Some ideas are not as wacky as they seem. Health Minister Kevin Falcon’s suggestion that we look at ways to turn part of our health care system into a gold mine is not one of these ideas. On closer examination it is just as wacky as it appears at first blush.

In interviews last week, he asked why British Columbia can’t be “the Mayo Clinic of the North?” Why not start looking at the potential of parts of our system for generating revenue rather than always simply focusing on the costs?

Like the idea of a perpetual motion machine, a device that produces more energy than it requires to run, Falcon’s proposal has some attractive elements as long as you are willing to overlook a few fundamental laws of physics, or in this case economics and politics.

Falcon told Vancouver Sun reporter Jonathan Fowlie that he is looking at the billions of dollars Americans are spending overseas in what is known as the medical tourism market. His idea is that they will happily pay a premium for surgeries that make use of excess capacity in our hospitals.

The profits will then pay for more health care for British Columbians, so rather than competing with local residents now on waiting lists, surgical tourists would enable health regions to provide more services, thus reducing waiting times.

As I say, it’s an attractive notion — a way to get more health care without having to pay more for it.

Part of the thinking behind the idea is refreshing and should be heartening for supporters of our public health care system.

First is the confidence implied by the minister that our system is able to deliver world-class health care at a competitive cost to both American health providers and the growing number of private clinics that have sprung up here over the past several years.

Second is the long-overdue admission that the province has taken a political decision to ration health care, that in many cases people are waiting for surgeries, medical tests and other treatments because we aren’t putting enough money in health care budgets, not because of a shortage of doctors, nurses or operating rooms.

So if we can find more money, we should be able to reduce waiting times for British Columbians. And if we can do it without raising taxes, all the better.
So if we can find more money,we should be able to reduce waiting
times for

But there are still a couple of fundamental flaws with Falcon’s idea. The first is that we don’t have a system that allows us to discern the cost of delivering any individual treatment. If we don’t know how much it costs to put in a new heart valve or replace a knee, how can we know what we have to charge in order to make a profit? This is an issue that also makes it impossible to determine whether we should be contracting out some treatments to private clinics as a way of improving access to health care.

It’s also not at all evident that we can compete in the health tourism market, which is based primarily on the lower labour costs in destination countries, such as Thailand and India. If we had a real cost advantage, I wonder why private clinics that are now advertising to Canadians would not already be actively soliciting that business.

The biggest issue is still political. The optics of offering through our public health care system services to Americans that Canadians are not able to get are simply appalling. The idea that someone from Seattle can pay for a surgery in Vancouver while a Vancouver resident has to wait — or go to Seattle — is so appalling, in fact, that a conspiracy theorist might speculate this whole plan is being considered to deliberately undermine the credibility of our public system to pave the way for its demise.

source: Craig McInnes – Vancouver Sun.com

This, as Singapore through Health Minister Khaw Boon Wan, started implementing this month of March the island city-state’s “elective hospitalization overseas option” for members of its healthcare program bannered by Medisave, touted as one of the best and most well-funded healthcare programs in the world.

Medisave, introduced in April 1984, is Singapore’s mandated national medical savings scheme which enables individuals to put aside part (6.5 to 9 percent, depending on age group) of their monthly income into personal Medisave accounts used to pay personal or immediate family’s hospitalization, day surgery (one-day surgical operations), and certain outpatient expenses.

Medisave currently has a total standing fund of 42 billion Singapore dollars (SD), equivalent to some 30 billion US dollars, and counts about 2.9 million account holders, in which each average member has SD14,900 accumulated savings.

Previously, Singaporeans, permanent residents, and their immediate families could only use their Medisave in local hospitals and for emergency hospitalization abroad. But starting this month, it is applicable for use in hospitalization and day surgeries in 12 selected hospitals in Malaysia.

Singaporeans will be able to save on their medical bills by up to 50 percent if they choose to have their medical treatment in Malaysia, according to experts, noting that “a heart by-pass which costs USD18,000 in Singapore only costs USD9,000 in Malaysia, while angioplasty, pediatric cardiology, as well as other specialized medical services, could cost only half the price as those in some Singapore hospitals.”

Minister Khaw Boon Wan said the government decided to expand the use of Medisave to cover elective overseas hospitalization following requests from many Singaporeans themselves.

“The scheme gives Singaporeans more choices especially for those who want to seek cheaper but good quality treatment from private hospitals overseas,” he said, adding that, “the old policy restricts the people who travel and work in Malaysia from using their Medisave and was thus a strain on their pockets.”

