Free healthcare; isn’t that amazing? Well, healthcare in Canada is far from free. It’s actually rather expensive, costing $4,443, per Canadian per year (WHO, 2013). It just seems free because it’s paid for via taxation and not on a “per encounter” basis like dentists, lawyers and almost all other services we pay for. “Customer” or “client” isn’t a word we hear very much in healthcare; “patient” implies a cozier, more caring relationship. But “patient” can also be a disempowering word, it implies the doctor tells one what to do and the patient does what they are told. But the patient is paying for the service, and it’s important for healthcare providers not to forget that. Patients are clients too.
So, how would you feel if your lawyer was running late, and kept you waiting for an hour or two before seeing you? You might pay 300 buck per hour for her expertise, and so you’d be unhappy to be treated like this. But when it comes to doctors, people are less quick to complain. That’s partly because the way doctors are funded changes the relationship. If you handed over hard cash every time you saw the doctor, you might feel more empowered. Not that I’d advocate for such a system – providing healthcare without regard for the ability to pay is a principle that Canada should be proud of. (Let’s put the issues of healthcare for refugees aside for another blog, later). So who is in charge of the patient-doctor relationship? Doctors talk about their patients. And patients talk about their doctors. Does a doctor have a patient, or does a patient have a doctor?
Behind the scenes (I work with doctors in a number of organizations) you’ll occasionally hear of community doctors complaining of other doctors poaching or stealing their patients. Is this driven by a desire for continuity of care? I hope so. Continuity of care is important. The alternative is that doctors want to keep patients because they desire the government revenue that they generate. So is it the case that some doctors don’t like competition; or is there a free market? Do we hear of shoe shops complaining of other shoe shops stealing their customers? We don’t, because it’s commonly accepted that shoe-buyers are free to buy their shoes where they wish. They pay for the shoes, and they can chose. The difference with doctors is that free market principles don’t apply. There isn’t enough supply to match the demand and therefore doctors may or may not be able to accept a patient. Doctors tend to offer 9 to 5pm services Monday to Friday, which doesn’t always meet the patient’s needs. Doctors aren’t used to having to compete for patients, suggesting that there is plenty demand for their services. This results in a lack of pressure to attract patients. Even a doctor who keeps a patient waiting or who’s office is difficult to communicate with, can clearly still retain enough patients. Is this good for healthcare – well, I guess that depends how much we value not just the quality of healthcare, but the way in which it is delivered. My guess is that if doctors felt more pressure to compete, patients would end up with an experience they were happier about.
About the author:
Chris Houston is a co-founder & Operations Manager of kid-E-care, and Operations Manager of Kindercare Pediatrics. He also serves on the board of Medecins Sans Frontieres, he also runs a global health module at University of Toronto.