PGP 2020

[parvisingh]

I agree with you. Both patients and doctors both have abused the system. Patients are not the only ones but there are a lot more patients than there are doctors. While I don't excuse the doctors for abusing it, however, their numbers are far far fewer of them than patients abusing it.

Some patients are stupid. As you said legislative changes are required. There should be some charge to see a doctor not 100% free. It should be in accordance with the family income. The poor pay less and the rich pay more. Any system is open to abuse the moment you make anything 100% free. I am in healthcare and doctors think they are god.

 

[screech339]

Some patients are stupid. As you said legislative changes are required. There should be some charge to see a doctor not 100% free. It should be in accordance with the family income. The poor pay less and the rich pay more. Any system is open to abuse the moment you make anything 100% free. I am in healthcare and doctors think they are god.

Doctors are not Gods however it is easier for a doctor to treat a patient that has a good medical history to go on. Try finding a diagnosis with any patient that has a paper thin medical history (that includes PGP parent/grandparent) is very challenging and stressful. They can't save everyone but hard decisions has to be made based on realistic circumstances.

However some families won't accept that reality and threaten to sue when hope isn't going to change reality when services / equipments are better suited to those who will actually has a better chance of surviving. There are a lot of anger from other families that needed the equipment more so than those who has no chance of coming out of it. They believe these people are being very selfish when all efforts has been made with no improvements. They are not the only ones needing access to equipment.

 

[nayr69sg]

We have been trying to improve the system for years with no improvement. Throwing more money won't fix it. As long as people don't pay for care people will abuse it. If user fees were allowed, ER would not be overcrowded with non-life threatening sick patients that a doctor at clinic can look at. The constitution needs to be changed to allow private care. Unless the constitution is changed, our health care will never get fixed.

A lot of people outside this forum on the social media have all believed that PGP can be a drain on healthcare. Are you saying all the people of social media are all wrong? There is a element of truth to their arguments against PGP.

Yes this is a forum about PGP, but putting blinders on without seeing / understanding the impact of PGP, not only the good impact but also the negative impact it has on Canada. Only see the "good impact" only without acknowledging the negative impact it has is wilful ignorance on your part.

Co pay. Or subsidized fees where the patient still pays.

Somehow in Canada people think this is the solution.

Hate to burst your bubble it ain't that simple.

Go look at the Singapore healthcare system. It is exactly that. Yet I have worked in Ed's that are overcrowded. Wait times of 6 hours. All this even though every single patient coming to the ED pays a flat fee of $110.

You may ask why it is still so crowded despite needing to pay $110?

The problem is that when patients choose to go to the ED it is not because of cost. It is because of the perception that they have a medical emergency.

If you raised the cost to $10,000 per visit sure you will reduce the crowd. But you will have very unhappy public. Of course $10,000 is ridiculous.

But at what price level do you use as being "fair" and NOT prohibitive. You certainly dont want peopel saying I cannot afford to go to the ED. But if the ED is affordable it will not deter people going to the ED.

The talk is all about how people abuse the ED. Yes some go there for minor ailments but they dont go there saying oh I have a minor ailment. They thought they had an emergency.

Also between the cost to see the FD vs going to the ED what should be the price differential? If the difference is small some will say it is more worthwhile to go to the ED where you get investigations and consults and procedures all under one roof.

There is no simple solution.

But I will tell you that more $$ is more likely part of the solution than less $$$.

Whether that money comes from the government or the people paying out of pocket doesnt really matter to the improvements in the system.

But if you change the source of money from the government to the people then you will lose control and say over the system as well.

This is a complicated topic that involves finance, society, philosophy, ethics, law and many other fields.

Take a look at the Singapore system. They actually have got most of it. But yet...yet.....there are so many in Singapore who curse the system.

Once you have patients paying they will feel it is their right to determine how the healthcare should be run. Also expectations go sky high. You pay out of pocket so why should we be waiting at all?

It doesnr work like that.

 

[nayr69sg]

Some patients are stupid. As you said legislative changes are required. There should be some charge to see a doctor not 100% free. It should be in accordance with the family income. The poor pay less and the rich pay more. Any system is open to abuse the moment you make anything 100% free. I am in healthcare and doctors think they are god.

Singapore has a means testing system to assist needy families with their bills

Anything that is affordable can also be abused. Not just free.

On the other hand you do not want health are to become unaffordable. But if it is unaffordable then people are less likely to go for the service.

It is a conundrum.

I will say the only thing that co pay systems achieve is to help the government reduce its expenditure on health care. Pass the cost to each person instead. It makes govt look good.

