Paid operation at MUHC opens hornets’ nest
The MUHC is in a spat with the Quebec government over an incident in 2011 in which a woman from Kuwait came to Montreal and paid $200,000 for a heart operation at the Royal Vic that she could supposedly not get anywhere else. The MUHC spokesman makes the shaky claim this was done on compassionate grounds; the health minister finds it unacceptable although his government was not in power in December 2011 when it happened, and the MUHC says they squared it with Yves Bolduc, health minister at the time.
I’m seeing contradictory stuff about how common this kind of thing is here. On CBC radio yesterday I heard a statement (from someone official but I didn’t take notes) that this was a one-off, done at the specific request of the Kuwaiti government and not meant to be an ongoing business proposition by the MUHC. But that item says “M. Fahey avance aussi que ce type d’opérations sont menées de manière plus ou moins régulière dans les centres hospitaliers du Québec et du Canada, toujours sur la base de la compassion” and the Gazette today has a story saying the government of Kuwait signed a contract with the MUHC to arrange for this kind of medical tourism over five years, but has uncovered some stunning irregularities in the whole deal. This story is a must-read.
An MUHC spokesman is quoted as saying “the staff worked on their own time and the beds the patient occupied were closed for budgetary reasons” – maybe he thinks this sounds more reassuring than it is. Doctors and nurses (presumably paid out of the fee?) do not have an inexhaustible store of workable hours, and if they’re motivated to work harder for this kind of gig, it does not bode well for us.
The bottom line here is that if the MUHC prioritizes selling services to wealthy foreigners, that leaves less for Quebec citizens whose taxes sustain the system. It’s being investigated.
Matthew 13:34 on 2013/02/02 Permalink
“MUHC prioritizes selling services to wealthy foreigners, that leaves less for Quebec citizens whose taxes sustain the system. It’s being investigated.”
Hold on. If the actual cost of the surgery was less than $200,000 to the MUHC, doesn’t that mean the surgery put more money into a system that is lacking sufficient funds for its citizens?
In the same light, two-tiered healthcare (just like two-tiered education) means everyone pays for the public, but not everyone necessarily uses it = only more funds per user for the public system. The best healthcare systems in the world are those that are two-tiered.
David Tighe 14:33 on 2013/02/02 Permalink
The operation would have required marginal expenditure on doctors and support staff salaries etc as well as utilities and so on. These could in theory have been used to provide local services. However, since the operating theatre would have been closed anyway through lack of funds, starting it up would not have consumed resources usable elsewhere. Furthermore, since the lack of places to operate normally prevents doctors from working as much as they could, the surgeons fees did not cost us anything. He would not have been working otherwise. Thus Québec must have made a healthy profit from the operation which could in theory be used to finance other operations here. Given that the system here is profoundly dysfunctional, with some resources stretched to the maximum, others grossly underused, a policy of selectively treating foreign patients at market prices but at less than marginal cost seems to me to be an excellent idea
steph 14:54 on 2013/02/02 Permalink
The problem is that our doctor/nurse/bed supply doesn’t even keep up with the public demand. Pricing the procedure at $200,000 probably only involves short term profits, there’s a lot more at stake then this quarters budget.
Kate 16:05 on 2013/02/02 Permalink
Hold on. If the actual cost of the surgery was less than $200,000 to the MUHC, doesn’t that mean the surgery put more money into a system that is lacking sufficient funds for its citizens?
In the same light, two-tiered healthcare (just like two-tiered education) means everyone pays for the public, but not everyone necessarily uses it = only more funds per user for the public system. The best healthcare systems in the world are those that are two-tiered.
There is a limit to the amount of health care service that can be provided.
If priority is given to people who can pay, those who cannot pay will have to wait and be seen when time can be spared from the business side of the service, which may be never.
Ant6n 20:20 on 2013/02/02 Permalink
Two-tiered any system is bad – everybody who makes the decisions and affects public opinion will be in the private one, and the public one will be left to rot. Eventually the people in the private system will want to get out of paying for the public one and then the public one will rot even more (this happens in Germany, where people who are _above_ a certain threshold when paying for the progressive public system can opt out all the way, effectively cutting off the higher tax brackets…)
David Tighe 10:51 on 2013/02/03 Permalink
I agree that two-tiered systems are bad in that they deprive the public system of resources. For example the UK. They however have no real human resource problems as they recruit nurses and doctors from many countries. However the situation in Québec is rather weird in that we an enormous unsatisfied demand and at the same time, grossly under-used resources on the one hand and massive human resources shortages on the other. In this context, which is a monument to lousy management, they may as well, like the universities in recruiting foreign students, milk the system for revenue which in turn could be invested in reducing bottlenecks. Ideally, the procedure could tend towards an optimal use of resources. In practise, doctors will probably get so hooked on this foreign clientele that it ignore us.
Kevin 08:48 on 2013/02/04 Permalink
Quebec’s healthcare system is messed up in so many ways.
We could start by getting rid of PREMs (sp?) and have the Ministry stop assuming all doctors work full-time.