The least expensive way to deliver Health Care is through a public system

Province of Manitoba Health Care Consultations
WInter 2002 CUPE Research

When Personal or Private Health Care Spending and Public or Government Spending is Added, Manitoba has been spending less on health care (per person) than many provinces, for a long time - because the system in Manitoba is more public (see CIHI figures).

For instance, we know that Manitoba public home care is the least expensive way of providing health care for those who can receive it at home. A recent home care study in BC by Professor Marcus Hollander shows that preventative home care reduces costs to the overall health care system. Hollander’s study compared two health regions in BC – one which cut preventative home care and one which did not. Those who were cut came back into the continuing care system in worse health than those who were not cut from home care services. They also experienced more suffering and emotional distress.

The public system is the best way to deliver health care. In a public system, there are no funds spent on profits, less spent on administration (including advertising and bill collection), and, less room for fraud. The public system has the advantage of greater public accountability and transparency.

It is also not wise to every consider Private Financing Initiatives (PFIs). Governments can always borrow money more cheaply than the private sector can so there are no savings to be had by levering money from the private sector. The Auditor General in Nova Scotia was very clear about this in his report on PPP (Public Private Partnerships) initiatives in the public school system. In the UK, PFI initiatives in hospitals have come under heavy criticism for providing huge profits to the private sector partner and reducing the number of hospital beds available to the public.

There is no question that the Federal government needs to increase CHST (Canada Health and Social Transfer) to the provinces so that the provinces can provide necessary health care services. At the very least the Federal government should provide $1 billion for health care to the provinces as a way to bridge the period before recommendations are made by the Romanow Commission. The only way to handle decreased Federal health care spending is to keep the health care system public. All the evidence shows that privatized health care costs more, so why would we want to go in that direction?

The present services provided under the public health care system in Manitoba needs to be maintained and expanded. An expanded pharmacare program, a national home care program, or public dentistry, are examples. Even though the home care program in Manitoba is publicly funded and delivered, it would be to Manitoba’s advantage to have a national home care program with national standards. That way, federal transfers could pay for the program freeing existing dollars to be spent on other health care needs.

We also need to keep lobbying the Federal government for increased health care funding as well as a proper Equalization payments program. The Federal lack of commitment to funding, however, means that this is no time for a provincial tax cut in Manitoba.

Drugs Costs in Manitoba are rising – What about using generic drugs?

British Columbia’s public generic drug pharmacare program (`referenced based pricing’), initiated by the previous NDP government, is a model that Manitoba could use and improve upon. Drug costs are considerably less when generics are used.

The provinces are currently considering a program of bulk buying of pharmaceuticals. If the provinces can agree to an effective common formulary, this may be one way to reduce costs. It will require some effective coordination and cooperation to negotiate the deals with the brand name pharmaceutical companies.

A universal pharmacare program should be seriously considered. Joel Lexchim has estimated that a national pharmacare program that provides first dollar coverage for all Canadians would cost $3.1 billion per year. This seems like a lot, but it is actually $650 million less than is currently spent on drugs (both public and private spending).

There are several advantages. No one would be shut out from receiving necessary drugs. Other health costs would decline with proper drug usage and prescribing practices. Employers would no longer have to foot the cost of their private sector drug plans. Of course, some of those savings would be returned to the government as taxes to support the new drug plan.

Australia has been able to keep spending on drugs 30% lower than the OECD average through their national drug plan. Canada’s spending is 30% greater than the OECD average.

We also need to continue or lobbying efforts for changes to the drug patent legislation established under Bill C91 which extends drug patents to twenty years, and Senate Bill S-17, which further delays the introduction of Generic drugs. Generics are not able to come onto the market so that savings can be realized.

Lobbying against trade agreements that give patented drug companies even more power, needs to continue (NAFTA, FTAA, GATS, GIA).

Focus on Health Maintenance and Primary Care Reform

Public primary care clinics open 24/7 with doctors and other health care practitioners on salary (instead of fee-for-service), would go a long way in terms of saving valuable health care dollars and potentially cutting the use and need for emergency room services and expensive technology such as MRIs. The Community Health Centre model is a good model on which to base our reforms. Multidisciplinary teams of health care providers (physicians, nurse practioners, registered and practical nurses, dieticians, optometrists, dentists, social worker and others).

However, we do not advocate for the U.S.’s health maintenance model (HMO), with its capitation funding mechanism, that can lead to the denial of truly sick patients and other significant problems.

On the health human resources side, the province needs to develop a cohesive plan to train, recruit and retain health care workers at all levels. Increasing seats for physicians and nurses are only part of the solution. All other care providers and support services need to be supported with adequate training and compensation levels in order to ensure that we can not only attract health care workers, but retain them as well.

Health Care Spending Per Person: An Ontario/Manitoba Comparison - 1997

In a more public health care system, Manitoba was spending $53 per person less. *(CIHI - Canadian Institute for Health Information)