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http://www.thestar.com/news/canada/article/860193--canada-should-charge-patients-for-health-care-oecd?bn=1
Comments?

Canada should charge patients for health care: OECD
Published 12 minutes agoEmailPrint
Rss ArticleHeather Scoffield
The Canadian Press
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OTTAWA-The OECD says Canadian governments desperately need to clamp down on their health spending, and they should do so by making patients carry some of the costs and by fostering more competition.

The influential Paris-based Organization for Economic Co-operation and Development says expanding deficits will explode unless provinces and Ottawa deal with the rising health care costs associated with a quickly aging population.

In a detailed analysis of Canada's health care system released Monday, the OECD highlights the long wait times and the shortage of doctors that already undermine patient care.

It warns that the costs and problems will only multiply as a larger share of the population reaches old age.

And unless Canadians want to give up other social services or shoulder heavier taxes, deep reform is required of the way health care is delivered.

“It's going to blow those budgets right out of the water unless Canadians dig deep in their pockets for major tax increases or cut back in a big way on other services,” said OECD senior economist Peter Jarrett.

The analysis is far more than a list of options from yet another think tank. It was put together with extensive input from the federal government.

It says health spending increases that have averaged eight per cent a year over the past decade need to be ratcheted down to about four per cent in order to be sustainable.

Although Ottawa has no obligation to follow its advice, such OECD reports are often used as a way for governments to get new policy ideas on the table.

The report comes just after the Canadian Medical Association and provincial governments separately recognized that the sustainability of the health care system is shaky. They both have a wary eye on the end of the federal-provincial funding agreement in 2014, and say negotiations for a new funding deal need to be trail-blazing.

Specifically, the OECD says Canada's public health care system is riddled with inefficiencies because patients don't realize the costs they incur, and because health care providers don't face any competition to keep their costs down.

Patients should be paying a small fee or a deductible for their health services, so they're not tempted to rush to the doctor for every little sneeze, the report urges.

“Canada is very unusual in not requiring any form of patient payment whatsoever for core services. Some form of pricing could be introduced in order to better reveal and ration demand,” the report says.

The OECD recognizes up front that medicare is sacrosanct in Canada, and that talk of patients sharing costs is taboo. But it argues that the taboo needs to be broken if the health care system is to remain properly financed.

“You've got to give up on this taboo of no co-payments or deductibles,” said Jarrett in a phone interview from Toronto.

But at the same time the OECD is concerned that the medicare system is too narrow. Governments in the past have sought to control health costs by excluding pharmaceuticals and home care from public funding.

Those two areas are increasingly important in determining health, and they're costing Canadians dearly, the report shows.

One way to make the introduction of a user-pay system more palatable for Canadians would be to bring more of the pharmaceutical and home care costs under the medicare umbrella at the same time, the OECD suggests.

The report also takes aim at the supply side of the health care business, urging more competition — either by setting published benchmarks that hospitals and doctors need to reach, or by allowing more flexibility for the private sector to get involved.

Doctors' pay should not just be based on fee-for-service, but also on the number of patients on each doctor's roster, the OECD says.

Plus, the private sector should be allowed to be more active in service delivery in order to keep costs under control, the report says.

“We think that's another taboo that needs to be discarded,” Jarrett said.

Several of the recommendations would require a liberal interpretation of the Canada Health Act, or perhaps even outright changes, the OECD recognizes.

As the federal-provincial funding arrangement heads towards its expiry date of 2014, now is the perfect time for governments at both levels to be re-thinking how they handle health care — especially since deficits are too large, the report says.

But the next funding agreement should be based on a formula linked to economic growth, rather than just a promise of cash from Ottawa, the report recommended. And the deal should be based more on a transfer of tax room from Ottawa to the provinces — another controversial idea that many negotiators have balked at in the past.

The analysis is part of a larger assessment of Canada's fiscal and economic health.

The OECD lauds Canadian governments for their aggressive actions during the global recession. The organization also praises Canadian banks for being efficient, well-supervised and conservative.

