Friday, October 30, 2009

Surgery cuts encourage private two-tier care

It doesn't matter what the intentions are. The Campbell government's actions are resulting in a shift to two-tier health care in B.C.
People who can pay get fast, effective treatment. The rest of British Columbians wait, suffer and get sicker.
Earlier this month, the Vancouver Island Health Authority said provincial funding was inadequate to maintain health care services. It chopped surgeries and support for seniors and people with mental illness.
For example, last year the health authority did 124 bariatric surgeries. The operations help obese people who have been unable to lose weight in less extreme ways. Their stomachs are made smaller or bowels shortened to reduce the absorption of calories the number of bariatric surgeries.
It's not easy to get on the list for the surgery, which is expensive and, of course, carries risks. Patients who receive referrals have tried other ways of losing weight and face serious health complications from obesity.
Tough luck, some would say. Try harder or suffer.
That ignores the reality of their illnesses. And it ignores the great costs that the system would face in coming years if they remain obese. Pragmatically, effective treatment is a good investment.
Last year, the health authority performed 124 of the procedures in Victoria. This year, it will cut the number to 80. Next year, it will reduce the number of surgeries to 52.
Demand hasn't fallen. The wait for treatment is measured in years.
But the health authority's provincial funding for this year falls $45 million short of what is needed to provide health care services. The gap will be greater next year.
So patients won't be treated.
Unless they have money.
The False Creek Surgical Centre, a private clinic in Vancouver, has been advertising an information centre in Victoria next weekend on its weight loss surgery. People can register for a presentation with light snacks and a chance to have questions answered. A similar session is planned for Kelowna later in the month.
It's a good business move. There are desperate people who have waited several years for surgery who now face an even longer wait. The surgical centre can offer them speedy, effective treatment.
Or the centre can if they have about $17,000 to cover the costs of lap band surgery and follow-up. The procedure involves placing an inflatable ring around the upper stomach, limiting the amount of food the person can eat and increasing the length of time to digest the food.
Bravo, say some people. If I can pay extra to jump the queue for other things, for higher quality treatment, why not for health care?
But so far Canadians have decided that health care is different. We have, after a fierce public discussion, decided that when care is rationed, it shouldn't be auctioned off the to the highest bidder.
If two people have an illness, then the decision on who gets treatment is to be based on medical need.
We've even written the principle into law. The Canada Health Act and B.C.'s Medicare Protection Act say people cannot pay extra for speedier treatment for any medically necessary procedure.
But the law is routinely ignored. Private clinics have pushed the boundaries in offering more and more surgery to those who can pay for faster treatment.
You can't argue credibly that the weight-loss surgery isn't medically necessary.
For starters, the diagnosis of medical need has already been accepted by the health-care system, at least for people on the wait list.
The False Creek Surgical Centre emphasizes the point. Obesity is not the result of a lack of willpower; "It's a disease that requires treatment."
And the centre also points out that the surgery can reduce patients' risk of diabetes, heart disease, stroke, cancer and other serious conditions.
I certainly don't fault people who decide to pay for the surgery. I probably would.
But the combination of surgical cutbacks and inaction on the expanding role of private clinics is taking us a long way from the principles of medicare - and the laws that set them out.
Footnote: The issue might end up being resolved in the courts. Four private clinics are challenging the government's ability to enforce the Medicare Protection Act. And a group of patients are suing to require the government to enforce the act.


Anonymous said...

Government services of all descriptions have been slashed to the point where the lives of British Columbians are at stake - if not already being lost. And just today I heard Gordon Campbell's brother calling for even more gutting and bloodletting; opinionating on-air that the cost of services is outstripping government's ability to pay. Well hellooo Michael - perhaps that observation just might have some little thing to do with the compounding of such monumental tax breaks that his brother legislated on DAY 1 of his anti-social anti-program philosophy. Many supporters of this divisive regime are lining up like vultures to privatize what's left of the bones of this once-great province. The unprincipled and cynical leadership driving this government's agenda is obviously designed to have the people screaming for privatization out of shear pain and suffering.

I say take me back to the equitable and balanced approaches of Barrett, Harcourt and Dosangh any time.


Anonymous said...

Don`t look for any comfort from our dim bulb health minister.It`s high fives all around at the fraser institute,too bad so many people didn`t consider what was obviously campbells next bold adventure at election time. this much i know for sure, you ain`t seen nuthin yet!

