by after tax dollars of consumers • Publicly funded system will result in no out of pocket expense for the consumer • Private sector system would result in expense for the consumer

  3. Gray C. Visions of our health care future: Is a parallel private system the answer? CMAJ 1996;154:1084-1087. • At the time this article was written, 1996, what percent of doctors favoured a parallel system? • 1996 polls commissioned by the Canadian Medical Association (CMA) • 70% of doctors favored a parallel private system • Only 40% of the general public demonstrated any support

  4. Gray C. Visions of our health care future: Is a parallel private system the answer? CMAJ 1996;154:1084-1087. • What is the “subsidized queue-jumping” used in Alberta’s ophthalmology clinics? • Permitting someone to pay in order to “jump the queue” for faster access to publicly insured services. • In Alberta, ophthalmology clinics operate on the principle of people who want immediate cataract surgery • Pay a “facility fee” of about $1000 • Rapid access to a surgeon • Surgeon then bills the provincial health plan for performing the procedure

  5. Gray C. Visions of our health care future: Is a parallel private system the answer? CMAJ 1996;154:1084-1087 • What is the federal response to these activities? - This contravenes the Canada Health Act and as a consequence of the actions of the ophthalmologists, Ottawa has been deducting $420,000 per month from its transfer payments to Alberta as a penalty

  6. Gray C. Visions of our health care future: Is a parallel private system the answer? CMAJ 1996;154:1084-1087. • Why did the study see a much larger private sector as inevitable? - Governments can no longer afford to supply the type of health care that Canadians want and expect. • Canadians want to invest in their health

  7. Gray C. Visions of our health care future: Is a parallel private system the answer? CMAJ 1996;154:1084-1087 • Canadians already have the option for two other items considered public goods: education and pensions. • We all pay for the public system through tax dollars and can also make the choice to spend our own money (after tax dollars) on private schools or pensions. • Influence of our American neighbors • Introduce Canadians to market concepts – viewing health as a consumer investment versus a public good.

  8. Gray C. Visions of our health care future: Is a parallel private system the answer? CMAJ 1996;154:1084-1087 What are Coffey’s arguments for a private health care sector? - A private sector would reduce waiting lists - Entice Canadians back from the States  allow recapturing of funds

  9. Gray C. Visions of our health care future: Is a parallel private system the answer? CMAJ 1996;154:1084-1087 • Reinvestment of new monies into upgrading of technology and buildings • Competition between the public and private health care systems  increased quality of service delivered and cost effectiveness of public health care system

  10. Gray C. Visions of our health care future: Is a parallel private system the answer? CMAJ 1996;154:1084-1087 • Why would it be necessary to expand the health insurance industry? • Many medical procedures may not be deemed medically necessary in a parallel public private system • Not covered by provincial government and therefore would be covered under health insurance plans

  11. Gray C. Visions of our health care future: Is a parallel private system the answer? CMAJ 1996;154:1084-1087 • There is a market to expand the health insurance industry for high volume low risk procedures (such as child birth) in a private system - American insurance companies can bring a lot of experience and knowledge  cost saving techniques and concepts such as risk sharing

  12. Gray C. Visions of our health care future: Is a parallel private system the answer? CMAJ 1996;154:1084-1087 • Is this a problem for Canada? • Thisis not a problem for Canada • Already a mature insurance industry that exists with considerable expertise in health care • Many Canadians already have group medical insurance for some services that are not necessarily considered to be medically necessary.

  13. Gray C. Visions of our health care future: Is a parallel private system the answer? CMAJ 1996;154:1084-1087 • Why is private insurance for some medically necessary treatment unlikely? - Most emergency medicine would have little appeal to private insurers  what comprises most of the health care that Canadians receive and spend money on - High-volume, low risk procedures • Generating more revenue with little costs and risks

  14. Gray C. Visions of our health care future: Is a parallel private system the answer? CMAJ 1996;154:1084-1087 • What are the arguments against a parallel system? • Health care costs would increase • Any extra revenue generated would be spent on administration vs reinvested into health care - Physicians leaving the public system - People less likely to contribute to a system that they are not using  quality of the public system will quickly erode

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