No Payor System

2) Each household has the individual freedom to choose a method of purchasing health care. It may elect to continue to receive health care through the current national system or to purchase health care from a newly created physician-partnership.

3) To establish an equitable health-care system it will be necessary to define the scope of health care services to be funded under the umbrella of these tax-preserved funds. This will establish a level playing field between the physician-partnerships and the national system. Open disclosure of fiscal performance by the physician- partnerships will properly inform the fiscal debate over adequate funding of health care. Once the parameters of basic coverage are established, uncovered levels of care should be available for purchase. This might take the form of secondary insurance provided by the physician-partnerships or Regional Health Authorities. Such secondary levels of care might include the assignment of private rooms in hospital, the ability to seek second opinions or consultations outside the membership of the chosen physician-partnership or to purchase specific aspects of care not covered by the government's definition of covered services. It would be wise to continue to prohibit third party private insurers.

4) In this new system the dynamics of competition will foster change. Patients will choose regional councils or physician-partnerships based upon the quality of services provided. The performance of these partnerships should be sufficiently transparent to allow patients to make rational decisions. This should result in a constant pressure to strive toward excellence. Use of health-care resources will need to be both efficient and effective. To maintain market share, partnerships will need to incorporate new modalities of therapy. As costs exceed the reasonable expectations of a given level of tax-preserved access the political process will face the ultimate fiscal responsibility to make reasonable societal decisions. Under these conditions the marketplace will gain new efficiency and sustain its relevance.

5) The government should continue to outlaw private health care insurance companies. This will protect the system from the inevitable drain upon resources that results from the effort of insurance companies to sustain profit.

6) Individual tax-preserved access guarantees that people will have funds to purchase their own health care. Before citizens pay any income tax they must first have sufficient tax protected funds to buy health care. By adopting this system Canada will create a Health First Nation. Access to health care takes precedence over any other government consideration.

B. Establish Physician Partnerships

1) Government should enact legislation to create physician-partnerships with fiscal responsibility equal to and independent of regional councils. These physician-partnerships will function as insurer for patients who elect to receive care from them. They will then need to pursue fiscal policies that result in an equitable averaging of cost over this population.

2) The initial program should limit the number of partnerships created. It would be prudent to foster competition without overly diluting the pool of patients. There should be no geographic restriction imposed upon these partnerships. Areas such as the Maritime Provinces or Prairie Provinces should be free to develop inter-provincial group arrangements which would benefit from economies of scale and therefore improve their economic performance. Such groupings may create synergy in solving common logistical problems inherent to their geography.

3) The legislation must stipulation that each physician partner is restricted to one vote and one share. All physicians employed by the partnership must become eligible for partnership, and therefore ownership, within a reasonable period of time. During this preliminary period partnerships may eliminate those physicians whom they deem to be unacceptable. A one physician, one vote policy is critical. Any imbalance in ownership will introduce a profit motive separate from the goals of the health-care system. The corollary to physician ownership is that these physician partnerships must not become subsidiaries of for-profit corporations, university systems or other public or private institutions. The economic motivation of these physician- partnerships must be entirely determined by the delivery of care to their patients. Shared ownership with universities or other health-care institutions will create an internal conflict of interest relative to patient care.

4) Each physician-partnership must establish a Board-of-Trustees composed of a majority of physicians counter-balanced by representative, responsible community members. This ensures community involvement in the process and provides a venue to influence policy and performance by the physician-partnership.

5) Each physician partnership must hire competent, non-physician, business leadership, approved by the Board of Trustees, to be fiscally responsible for the well-being of the entity. This business leadership should have non-voting seats on the Board-of-Trustees and be responsible to both the Board and the general membership of the physician-partnership.

6) Each physician-partnership established under the terms of this legislation should receive a start-up development grant. This grant should cover the costs of formation: recruiting physicians, hiring business leadership, establishing bylaws and rules, and developing internal fiscal policies. Advertising to solicit patients will be an additional critical initial cost.

7) To initiate operations each partnership must be required to enroll a minimum number of patients. Success of this system depends upon each partnership generating sufficient income to establish a fiscally responsible budget. This initial budget should allow efficient averaging of cost-of-care for their population as well as provision for investment, both to write off obsolete programs and to build future capabilities.

8) To ensure that health care is adequately funded there must be a benchmark against which excessive constriction of funds can be measured. The most visible and vulnerable aspect of the partnership’s budget is the aggregate physician income. There must be both a minimum and maximum level of reimbursement beyond which aggregate physician income within the partnership cannot, by law, be allowed to vary. These levels should be established as a percentage of the gross tax-preserved income from patients received by the physician-partnership. Part of the success of these partnerships will depend upon the ability of physicians to increase their salaried income based upon medical expertise, participation in partnership programs designed to improve their population’s health, and contribution to programs which reduce the cost of health care. If they are to be rewarded for reducing the cost of care through contributions to greater efficiency this must not lead to their ultimate penalization. There must be a floor below which physician compensation does not fall. It should be the responsibility of the board of trustees to inform their constituency should this economic indicator foretell an impending crisis in health care funding.

9) Each physician partnership should publish an annual report which includes an accounting of both fiscal and medical performance. This dual reporting gives the public access, not only to the performance of each physician-partnership, but also to the performance of the health-care system in general. Partnerships might also use this opportunity to report the effectiveness of programs designed to improve the delivery of care and to indicate progress in targeted programs against major disease categories.

End of Part II

Canada Health Act: Proposed Reorganization:

• Part I
• Part II
• Part III
• Part IV