Health gap and economics

Issue: BCMJ, vol. 45, No. 10, December 2003, Page 524 Editorials

With the current medical-political mood in both this province and this country running close to the boil, it is difficult to write about anything apolitical. One of the more worrisome recent trends is a strident, freely articulated political “need” to gain control over doctors and the services they provide. This is not only evident in Quebec; the BC government recently gave notice that it intended to amend the Health Practitioners Act in order to wrestle control of BC doctors’ professional conduct from the BC College of Physicians and Surgeons (a plan it has decided to rethink). This is a move that smacks of mean-spirited retribution after the government was forced to “cave” earlier this year. However, I don’t think we’ve seen the end of this little trial balloon.

Part of this drive to control doctors also involves controlling the ability of doctors to use new technology. The BC government has placed a moratorium on the acquisition on new technology, and no one knows when it will be lifted. As a result, we see physicians making do without the benefit of new, very effective technology—and for some reason, not complaining (very loudly) about it.

PET scanning is a good example of a technology that is recommended in the intervention equation and follow-up assessment of many malignancies, but is very difficult to obtain in this province. In the US it is considered malpractice not to use PET scanning in the initial pretreatment and follow-up assessments of many malignancies. Some will argue that this imaging technique is not necessary, but I would be willing to bet that there are far more voices on the yea than the nay side.

There are also great strides being made in micro-invasive and endoscopic procedures, but they are not being done here because apparently we can’t afford the equipment or the cost of training the surgeons, who must go elsewhere to be trained. One result of this will be an exaggeration of the already widening economic gap between Canada and the US. American workers will have access to these minimally invasive surgeries and will return to the workplace much faster than their Canadian counterparts. Canadian companies will be forced to either wait for the Canadian system to take care of their employees with older surgical procedures with their attendant longer recovery periods or decide to pay for surgery in the US. The result of not being able to do the newer surgeries here will be a widening trade imbalance irrespective of which decision is made because they will just be able to do it cheaper than we can.

Nowhere is the level of dysfunction in the Canadian system clearer that in the field of occupational medicine. Far too many Canadian-based companies are struggling to keep their heads above water, in large part because of significantly large numbers of their skilled workers off on disability and waiting for access to care. The yearly disability costs of many large companies is staggering. In fact, when you look at the annual disability costs for crown corporations in BC, you can almost feel the vacuum sucking the money out of your wallet. For the most part, besides inefficient or non-existent case-management in these organizations, the most obvious and pervasive problem contributing to prolonged disability costs is “reasonable access to care,” one of the cornerstones of the Canada Health Act.

So, if we want to even the economic playing field between us and the Americans, the problems our industries face with respect to access to care have to be faced. Obviously, the crafting of an acceptable solution equation will benefit everyone in this country, but I believe that our politicians lack the insight and cojones to finally choose to go down the right road. There is now a widely shared and very realistic fear that the status quo will only result in a playing field that we are all in danger of falling off of.


James A. Wilson, MD. Health gap and economics. BCMJ, Vol. 45, No. 10, December, 2003, Page(s) 524 - Editorials.

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