The report says Canada's economic recovery is “well under way” despite recent weakness in the economy. It forecasts growth of 3.5 per cent in 2010 and just over three per cent in 2011.

But it warns that deficits, particularly in Ontario and Quebec, are too large and need immediate attention. Economic growth in the future won't be as robust as in the past, so governments can't simply assume that their deficits will melt away with time, the report warns.

The report also chides Ottawa for opting to follow the American lead in fighting climate change, since U.S. climate policy is stuck in political limbo.

“It doesn't look like anything is going to happen there for years,” said Jarrett. “It's harder (for Canada) to maintain that position, to just see what the Americans will do.”
 
Re: Health Care In Canada - Proposed Reform

Could something like this move the Canadian Government to stop taking in so many refugees/immigrants/family applicationsfor parents etc?

It has been debated that aside from aging populations, the above adversly impact on the quality /time of treatments at hospitals etc. In another article, commentators indicated a belief that there were just too much immmigrants over burdening the systems etc. and that it should be minimised until services can catch up with the demand. Many people also expressed a genuine dislike/hate for refugees seeing that they get free housing etc and the ordinary citizen has to pay so many taxes. I having been reading canadian papers daily and reading the comments of canadians and its interesting to know what your view points are since we are on the other side of the table.
 
Re: Health Care In Canada - Proposed Reform

I can understand the frustration. I think it's one thing to bring in a spouse or children, but quite another to bring aging parents and other relatives. Children and spouses will work and pay taxes and contribute to Canada and the funding of healthcare, while elderly immigrants would not. Canada needs younger immigrants due to the fact that they have an aging/shrinking native population, but they don't need more aging people to strain the system.

This is what many families do here in Canada (we used to live in an immigrant heavy neighborhood so I saw this all the time): Someone is sponsored to Canada as a spouse (sometimes legit, sometimes not). Once they come, they sponsor their elderly parents, who sponsor their children and other relatives in turn.

I understand that people want their families with them! I'm a family class applicant, of course! However, between this influx of illegals (yes, those Tamils were illegal, not refugees. They were in a third safe country!) on boats and growing deficits in healthcare, Canada may well turn to reducing immigrants in the future... or at least, taking a closer look at their ability to work and contribute to the society in which they are immigrating to as opposed to putting a bigger strain on the system. I speak for myself in saying that as soon as my PR comes through, I will be working and paying taxes in Canada. Not every immigrant is like that...

I doubt anything major will happen anytime soon.
 
Re: Health Care In Canada - Proposed Reform

I was thinking that they need to raise the age of retirement to like 70 seeing that canadians are living so much longer...let the seniors contribute!heheh..seriously though i can see that happening in the future.

I also think they should reunite spouses with their families asap so that more babies making...the more younger generation to take care of the old...

And huge incentives should be given to families to make babies :0 Yep!!!!!


BTW I hear a second boat of tamils want to come...dunno how true that is. But canadians are pissed off.
 
Re: Health Care In Canada - Proposed Reform

They already get huge incentives to have kids, at least compared to my homeland (the US). A year of maternity leave is unreal to me! I don't have and don't want children so that kinda bugs me sometimes (why don't I get a year paid leave?!), but I can understand the government wanting more Canadian born children.

The situation with the Tamils makes me mad too! Everyone here is livid on my behalf, since I am doing this legally and have to wait months and months while they get the red carpet treatment! They were in Thailand when they caught that boat... they weren't in any danger. If I had 50,000 like they paid out, I would do the process legally.

I read a report that 75% of Canadians wants the Navy to escort them all back to their boat and out to sea!
 
Re: Health Care In Canada - Proposed Reform

My opinion is that the Canadian government should double check their "Refugee" program. I can't believe anyone can come into Canada, make up some weird story and get paid to live here.

Every time I see the words FAILED REFUGEE I instantly think of SCAMMER..
 
