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Health Canada Editorials Necessary experiments (The Ottawa Citizen)


The Ottawa Citizen 2006.03.02 Final News Editorial A14 The Ottawa Citizen 548

After years of national paralysis there is finally −− and thankfully −− a willingness to experiment with new approaches to health− care policy, the latest such laboratory being Ralph Klein's Alberta. Quebec opened the first less than two weeks ago with its own health−reform proposals, but Alberta is considering more radical experiments, particularly in allowing patients to pay privately for joint−replacement and cataract surgeries. There's no specific proposal on the table yet, but Premier Klein says he hopes to have new health rules in effect by fall, after long public consultations. Alberta has oil money underwriting its experiments, which gives the province a lot of freedom. Under the Canada Health Act, Alberta's federal transfer payments could be docked if Mr. Klein doesn't pay for all medically necessary treatments in the province. But so what?, Mr. Klein can say. A province with a $7.4−billion annual surplus can do without the $1.9 billion in health money the federal government sends it. So Mr. Klein and Health Minister Iris Evans can muse about letting Albertans jump the queue for joint replacements by paying out of their own pockets, and letting doctors take public money for some services and private money for others. The first measure would pretty definitely violate the Canada Health Act and the second might, depending on how it's administered. Mr. Klein swears that a patient's ability to pay won't affect access to medical care in Alberta, but it's hard to believe him: Your ability to pay affects your treatment in any province, even public−medicare−mad Ontario. Here, most patients pay out of their pockets (or through private insurance) for medicines, eye exams, dentistry and physiotherapy, to name just a few things that might reasonably be considered "medically necessary." Patients with money have the option of paying for virtually any service they want in the United States; others cross into Quebec to pay for diagnostic scans. Joint replacements and cataracts are in a grey zone close to dentistry and eye exams. Bad knees and hips might be agony and failing vision a major handicap, but they don't necessarily kill you, which is why governments have let waiting lists for replacement surgery grow so long. Quebec's solution is a promise to pay for hip and knee replacements outside the province for patients who are stuck in wait−list purgatory. Alberta's solution is to let patients pay for the surgery themselves if they don't want to wait. This is good. At last, we'll start to see hard evidence for or against each approach. 35


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