Thanks Bill, I came upon this older post when i was researching for news and updates on private sector initiatives in the public health system in Nova Scotia. I will be quoting you in an upcoming debate panel in which I am participating with the Globe and Mail . Excellent points and well articulated , as usual
I usually like your thinking but we need to get out of the box. Health care will never be resolved with normal views. We don’t have a health care system; we have an illness care system.We must force people to look after their health by restricting care. Diet, Exercise, and Healthy Living must predominate. Prescriptions for Exercise, Weight, Healthy Habits should reduce heart problems, diabetes, and should exclude repeat Dr.visits if no improvement is seen.
Treat health care as a privilege not a right. It is ridiculous for a rich country to steal doctors from the third world. Our medical education system is broken. We are educating specialists when what we need are family doctors.
I could go on and on but how do you reduce costs when the cures for more diseases take place and the diagnostic and treatment facilities proliferate?
We need a completely new direction to solve the system from bankruptcy.
Your opening salvo – “In a single-payer system, the only way to control costs is to control supply.”
– is a bit reductive don’t you think!
We have enough examples of health care systems in the world to know how variable they can be in terms of service delivery, costs and efficiency. It ought also to be obvious that health care systems are good indicators of a country’s governance proficiency. The systems work best, including those with a degree of privatized services, in countries with competent public sectors.
Privatization can be useful. It depends on how it fits with the overall health care system and the level of control. In other words it has to be purposeful, not ideologically motivate and especially not a stop-gap measure in a system out of control!
In countries where it is out of control, such as the USA and the UK, or risks getting out of control, as in Canada, privatization isn’t helpful. It just speeds up the decline of the public service, without improving efficiencies or reducing costs, over all. And it aggravates the governance problem, first by creating new special interests and second by side stepping the governance problem.
Thanks Max. You are right that there is considerable opportunity for improvement in efficiency which would enable more care for the same expenditure. But that does not change the fact that the budget will always be less than would be required for all the perceived needs for health care.
I get what you’re saying and do understand.
It just seems to again separate the “rich” from the “poor”.
Being from the “poorer” group, it may just be the perception people have. I get to talk to a lot of people about this.
Could be envy, and feeling lower class, one can get a complex and feel resentment.
You say it frees up the system for those of us who need health care, and I guess time will tell.
I agree there is room for private health care in Nova Scotia and a statement you made about private practice freeing up spots for those who use the public system was one that I echoed in my Letter to the Editor.
A case in point is my own situation. I suddenly had an issue with osteoarthritis in my knee and sought out solutions on the Internet, AFTER going to my family physician.
At the time, the pain was severe and I thought I would need a knee replacement, and because I can afford it, looked to 3 locations that would do it for me. One was in Massachusetts, and the others were in Toronto and Montreal, all private clinics. Their presentations were superb, showing the operating theaters, describing pre-care, operation, and post-care.
They provided stats and anecdotes and a price of $25,000. Unfortunately all companies required someone to accompany me from these locations after the operation, and I had no one that could.
So I looked at other possibilities and discovered the Arthritis and Injury Care Center. My family doctor gave me a referral to this private company and I saw a specialist downtown in less than 4 weeks! They fit me for a knee brace and injected my knee with hyaluronic acid, both NOT covered by health care, so I had to pay out of pocket. The injection was $420, but that was cheaper than the $600 my family doctor said it would be if he had done it, because the Care Center can buy this stuff in bulk. The injection was done by another orthopedic specialist.
I thought your piece today was one of the most compelling yet on a subject that desperately needs to be addressed. Those that I speak with, who know much more than me, argue forcefully that we continue to address health care incrementally. One Sage person argued years ago that creating a Crown Corporation would put responsibility for results with executives driven by goals with accountability. As important, it would separate politics from performance. Others have argued that the Danish public health system is quite efficient because it is managed privately. For some reason, we refuse to look at best practices….politicians perhaps.
I think within the last two months. Here is what the Department says about the arrangement. “The Province now owns the building Scotia Surgery is operating out of. Nova Scotia Health has a contractual agreement with Scotia Surgery Management Inc. to continue to manage the operating room portion of the facility and to support the surgeries that are occurring at this site.”
Thanks Bill, I came upon this older post when i was researching for news and updates on private sector initiatives in the public health system in Nova Scotia. I will be quoting you in an upcoming debate panel in which I am participating with the Globe and Mail . Excellent points and well articulated , as usual
Robert Zed | December 28, 2023 |
Bill
Great health care article in yesterday’s CH!
