Transcript Document

New Brunswick’s Public Health
Care: At the Crossroads
Michael McBane
Canadian Health Coalition
www.healthcoalition.ca
Financial Overview for N.B. 2011-12
N.B. Revenue
2013-2014
Federal Transfer Payments
2013-2014
$52.5 billion in federal cuts
Over 10 years
Federal cuts to N.B. Health Transfers
0.00
-20.00
-40.00
-60.00
-80.00
-100.00
Total cut in funding over
10 years: $715 million
-120.00
-140.00
-160.00
Losses from change
2023/24
2022/23
2021/22
2020/21
2019/20
2018/19
2017/18
2016/17
2015/16
2014/15
-180.00
Canada Health Act Annual Report
2011-2012
• Number of participating physicians: 1,618
• Number of opted-out physicians: 0
• Number of private for-profit facilities
providing insured health services: 0
• Payments to private for-profit facilities for
insured health services: 0
.
The Story
• Health Care’s spending not “out of control”
• Aging population won’t break the bank
• Affordable public solutions to all healthcare
problems – the 2nd Stage of Medicare
• Focus on primary health care and prevention
and other community based services like home
care.
Medicare’s Second Stage
“Those of us who talked about Medicare back in the
1940’s, the 1950’s and the 1960’s kept reminding
the public there were two phases to Medicare. The
first was to remove the financial barrier between
those who provide health care services and those
who need them. …
The second phase would be the much more difficult
one - to alter our delivery system to reduce costs
and put and emphasis on preventative medicine....
- Tommy Douglas 1979
Imagine if all physicians were part of
the health care team…
“Canada’s system of independent physician
private practice is the biggest elephant in the
room.”
-Michael Rachlis, MD
New Brunswick Extra-mural program
• Comprehensive home health care services
• Providers: nurses, licensed practical nurses,
registered dietitians, respiratory therapists,
occupational therapists, physiotherapists, speech
language pathologists, rehabilitation aides and
social workers.
• Services: acute care, palliative care, home oxygen
program, long term care assessment and
rehabilitation services.
It’s Time for Pharmacare
1. Universal & Equitable Access
2. Safe & Appropriate Use
3. Cost-controls & Affordable
Privatization drives up spending
• Encourages overuse of high-cost tests,
procedures, and inappropriate medication to
increase income and profit.
• Fraudulent billing by physicians and facilities
adds at least 5 % to the total cost of care in U.S.
• Profit-seeking physicians and facilities will
abandon rural and remote communities
This is what for-profit health ‘care’
looks like:
1. For-Profit nursing homes
2. For-profit surgical clinics & hospitals
3. For-profit pharmaceuticals
4. For-profit health insurance
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1. For-Profit Nursing Homes
Abuse & Neglect On The Rise At For-Profit
Nursing Homes
Q. How do you make money in a nursing home?
A. Divert funds and focus away from clinical care.
“It is unwise to entrust the sick and the frail elderly in the hands of
profit-seeking firms.” -- American Journal of Public Health (Vol. 91, No.9)
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2. For-Profit Clinics & Hospitals
•
•
•
•
Prevented public audit
Charges Illegal user fees
Unlawful billings
Patients must sign false
statements
• An extra 2200 deaths a year
in Canada if we converted
to investor-owned private
for-profit hospitals
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3. For-Profit Pharmaceuticals
• Millions of Canadians can’t
afford access;
• Rx costs are 30% above
international average;
• 4th to 6th leading cause of
death; *
• Prescription use driven by
advertising not evidence.
* Lazarou, J., JAMA, 1998
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Rx Spending per capita
4. For-Profit Health Insurance
• Is more expensive and
drives up costs
• Denies access for the sick
(pre-existing conditions)
• Denies access to those
who can’t afford to pay
• Not new – Canada had
private insurance and
rejected it for Medicare!
-CIHI, 2012
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Ethics + Evidence + Economics
= Public Support
The federal government should ensure that all Canadians, no matter
where they live or their ability to pay, get access to healthcare.
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What the few want:
• Open up the delivery of health services to
market rules and divert public funds to the profit
seeking private enterprise.
• Segmentation of ‘markets’, access, coverage.
•
Cherry-pick and provide only the profitable
services in the profitable ‘markets’
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More private means less public
•
•
•
•
Draws off resources from the public system
Increases costs overall
Introduces the inequities of the U.S. system
Gives too much care for those who don’t need
it and not enough for those who do.
Source: Marcia Angell, MD, “Privatizing health care is not the answer”,
Canadian Medical Association Journal, 2009.
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Public Solutions
To avoid all these problems you have to:
1) Keep services out of the hands of for-profits;
2) Replace fee-for-service payments to MDs;
3) Organize delivery with teams in community
health centres;
4) Encourage quality of care over quantity;
5) Keep people healthy (food, housing, income…).
Solving Medicare’s Problems
• Misuse of prescriptions
- prescription drugs (ADR a leading cause of death)
- patients in acute beds, inappropriate referral to specialists
• Overuse from over-diagnosis
- average of 16 prescriptions per Canadian in 2011
- MRIs: 4 million inappropriate (10-20% of referrals)
• Underuse of prevention
- prevention and public health
- non-therapeutic treatments + TLC
- common sense: diet, home & community supports
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Our values
Health as Public Good
Keep people healthy
Integration & Teamwork
Protect the vulnerable
Values in conflict
Health as Public Good
Health as Commodity
Keep people healthy
Profit from illness
Integration & Teamwork
Fragmentation & Competition
Protect the vulnerable
Exploit vulnerability
Medicare Works…
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…and Canadians want more of it!
 Universal public drug plan
 Home Care and Long-term care standards
 Adequate and stable federal funding
“The price of Medicare is
eternal vigilance.”
-- Tommy Douglas
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Conclusion
• Canadians want a stronger public health
care system;
• Medicare won’t survive without federal
leadership:
• What stands between Medicare and its
destruction are the peoples of Canada!
Think about Medicare before you vote in 2015