Friday, 14 September 2007

Cost of an ambulance ride about to change

When I came to Canada I thought it had a public health system analogous to the British National Health Service. Which the British all regard as some sort of sick joke and hope their employer pays for BUPA so they don't have to share an open ward with really sick people if they do have to go to hospital. But is actually quite good - especially when compared to the US, if not Cuba.

Canada I learned is a little different. For one thing hospitals kept asking me for money - or offering to sell me raffle tickets. Now I know they did that in Ireland, but that was before they joined the EU and got rich enough to pay for their own hospitals. But Canada? One of the richest countries in the world - yet they have to go begging to buy a scanner?

Then I had a medical emergency and was carted off to hospital. Got great care and the problem was sorted out. What I really did not expect a few months later was the bill for the ambulance. Which was not only not covered by the provincial health program but was also not covered by the private health insurance either. And for both of those I had deductions from my pay cheque. In fact I was paying much more in tax in Canada than I ever had in the UK, and the service was - ok let's go back to first principles.

Once upon a time we all paid for health care. Which meant most people didn't get any. Since medicine was at that stage pretty hit and miss that really did not make a lot of difference. The barber was also the surgeon. Your granny probably knew more about pharmceuticals that actually worked than the quack did. But people who work in public policy worked out that as a nation we could not afford this approach any longer. For one thing, there were no longer lots of strong young men brought up in the countryside with good diets, fresh air and reasonably clean drinking water - or ale, which, because it was boiled as part of the brewing process, was disinfected. The industrial revolution meant that the strapping sons of the soil were now stunted, pale and sickly. They were not fit for the army.

That was where the concern for health came from. And the Crimea. Which demonstrated that the field hospitals were much more likely to cause death than the enemy. It took a while but eventually the cost benefit analysis of universal, publicly funded health care started to be obvious even to Members of Parliament - as usual the last to come on board.

The working premise of public health was that you got the care you needed, not the care you could afford at the time. There were systems of payment which were based on insurance policies, but it was always recognised that some people would not even be able to pay these small premiums. That did not mean they would be left to charity.

Now there has always been discussion about how to pay for health care. And since it has got better - and much more expensive - there is a profit to be made by better service delivery. Since health care based on need means some sort of "triage" - and people whose pockets jingle do not think they should wait even if the person next to them is visibly bleeding to death. And for some services of very dubious benefit such as liposuction the public health service really does not see as important when burn victims actually need the services of the most skilled plastic surgeons.

So some charging has always been there. And some remedies do not need a prescription and those that do may incur a flat charge, under some circumstances. This stops people going to their doctor for an aspirin.

But charging for ambulances? What the heck is that about? The patient doesn't call the ambulance in most cases. Concerned family, or even bystanders, sometimes qualified first aiders. But if you are suffering a heart attack or have been pulled from a car wreck you are not going to be asked if you want an ambulance or feel up to taking a cab!

And anyway the bill arrives months after the incident. So it is not at all likely to influence behaviour is it? Is there really such a huge risk of people calling the men in the white van for trivial complaints that you need an $80 fee to make them think twice?

Bizarrely, the NDP slags the decision as as a "tax on the sick" but then thinks it should be "levelled down". Why not abolished?

And why isn't it covered by Blue Cross? Comprehensive car insurance means that when my headlight gets taken out by an errant bird they pay. Nothing to do with fault - just they cover that risk, and I pay them to do so.

Does anywhere else in the world charge for public emergency ambulance services?

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