First of a two-part series Tony Gosgnach
The Interim
Every year, it takes up a huge chunk of federal and provincial budgets, is thought to kill 24,000 born people – and another 100,000 or so pre-born persons – and is rife with fraud to the tune of up to $10 billion. What is it?
Why, the Canadian medical system, of course. At a time when health care ranks as the top, or almost the top, priority for the Canadian electorate, surprisingly little attention is paid to the myriad of serious problems plaguing the system, apart from what is often ballyhooed as chronic funding shortages.
Readers should note that this article is, by no means, meant to denigrate the professionalism, dedication and integrity of individuals working heroically within the Canadian medical system to save lives and maintain individuals’ good health. Instead, it is intended to serve more as an indictment of the leaderships within the Canadian medical system – those individuals and entities that are often seen shilling for the abortion and contraceptive industries and the like. Those leaders have also thrown out the classic Hippocratic Oath and pay lip service to ethics within both training and practical regimens.
In beginning our look at the Canadian medical system, it is worthwhile to examine some overall numbers. As alluded to at the outset, Canada’s health care system gobbles up what can only be described as astronomical sums of money for perhaps-questionable returns. It is known that, according to a the Canadian Institute for Health Information report, health care spending in Canada saw an increase of nearly $100 billion within a 20-year span, from $37 billion in 1984 to $130 billion in 2004. Ontario alone now spends a remarkable 40 per cent ($32.9 billion) of its entire provincial government budget on health care and yet, the province’s hospitals continue to report deficits of half a billion dollars a year.
What are citizens getting for all this money? In what was described by a health services researcher as an “explosive” result, the Canadian Adverse Event Study, the first of its kind in this country, found an astonishing 24,000 hospital Canadians died in the year 2000 at the hands of medical personnel from errors that could have been prevented. In all, some 185,000 fatal and non-fatal mistakes occurred – 7.5 per 100 hospital patients. Nearly a quarter of Canadians – 5.2 million – said they or a family member experienced medical errors or preventable adverse effects while being treated in a hospital.
Another study found that for every “adverse event” that is detected, 20 to 25 others are not. The problem is known to be serious enough that a special task force on patient safety is recommending yet more money – this time, $10 million – be poured into creating a national institute that will identify, track and find ways to reduce medical errors.
Dr. John Wade, chair of a national steering committee on patient safety, wants to change what he described as an environment of fear and blame within the health care profession, in which workers feel uncomfortable about speaking out about errors out of fear of lawsuits or disciplinary action. Others are citing a “culture of silence” within hospitals. It has been reported that hospitals are encouraging the voluntary reporting of mistakes – leading one to ask what they have been doing otherwise: covering them up?
It’s not as if the health system’s customer’s aren’t noticing what’s going on. According to the Canadian Medical Association’s 2004 national report card, 41 per cent of Canadians gave health care poor grades, with 11 per cent flunking it altogether. CMA president Dr. Sunil Patel said at the time that the figures prove Canadians’ “confidence in the health care system is eroding.”
The situation is even drawing attention internationally, as the Reuters news service characterized Canada’s health system as “creaking alarmingly, with long wait lists for treatment and shortages of cash and doctors.” Average wait times for treatment in this country hover around 17-18 weeks. The Fraser Institute cynically describes our medical system as one “offering low expectations cloaked in lofty rhetoric.” An unnamed doctor was quoted as saying, “There is a lot of inhumanity built into the system.”
Fifteen per cent of Canadians didn’t have a family doctor as of 2003 and a recent report by the Canadian Institute for Health Information noted millions of Canadians are going without needed health care. This is principally because, despite the huge sums expended on the socialized system, many facets of health care are paid for out-of-pocket – prescription drugs, dental work, vision care, home care, psychiatric services, addictions treatment and accommodations in nursing homes and institutions.
Sun Media’s Greg Weston, writing in September 2004, observed that “free” health care in Canada costs the average Canadian family a staggering $5,500 a year, whether they use it or not. He described the system as “dysfunctional” and charged that, while politicians claim user fees would be the death of medicare “and the demise of Canada as we know it,” individuals are already coughing up $18 billion a year for health services straight out of their pockets.
