Saturday, 19 March 2011

Health Care Access

An Ontario woman with breast cancer was recently controversially denied treatment with Herceptin.  (link to a comment from the woman affected.) Herceptin is very expensive and because her cancer was caught early and the tumour is small, it's not clear the treatment will be very effective in treatment or in preventing recurrence. I'm not going to try to argue the medical issues involved in this recent case,  except to say that if the G & M is wrong about this case, the general point still stands, i.e., that any health care system has to draw lines and balance costs with potential returns.  I should also note that the Canadian system, from what I've experienced and understood, is far less niggardly than the US insurance payers and respectful of what doctors deem to be the right treatment options. The sense I have in the US, unlike in Canada, is that doctors are fighting with the insurance companies to get the right treatment options. But there's a key difference between the US and Canadian system: if a treatment is refused in the US, one still has the option of paying for the treatment if s/he believe it's what s/he needs.

The lack of such an option underscores a key and, I believe, somewhat unique characteristic of the Canadian health care distribution system, and that's the fact that this woman has no recourse to avail herself of this treatment, within Canada, after the insurer has declined to cover it. Regardless of what we think about allowing those willing to pay to jump the queue for services, this seems to be a different issue. In this case the government has simply refused her a place in the queue. In that situation, shouldn't the woman be allowed to access the treatment if she's willing to pay for it and take her place in the queue? (Admittedly, insofar as need as prescribed by the system defines the queue, it's not entirely clear where that place should be, but surely that can be determined.) The Canadian system has proven to be a very effective means of justly distributing high quality health care at lower costs, but when it actually prevents a person from getting a treatment that a person believes s/he needs, hasn't it crossed the line from being just a distribution system? Proponents of universal health care argue, rightly, I think, that access to health care is a fundamental right. But that has to cut both ways, ensuring access to quality care for all citizens, but also not denying access to those pursuing what they deem to be their best interests in terms of maintaining or restoring health and willing to pay the financial costs for it.

1 comment:

Corrie P said...

You have a point, Mike, I went to my family doctor yesterday to ask about getting minor surgery done on my foot. He simply said "No, you need to go to a different treatment.", giving me no other options. I would like to get more info as to what is available, but the family doctor seems to have all power when it comes to making that decision. He also knows what health care covers in certain age groups and he was obviously not eager to discuss it. This all went through my head AFTER I left his office.