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© Copyright 2000 Rogers Media. The following article first appeared in the July 2001 edition of
BENEFITS CANADA magazine.
An open letter
Roy Romanow is leading a royal commission on the future of healthcare. Here's what the benefits
community has to say to him.
By Kathryn Dorrell
Canada's healthcare system is still regarded by many as the best in the world--a hallmark of our kinder,
gentler society. Yet, increasingly it is attacked as being a crumbling socialist regime that encourages
wealthy citizens to purchase faster care outside of its borders.
Love it or hate it, few would disagree with the need to re-examine the system. Ottawa has decided to do
just that--take a good, hard look at our healthcare system--to determine in what direction it should head.
In true Canadian fashion, this calls for nothing short of a royal commission. Former Saskatchewan premier
Roy Romanow is leading the 18-month review, which will be completed next November. The commission has the
opportunity to produce a visionary report that--unlike so many of the healthcare studies that have preceded
it--will actually serve as a blueprint for the future.
Romanow has spoken with some of this country's finest healthcare experts. He also plans to talk to ordinary
Canadians about their values, needs and concerns. One important group that is too often overlooked in the
national healthcare debate has a lot of value to add to the commission--and that's the benefits plan
sponsor community.
DEAR ROY
Benefits plan sponsors have felt the impact of changes in the public healthcare system for many years now,
as their health programs take up the slack from government cutbacks. While the irony of the debate over
preserving the so-called public system isn't lost on plan sponsors, the public/private debate is an issue
that you must resolve.
"The federal government needs to meet with employers. We are paying employer health taxes and for the cost
of government downsizing [in healthcare budgets and resources]," says Gail Stevely, benefits administrator
with the City of Hamilton in southwestern Ontario. "The savings are coming out of our [employers']
pockets."
Jane Petruniak, a consultant with Watson Wyatt in Toronto, concurs. "[The commission] has to look at the
ability to buy private coverage and the role of the private sector," she says. Calling for a clean slate
approach, Petruniak is urging you, Mr. Romanow, to go beyond simply "fixing what's there, to develop a true
vision for the future."
While the plan sponsor community realizes that universality is highly valued, the commission must assess
what services are covered under the public umbrella. This much-needed assessment will act as a vital
resource in helping employers structure their health benefits plans. "The cost of providing good benefits
is [becoming unaffordable]," says Stevely. "We need a better definition of medically necessary services and
what is [considered] lifestyle."
INTEGRATION AND ACCESS
Add the task of drafting a plan for a truly integrated healthcare system to the commission's priority list.
"There is not enough focus on a system and too much on individual silos," says Petruniak. Once again, an
integrated system, in which all parties communicate with one another, will better enable plan sponsors to
tailor their resources to employees' needs. In the end, it is individual Canadians who benefit from this
the most.
The public system moved away from hospital-based care to homecare before all the necessary support systems
were put in place, says Gary Dobbie, vice-president of compensation and benefits with the Royal Bank in
Toronto. The commission needs to know that this has placed an onerous burden on working Canadians and
employers alike.
We need the commission to recommend a public resource network that helps Canadians find support in their
community for family members who require homecare, says Dobbie. He adds the homecare issue is crucial to
resolve as our aging population will put more pressure on the healthcare system, caregivers and employers
in the years to come--all at a time when organizations are grappling with productivity challenges and
absenteesim.
The existing system has also created a serious problem in terms of access, says Dr. Arif Bhimji, president
of the Concord, Ont. consulting firm, At Work Health Solutions. Mr. Romanow, are you aware that hundreds of
millions of dollars (much of it paid for by employers and insurers) are wasted on replacement income for
individuals who are waiting for diagnostic tests, treatments and surgery because of access issues?
Dr. Bhimji says the cost of replacement income for employees waiting for treatment often exceeds the
expense of their actual care. This is another burden on employers. "We need a solution to access," says Dr.
Bhimji. "Anything short of that is a failure on the part of Mr. Romanow."
ACCOUNTABILITY
Another problem in the system that the commission needs to address is accountability. Jim Norton, senior
vice-president with Aon Consulting in Toronto, says accountability is needed to ensure that both patients
and doctors are not abusing the system. Norton presents a U.S. example to demonstrate the importance of
physician accountability.
A New York state study completed several years ago tracked the health status of cardiac patients back to
their surgeons. "Within two years of the report, the death rate among these cardiac patients decreased by
35% as surgeons were held accountable," says Norton.
He adds that recent studies show up to one-third of surgeries in Canada may not be needed. "There are great
wastes in our system. My sense is that there are enough doctors, hospital beds and money in the system.
There are ways to make the current system better without pumping more money into it."
Indeed, Mr. Romanow, reducing waste could free up funds for a national pharmacare, homecare or even dental
program. This would allow organizations to focus more of their attention and finances on core business
activities.
However, accountability must also be applied to employers, says Martin Shain, a senior scientist with The
Centre for Addiction and Mental Health in Toronto who specializes in examining the role of the workplace in
individuals' health status.
The commission should hold employers that clearly have poor management practices accountable for the harm
they wreak on the public health system, says Shain, just as organizations can be fined for exceeding
pollution levels and health and safety violations. Mr. Romanow, perhaps it is also time to give health tax
rebates to those organizations who offer comprehensive wellness programs and have an above-average heath
status in their employee population.
ALTERNATIVES
Hopefully, the commission will look beyond traditional bastions of care. Norton calls for a far greater use
of nurse practitioners and pharmacists. "Doctors don't have to do everything. That's one of the reasons why
we have such long waiting lists."
Petruniak adds that alternative health resources need to be brought into the debate. These resources are
increasingly in demand, and employers and governments need assistance in defining the role of these
services in the context of public and private coverage.
Mr. Romanow, as you are aware, over the past decade there has been immense pressure and change in our
healthcare system. What you may not realize is that the benefits plan sponsor community has arguably played
as important a role in ensuring the good health of Canadians as healthcare institutions and
doctors--picking up the tab for life-saving prescription drugs, guiding individuals to homecare and
eldercare resources and launching a wealth of wellness programs that have kept a significant number of
Canadians out of hospital corridors.
In fact, employers now pick up one-third of total drug costs. Would any other commission ignore this
percentage of its stakeholders when making plans for the future? Not likely.
Mr. Romanow, it's time to lead this country's healthcare system into the future--with the benefits plan
sponsor community at your side.
Kathryn Dorrell is associate editor with benefits canada.
kdorrell@rmpublishing.com.
This open letter will be forwarded to Roy Romanow.
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