Re: Health Care In Canada - Proposed Reform and closing doors to newcomers

Closing Toronto to newcomers would lead to economic collapse

JENNIFER ROBERTS FOR THE GLOBE AND MAIL
Why Rob Ford's solution to the city's fiscal woes would hurt, not help us
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. Article Comments (130) John Allemang

From Saturday's Globe and Mail
Published on Friday, Sep. 10, 2010 7:52PM EDT


.One-third of the voting public takes Rob Ford very seriously, according to the pollsters. Which leaves the remaining two-thirds in a state of intellectual despair: What kind of rational response can you give to a man who says he wants to keep newcomers out of Toronto?

The polls show Etobicoke's Great White Hope solidifying his lead, and his appeal to disenchanted voters increasingly tempts other mayoral candidates to badmouth the Milleresque status quo. Heck, maybe we're all prepared to channel our inner Mr. Grumpy if simple resentment will bring us a low-cost city that actually works.

But closing the gates, tossing away the welcome mat, and junking the Diversity Our Strength civic motto? “We can't even deal with the 2.5-million people in this city,” Mr. Ford said in the TV debate that first popularized his anti-outsider views. “I think it's more important that we take care of the people now before we start bringing in more.”

As part of the campaign platform for a fiscally frugal candidate, this reluctance to grow sounds persuasive. Our roads are clogged enough already. More people can only make them worse. Or, we don't have enough tax dollars to deal with public housing as it is. So where will we find the money to build more towers when all those impoverished foreigners get off the boat?

But Mr. Ford's followers should be very careful what they wish for: However unworkable the city seems to them now, a city without newcomers will face a much more desperate future. We're not talking slow-moving commutes, rude TTC employees and the occasional garbage strike – this Tea Party resistance movement is a recipe for urban extinction, and not just because there'll be nobody around to serve the tea.

“If you think growth is bad,” says Joe Berridge, a partner at Urban Strategies Inc., “just try the alternative.” The economic activity generated by young, energetic newcomers to Toronto actually makes our lives richer, literally as well as figuratively. “There's absolutely no evidence that any of the city's social or physical problems are due to the strains of immigration,” Mr. Berridge says. “Our transport system is appalling, but that's because it's just too old, and we've refused to spend money on it.”

Our transport system was similarly gridlocked and antiquated in the post-war years. But rather than shut down growth and curb spending, we built a gleaming new subway system, metropolitan Toronto's first great megaproject. Or rather, newcomers from war-ravaged Italy built our subway. But old Torontonians and their government had the will to do it.

If you prize empty roads, of course you can always move to Detroit. Successful cities, alas – even those with the will to invest in efficient public transit – are crowded cities. Nobody in New York or Paris or London is whizzing along the avenues while crowing about their low taxes.

In any case, recently arrived immigrants probably won't make the gridlock worse, since they're heavy users of our slow and meandering suburban bus system. If hours spent commuting do indeed hurt Toronto's productivity, they should be the first to complain.

Mr. Berridge's company specializes in urban regeneration, trying to revive once-bustling cities such as St. Louis, Manchester and Bordeaux that have lost their appeal to the wider world. “You don't want to be there when everybody is fighting over the shrinking pie. The great thing about Toronto is that the pie keeps growing – if the city were a business, we'd be laughing all the way to the bank.”

Somehow, the Ford supporters manage to convince themselves that a no-growth city would immediately shed all the perceived problems of bigness and openness while retaining the benefits. But the absence of newcomers would deaden Toronto's vitality without improving the city's faltering infrastructure or tax base.

“People would be hurting themselves in more ways than they realize,” says Kevin Stolarick of the University of Toronto's Martin Prosperity Institute. “Yes, you can pick out the worst things about the city, and say Toronto is less affordable than other cities. But that's the direct result of people wanting to live here – it's a measure of success.”

New standards of success aren't necessarily at the top of Mr. Ford's wish list though – that's more of an old-style, David Miller kind of Toronto. So he may feel free to sacrifice the Prosperity Institute's civic model, along with the prosperity it holds out. The Ford vision is more about cutting costs than making money or having fun – with a nostalgic, pre-gridlock Toronto waiting at the end of the rainbow.

