Watching the dog and pony show at the recent first minister’s meeting on health care here in Vancouver was more entertaining than anything in recent memory, but I’m not quite sure who between Ralph Klein and Gordon Campbell was the dog and who was the pony. Mike Harris, who has kind of a hang dog look whenever he is interviewed, wanted to be seen as a player, but instead looked lost as he scrambled to keep up with the far western duo. The Quebec delegation looked like wannabes, but I guess they didn’t want anyone in la Belle Provence to think they were anything less than la première étoiles of health care and maintained their customary separateness unless there was a photo-op.
Alberta once again seems to be leading the way as they announced they have accepted and plan to institute the Mazankowski Report virtually in its entirety as quickly as possible. BC, Ontario, and Quebec all sound like they are considering many of Don Mazankowski’s recommendations, and all of this will happen long before the Romanow Report is released. The Big Four have all indicated that the Romanow Report is a federal initiative and its recommendations will not influence health care funding decisions of the so-called have provinces. Alberta reiterated that the federal government, as a contributor to only 13% of the total provincial cost of medicare, is in no position to dictate anything to the provinces. As Ralph Klein said, “all they can do is withhold an already insignificant amount of funding dollars.” Of even more interest, after the announcement there were no objections from the federal government. Why not?
Alberta plans to increase MSP premiums by about 40%, look at core services and subsequently de-list a substantial number of items, look at alternative physician payment models, and aggressively enlist public-private partnerships (increasingly called P3 initiatives by health economists and others).
About 4 years ago I wrote on these pages that the BC government and the BCMA should discuss the possibility of initiating a physician payment plan that paid about half the province’s doctors by salary and half (if they desired) by fee for service—funded both publicly and privately. In other words, the more entrepreneurial docs would be free to explore the expanding private medical sector while still being able to participate in publicly funded medicine if they wished. In fact, it would make sense to make it economically attractive for these docs to spend time in the public system.
The coming changes are going to alter all our professional lives, but we all know they are necessary. We have been trying to get the attention of our elected officials for years, and finally, as the collapse of the system appears imminent, they seem to be listening. It is in all our best interests to make sure they are hearing the right people. If there is an opportunity to write, speak, lecture, pontificate, elaborate, expound, or support a spokesperson on the topic of medicare and how to make it work, get off your apathy and make yourself heard.
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Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
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