- © 2004 Canadian Medical Association or its licensors
Noralou P. Roos and associates1 document the role of poverty as a justifiable factor for increased utilization of health care services, because those of low socioeconomic status have poorer health status. However, the authors do not appear to prove that universal comprehensive insurance does not increase utilization.
For years, during informal discussions at work, continuing medical education courses and social events, I have been hearing family physicians readily acknowledge that their rate of referral to specialists is probably excessive and that they have ordered questionable investigations under perceived pressure from patients and fear of legal action. In these situations, universal health insurance has undoubtedly freed both physician and patient from financial accountability.
To reduce the present financially unsustainable rate of annual growth in health care, Canadian politicians should follow the suggestions of Roos and associates1 by focusing on evidence-based medicine, physician practice patterns and hospital management, but not user fees and medical savings accounts. Fortunately, recent proposals that might moderately reduce utilization2 inspire optimism that sufficient funds will be generated justly and fairly. Such funds are urgently required for the financial sustainability of Canada's health care system. Modest annual premiums could be introduced, calculated as a fair percentage of income above the poverty line. In addition, health care services could be treated as a taxable benefit on income above the poverty line, with a maximum calculated as a fair percentage of income.
Canadians accept average annual expenses of more than $1000 for car insurance,3 $700 for gambling4,5 and (for anyone who indulges in a large coffee and a doughnut each weekday) $500 at Tim Hortons, but, remarkably, they appear reluctant to preserve health care by paying for a modest portion of their physician and hospital services!
Ross McElroy Family Physician (retired) Tavistock, Ont.