CCPA-MB FastFacts
January 23, 2002
HEALTH CARE PANIC LEADS TO BAD DIAGNOSES, HARMFUL PRESCRIPTIONS
by Peter Hudson
Everybody take a deep breath. The current debate about the future of
health care is taking place in an atmosphere of fear and panic
ï
precisely the emotions that will lead to bad decision making. The
over-reaction is fueled by prominent figures such as Alberta¹s Ralph
Klein when they declare that medicare is about to ³hit the wall.² That is
simply not true.
It is true that health spending has risen sharply in the past five years.
In part, however, this increase is simply catch-up for under-funding
during the early 1990s, and so current trends are not evidence that the
system is heading full-speed into unsustainability.
In general the Canadian health system is one of the best in the world; it
will remain so only if we resist responding to the hysteria by gutting or
selling it off. A more responsible approach would be to identify the
central challenges, including the costs that are driving health spending,
and address them accordingly.
PHARMACEUTICALS
From 1987 to 1996, the cost of prescriptions in Canada rose 93% compared
to an increase of all consumer prices of 23%. Drug costs grew
proportionately faster than any other item on the nation¹s health bill,
from 9% of total health expenditures in 1984 to 12.7% in 1994 and over
14% by 1996. In Manitoba, drugs costs paid by the Pharmacare program rose
40% in just two years (1998-2000).
In effect, we gave away health care resources in exchange for increased
profits for pharmaceuticals companies.
Many of the new drugs coming on the market are no improvement on the old,
and are incompletely evaluated. Some are simply an older drug with minor
modification brought onto the market to gain another 20 years of patent
protection for the company (for example see Glaxo-Welcome¹s FloVent
substituted for Beclaven at twice the cost).
The ideal response to this is at the federal level in the form of a
national drug coverage program, a repeal of the over-generous patent
protections extended to the drug companies by Brian Mulroney, bulk
buying, an improved review process, a Crown corporation producing generic
drugs and de-listing of drugs deemed to be ineffective or too expensive.
Thus the major provincial response ought to be in alliance with the other
provinces to bring about these changes at the national level. It might
also be possible to bring about a similar scheme on a regional basis
failing Federal cooperation.
AGEING POPULATION
The ageing population is a gradual phenomenon that on its own does not
come close to explaining a sudden rise in spending. And to the extent
that this demographic shift does account for a proportion of the upward
cost pressures, it is because of the way that the existing system
responds to it, rather than the phenomenon per se.
Ageing is chronic, and our health care system is set up to deal with
acute care. While the Manitoba government deserves congratulations for
its initial steps toward changing this, the elderly are still too often
being cared for in acute care hospital beds instead of in personal care
homes or with an array of home care support services. The latter is far
less expensive, as well as being a more appropriate form of care for the
elderly.
DOCTORS
Doctors¹ fees and salaries combined now account for about two-thirds of
total health care expenditures in Manitoba. There is no easy or quick
response to this cost driver. One long-term possibility is a salaried
system for physicians. Another is a delivery system in which other health
care professionals, working with physicians in teams, perform many of the
diagnostic, counselling and treatment functions now the exclusive
prerogative of the physician. There are studies and pilot projects that
demonstrate that this is not only possible, and less expensive, but also
a more effective form of patient care. Privatization is touted as a
response to this difficulty, but private provision does not deflate
physician remuneration (the opposite in many instances).
Hospital costs have remained fairly constant. Even so there are savings
and improved care that could be realized over the long term by moving to
a system that relies less on acute care and more on primary and community
care, early diagnosis, health promotion and prevention. A comprehensive
network of community health clinics, utilizing professional teams, total
patient care, research into environmental health, and health promotion
could be the primary link and referral source to the acute care system of
hospitals.
Similarly, health care reform must take into account the broader
determinants of health. Low-income people disproportionately enter the
health care system at the acute care stage. In other words, in the most
expensive way possible. Reduced inequality, new housing and job creation
initiatives, better child care, and improved environmental health all
must be feature in an effective, long-term strategy to reduce the
stresses on the health care system.
Hysteria about the state of the health care system is leading too many
politicians in exactly the wrong direction: privatization. This would do
nothing to address the real, immediate cost pressures. Climbing drug
costs illustrate how those sectors of health care that are in private
hands are the ones that are driving up health care costs. Why would we
contemplate more privatization when it is the private sector that is
already a major part of the problem?
In the longer term, a major part of sustainable health care reform must
include a move from acute care to community and preventative care. Yet
privatization works against this: for the private sector, the lucrative
areas are all acute care, including drugs, surgery, and hospitals.
Gary Doer has pledged to tell the other premiers at their conference this
weekend that a publicly funded, universal health care system is the best
and most sustainable in the long run. If he is successful in making the
case for Manitoba¹s seven priorities, his will be a vital contribution in
a climate of exaggerated fears.
ïPeter Hudson
Peter Hudson is a Senior Scholar in the Faculty of Social Work at the
University of Manitoba, and Chair of the Canadian Centre for Policy
Alternatives-Manitoba¹s Health Reform Working Group.
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