17 March 2010

Healthcare corner #11 - Chaoulli decision, wait times, and efficiency

a couple different but related topics.

we finished the last of the efficiency lectures with a few more canadian tidbits:

- there is a canadian agency for drugs and technologies in health (CADTH) that has the function of providing information for better effectiveness and efficiency. programs at CADTH:
1. the health technology assessment (HTA) provides information on clinical and cost-effectiveness of drugs, medical technologies, and health systems.
2. the common drug review (CDR) conducts reviews of the clinical and cost-effectiveness of drugs and provides recommendations to the provinces about which drugs are the best investment to cover under their public drug plans.
then we had some discussion on canadian wait times:

- in 2004, the canadian ministers of health developed a ten-year strategy to strengthen health care which included a plan to reduce wait times: benchmarks identified for waiting times in five care types, multi-year targets, strategies to improve access in priority areas, and public reporting of wait times.

- the goal of establishing benchmarks produced these targets in 2005:
1. radiation therapy for cancer = within 4 weeks of the patient being ready to treat
2. surgical repair of hip fracture = within 40 hours
3. cardiac bypass surgery = within 2-26 weeks (depending on urgency)
4. hip and knee replacements = within 26 weeks
5. cataract surgery = within 16 weeks for high risk patients
- in 2006, they were able to report median waiting times for:
1. specialist visit for a new illness/condition = 4 weeks
2. selected non-emergency diagnostic tests (MRI, CT scans, etc) = 3 weeks
3. non-emergency surgery = 4 weeks
lastly, we talked about the supreme courts "chaoulli decision." im confident that my lawyer friends would be better able to interpret, discuss, and summarize this topic, but from our short readings and discussion in class here is my version:

- patient george zeliotis wants hip surgery. there are delays related to the quebec wait listing and also individual factors (he has depression and is often indecisive. he has sought a second opinion for surgery and it was recommended that he wasnt an ideal candidate because he had had a heart attack and bypass surgery earlier in the year). he wants to be able to get his surgery according to his own preferences and seeks private insurance to pay for this surgery. but, because this surgery is covered under the canada health act by the public-pay system, there is no option to purchase insurance to cover this surgery (canadians often have supplemental insurance for things not covered by the private system: dental, eye care, elective procedures, etc. but there is no option to buy private insurance for things that are already covered publicly).

- doctor jacques chaoulli wants to set-up a home-based, 24-hour medical practice and attend to his patients as he sees fit. he has had much resistance from the quebec government as to whether they will reimburse him for care he provides to patients in this way. the provinces public health care has restrictions on what types of services and practices will get reimbursed by public funds. chaoulli doesnt want to be forced out of the public sector and have to practice privately because few patients will be able to/want to pay out-of-pocket for his services.

- chaoulli and zeliotis team up to sue quebec to overturn its laws to prohibit private health insurance for those services that are already provided by the public system.

- the case eventually went all the way to the canadian supreme court where the court was divided. it agreed that the laws violated both the national and provincial charters but, in the end, their decision only ends up affecting quebec. so now, in quebec, there is an option to purchase private insurance for procedures that are normally provided in the public sector. this is still not an option in the other provinces.

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