From: gld@cunixb.cc.columbia.edu (Gary L Dare)
Subject: Re: Canadian Health Insurance (was: health care industry woes)
Reply-To: gld@cunixb.cc.columbia.edu (Gary L Dare)
Organization: The Bates Motel
Distribution: usa
Date: Sat, 21 Nov 1992 22:34:24 GMT

starr@genie.slhs.udel.edu (Tim Starr) writes:
>gld@cunixb.cc.columbia.edu (Gary L Dare) writes:
>}Canada has a public health insurance system ("PHI" in Americanese)
>}funding private doctors, and public and private hospitals.
>
>This "public" bit contradicts your claim that Canada has separation
>of medical service delivery and State.

Getting around the "just one drop/just one penny" aspect for a moment,
is this better? (-;

	Canada has a public health insurance system that pays for
	a patient per-visit and per-procedure at private doctors,
	and public and private hospitals.

Doctors must licence and capitalize their own practices.  Pay rent.
Hire office staff and nurses.  Group together into firms just like
lawyers.  Nobody tells them how to do those things within the law.
Patients come in, doctors expect to get paid.  They bill insurance 
for whatever was done.  No insurance? -- then it's cash (e.g., some
tourist emergency, or American tourist with private insurance plan
that has stiffed their practice in the past).

I've not seen any differences at this level in either Manitoba,
Alberta, Ontario, Quebec or New Jersey (as I've said previously, my
girlfriend gets what is arguably some of the best health insurance
from her father, a research exec with a major Euro-American drug firm,
had a back condition and from seeing her go through the rounds in New
Jersey, that reminded me of what I saw back home -- I'm the one who
usually gets stuck driving a friend or relative to the doctor ...
hey, maybe I'm that good? (-;).

There is a significant, an in most cases majority, chunk of hospital
activities where the government has no say whatsoever; just the board
of directors, senior staff, powerful donors (e.g., the Bronfmans of
Seagram Distilleris are a major part of Montreal's Mortimer B. Davis
Jewish General Hospital; there is a ward (either cancer or geriartric)
named after family matriarch Sadie and I'm under the impression that
Mortimer B. Davis is her father ...  I guess that naming it after Sam,
who ran hooch to the U.S. out of Western Canada, might be too much for
some folks (-; -- we never had Prohibition in Canada, by the way).

While they get a fixed budget that is for facilities (electricity,
water, heat, snow-shovelling, etc.) like the universities, the medical
treatment is billed by patient, per-procedure through health insurance
or cash.  The equipment is bought by a combination of discretionary
funds from the facilities budget, grants (private and public) and
their philanthropy arms.  The hospital has to figure out what it wants
and needs.  For practical purposes, no piece of equipment can be
bought outright by any government because the Canada Health Act
legally requires the costs to maintain it be fixed into the Budget --
I'm told by my Dad's Tory lawyer friend (the hospital philanthropy
guy) that it was put in by the Liberals* to prevent socialization (a
grudging concession, no doubt (-;).

(* as in the UK party of Benjamin Disraeli and Winston Churchill.)

You see, a potential danger is a New Democratic Party (i.e., Labour)
provincial administration who would want to get the government into
the health care business.  Their ideal is the Atlee British Labour
government that set up National Health Service; the continentals
(Germany, France**, Holland, etc.) set up their health insurance as 
an incremental step to prevent socialized medicine if a Labour-style
party took the next election.  The Liberals did the same thing with
Paul Martin, Sr.'s Canada Health Act under PM Lester "Mike" Pearson's
Liberal federal government, partly in response to Tommy Douglas and
the NDP who were trying to move Saskatchewan towards an NHS-style
system.  In my province, Manitoba, the insurance plan was set up by
Walter Weir's Conservative government and my dad's lawyer friend 
(that Tory hospital philanthropy guy) was involved in the legal work
transitioning basic medical coverage and liabilities from private
insurance (which was not a significant player in the 1960's, when
people mostly paid cash).  We did not have any massive transition.
The need for insurance grew in all countries with progress, and that
is why we have the situation that we have now.  Back then, health
insurance was considered at the same level as fishing licences.

gld

** the Summer 1992 edition of France magazine, copies of which might
still be available from your college French Dept./Maison Francaise,
library or maybe your local Alliance-Francaise outlet, outlines the
system of private supplementary insurance beyond basic ... 75% of
the French hold some form by private subscription or work benefits.
--
~~~~~~~~~~~~~~~~~~~~~~~~ Je me souviens ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Gary L. Dare				Jesus Saves!
> gld@cunixd.cc.columbia.EDU 		Gretzky gets the rebound -
> gld@cunixc.BITNET			he shoots, he scores!
Newsgroups: talk.politics.medicine