See how little we spend on healthcare? Wow! Yeah cos the people themselves have to pay.

Then the people expect a way higher level of service. Hey I paid $110! And I am waiting for 3 hours! Well sorry the other 100 people in the ED also paid $110. And they have also been waiting.

 

[screech339]

Co pay. Or subsidized fees where the patient still pays.

Somehow in Canada people think this is the solution.

Hate to burst your bubble it ain't that simple.

Go look at the Singapore healthcare system. It is exactly that. Yet I have worked in Ed's that are overcrowded. Wait times of 6 hours. All this even though every single patient coming to the ED pays a flat fee of $110.

You may ask why it is still so crowded despite needing to pay $110?

The problem is that when patients choose to go to the ED it is not because of cost. It is because of the perception that they have a medical emergency.

If you raised the cost to $10,000 per visit sure you will reduce the crowd. But you will have very unhappy public. Of course $10,000 is ridiculous.

But at what price level do you use as being "fair" and NOT prohibitive. You certainly dont want peopel saying I cannot afford to go to the ED. But if the ED is affordable it will not deter people going to the ED.

The talk is all about how people abuse the ED. Yes some go there for minor ailments but they dont go there saying oh I have a minor ailment. They thought they had an emergency.

Also between the cost to see the FD vs going to the ED what should be the price differential? If the difference is small some will say it is more worthwhile to go to the ED where you get investigations and consults and procedures all under one roof.

There is no simple solution.

But I will tell you that more $$ is more likely part of the solution than less $$$.

Whether that money comes from the government or the people paying out of pocket doesnt really matter to the improvements in the system.

But if you change the source of money from the government to the people then you will lose control and say over the system as well.

This is a complicated topic that involves finance, society, philosophy, ethics, law and many other fields.

Take a look at the Singapore system. They actually have got most of it. But yet...yet.....there are so many in Singapore who curse the system.

Once you have patients paying they will feel it is their right to determine how the healthcare should be run. Also expectations go sky high. You pay out of pocket so why should we be waiting at all?

It doesnr work like that.

You keep referring to Singapore as an only example. It seems that the problem lies with Singapore only. Otherwise we would see the same in European countries as Singapore. Why are we not seeing this problem in Europe? They must be doing something right that Singapore is not doing.

I said we can try to emulate Europe system and use what works and what doesn't. User fees / co-pay is part of a solution. Not the only solution. Perhaps Singapore should look to European model as well and try to copy them. If Singapore doesn't fix their problems, they are no better than Canada, only worst because they can actually change the system. Nothing is preventing them. Whereas Canada cannot since it requires constitutional changes. Good luck with that.

 

[nayr69sg]

You keep referring to Singapore as an only example. It seems that the problem lies with Singapore only. Otherwise we would see the same in European countries as Singapore. Why are we not seeing this problem in Europe? They must be doing something right that Singapore is not doing.

I don't speak about systems where I have not worked at. As I have mentioned the media is one of the WORST places to look for information about healthcare systems and their effectiveness. And I speak from first hand personal experience.

For the matter, healthcare is deeply personal. And every case is different. Every illness. Every condition.

A child with a cough and cold and pink eye and fever can be deemed as a trivial condition to bring to the ED. But a child who has Kawasaki's Disease could present with the same symptoms.

Maybe a sibling had KD?

Maybe they have an abusive father?

Maybe their mom is depressed or has Munchausen by proxy?

I have learned not to judge any patient presenting to the ED or clinic. You would not appreciate anyone questioning your decisions to go to the ED or any doctor.

I am sure Europe has its problems too.

Anyone here from Europe? Please share.

When I tell my friends and relatives about the system in Canada they sing praises of it.

Canada:

1) Universal healthcare. All are covered.
2) You never have to worry about whether you can afford to be sick.
3) You never worry if you cross the road and get hit by a car if you can afford to get treatment. And the subsequent care if you are paralyzed.
4) You never worry as a young parent what will happen if your child gets struck with cancer.
5) Doctors are paid flat fees. No upselling. No looking to see if you can afford it before charging more
6) You dont have to get torn whether to have that MRI or CT scan or scope or even HBA1c because it costs $X to your pocket. leave it to the doctor to decide what is best for you
7) Doctors dont have to spend time discussing Dollars and cents with patients after going through the assessment and explaining what needs to be done
8) Strong robust fields of Palliative Healthcare, Renal Medicine (dialysis). In systems where fields compete for $$ these two often are thrown by the wayside because there is little money in it.

and so on....


Do we really want to hijack this thread?

