VANCOUVER -Provinces should fund hospitals based on the number of patients they treat instead of handing over a lump sum that forces them to close beds and operating rooms when the money runs out, says the incoming head of the Canadian Medical Association.
Dr. Brian Day said the result of the current way of doing things, the so-called global funding model, is long wait lists that leave thousands of people suffering as their condition deteriorates.
Gridlock in emergency rooms is inevitable because patients linger there when there aren't any beds available on wards, he said.
A market-oriented approach would give hospital administrators the incentive to provide better, faster service because they'd be competing for patients to get funding, he said.
Countries like Britain have dramatically reduced wait lists with such fee-for-service funding and Canada should follow their example, Day said.
"France, Sweden, Germany do it and they have no wait lists. This has been done in all of the successful countries that have universal health care. Britain is of interest because three or four years ago they were where we are now.
"I call it patient-focused funding and I predict that B.C. will be the first province to introduce it in Canada."
The British Columbia government is in the midst of a so-called conversation on health to get public input on dealing with the needs of an aging population and hospitals' budgetary constraints.
Last year, Premier Gordon Campbell travelled to several European countries to review their health-care systems.
Colin Hansen, the acting health minister, said the government is considering several possible changes to overhaul an ailing system.
A budget deficit forced the Vancouver Health Authority to close about three dozen beds and three operating rooms at two hospitals last week as the Opposition New Democrats created an uproar with demands that the government increase funding.
"It's certainly a model that's being looked at," Hansen said of the British approach to hospital funding.
He said a centralized surgical clinic at the University of B.C. for hip and knee replacements has already cut wait times and the pioneering shift has been copied by Alberta.
Such procedures are only going to increase with aging boomers.
"The number of knee replacements, for example, has increased by 81 per cent in the last five years," Hansen said.
Other provinces are also dabbling with health-care reforms.
Last year, Alberta shelved its controversial Third Way approach, which included plans for a private insurance system that would allow patients to pay for some procedures to get quicker service.
Day said it's clear governments have to take drastic steps to ensure that people get timely access to care.
"One of the big problems that governments have yet to learn in Canada is that to have people waiting costs more than to treat them quickly," he said.
Day, dubbed Dr. Profit by his critics, is a well known proponent of private clinics and has been operating his own facility since 1996. He said such clinics could still play a role if the hospital funding model were changed.
But not everyone agrees with Day's prescription to deal with long wait lists.
Harvey Voogd, spokesman for the national lobby group Friends of Medicare, said two conferences in Alberta last year - one hosted by his group and the other by the Conservative government - failed to turn up any evidence that Britain's approach is effective.
"I would challenge Dr. Day on the evidence that there's no wait times in the United Kingdom," Voogd said from Calgary.
"It's an intellectually alluring idea that hospitals competing will somehow work and everybody will get treated fairly.
"I'm not at all convinced that that's the case," he said, adding health care is not a commodity suited to competition.
Wait times spiralled upwards in the mid 1990s after the federal government slashed funding to the provinces.
But new money from Ottawa since 2004, along with centralized hip and knee replacement surgeries in B.C. and Alberta, has dramatically reduced wait times, he said.
Dr. Michael Rachlis, a Toronto health policy analyst, said Britain's funding model may not result in the best health care for patients.
"It encourages volume but not necessarily quality," he said, adding hospitals would choose cases that aren't too complicated because they'd use fewer resources for a fixed amount of money per procedure.
Centralizing procedures such as cataract surgeries at publicly funded out-of-hospital facilities has been a proven way to reduce wait times, Rachlis said.
"The largest out-of-hospital surgical facility in all of North America is the Queensway surgery centre in Toronto and it's part of a public hospital," Rachlis said.
In Winnipeg, an increasing number of cataract surgeries are performed at the publicly owned Pam Am Clinic, bought by the Manitoba government to fast track such procedures.
A study released last year suggests excessive wait times for treatment cost the economies of B.C., Alberta, Ontario and Saskatchewan $1.8 billion in 2005.
The study, by the Ontario-based Centre for Spatial Economics, analyzed wait times for hip and knee replacements, heart surgery, MRIs and cataract surgery.
It was commissioned by the Canadian Medical Association and the B.C. Medical Association and considers everything from loss of an individual's income to lost tax revenue for governments and costs associated with a caregiver's time off work.
