CUPE Manitoba’s Submission on the Senate’s "Issues and Options" Health Care Report - chaired by Senator Kirby - October 15, 2001

Introduction

CUPE Manitoba represents 24,000 members who work in health care, social services, municipalities, libraries, schools and other public sectors. We represent approximately 10,000 health care workers in Manitoba, while nationally CUPE represents some 150,000 health care workers among its half-million-strong membership. We welcome this opportunity to present to you our views concerning the state of the health care system in Manitoba and Canada.

CUPE Manitoba members are very concerned about the future of Medicare and health care in Manitoba and in the country. We are a strong supporter of our public health care system. Many of us remember when there was no Medicare or public health care program. We had to worry about how we were to pay medical bills if we, or a member of our family, fell sick. We had to experience, or watch other families’ experience, bankruptcy, if medical bills became too high. This time cannot come again and we at CUPE Manitoba are working hard to ensure this.

Our submission will be divided into three main sections:

*how the quality of care can relate to the type of health care delivery

*waiting lists and non-profit and for-profit health care

*sustainability of the Canadian Health Care System including options for funding

Lessons from other health care systems from around the world will be integrated into these three sections.



Quality and Health Care Delivery

Who ensures quality care in a for-profit system? For-profit health care companies are accountable to their shareholders. For-profit health care companies are not accountable to hospital boards or elected members of a provincial or federal parliament which is the case in a publicly funded and administered health care system.

In Manitoba, involvement of the private sector in the centralized hospital food system of the Urban Shared Services Corporation (USSC) was a disaster. The USSC went grotesquely over budget. The plans developed by the private sector did not meet the needs of Winnipeg hospitals. A new plan had to be developed.



In the U.S., The National Kidney Foundation found that the percentage of people on dialysis who die each year was higher in the United States (in its for-profit health care system) than in any other industrial country(i) . In the journal Med Care in 1997, it was argued that Canadian dialysis patients’ outcomes are better, and costs are lower, than for comparable patients in the U.S.(ii)

There is more equal access to quality care in a publicly funded and publicly provided health care system. A 1996 study published in Health Affairs, argues, that in the United States, preventable hospitalization rates were 2 to 4 times higher in areas with ‘poor’ zip codes than in areas with ‘wealthier’ zip codes. However, in Canada, preventable hospitalization rates were less likely to vary by income.(iii)

To what extent does accountability affect quality of care? One example comes from U.S. Nursing Homes. Approximately two-thirds of all U.S. Nursing Homes are for-profit. In 1997, an analysis of HCFA survey data (Federal Nursing Home Inspections), for the U.S., revealed the following:

Nursing Homes Cited for Quality Deficiencies(iv)

Inadequate Assessment 31%

Unsanitary Food 24%

Unsanitary Environment 18%

Pressure Sores 17%

Improper Restraints 15%

Improper Drug Prescriptions 11%

Waiting Lists

There is an argument that a parallel private for-profit health care system would decrease waiting lists – in both the for-profit health care system and in the public/non-profit health care system. The main reason that this argument is flawed, is that it is assumed that the number of health care practitioners increases if there were more for-profits centres. This would most likely not occur and health care workers would be split between two systems – public and private.

Between 1998 and 1999, the Manitoba Centre for Health Policy and Evaluation found that cataract patients had to wait about four months longer for a doctor who worked in both the public/non-profit and private/for-profit system than those patients who waited for a doctor who only worked in the public/non-profit system. Waiting times for cataract surgery in both private and public hospitals in Brandon and Winnipeg over the period 1992-93 to 1996-97, was researched. It was discovered that there was only a 7-10 week wait for surgeons operating only in public hospitals. The surgeons who operated in both private and public hospitals had public hospital waits ranging from 14 to 23 weeks.(v)

In Richard Plain’s (Ph.D. Econ) The Privatization and the Commercialization of Public Hospital Based Medical Services Within the Province of Alberta: An Economic Overview (March 2000), he argues that private and for-profit health care organizations will mean two waiting lists, as physicians work for both the for-profit and non-profit sector. The private for-profit list will consist of patients who will pay additional user fees and/or require the least costly treatment, while the public/non-profit list will consist of the “low income basic medicare patient”.(vi)

The National Health Services (NHS) in England allows both private and public sector hospitals. The result has been that physicians are being drained from the public sector into the private sector and it is even more difficult to find specialist services in the public sector.(vii)

Sustainability of the Canadian Health Care System including options for Funding

Modernization, not privatization, is what is needed in terms of health care reform. The Federal, Provincial and Territorial Health Ministers in September 1998 identified the need for primary health care reform. An integrated health care system between primary, acute care, long-term care and home care, where physicians receive salaries, is preferable. However, we do not advocate for the U.S.’s health maintenance model (HMO), with its denial of service to truly sick patients and other significant problems.