 

[nayr69sg]

https://www.politico.eu/article/europe-health-care-systems-on-life-support-special-report-drug-pricing-medicines-public-services/

https://www.forbes.com/sites/stratfor/2017/08/08/health-care-a-universal-problem-without-a-universal-solution/#603af1ce2607

 

[screech339]

I don't speak about systems where I have not worked at. As I have mentioned the media is one of the WORST places to look for information about healthcare systems and their effectiveness. And I speak from first hand personal experience.

For the matter, healthcare is deeply personal. And every case is different. Every illness. Every condition.

A child with a cough and cold and pink eye and fever can be deemed as a trivial condition to bring to the ED. But a child who has Kawasaki's Disease could present with the same symptoms.

Maybe a sibling had KD?

Maybe they have an abusive father?

Maybe their mom is depressed or has Munchausen by proxy?

I have learned not to judge any patient presenting to the ED or clinic. You would not appreciate anyone questioning your decisions to go to the ED or any doctor.

I am sure Europe has its problems too.

Anyone here from Europe? Please share.

When I tell my friends and relatives about the system in Canada they sing praises of it.

Canada:

1) Universal healthcare. All are covered.
2) You never have to worry about whether you can afford to be sick.
3) You never worry if you cross the road and get hit by a car if you can afford to get treatment. And the subsequent care if you are paralyzed.
4) You never worry as a young parent what will happen if your child gets struck with cancer.
5) Doctors are paid flat fees. No upselling. No looking to see if you can afford it before charging more
6) You dont have to get torn whether to have that MRI or CT scan or scope or even HBA1c because it costs $X to your pocket. leave it to the doctor to decide what is best for you
7) Doctors dont have to spend time discussing Dollars and cents with patients after going through the assessment and explaining what needs to be done
8) Strong robust fields of Palliative Healthcare, Renal Medicine (dialysis). In systems where fields compete for $$ these two often are thrown by the wayside because there is little money in it.

and so on....


Do we really want to hijack this thread?

You're preaching to a choir when it comes to the benefits of Canada health care. But it comes with a cost. Long wait times, poor quality care. Those that praise Canada's from Europe are likely those who are not getting the care they think they deserve. Our medical care is based on the premise that those at bottom of pyramid (young workers) supports those at top (seniors). This works well after the WW2 when there are so few seniors. With baby boomers and seniors living longer, they are now reaching the top of the pyramid. The pyramid structure will soon reverse upside down with more seniors at top with fewer younger workers supporting the top. It will not be sustainable for very long. Until we import enough YOUNG workers that settle in Canada and not leave after getting citizenship, importing in more seniors (PGP) to add to the top with the increasing number of boomers, isn't going to help a whole lot.

Take a look at the provinces that has more seniors living than there are young workers. Their health care is in trouble as the debt is growing and growing to cover cost of medical care for seniors without enough tax revenue from able-bodied workers. The system needs to change to reflect that. We can't keep piling on debt without consequences. We have seen examples of that with Venezuela. Once had the best medical system in the world, now look at Venezuela. Everyone there want to leave. Canada will end up like Venezuela if Canada does not change it system soon and keep piling more debt.

Anyway, I will stop talking about health care (can't speak for canuck78) if you acknowledge that PGP does and can have an impact on Canada's healthcare.

 

[Dainik]

We have been trying to improve the system for years with no improvement. Throwing more money won't fix it. As long as people don't pay for care people will abuse it. If user fees were allowed, ER would not be overcrowded with non-life threatening sick patients that a doctor at clinic can look at. The constitution needs to be changed to allow private care. Unless the constitution is changed, our health care will never get fixed.

A lot of people outside this forum on the social media have all believed that PGP can be a drain on healthcare. Are you saying all the people of social media are all wrong? There is a element of truth to their arguments against PGP.

Yes this is a forum about PGP, but putting blinders on without seeing / understanding the impact of PGP, not only the good impact but also the negative impact it has on Canada. Only see the "good impact" only without acknowledging the negative impact it has is wilful ignorance on your part.

Take deep breaths bro and drink a glass of cold water.

 

[screech339]

nayr69sg: Thanks for giving my post a thumbs up. Does that mean you acknowledges that PGP does and can have an impact on health care?

 

[nayr69sg]

You're preaching to a choir when it comes to the benefits of Canada health care. But it comes with a cost. Long wait times, poor quality care. Those that praise Canada's from Europe are likely those who are not getting the care they think they deserve. Our medical care is based on the premise that those at bottom of pyramid (young workers) supports those at top (seniors). This works well after the WW2 when there are so few seniors. With baby boomers and seniors living longer, they are now reaching the top of the pyramid. The pyramid structure will soon reverse upside down with more seniors at top with fewer younger workers supporting the top. It will not be sustainable for very long. Until we import enough YOUNG workers that settle in Canada and not leave after getting citizenship, importing in more seniors (PGP) to add to the top with the increasing number of boomers, isn't going to help a whole lot.