He asserted that the system cannot sustain, let alone better, the level of health services to Canadians and their families. He also expressed concern over what lies ahead. “Spending on health care will grow at up to 9 per cent a year. As a matter of perspective, in 18 months, those spiralling costs alone would eat through all of the $12 billion in increased funding the feds are now offering the provinces over five years. As for the future for the Canadian taxpayer, it doesn’t take a mathematician to figure out the impact of adding even a 5 per cent a year increase to the existing family burden of $5,500. The medicare message is clear – fix it or go broke.”
The last thing those struggling families might want to hear is that health care workers are overpaid and that fraud and inflated claims are rampant. Sadly, that seems to be the case. A Fraser Institute study released in September 2004 found Ontario hospitals are paying their workers too much money and that rising payrolls ate up all the additional tax dollars given to hospitals by the provincial government between 1997 and 2002.
The number of hospital workers making over $100,000 tripled since 1996 and the average pay for those making the most money increased a whopping 60 per cent. Yet, a spokesperson for the Ontario Hospital Association suggested Ontario hospitals “are among the country’s most efficient and continue to improve upon that.”
Efficient or not, citizens may not have been reassured after the Canadian Health Care Anti-Fraud Association found in a survey released this past September that health care fraud costs this country $3 billion to $10 billion a year. “It’s a big problem,” said Michael Chettleburgh of Fraudbox Inc, which conducted the survey, by way of understatement. “Would that affect you as a health consumer? I would suggest it does.”
Some estimates pegged the rate of fraudulent claims at six to 19 per cent. The most common forms are billing for services never provided, unnecessary care, mis-representing non-covered procedures as necessary and billing for services provided to a fictitious patient. Most of those surveyed called for more serious penalties for health care fraud.
Despite all the fraud, death, overspending poor service, the problems don’t end there:
•While referring to a recent book on the Nancy Oliveiri affair, a professor of medicine at McMaster University in Hamilton suggested whistleblowers in the medical system “face great risks.” Dr. Gordon Guyatt says the pharmaceutical industry is facing criticisms for extravagant gift-giving to potential prescribers of its drugs, large payments to experts in positions to make influential recommendations, withholding data from researchers, ghost writing of manuscripts and withholding information on the deleterious effects of its drugs. As well, on the university medical research front, there is a premium on employees serving institutional interests, an increasing intolerance of dissent and criticism and an erosion of academic freedom.
•The sorry state of Canadian health care is fuelling a boom in private care and speedy service in the U.S. In just the past year, such business has as much as tripled.
•Superbug infections are spiralling in Canadian hospitals, killing as many as 8,000 people a year and costing the health system $100 million. Statistics show 250,000 Canadians get sick from preventable infections every year. A CBC News investigation last spring found that restaurants have more germ-fighting regulations to contend with than hospitals do.
•The Canadian Taxpayers Federation projects that at present rates, Ontario will spend an incredible 85 per cent of its entire provincial budget on health care alone. This will be even though the average Canadian family forks over 48 per cent of its income in taxes.
•Doctors who are rude, throw tantrums, or bully patients and co-workers are commong enough that the College of Physicians and Surgeons of Ontario is drafting a program to deal with them. The president of the Ontario Nurses Association said, “This is not fiction. It’s a serious problem that has to be dealt with.”
•The Canadian Medical Association Journal raised questions about whether governing bodies adequately police potential conflicts on interest in the referral practices of doctors. Two commentaries raised the possibility of doctors receiving kickbacks from diagnostic or supplementary health clinics for referring patients to them or ordering unnecessary tests to be performed in laboratories in which the doctors have a financial interest.
•An Agence France Press article exposed “the secret world of doctors’ slang,” in which patients are labelled with acronyms such as ATFO (“asked to f—- off”) and PAFO (“p——- and fell over”). Another acronym label is DBI, for “dirt-bag index (referring to a patient’s hygiene). Patients near death are described as “circling the drain,” “good for parts only.” The “Q sign” refers to a patient with his tongue hanging out of his mouth in a terminal condition. A British medical official who chronicled the terms agreed they were offensive, but serve to “depersonalize the distress encountered in doctors’ everyday working lives … Often, someone else’s pain is too much for us, so we cut off.”
