New Brunswick’s Public Health Care: At the Crossroads

Michael McBaneCanadian Health Coalitionwww.healthcoalition.ca

Financial Overview for N.B. 2011-12

N.B. Revenue2013-2014

Federal Transfer Payments2013-2014

$52.5 billion in federal cuts Over 10 years

Federal cuts to N.B. Health Transfers

2014

/15

2015

/16

2016

/17

2017

/18

2018

/19

2019

/20

2020

/21

2021

/22

2022

/23

2023

/24

-180.00

-160.00

-140.00

-120.00

-100.00

-80.00

-60.00

-40.00

-20.00

0.00

Losses from change

Total cut in funding over

10 years: $715 million

Canada Health Act Annual Report 2011-2012

• Number of participating physicians: 1,618• Number of opted-out physicians: 0• Number of private for-profit facilities

providing insured health services: 0• Payments to private for-profit facilities for

insured health services: 0

.

The Story

• Health Care’s spending not “out of control” • Aging population won’t break the bank • Affordable public solutions to all healthcare

problems – the 2nd Stage of Medicare • Focus on primary health care and prevention

and other community based services like home care.

Medicare’s Second Stage

“Those of us who talked about Medicare back in the 1940’s, the 1950’s and the 1960’s kept reminding the public there were two phases to Medicare. The first was to remove the financial barrier between those who provide health care services and those who need them. …The second phase would be the much more difficult one - to alter our delivery system to reduce costs and put and emphasis on preventative medicine....

- Tommy Douglas 1979

Imagine if all physicians were part of the health care team…

“Canada’s system of independent physician private practice is the biggest elephant in the room.”

-Michael Rachlis, MD

New Brunswick Extra-mural program

• Comprehensive home health care services

• Providers: nurses, licensed practical nurses, registered dietitians, respiratory therapists, occupational therapists, physiotherapists, speech language pathologists, rehabilitation aides and social workers.

• Services: acute care, palliative care, home oxygen program, long term care assessment and rehabilitation services.

It’s Time for Pharmacare

1. Universal & Equitable Access

2. Safe & Appropriate Use

3. Cost-controls & Affordable

Privatization drives up spending

• Encourages overuse of high-cost tests, procedures, and inappropriate medication to increase income and profit.

• Fraudulent billing by physicians and facilities adds at least 5 % to the total cost of care in U.S.

• Profit-seeking physicians and facilities will abandon rural and remote communities

This is what for-profit health ‘care’looks like:

1. For-Profit nursing homes2. For-profit surgical clinics & hospitals3. For-profit pharmaceuticals4. For-profit health insurance

HealthCoalition.ca

1. For-Profit Nursing Homes

Abuse & Neglect On The Rise At For-Profit Nursing Homes

Q. How do you make money in a nursing home?A. Divert funds and focus away from clinical care.

“It is unwise to entrust the sick and the frail elderly in the hands of profit-seeking firms.” -- American Journal of Public Health (Vol. 91, No.9)

HealthCoalition.ca

2. For-Profit Clinics & Hospitals

• Prevented public audit • Charges Illegal user fees • Unlawful billings• Patients must sign false

statements

• An extra 2200 deaths a year in Canada if we converted to investor-owned private for-profit hospitals

HealthCoalition.ca

3. For-Profit Pharmaceuticals

• Millions of Canadians can’t afford access;

• Rx costs are 30% above international average;

• 4th to 6th leading cause of death; *

• Prescription use driven by advertising not evidence.

* Lazarou, J., JAMA, 1998

HealthCoalition.ca

Rx Spending per capita

4. For-Profit Health Insurance

• Is more expensive and drives up costs

• Denies access for the sick (pre-existing conditions)

• Denies access to those who can’t afford to pay

• Not new – Canada had private insurance and rejected it for Medicare!

-CIHI, 2012

HealthCoalition.ca

Ethics + Evidence + Economics= Public Support

The federal government should ensure that all Canadians, no matter where they live or their ability to pay, get access to healthcare.

HealthCoalition.ca

21

What the few want:

• Open up the delivery of health services to market rules and divert public funds to the profit seeking private enterprise.

• Segmentation of ‘markets’, access, coverage.

• Cherry-pick and provide only the profitable services in the profitable ‘markets’

HealthCoalition.ca

22

More private means less public

• Draws off resources from the public system• Increases costs overall• Introduces the inequities of the U.S. system• Gives too much care for those who don’t need

it and not enough for those who do.

Source: Marcia Angell, MD, “Privatizing health care is not the answer”, Canadian Medical Association Journal, 2009.

HealthCoalition.ca

Public Solutions

To avoid all these problems you have to:

1) Keep services out of the hands of for-profits; 2) Replace fee-for-service payments to MDs; 3) Organize delivery with teams in community

health centres; 4) Encourage quality of care over quantity;5) Keep people healthy (food, housing,

income…).

24

Solving Medicare’s Problems

• Misuse of prescriptions- prescription drugs (ADR a leading cause of death)- patients in acute beds, inappropriate referral to specialists

• Overuse from over-diagnosis- average of 16 prescriptions per Canadian in 2011- MRIs: 4 million inappropriate (10-20% of referrals)

• Underuse of prevention- prevention and public health- non-therapeutic treatments + TLC- common sense: diet, home & community supports

Our values

Health as Public Good

Keep people healthy

Integration & Teamwork

Protect the vulnerable

Values in conflict

Health as Public Good Health as Commodity

Keep people healthy Profit from illness

Integration & Teamwork Fragmentation & Competition

Protect the vulnerable Exploit vulnerability

27

Medicare Works…

HealthCoalition.ca

…and Canadians want more of it!

Universal public drug plan Home Care and Long-term care standards Adequate and stable federal funding

“The price of Medicare is eternal vigilance.”-- Tommy Douglas

HealthCoalition.ca

Conclusion

• Canadians want a stronger public health care system;

• Medicare won’t survive without federal leadership:

• What stands between Medicare and its destruction are the peoples of Canada!

Think about Medicare before you vote in 2015