“It’s one of those things that you allow because this is a patient’s Medisave account and it opens up options for them,” the minister further explained.

Malaysian hospital officials were quick to emphasize that their medical services, including modern treatment procedures in neurosurgery, orthopedics, and urology are comparable to, if not even better than, those in some hospitals in Singapore as well as in other countries, noting that at least 10 percent of their medical tourism clients comprised of Singaporeans even before the introduction of the elective overseas hospitalization.

One hospital has likewise announced its “scheduled signing of a Memorandum of Understanding (MoU) with Australia’s Macquirie Neurosurgery to enable renowned surgeon, Dr Micheal Morgan, to work exclusively with it to provide high-end neurosurgical procedures.”

Already, the expanded Medisave service is gaining attraction as reports revealed a surge of inquiries from among Singaporeans regarding details of overseas medical treatment.

The development likewise serves as an added boost to Malaysia’s medical tourism, as this country’s hospitals particularly in Kuala Lumpur have thus initiated partnering with tour operators and airline companies for offering of efficient, hassle-free, and overall “seamless travels” between the two countries, up to a point of arranging ambulances’ straight travels between hospitals and airports.

Hospital officials likewise assured Malaysians that the influx of Singaporean patients would not drive up prices of medical services and pose multi-tier quality, declaring, “It is, and will remain, a one-tier policy, meaning: one price and one, same quality for anybody who wants medical treatment in a Malaysian hospital, whether patients are Malaysians or foreigners.”

Malaysia’s medical tourism industry players said they have indeed been eyeing big markets not only from Singapore but also from the Philippines, Vietnam, Laos, and the Middle East.

source: inquirer.net

In socialized medicine what happens over time is that the system responds to itself , not to the ultimate customer.  The doctor , who was previously the head of the team , on in previous – pre team work times – was the absolute power and arbitrage.  Not so in socialized medicine.  The doctor answers to the clinic that employs him or her , or to bureaucrats not to the consumer.  On top of that it is not as if the medical consumer has a choice.  Imagine a medtravel tourist complaining in writing to an address .  The bureaucrat /s could care less.  Their concern is their budget , their charts and graphs.  On top of that their biggest responsibility is not to get their boss or themselves in trouble or draw attention to themselves.If a letter or email arrives – so what .  That person lives far away.  they cannot even vote or complain to the health minister or political party leaders – who cares.  Its a matter for the medical bureaucratic system to put in time for its pension , go to lunch go home at 3:30 – stop the work on the graphs and charts at 2:30 p.m.  Thats about it. On top of that to pretend and actually believe in their mind and heart of hearts that the world and especially the medical system functioning is dependent on them and their unique and powerful administrative skills.

After all the less resources available in the end after pilfering the medical system of funds , the more the need for more administration to parcel out those limited resources in the medical and healthcare systems.

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                   The self written and distributed newsletter notes that “….. then there is the “stupid”  decision to cut back on emergency services at the Seven Oaks Hospital in Winnipeg Canada.  It seems that after a major update to the emergency department of this major regional medical center’s emergency department that the working hours of the emergency department were cut back.  Talk about the left hand not knowing what the right hand was doing – in plain site.   The amazing part is that even with press releases on the openings of the updated unit complete with a ribbon cutting ceremony and a how to reach pdf being written and offered on the actual hospital website the cutbacks went into place.

Phase 1 of New Emergency Department is now complete!

Phase 1 of the new Seven Oaks Hospital Emergency Department is now complete.  A Ribbon Cutting Ceremony officially opening the new facility was held on August 19. 

 “This state-of-the-art department was designed to ensure we can provide our citizens with the best emergency care possible,” said Health Minister Theresa Oswald. “This expanded emergency department means improved care for patients and their families, and a better work environment for our health-care professionals.” 

Please see the attached .pdf files for information on the new facility and Press Release.

Phase 1 of New Emergency Department is now complete!

Attachment	Size
When To Go To The ER.pdf	91.71 KB
New Emergency Department Ribbon Cutting.pdf	297.45 KB
Press Release August 18 2008.pdf	100.58 KB

        If one looks at a map of the coverage area of the catchment areas of the Seven Oaks Hospital  (SOGH) is clearly visible.  There are no other major regional medical centers what so ever in the adjacent local and rural areas just north of the only major center in this very large geographic areas of the Province of  Manitoba.

