Dr. Brett Belchetz says patients are visiting his emergency room dozens of times a year to get a diagnosis they want or acquire narcotics. He calls for reforms to Canada’s underperforming health care system.

OTTAWA, Sept. 18, 2014 – Canadian governments are fomenting abuse of the health care system by failing to force abusers, some of whom needlessly visit emergency rooms dozens of times a year, to pay a user fee, a new MLI Straight Talk Q&A reveals.

Dr. Brett Belchetz, a practising emergency room physician in Toronto, cites the example of a patient with a cold who wants a doctor to prescribe antibiotics.

If their family doctor doesn’t give them what they want, they will go to a walk-in clinic. After that they’ll see him in the emergency room for another crack at getting the medication. Others are making as many as 50 repeat visits in an attempt to get narcotics. And Dr. Belchetz is aware of patients who, unsatisfied with a diagnosis, have sought and received up to 14 CT scans, at a cost of $1000 apiece.

“I would say that what I’m talking about is probably not an uncommon experience for people in emergency medicine. I think the willingness to talk about it is more uncommon. I think as physicians we’re very afraid to in any way criticize the behaviours of our patients”, says Dr. Belchetz.

He places this issue in the context of Canada’s poor performance when compared to other nations. In a recent Commonwealth Fund report, Canada was ranked 10th out of 11 systems in the most developed nations, trailing only the United States. Canadians are paying more and getting poorer outcomes, notes Dr. Belchetz: “Our system costs about $4500 per person per annum and the United Kingdom’s system, which is the number one performing system in the world I believe, is only around $3400 or so.”

He says the problem is the overwhelming focus on public medicine, rather than the mix of public and private found in more successful health systems. Canada’s system is encouraging the kinds of abuse seen in his ER, according to Dr. Belchetz, and creating numerous other inefficiencies.

“This kind of thing is costing the system tremendous amounts of money and we need to do something to prevent the rampant abuse … that happens when the price for access to care is zero”, he says.

Dr. Belchetz says it’s possible to charge user fees that discourage frivolous use, and allow some private delivery or funding of care, while preserving universal access. He recommends that policy makers look to successful systems in places such as Europe for lessons on how to reform the Canadian system.

“The UK system, Swiss system, Swedish system: let’s look at the phenomenal outcomes that all of these people have achieved by allowing some amount of private health care into their systems”, says Dr. Belchetz.

As it stands now the debate here is polarized between the systems in Canada and the United States. The Canadian system’s overreliance on government fails to take advantage of market forces, he says, while the private sector in the United States isn’t designed to offer low-income residents access to quality care.

MLI has drawn three recommendations from its discussion with Dr. Belchetz:

  1. Repeal the Canada Health Act and begin to allow those who can pay for their own care to do so and relieve pressure on the system.
  2. Implement user fees to reduce abuse of resources and deliver price signals to increase supply and reduce demand, while preserving access for patients of limited means.
  3. Stop concentrating on the poorly performing US system and look to better-performing systems in Europe and elsewhere for policy ideas.

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Brett Belchetz is a practising emergency room physician in Toronto, and a former management consultant with McKinsey and Company. He obtained his undergraduate degree in Statistical Sciences from the University of Western Ontario and his Doctor of Medicine degree from the University of Toronto.

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