Allan Shaw | May 14, 2023 |
I usually like your thinking but we need to get out of the box. Health care will never be resolved with normal views. We don’t have a health care system; we have an illness care system.We must force people to look after their health by restricting care. Diet, Exercise, and Healthy Living must predominate. Prescriptions for Exercise, Weight, Healthy Habits should reduce heart problems, diabetes, and should exclude repeat Dr.visits if no improvement is seen.
Treat health care as a privilege not a right. It is ridiculous for a rich country to steal doctors from the third world. Our medical education system is broken. We are educating specialists when what we need are family doctors.
I could go on and on but how do you reduce costs when the cures for more diseases take place and the diagnostic and treatment facilities proliferate?
We need a completely new direction to solve the system from bankruptcy.
Wayne Armitstead | May 14, 2023 |
Your opening salvo – “In a single-payer system, the only way to control costs is to control supply.”
– is a bit reductive don’t you think!
We have enough examples of health care systems in the world to know how variable they can be in terms of service delivery, costs and efficiency. It ought also to be obvious that health care systems are good indicators of a country’s governance proficiency. The systems work best, including those with a degree of privatized services, in countries with competent public sectors.
Privatization can be useful. It depends on how it fits with the overall health care system and the level of control. In other words it has to be purposeful, not ideologically motivate and especially not a stop-gap measure in a system out of control!
In countries where it is out of control, such as the USA and the UK, or risks getting out of control, as in Canada, privatization isn’t helpful. It just speeds up the decline of the public service, without improving efficiencies or reducing costs, over all. And it aggravates the governance problem, first by creating new special interests and second by side stepping the governance problem.
Maxwell Stanfield | May 14, 2023 |
Thanks Max. You are right that there is considerable opportunity for improvement in efficiency which would enable more care for the same expenditure. But that does not change the fact that the budget will always be less than would be required for all the perceived needs for health care.
Bill | May 14, 2023 |
I get what you’re saying and do understand.
It just seems to again separate the “rich” from the “poor”.
Being from the “poorer” group, it may just be the perception people have. I get to talk to a lot of people about this.
Could be envy, and feeling lower class, one can get a complex and feel resentment.
You say it frees up the system for those of us who need health care, and I guess time will tell.
Deborah | May 14, 2023 |
Thanks. You are not alone in feeling that way.
Bill | May 14, 2023 |
I agree there is room for private health care in Nova Scotia and a statement you made about private practice freeing up spots for those who use the public system was one that I echoed in my Letter to the Editor.
A case in point is my own situation. I suddenly had an issue with osteoarthritis in my knee and sought out solutions on the Internet, AFTER going to my family physician.
At the time, the pain was severe and I thought I would need a knee replacement, and because I can afford it, looked to 3 locations that would do it for me. One was in Massachusetts, and the others were in Toronto and Montreal, all private clinics. Their presentations were superb, showing the operating theaters, describing pre-care, operation, and post-care.
They provided stats and anecdotes and a price of $25,000. Unfortunately all companies required someone to accompany me from these locations after the operation, and I had no one that could.
So I looked at other possibilities and discovered the Arthritis and Injury Care Center. My family doctor gave me a referral to this private company and I saw a specialist downtown in less than 4 weeks! They fit me for a knee brace and injected my knee with hyaluronic acid, both NOT covered by health care, so I had to pay out of pocket. The injection was $420, but that was cheaper than the $600 my family doctor said it would be if he had done it, because the Care Center can buy this stuff in bulk. The injection was done by another orthopedic specialist.
Bob Found | May 14, 2023 |
I thought your piece today was one of the most compelling yet on a subject that desperately needs to be addressed. Those that I speak with, who know much more than me, argue forcefully that we continue to address health care incrementally. One Sage person argued years ago that creating a Crown Corporation would put responsibility for results with executives driven by goals with accountability. As important, it would separate politics from performance. Others have argued that the Danish public health system is quite efficient because it is managed privately. For some reason, we refuse to look at best practices….politicians perhaps.
Denis Connor | May 14, 2023 |
Excellent effort Bill! When did the government buy Scotia Surgery?
Wayne Fiander | May 13, 2023 |
I think within the last two months. Here is what the Department says about the arrangement. “The Province now owns the building Scotia Surgery is operating out of. Nova Scotia Health has a contractual agreement with Scotia Surgery Management Inc. to continue to manage the operating room portion of the facility and to support the surgeries that are occurring at this site.”
Bill | May 13, 2023 |