”

”

source:  http://www.travelmanitoba.com/default.asp?page=130&node=585

      Further the writer of this article notes:  ” Cutting back these emergency services goes against the concept of community based hospitals, which if managed properly are more cost effective and can provide the same level of care as the Health Sciences Center ( the major teaching hospital and medical center in the major and dominant city  of Winnipeg in the whole Canadian Province of Manitoba ).

	820 Sherbrook Street Winnipeg, Manitoba, Canada R3A 1R9                                   telephone 204-787-3661

Search the HSC website

Tuesday, April 28, 2009

News Click for more news Patient & Visitor Info Well Wishes Visiting hours and other info Where to park Where to eat and shop Where to stay ATM locations Smoking policy Maps & Directions Directions to HSC Map of HSC Printable map HSC Retirees Welcome to Health Sciences Centre Winnipeg. Located in the heart of Winnipeg, Health Sciences Centre (HSC) is one of Canada’s largest tertiary care facilities. We play a unique role in providing health care services to residents of Manitoba, northwestern Ontario and Nunavut. We are a major referral centre for complex health problems that require expert consultation and management. We are also Manitoba’s designated trauma centre and the centre for transplants, neurosurgery, burns and most hospital-based pediatric care. Our highly skilled teams of patient care professionals provide acute and continuing care to the ill and injured. Our support teams ensure that visiting and receiving care at Health Sciences Centre is a comfortable and safe experience. May hope flourish in this place. source:  http://www.hsc.mb.ca/    The writer of the pamphlet goes on to say “  What I have found over the last few weeks , and time period,   is that many healthcare workers ( in the City of Winnipeg and Manitoba Canada areas), in general , are very opinionated  about the Winnipeg Regional Health Authority (W.H.R.A.). 287 Broadway Winnipeg, MB R3C 0R9, Canada (204) 926-6000? wrha.mb.ca Medical Tourism Medical Tourism http://unidrugs.com/ Unidrugs.com is an online pharmacy that provides cheap prescription drugs online with convenient ordering and confidential delivery www.mmedsolution.com 287 Broadway Winnipeg, MB R3C 0R9, Canada (204) 926-6000? wrha.mb.ca

Canadian Doctor: Shortages So Bad North Of The Border Some Towns … – Dr. David Gratzer, writing in the Wall Street Journal, also makes a good point about just how dependent the Canadian health care system is on America’s. Indeed, Canada’s provincial governments themselves rely on American medicine. …

Why we need a public options for health care and debunking … – Every time we try to have a discussion about a public single payer option we hear how we shouldn’t have it and Canada as used as an example of how bad public health care options are. This article debunks the myths surrounding Canadian health … As a Canadian living in the United States for the past 17 years, I am frequently asked by Americans and Canadians alike to declare one health care system as the better one. The article continues, debunking myths about Canadian …

Wash Park Prophet: Canadian Health Care Works – The things that work in the Canadian health care system are explained here. I suspect, although the article does not say so, that in addition to having lower administrative costs and saving money with preventantive care, that many providers are also paid less richly in Canada than in the United States (although providers in Canada have essentially no bad debt losses, while American providers are swimming in bad debt). Posted by Andrew Oh-Willeke at 6/09/2009 12:08:00 AM …

By Alex Kuli

Aug. 28 (Bloomberg) — For Magdolna Vincze, free health care was never so expensive.

When giving birth to her second son in 2004, her payroll contributions into the state insurance system weren’t enough to guarantee the medical care she needed, she said. So Vincze did what she said is expected of patients: She bribed staff at Budapest’s Szent Margit hospital more than 100,000 forint ($522), about a month’s take-home pay for the average Hungarian.

“Everyone knows it’s unethical,” says Vincze, a 34-year-old telephone company worker. “People feel pressured. They’re afraid they won’t get personal attention, the doctor won’t even look at them, the nurses won’t go into the room, they won’t tell them about the newest treatments.”

Hungarians grew up giving communist-era doctors what they call “gratitude money” to secure comforts not provided by the state. Hungarians now pay doctors as much as 100 billion for int under the table a year, Health Minister Agnes Horvath says. The practice inflates Hungary’s health budget as doctors prescribe unnecessary procedures in hopes of maximizing illicit income, she says.

The debate over bribery comes as the government proposes changes to the way health care is funded and paid for. Medical spending affects the country’s battle against the European Union’s widest budget deficit, which reached 9.2 percent of gross domestic product last year.

