Stepping into the fray

Issue: BCMJ, vol. 44, No. 6, July August 2002, Page 285 Editorials

In May of this year the government and the physicians of British Columbia engaged in a very nasty altercation to try to settle the fee dispute for the province’s doctors. It was obvious that this compensation package—as well as that of the nurses, the HEU, and health care spending in general—threatened one day to engulf the whole provincial budget.

Most people believe that some clarification of the Canada Health Act is necessary. It was never meant to provide all levels of care to everyone on demand. However, it is somewhat touchy trying to tinker with an Act that has been described as “a defining principle of Canadian society.”

Not only that, but Canadians seem to have gotten out of the habit of paying for anything that has a vague sniff of having to do with health care (unless it is something that they do not need, such as cosmetic surgery, in which case they are perfectly happy to pay).

Having said that, however, I think most of us believe that something needs to be done. Most of us look to government and health care professionals for some suggestions. Surprisingly, physicians seem to have few ideas. Some of this, of course, is self-interest and some is a genuine wish to not disenfranchise the working poor who may be denied a treatment simply because they cannot afford it. I think a large part of the physicians’ reticence to become involved is because of political correctness. They worry about appearing to favor a “for-pay” system.

I personally believe in the Canadian system. I have worked in the United States and seen how a brutal capitalist system can ruin a family while providing questionable care. However, I too believe that our system needs modification, and I have a few thoughts about my own area that raise some questions. I am sure that all subspecialists and family practitioners would have similar questions in their own areas of expertise.

• If a patient must wait 1 to 2 years for a treatment, is that treatment really necessary? If it is necessary, is it reasonable to make the patient wait that long? Is there a reasonable waiting period beyond which a patient should be allowed to either purchase private insurance or pay privately to have this procedure done, since surely it means that the global health system has failed this particular patient? If it is not necessary, then drop it from coverage completely and allow patients to get decent insurance, which will allow timely care. Examples might be procedures for varicose veins, hernias, and total hip arthroplasty.

• All patients are entitled to second or even third opinions, but surely it is reasonable that the patient pay for at least part of these second or third opinions. (I have seen patients for second and third opinions for claudication and varicose vein treatment.)

• There are many patients undergoing complex investigations, medical interventions, and surgical treatments who have never paid taxes in this country. Is this appropriate? Perhaps, but I think it needs to be addressed and costed-out in a system that is floundering.

• If a patient wishes to discuss a test over the phone or have a prescription renewed without coming to the office, then surely they should be allowed to pay the physician directly for the convenience of this benefit.

I realize that these questions raise complex philosophical, social, and economic issues. Are they contrary to the Canada Health Act? I think not. Would implementing some changes based on these few suggestions (as well as similar changes in other fields of medicine) cause a collapse of Canada’s health care system or the demise of Canadian society in general? Again, I think not.

Frankly, I think most of us are very suspicious of change and are hesitant to get involved because we want to protect our own turf. However, if we do not become involved, there are plenty of others who are quite willing to affect changes in health care that we may not agree with.


Anthony J. Salvian, MD. Stepping into the fray. BCMJ, Vol. 44, No. 6, July, August, 2002, Page(s) 285 - Editorials.

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