Public/Private Health Care
I have mentioned a few times over the years that if you haven’t changed your mind recently, it’s probably ossifying. So, I am gratified to find that, having received quite a bit of new information lately on this topic, I have modified what used to be a fairly solid stance.
It has been my observation in the past that the really successful health care systems in Europe — especially France, the one I am familiar with — are a combination of public and private systems. The problem I failed to consider with this approach is that those are there, and we are here.
The important factor is that the European systems work in a far more socialist environment, both socially and politically, than Canada has. So, for example, most of a doctor’s medical training is provided free by the state. However, in return for this, new doctors are required to work for a few years wherever the government needs them. On salary. As you might suspect, a good percentage of those doctors settle down and stay where they started. So even the smallest regional hospitals have a full slate of specialists, and even towns of 1,500 people have at least one doctor.
The Canadian System
Our doctors and nurses work in a much more capitalist environment. Medical trainees of all sorts are expected to cover a larger share of their education cost (but far from all of it) and are free to follow the market wherever they choose to look for work.
Pointy End Solution
So, while it looks like the problem is that we don’t have enough doctors and nurses for the public system, the real problem is that they have been hired away from the public system by the more expensive private system. For example, nurses burn out from overwork at public hospitals and quit to work for private companies, which pay them more money and give them more control of their work hours.
The short term, reactive result is that hospitals, desperate for nurses, hire the same people from the private companies, paying the extra wages plus the profit of those companies.
Long-Term Solution
What we really need to do is fund the public system, including training centres, properly so we have enough staff for public hospitals and working conditions that will keep them there.
Second Problem: Dependence on Hospitals
On the topic of short-term solutions, our whole system is based on a reactive model. Somebody gets sick, they stay untreated until they’re ill enough to need the hospital. Then we heal them.
The better solution is to keep people from getting sick and to treat them before they need to come to the hospital. Then the hospitals wouldn’t be swamped. But most of our health care funding is swallowed up in reactive care.
The Bottom Line
We don’t spend enough government money on training medical staff and keeping them in the public system.
We don’t spend enough government money on the things that keep people from having to go to the hospital.
P S
And I have a sneaking suspicion that too many doctors (perhaps 2/3 of them) in Canada are entrepreneurs running their own businesses, with high overhead in staff, equipment, malpractice insurance, rent and expected profit. I suspect that in systems like the French one, there are many more doctors on salary, working in clinics where the overhead is paid by the government. Comparable data is hard to find because, as I mentioned above, the systems operate differently.