The shortfall forced Hungary to abandon plans to adopt the euro as its currency by 2010. Overspending on health alone last year was equivalent to about 2 percent of GDP, according to the Health Ministry’s Web site.

Acceptable, But Unfair

About 60 percent of Hungarians consider medical bribery acceptable, though nearly all of them say it’s unfair, according to an opinion survey published July 24 by Median, a private Budapest polling agency. More than a third would ban it, the poll showed.

Horvath’s measures to fight bribery include a 300-forint fee for doctor’s visits, which used to be free. Patients who pay a fee are less likely to slip cash to the doctor, she said.

Ferenc Odor, a member of the main opposition party, Fidesz, instructed hospitals July 31 to post Horvath’s picture on machines where patients pay the fee, according to a party Web site.

“People should know who to thank,” the statement said.

Horvath’s party, the Free Democrats’ Alliance, responded by asking Odor to provide patients with bribery envelopes bearing a picture of Fidesz leader Viktor Orban.

Stay Awhile

Some doctors prescribe unnecessary hospital stays because overnight patients are more likely to hand out cash, Horvath said. Slightly more than 2 percent of surgeries were performed on an outpatient basis in Hungary in 2004, compared with 53 percent in Britain and 48 percent in the Netherlands, according to the Health Ministry’s Web site.

Doctors hate taking cash and prescribing unnecessary treatments, says Geza Gyenes, chief secretary at the Hungarian Doctor’s Chamber. The problem is, doctors are underpaid, with some earning a base pay near minimum wage, he said.

“An assistant bricklayer gets paid better than a doctor,” Gyenes says. “If we didn’t have gratitude money, not one doctor would have stayed in this country” after communism collapsed, he said.

Still, many doctors are well paid, and bribes exacerbate income differences, says Finance Minister Janos Veres.

“Who gets the most gratitude money? The professor at the clinic, whose income isn’t low,” Veres says. “Who gets the least? The coroner in the mortuary, even though his salary is low.”

Commonplace

Medical bribery remains commonplace in the east 17 years after communism collapsed, former Dutch Health Minister Hans Hoogervorst, who served as an adviser to Hungary’s health ministry earlier this year, said at a June 14 press conference.

Latvian President Valdis Zatlers, a surgeon, told the Diena newspaper in May that he’d received under-the-table gifts from patients during his 27-year career. He didn’t specify when, or how much he’d received. He was fined 250 lati ($495) in July in connection with an incomplete tax declaration, state revenue service spokeswoman Agnete Busta said.

The city of Budapest, which owns Szent Margit and other hospitals, doesn’t have the wherewithal to eliminate gratuities, Deputy Mayor Csaba Horvath said July 20.

“It’s impossible to change a 40- to 50-year-old practice from one day to the next, that’s why banning it wouldn’t be effective on its own,” says Horvath, who is no relation to the health minister.

Options

Criminalizing the practice will only drive it underground, Health Minister Horvath says. Instead, the ministry has implemented rules to ensure patients don’t bribe their way to the front of a waiting list, she said.

In June, she awarded 3.3 billion forint to institutions to build outpatient surgery facilities. Hospitals can save an estimated 814 million forint a year by not requiring patients to stay overnight for certain operations, Horvath said at an Aug. 9 press conference.

Hungary’s program to overhaul health insurance may help to eliminate bribes, says Mihaly Kokeny, a member of Parliament who heads the Health Committee. By 2009, the state will break its single health insurer into several funds with minority private ownership. The funds will choose which hospitals they’ll contract with and may stay away from the ones they deem corrupt, he says.

Competition between providers has eliminated coercive tipping in other formerly communist industries, such as gas stations, said Zsombor Kovacsy, president of the Hungarian Health Insurance Supervisory Authority.

“Without gratitude money, they filled your car with petrol, but didn’t clean it at all,” he said in a May 21 interview. “Now, I never give gratitude money to the petrol station guys, and they do everything. So I think that the mentality of competition and well-regulated procedures can help a lot.”

Polling data shows that Slovakia discouraged bribery after it introduced visit fees similar to Hungary’s in 2003, said Tomas Szalay, a partner at the Health Policy Institute in Bratislava, Slovakia.

Patients “pay cash and feel that it isn’t for free,” he says. “Why should they give something more?”

To contact the reporter on this story: Alex Kuli in Budapest at akuli@bloomberg.net

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