No. 24: Canadian Doctors for Medicare e-Rounds 2009 Year in Review

Background: Medicare e-Rounds are structured abstracts authored monthly by Canadian Doctors for Medicare (CDM). Now completing our second annual series, e-Rounds is one of the tools we use to promote CDM as an evidence-based (and values-driven) organization that works to ensure that peer-reviewed literature on publicly-funded Medicare, private insurance, the funding and delivery of health care, and ideas for improving Medicare is available to and understood by Canadian physicians. In our second series, we have looked at health reform in the United States on three occasions (e-Rounds Nos. 14, 19, and 23), reviewed health care outcomes in Canadian for-profit and not-for-profit long-term care settings (e-Rounds No. 17), examined the impact of private insurance and privately-funded health care in general (e-Rounds No. 16) and on patients (e-Rounds No. 22) and physicians (e-Rounds No. 20) in particular. In addition, we could not resist commenting on the investments of the insurance industry in big tobacco while simultaneously selling health insurance (e-Rounds No. 21), and on the political use of poll results to support a private, for-profit health care system (e-Rounds No. 18). As in our first series, we shed a light on how Canadian Medicare is falling short in some areas when compared to other OECD countries, and we showed where there are opportunities for improvement to our health care system (e-Rounds No. 15).

Objective: 1) To summarize the evidence derived from 12 papers reviewed for Canadian Doctors for Medicare’s monthly Medicare e-Rounds (2009) and present an informed analysis of the influence that private health care has – or could have – on Medicare; and 2) to suggest opportunities for improving Canada’s publicly-funded Medicare system.

Synthesis: The evidence in this series (2009) supports the conclusion of the first series (2008), namely that private funding, or private for-profit delivery of health care, does not confer better health outcomes (e-Rounds No. 17), but rather complicates physicians’ practices (e-Rounds No. 20) and increases the risk of medical bankruptcy for patients (e-Rounds No. 22). Without a doubt, this is well known by proponents in the U.S. of a Canadian-like publicly-funded health care system for Americans, but it appears as if a single-payer, universal health care system will not be adopted in this cycle of U.S. health care reform. At the time of this writing, it is still unclear what reform will take place in the United States (e-Rounds Nos. 19 and 23) and what lessons will be learned from its long history of private funding and profit-driven health care delivery (e-Rounds Nos. 14 and 16). Meanwhile, opponents of publicly-funded health care have lambasted the “Canadian-style system,” branding it as some form of dreadful “socialism” and claiming that it disadvantages patients and is wholly unacceptable to those who seek “choice” and liberation from the real or perceived intrusion of “government” in their lives. Never mind that U.S. Medicare, perhaps the most popular social program in U.S. history, is publicly funded and universally available to all Americans over the age of 65 years. In all of this, it goes almost without saying that the influence of the insurance industry and the medical-industrial complex is extensive (e-Rounds No. 21) and that polls can potentially influence public opinion about private health care, regardless of whether their methodologies are credible (e-Rounds No. 18).

As we have previously suggested, whatever changes take place in America, they will almost certainly influence the direction of reform in the Canadian health care system. But, this aside, we must attend to our own business and the continual improvement of Medicare in Canada. Medicare continues to evolve and must undergo necessary improvements if it is going to fulfill its intents and purposes. By shining a light on the limitations, we observe, for example, that when compared to 7 OECD countries Canadian physicians are less likely to use electronic health records (e-Rounds No. 15). Moreover, we in Canada have been doing a poor job of patient care transitions and hand-offs, after-hours access, and managing some waiting times. These are challenges that partially explain why Emergency Rooms seemed backed up and why some patients do not have a “medical home.” These are important symptoms of a primary care system under stress.

Limitations: Our structured abstracts are of peer-reviewed literature and therefore the content of our sources is finite and often heavily weighted to U.S. experiences. The selection of articles is not driven by an independent editorial board, but is deliberately designed to proffer a deeper and broader understanding of private financing and for-profit delivery and their potential impact on the core principles that underlie the definition of Medicare in the Canada Health Act. Of course, the two editors are members of CDM and both are biased in their commentary by their own analyses of the evidence and by their experiences with health care systems around the world. We admit that any and all of these limitations may affect the relevance or validity of our expressed assertions and opinions.

Summary: Medicare e-Rounds will continue to be written in 2010 in an effort to scrutinize and report on evidence relating to public and private funding and delivery of health care in Canada as well as on opportunities to improve our Medicare system. 

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