Let's look more closely at his newcomer-free city. The first thing we see are the obvious disappearances, the missing applicants for those highly visible jobs traditionally taken on new arrivals: Children and seniors and the infirm would lose their caregivers, fast-food restaurants would become slower and fewer, cabs would disappear from the streets as fewer overeducated immigrants arrived with a willingness to work hard for a lower wage but a better future for their overachieving offspring.

But that's just the starting point of the Ford revolution, and it misses out on the subtler but more widespread damage done by his Little Toronto musings. “This would have a huge effect on the labour market,” says Alan Broadbent of the Maytree Foundation. “Once the economy comes back, the worker shortage is going to be a serious, serious problem. The birth rate in Toronto is well below replacement, which has a huge effect on the labour market.” Either we need a constant flow of newcomers, or less effective forms of birth control – a subject to which Mr. Ford has not yet turned his thoughts.

Mr. Ford made his controversial comments shortly after a shipload of Tamil refugees reached Canada, leaving the implication that newcomers were rule-breaking have-nots who would take more than give. But any analysis of modern Toronto dispels his simplistic response – immigrants generally are better educated than their homegrown Toronto equivalents, and they raise children who are academic and economic overachievers.

Immigrants aren't a burden to the taxpayers and a drain on the economy. In fact, to a large extent they are the economy. An analysis of the Toronto job market prepared by Karen King of the Martin Prosperity Institute estimates that there are more than 125,000 immigrants working in business and finance occupations alone, or almost half of the city's total. In health and science occupations, more than half the work force is foreign-born. Newcomers are the rule, not the exception. Perhaps not enough of them are in management, but that doesn't seem to be Mr. Ford's main complaint.

Toronto regularly ranks in or near the top cities in the world when judged both by economic impact and cultural livability – maybe, just maybe, there's a connection. Or maybe the world rankings don't give enough weight to perceptions of gridlock and the role played by newcomers in making pure laine Torontonians feel displaced.

Montreal, points out Ryerson University political scientist Myer Siemiatycki, once held the title of Canada's leading city. But a Quebecois version of Rob Fordism – resisting newcomers and their tradition-challenging ways – led to a deliberate downsizing that in turn enabled Toronto's dramatic post-war growth.

“Toronto's rise onto the world stage has been driven by immigration,” says Prof. Siemiatycki. “The issue of population capacity is a legitimate issue to consider, and the stagnation of infrastructure can become an impediment to Toronto's quality of life. But the answer isn't to shut down growth. In an increasingly knowledge-based, globalized economy, you don't want to turn away smart and well-connected people.”

Or maybe you do – those hard-working foreigners make the rest of us look like overpaid whiners.
 
Re: Health Care In Canada - Proposed Reform

The author of that article is right... about the hard working immigrants. If someone is bringing over elderly parents or family members, they won't work and contribute to the society.

"The economic activity generated by young, energetic newcomers to Toronto actually makes our lives richer, literally as well as figuratively."
 
Re: Health Care In Canada - Proposed Reform

My hubby works for that company... :P :P :P :P :P :P :P :P :P :P :P :P :P :P :P :P :P :P ;D ;D ;D ;D
 
Re: Health Care In Canada - Proposed Reform

sbwv09 said:
The author of that article is right... about the hard working immigrants. If someone is bringing over elderly parents or family members, they won't work and contribute to the society.

"The economic activity generated by young, energetic newcomers to Toronto actually makes our lives richer, literally as well as figuratively."

I know alot of old trinis with children in Canada. They live in Trinidad and only when they need medical care do they go abroad as they got citizenship there. Now I dunno if thats wrong or right..but I feel that if you get PR or citizenship and chose to live in your country and only go to Canada just keep the said PR active and in status then something is just wrong. Cause if you were living in Canada then perhaps you might be contributing...taking care of the grand kids, taking a side job (plenty seniors are healthy), investing your money into the Canadian Systems etc. If you are taking advantage of the system then you are living off the system. I dont know but do these people get pensions from Canada as well?
 
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