Manitoba Pan Am Clinic

Recently, the Manitoba government has purchased the previously for-profit Pan Am Clinic. At the clinic, out-patient surgical procedures are performed. This is an example of how non-profit and public health care delivery can change and reform to meet today’s demands and standards. Thus the motto – “modernize don’t privatize”. All cost savings, as a result of the Pan Am clinic, are put back into the public system instead of going to private profits. Last month the province announced it was doubling the surgical procedures performed at the clinic due to its success.(viii)

Other Manitoba Community Health Clinics

There are other community, publicly-run, health clinics in Manitoba. These clinics see patients who would otherwise go to higher-costing health care services for care. Examples are Klinic Community Health Centre, Mount Carmel Clinic, Women’s Health Centre, Nor’West Co-op Health Centre, the MFL Occupational Health Centre and Village Clinic Health Centre. While the model is an exemplary one, funding for community health clinics must be appropriate in order for overall health care savings to occur. Community health clinic workers need wage parity with other health care workers, including hospital staff, especially for recruitment and retention purposes. If this occurs, health and savings could be the result. A Saskatoon clinic study found that overall costs were 17% lower for patients attending the Saskatoon clinic than for those treated in the fee-for-service system.(ix)

Manitoba Public Home Care

Another example of how public health care is working in Manitoba, is Manitoba’s home care system. Manitoba has a publicly funded and publicly-run, home care system. Everyone has access to home care, if they need it, and publicly run means one central administration. In other provinces where home care is contracted out, many administrations exist which overburden the system with unnecessary costs.

In the mid-90’s, the Manitoba government experimented with privately delivered home care. The company formerly named Olsten was awarded a contract. Home care workers went on strike in 1996 to oppose the private home care companies. Workers and patients knew this would mean care would also suffer. Patients, families and workers rallied together to force the government to back down and less than a year later the government admitted the public sector could do the work better and cheaper and Olsten left the province.

Increased Federal CHST Payments

The CHST tax transfers result from a 1977 agreement between the federal and provincial governments. When adjusted for inflation, the real Federal CHST transfer to the provinces in 2000-2001 was approximately 23% below 1993-94 CHST levels. This means that the CHST cash transfer amounted to approximately $444 per Canadian. However, the Federal government has billions of dollars in surplus and cut taxes, $100 billion last fall. Increased CHST transfers are badly needed for a successful public health care system.

Private Health Care Costs More

Private health care is much more expensive than public health care. Private health care companies collect overhead for advertising and other administration costs – such as billing. Private health care costs more because of the profits to their shareholders – and costs in order to pay taxes. When asked about private/for-profit clinics, a senior researcher at the University of Manitoba’s Centre for Health Policy and Evaluation said “if you allow private clinics into the system, you can’t control costs – the costs skyrocket”.(x)

For-profit U.S. health care costs are increasing at a faster rate than Canadian non-profit health care costs. In 1997, the Organization for Economic Cooperation and Development (OECD) reported that U.S. health costs were indexed at $US 4.090 compared to Canada’s costs which were $US 2.095.(xi)

In the United States’ mainly for-profit health care system, there are four main factors which increase health care costs: no cost control; profits and executives salaries; administration and overhead; and fraud, corruption and unaccountability. Costs in a for-profit health care system are not controlled as the drive to increase profits is not controlled. Only corporations benefit.(xii) Profits and executive’s salaries are always increasing. In 1995, overall administrative costs for the health care system in the U.S. was at $US 995 per person, whereas in Canada the same costs were at $US 248 per person.(xiii) Columbia/HCA hospitals in the U.S. inflated Medicare billings by diagnosing illnesses as more serious than they really were or “upcoding” diagnosis-related groups (DRGs).(xiv)

Private Health Care And Superbugs

As cleaning work in hospitals has been contracted out, hospitals have seen an increasing number of Superbugs. Superbugs are bacteria which are resistant to most antibiotics. VRE (a Superbug) has increased 34-fold in Canada between 1989 and 1996.(xv) In New Zealand, MRSA (another Superbug) has been a problem, particularly at one North Shore hospital where the cleaning has been contracted out to a private company. A hospital official at this hospital was quoted as saying that “the standard of cleaning is a dangerous disgrace in the hospital. The spread of MRSA…is a direct result of this”.(xvi)

Conclusion

Henry Mintzberg, a Professor at McGill University has been quoted as saying that governments cannot be “pressured to imitate business as if techniques that were developed for business are universal”.(xvii) Contracting out services “is an abhorrent notion for government. It’s a trivializing notion for government. I’m a citizen. I expect a heck of a lot more from my government that just a customer relationship. It’s what I expect from my automobile dealer, and I get it and I’m happy with it, but it’s not what I expect from my government”.(xviii)

Quality health care means public and non-profit health care. Health care is not a commodity. It is not a goods and service which can be traded. Health care is a right for every Manitoban and Canadian citizen, not a privilege. Shorter waiting times and a sustainable health care system can be achieved through appropriate public health care funding and public health care delivery.

Jf/opeiu 491/October 15, 2001