Take a look at the provinces that has more seniors living than there are young workers. Their health care is in trouble as the debt is growing and growing to cover cost of medical care for seniors without enough tax revenue from able-bodied workers. The system needs to change to reflect that. We can't keep piling on debt without consequences. We have seen examples of that with Venezuela. Once had the best medical system in the world, now look at Venezuela. Everyone there want to leave. Canada will end up like Venezuela if Canada does not change it system soon and keep piling more debt.

Anyway, I will stop talking about health care (can't speak for canuck78) if you acknowledge that PGP does and can have an impact on Canada's healthcare.

Of course PGP will impact Canada's healthcare. Any increase in population will - eventually.

I still dispute your statement about "Poor Quality Care". Canada actually has very good quality care.

I really dont think Canada is anywhere near Venezuela - socially, economically , politically.

Speaking of debt......

http://www.rbc.com/economics/economic-reports/pdf/canadian-fiscal/prov_fiscal.pdf

Go to page 12

The debt to GDP ratio of provinces.

AB is 10.3%
BC is 14.6%
Sask 15%
ON is 39.9%!
Que 37.8%!
NB 36.7%
NS 33.4%
PEI 32.3%
NL 39.1%
Man 34.7%
Federal is 30.7%

The debt is not distributed equally.

Canada would do well to let the west work and earn money. Or maybe the west should leave Canada.

You have a situation where family members are spending on their credit cards and then asking a small number to pay for the bills. And then have the cheek to scold those paying family members for how they make the money to pay the bills.

 

[nayr69sg]

nayr69sg: Thanks for giving my post a thumbs up. Does that mean you acknowledges that PGP does and can have an impact on health care?

Yes it will of course. I have never denied that fact. But PGP alone does not break the system. And can the system find ways to cope with an extra 10k of old folks? Of course it can.

There are bigger problems for this country.

Debt for example.

I remember a Star Trek Next Generation episode that had an alien race which would celebrate a persons 70th? birthday after which they commit suicide and everyone celebrates.

it was their answer to healthcare burden, old age.

The philosophy was to go out on a high. At an age where they are good and people will remember them well. Rather than degenerate, slowly deteriorate and be forgotten.

I am not saying that this is the solution for us. But this is a much bigger discussion than criticizing PGP.

 

[screech339]

Of course PGP will impact Canada's healthcare. Any increase in population will - eventually.

I still dispute your statement about "Poor Quality Care". Canada actually has very good quality care.

I also dispute your statement that Canada has "good quality care". So waiting for months for appointment, after getting an referral from your family doctor, if you have one, to see a specialist for consultation along with another long wait time for an scheduled operation is in your view "good quality care"?

 

[Niharika_11]

Take deep breaths bro and drink a glass of cold water.

Lolz

 

[nayr69sg]

I also dispute your statement that Canada has "good quality care". So waiting for months for appointment, after getting an referral from your family doctor, if you have one, to see a specialist for consultation along with another long wait time for an scheduled operation is in your view "good quality care"?

I have often told friends and relatives that what a patient thinks is a good doctor or good care may not necessarily be what a doctor who is learned in the field recognizes as good medicine.

It depends. What condition are you referring to? How many months is "months" 1-2? 3-4? 5-6? 9-12? 12-18?

Ideally there should be ZERO wait time.

Well if you have private healthcare facilities the wait should be zero right? Well think again. You still wait. Supply and demand. There will be surgeons and specialists who will be more popular than others. Do you prefer to wait for the good surgeon with excellent reviews and reputation? Or not wait and go for the new kid on the block?

Patients also sometimes fall for the doctor who is a great orator and communicator. Or simply the one who has great bedside manners and maybe will tend to go along with what you want rather than follow the guidelines on good medicine with least waste.

To me good quality care is when the right things are done for the right conditions and with the least morbidity and mortality and complications.

wait times that do not impact overall outcome is not a factor for me.

On that note as a physician I make it a point for my patients to have almost zero wait time. I pride myself in doing it. But a lot of work has to be done in preparation before I see the patient. going through their charts, searching up information on the database. It can be done. I have also seen doctors who dont bother about letting patients wait. Come in late. Take their time with a cup of coffee first etc.

But there will be patients who will be willing to wait for a particular doctor versus one that they dont need to wait for too.