Gazetteer said...
This comment has been removed by the author.
Gazetteer said...

(sorry me above - fixing a typo....)



On this one I can't disagree with you more.


Because, now more than ever, it DOES matter what the intentions are.


(Not that I am entirely sure that we truly disagree here.....It's just that I honestly believe that it is critical that we do get to crux the 'intentions' issue immediately to ensure that obfuscucatory budgetary 'reasons' are not used as an excuse to destroy Universality without the citizenry's even knowing that it is happening)

paul said...

It is a disagreement, but you're not alone in thinking I'm wrong.
I think intention is unknowable and speculation about it almost always weakens an argument and policy discussion. It leads to pointless partisan back and forth about who cares about people or the province of whatever.
Did the people in the Clark NDP government turn a blind eye to the expansion of private clinics and two-tier care because they were distracted, or they thought it a no-win political battle or they welcomed the outlet for disgruntled people on wait lists? Who knows?
Are the Campbell government crew doing the same thing because they favour private care or think health-care expenditures are out of control or think it's a no win-political battle? No real idea.
Really, all that matters is what they do and how it affects people now and in the future, I'd say.

Gazetteer said...

Fair enough Paul - thanks.

I'll give it a re-think and post-up on it myself.

(and for the record, I took umbrage with the Clark gov't's strategy as well - just wasn't up in the toobz then)


Dawn Steele said...

It’s the exact same thing with kids services – e.g. special ed & autism programs.

MCFD: Autism early intervention programs closed & families instead given subsidies for a fraction of program costs. Treating autism is now a privilege only for the rich in BC.

In public, Minister Polak simply denies anything was cut. In private meetings (such as one I attended Friday), her rationale is purely ideological & totally nonsensical.

1) Govt should not be funding programs or telling families how to treat kids, so she’s just giving everyone subsidies.

(Right - because having a kid with autism gives us a free PhD in developmental pediatrics, plus the clinical experience needed to manage a hugely complex developmental disorder.

Sarcasm aside, this contradicts the Minister's own autism policy advisor, who stated in a recent presentation that direct subsidies are often poorly spent in this DIY model, which forces families to play small business manager/ employer, program supervisor & clinical director )

2. Polak says rising autism rates demand new approaches to ensure sustainability.

(Right -because taxpayers would prefer to trim a measly $3 million for proven early intervention off BC's huge but temporary/ cyclical ’09 deficit & instead pay an extra $3 mill in future lifetime costs for EACH CHILD whose parents can’t cover the extra $40,000/year to provide needed therapy privately.

This also ignores that BC’s growing autism budget is almost entirely tied to the subsidy program (the programs being cut still cost almost the same as when they were first established) so the changes won’t contain BC's rising autism costs and will in fact hugely exacerbate growing costs in other areas, such as special education, costly government care and adult residential programs.

Special Education: Erosion of services since 2002 (when most targeted grants were eliminated) has forced hundreds of families i(who can afford it) into private alternatives: i.e. two-tier special ed. (In many cases, these private models are poorly supervised, non-accredited etc but that's another story...)

Both examples illustrate that govt chose routes to "sustainability" that help wealthy families support special needs while poor kids are denied a chance to succeed. With 30% of kids failing to graduate, that's a huge, avoidable burden on adult social services.

These are deliberate, class-based choices that weaken our social fabric, our economy and our democracy. If funds are indeed limited, we’d be better off targeting vulnerable kids.

All-day K is another example of doing the exact opposite. The Ministry review showed proven benefits/pay-back only for children with vulnerabilities. Taxpayers would be better off instead investing in targeted early intervention for kids at risk.

So it’s not about sustainability or insufficient $$. Unless it’s gross stupidity and incompetence, consistent choices are being driven by utterly crass short-term political goals. But like Paul, I’m loath to speculate publicly about whether its one, the other or both.

Gazetteer said...

Dawn said:

"But like Paul, I’m loath to speculate publicly about whether its one, the other or both."

Sorry to poke this wasps' nest again, especially when I said I'd go off and try to make my own thoughts more coherent, but before I do I've go ask....

'Why are you loathe to speculate?'

Is it for lack of concrete evidence?

Or is it something else?




Gazetteer said...




Anonymous said...

Thank Philip Till he thinks Dr. Day is a hero.