EXCLUSIVE INTERVIEW - NADEEM ESMAIL: Fraser Institute Director talks healthcare reform
Economist and analyist Nadeem Esmail is the Director of Health System Performance Studies and Manager of the Alberta Policy Research Centre at The Fraser Institute. As part of the Institute's seminar on public policy issues, Esmail discussed the potential for changes in Canada's healthcare system.
You call the Canadian healthcare system broken. Can you elaborate on how it is broken and where the problem is?
You have to look at it from the eyes of the patient, and that's when you realize how dysfunctional the system really is. It starts with an individual who says, "I think I have a problem." More than 1.2-million Canadians in 2003 could not find a regular family doctor.
If you get into the doctor's office, on average, you can expect to wait over nine weeks to see a specialist. You can wait for ten weeks for MRI machines, nearly five weeks for CT scans, nearly four weeks for ultrasounds. The diagnoses with the specialists take an incredible amount of time. Once you go to the specialist, there's a second queue that you have to go through to go to the operating room. On average, it is over nine weeks, but it can stretch into months or even years for some patients.
By the time you actually get the surgery, you often end up getting lower health care than what is available in other nations, because of the way we're delivering health care. All along, the patient has not received the healthcare from a system that is really world-class as we are told. If you look at it from a pluralist perspective, this system has been treating a patient terribly and perhaps inhumanely in delivering their care, does a reasonably good job at saving their life; not a great one, but a reasonably good one, this system is the developed world's third most expensive universal-access healthcare program.
We have one of the most expensive universal-access healthcare systems in the world, yet we deliver some of the worst access to healthcare, technology, to physicians in the world. That is a broken system.
Would you base the healthcare system on a different model that is in place in other countries?
It's not about adopting a model or adopting a different model; it's about adopting the right policies, those policies that have been proven to improve universal-access healthcare systems that have been proven to allow a population, to allow a group of individuals to better deliver the promise of universal access to healthcare. It's a promise that we are not fulfilling in Canada; it has been shown that cost-sharing is very important in the universal-access healthcare program. Having patients share the cost of the care they receive. Private competition in the delivery of publicly-funded and publicly-guaranteed services is important to ensure that you're getting the most care for your dollar and the best bang for the buck. Competition in the finance area, allowing patients to pay privately if they choose to do so, also means you get better care for the dollar and the best bang for the buck in healthcare than you would otherwise.
We have, in Canada, chosen the wrong policies in these areas, and we need to begin emulating all of those nations, all of the world's most successful universal healthcare programs, all nine of them who have taken these policies and implemented them into the healthcare program, to the benefit of patients.
Opponents of privatization of healthcare argue that doctors will flock to the private sector for better wages and drive up the cost of specialized care. Do you think this will happen?
It doesn't happen in practice. If you do this properly, you will get a better system. That's not to say that you can't go and muck it up with the wrong policies, but it's often that these individuals that are so concerned with this are trying to embrace the wrong policies. You end up making poor use of your physician resources in either sector; in Canada, we do not let physicians work to their full capacity or desires. We limit them, in terms of operating hours. It's not unusual to hear a physician operate four or eight hours a week. Truly, they can do more than that, and many of them desire to do more than that, but that's what they're limited to. We have limits on how many patients can be seen in a certain time period, how much work can actually be billed to the government; we don't let physicians practice to the fullest of their desires, we cap them. In the private sector, depending on who the physician is, in all likelihood, there isn't going to be sufficient demand in that sector to fully utilize those physicians. What many developed nations have figured out, including Australia, Sweden, Italy; any number of nations have figured out that the best use of physician resources comes from allowing the physicians to work in both sectors.
There are suggestions to potentially shorten medical school times from four to three years to increase the number of doctors in the country.
The problem doesn't lie in how many years we're training physicians for or how we train physicians; the problem lies in the number of physicians we train. We've been limiting it for years. In 1993, government decided to restrict physician training in Canada because they were worried about a surplus of physicians. We should let Canadian students who are capable of becoming physicians, who are capable of getting into medical school get into medical school. We shouldn't be so severely limiting it, turning students away by the hundreds at the doors, and having these students go to Ireland, the United States and other countries to become physicians, when what they wanted to do is train here and treat Canadians.
By letting in more students into medical schools, would that lower the bar of medical admissions standards?
There is a truth to that, but look at where the bar is now. The bar now is so high that the people we turn away at the door can go to the United States, can go to Ireland, can go into medical school and become full practicing physicians. Our bar is set exceptionally high. If you talk to the medical schools across the country, what you will find is that many of the students who are turned away are fully capable to do it, they are at the top of their class; they're just not at the very top of their class.
-Compiled by Ken Sun
2008 Woodie Awards
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