What a Concept: The Patient as a Health Care Consumer

Commentary, Frontier Centre, Healthcare, Media Appearances

Imagine if the balance of power within Canada’s health care system swung from provider to the patient.

That would be quite a paradigm shift. Right now governments make all the rules and doctors make all the medical decisions.

The patient is not so much a consumer as a humble and relatively powerless supplicant.

Personally, I’ve never thought to ask for electronic access to my medical records.

Never dreamed of exercising power under a patient’s bill of rights.

Never imagined a situation in which I might bypass my GP to directly access care from a specialist.

Good thing, too. Because Canada’s medicare system does not feature any of the above.

A study released Monday, comparing health care in 29 European Union countries plus Canada, reveals we perform poorly, particularly when it comes to patients’ rights and accessibility.

In fact, we placed 23rd, of 30, on the first “Euro-Canada Health Consumer Index.”

Since 2005 the index has provided an annual report card for medical systems on the other side of the pond. The project is the work of an independent think-tank, the Health Consumer Powerhouse, based in Brussels and Stockholm.

Last year the Winnipeg Frontier Centre for Public Policy joined the exercise, to provide

Canadians with perspective on how medicare compares to the European systems.

The report expresses hope that, with comparative data in hand, Canadians will start demanding more of their health scheme.

The Frontier Centre asserts it’s more logical to compare Canada’s system to those in the EU than to U.S. health care because the latter is a private sector, service-oriented model.

The findings, however, do not make for happy tidings.

The 41-page report concludes Canada “spends more money to achieve worse results than any other country.”

Canada spent $160 billion — nearly $5,000 per person — last year on health care, 71 per cent of which derived from public sources. This reflects higher per capita spending than all 29 countries except Norway, Switzerland and Luxembourg.

Declares the report: “When adjusted for bang for the buck, [Canada] is 30th of 30 in the index.”

Researchers considered five barometers: Patient rights; waiting times; health outcomes; access to drugs, and generosity of the systems as reflected by kidney transplants, early childhood vaccinations and state-sponsored dental care.

Canada scored 550 of a possible 1,000, compared to top-ranking Austria, with 806 points. Others in the top five: Netherlands, Switzerland, Germany and France.

Accordingly, the report recommends smarter spending for Canada, rather than more money. “Much more can be done with the money being spent.”

The index found that Canada does reasonably well in terms of all-important health outcomes, for example, heart attack survival. But we score badly — on a par with Poland — on consumer friendliness. That is, Canada tends to be “disdainful of the rights of health care consumers.”

Canada, says the report, “suffers from what seems to be an expert-driven attitude to health care.”

The report notes disapprovingly that self-referral to specialists isn’t permitted. Medical records, not yet in electronic form, remain the property of doctors. Canada lacks a patient charter of rights. And patients aren’t involved in health care policy-making, a top-down affair coordinated by Ottawa and provinces.

Rather than thinking of health care as a rationed set of public goods, it ought to be considered more as consumer-related services.

The report’s authors are on to something here. Last week, CBC TV reported the Ontario College of Physicians and Surgeons is concerned about a new trend — doctors taking it upon themselves to screen for patients, turning away people who might present too big a load!

Says the report: “Canada lacks a culture in which consumers have high expectations of health care services, and significant reform is unlikely without this.”

Of course it’s difficult to have high expectations when you get screened to access a doctor’s patient roster, or after hours spent in an emergency room you step forward only to have a harried hospital nurse instruct you to get back to your seat and wait until you’re called.

For all the billions taxpayers spend on health care, a little empowerment would be a fine thing.