Alberta reshapes medicare

如花 · 发表于 2006-3-1 02:01

From Wednesday's Globe and Mail

EDMONTON — Doctors could work in both the private and public health-care systems at the same time and patients could pay to have some procedures done quickly under a sweeping Alberta proposal that threatens to pit the province against Ottawa in a showdown over the future of medicare.

"The health system must change to survive," Premier Ralph Klein told reporters yesterday after releasing his long-promised "third-way" proposal for health-care delivery. "This is not about playing politics, or starting fights with anybody, or defending our turf."

Mr. Klein stressed that his Progressive Conservative government's 10-point plan is only a proposal and that he wants Albertans to provide feedback before April 1. "If there is a better idea, we'll use it," he pledged.

However, the Alberta Premier expects the measures, which are meant to reduce waiting lists and control the skyrocketing cost of health care, will likely pass before the spring session of the legislature ends in May. Medicare costs now run about $9-billion a year in the province and eat up close to 40 per cent of its operating budget.

Alberta is not the first province to open the door to private health-care delivery: Quebec said last month it would pay for hip and knee replacements and cataract surgery at private clinics if necessary, and British Columbia has signalled an interest in allowing more private care. But Mr. Klein's proposal is the most sweeping and could put Prime Minister Stephen Harper's new Conservative government in a difficult political position as it tries to uphold the Canada Health Act while not upsetting its deep Alberta roots.

The province's Health Minister, Iris Evans, said the proposal is simply an attempt to find a "middle ground" that would keep the public health-care system strong, adding that she isn't sure whether the plan would violate federal laws.

"You can talk about it being two-tiered health care — but it's no different from what's going on in Quebec, it's no different than what's going on everyplace they have a private clinic," she said. "It's people making choices for themselves."

Quebec doctors, however, are not allowed to switch back and forth between public and private systems. Instead, they must choose one or the other.

Ms. Evans said doctors in Alberta who opt to work in the mixed system would be subject to restrictions, which have not yet been determined.

She said doctors would probably have to spend a certain number of hours on the public side before being able to work privately. Only non-essential procedures such as hip and knee replacements and cataract surgeries could be offered privately, she said. How much doctors could charge patients in the private system has also not been decided.

Alberta sent copies of its proposal to Mr. Harper and federal Health Minister Tony Clement yesterday morning. The plan also calls for an end to government funding for experimental treatments and drugs.

Mr. Clement told reporters in Ottawa that any changes to the health-care system must be done within the confines of the Canada Health Act, but refused to say whether he believes Alberta's proposal meets that test.

When asked whether patients should be allowed to pay to get treatment faster than the public system can offer, Mr. Clement said, "I think the Canada Health Act is clear on that question," but he did not elaborate.

Mr. Klein would not say what his government would do if Ottawa tries to stop it from going ahead with its plan. "We'll cross that bridge when we get to it," he said.

Opposition parties in Alberta said the changes would alter medicare forever. The last time Mr. Klein tried to expand the delivery of private health care in Alberta, six years ago, his plans were met with huge protests at the legislature.

Friends of Medicare Alberta co-ordinator Harvey Voogd expects Albertans to soundly reject the government's health-care proposals.

"I have no doubt that the final decision-makers on this issue will be Albertans," he said. "As the details come out, Albertans will react very strongly and the government will have to either acknowledge that or pay a political price."

Cy Frank, the Calgary doctor who spearheaded a pilot project that resulted in a dramatic drop in waiting times for hip and knee replacement, said nobody in the government had consulted him or his peers about allowing patients to pay for certain orthopedic services.

"We're not aware of any such plan, but I know they've been musing about that," said Dr. Frank, who is director of Alberta's new Bone and Joint Institute.

Launched last April, the pilot project has seen waiting times for hip and knee replacements slashed. Patients are on the operating table 11 weeks after the first referral to an orthopedic surgeon rather than the usual 19½ months.

But Colleen Flood, a health law expert at the University of Toronto, said research has shown that waiting times in the public system have actually increased in countries such as New Zealand, Ireland and Spain that have allowed doctors to work in both the public and private systems.

"Many countries that allow a private tier have a raft of complicated legislation to try to suppress its ability to flourish," she said.

With reports from Dawn Walton in Calgary and Gloria Galloway in Ottawa

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[亚省新闻] Alberta reshapes medicare