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National Post

 

The Hip That Changed Health Care History

March 07, 2006

By David Gratzer

PRINTER FRIENDLY

I think we're finally moving forward," Dr. Brian Day tells me. It's not even 9 a.m., but Dr. Day bubbles with life. He laughs, tells stories about past radio interviews, and enthuses about the coming months. Dr. Day, a surgeon, is the medical director and president of Cambie Surgical Centre. These days, he has much to celebrate -- including Canada's shifting view of private medicine.

Despite our shared interests, Dr. Day and I have never met before this morning. Back in the mid-1990s, I wanted to write an article on his private clinic, but couldn't find a newspaper interested in the pitch. Back then, Cambie was a small operation, focused on orthopedics.

Times have changed. This month, The New York Times interviewed Dr. Day. His clinic grows, covering a variety of surgical procedures, and there is talk of expansion to Calgary, Toronto and Montreal. Dr. Day is now president-designate of the Canadian Medical Association. "I'm suddenly respectable," he jokes about the new title.

Life is not without complications. Dr. Day still faces a vote -- and a potential challenge -- in his presidential bid (the CMA's elections are only modestly less convoluted than a papal selection). The Ontario government warns of legal action if his clinic hangs a shingle in Canada's largest province. Yet Dr. Day is undaunted. He looks forward to representing the medical profession in the public eye and, if need be, his clinic in the courts of Ontario.

The personal success of Brian Day reflects the remarkable change in Canadian attitudes toward private medicine. Not that long ago, of course, "private" couldn't be used in the same sentence as medicare. So-called experts touted our public health care system as the envy of the world. And while they reluctantly admitted there were some problems, they argued that everything could be fixed with new public money. Talk of private health care was dismissed as "Americanization."

Some in academia still speak in these terms. But most don't. Last June, the Supreme Court of Canada had a harsh appraisal of medicare, declaring: "access to a wait list is not access to health care."

The Justices' decision -- involving a patient awaiting a hip replacement in Quebec -- has up-ended the debate. Call it the hip that changed history. Even Martin Cauchon, the Chretien-era Cabinet minister, now supports a reconsideration of the Canada Health Act.

That federal legislation still remains unquestioned by many pundits and policymakers. But private medicine expands. Every week, one new private clinic opens in Canada. Dr. Day estimates that 50,000 British Columbians alone use some type of private health service every year, mainly diagnostics.

And it's part of a larger trend. Quebec recently announced a health-care guarantee for hip and knee replacements that will almost surely see thousands of procedures performed in private clinics (but with public funding). The Premier of British Columbia toured a variety of European countries to better understand how to blend private and public systems. Alberta's Premier Ralph Klein muses again about private medicine.

It is this last announcement that has caused the greatest fuss. Klein's suggestion is, according to the Globe and Mail, "radical" and a "perversion." Strong words, but why?

Here is the bigger question: does anyone really believe that Canadians don't already pay for faster treatment? It's not simply Dr. Day's clinics that offer queue-busting care for a price. Across the country, and in particular in Quebec, Canadians can opt out of the lengthy wait lists of the public system. And for people uninterested in comparison shopping, medical brokerages such as Timely Medical Alternatives will offer a menu of private options both north and south of the 49th parallel, all at a discount.

Let's not get ahead of ourselves. The debate over Canadian health reform has only just started. An openness to discussing options on the supply side is a good first step. But with an aging population and ever-increasing options for care, some reconsideration of Canada's zero-dollar health insurance is also needed.

Still, the progress is palpable -- not an Americanization, but perhaps a Europeanization. Tim Evans, a senior fellow at the Centre for the New Europe, observes that "there is no ideological debate about who provides the care [in continental Europe.] There are only good hospitals and bad hospitals, not public and private ones." Dr. Evans isn't exaggerating: St. Goran's, the largest hospital in Stockholm, is privately run and managed.

Canada is slowly moving in that direction. It's difficult not to marvel at the enormous change that's taken place on this side of the Atlantic.

"I don't think that a Cambie clinic in Toronto is going to solve all of our problems," Dr. Day notes. "But I think its part of the solution." Such a statement would have been bold just a few short years ago. Today, it seems remarkably unremarkable. But then again, Dr. Day is strangely respectable now.

Original Source: http://www.nationalpost.com/news/story.html?id=c3d29f8e-72e8-4611-b5a1-6dd324a7a05e

 

 
 
 

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