VANCOUVER - The incoming head of the Canadian Medical Association has a dream - to eliminate health-care wait lists so people get treatment without suffering to the point their conditions gets even worse.
But his plan is already stirring up opposition in the medical community by those who say it's based on a British approach that's shown to be failing. "I want to accomplish the end of waiting for necessary health care in Canada," says Dr. Brian Day. "I would like to at least initiate the process whereby we don't have patients suffering and dying on wait lists."
Day will be officially appointed the association's president next week during its four-day meeting in Vancouver.
The 60-year-old orthopedic surgeon is no stranger to controversy. He was labelled Dr. Profit by his critics after opening Canada's first private surgery clinic 11 years ago in Vancouver.
Day insists wait lists can be eliminated if Canada adopts Britain's method of funding hospitals.
But his critics say the payment-by-results scheme - in which the government pays hospitals based on the number of procedures they perform - has been an abysmal failure and Canada should not make the same mistake.
Day disagrees, saying Britain's funding scheme, introduced three years ago, gives hospitals the financial incentive to operate like businesses. Patients can choose among five facilities - including one that must be privately run - to get their treatment.
The hallmark of the British model is that it has introduced competition into health care so hospitals must provide good service or lose patients who can go elsewhere, Day said in an interview with The Canadian Press.
Patients can weigh their choice based on everything from the food served to a hospital's infection rates and outcomes of medical procedures - information readily available to consumers of the health-care system.
Under Britain's previous system of so-called global funding, the government gave hospitals a set amount of money as part of an annual budget. When the money ran out facilities closed beds and cut operating-room time for surgeons, resulting in ever-growing wait lists, Day said.
The same funding model is still used in Canada, to its detriment, he said.
Day's opponents say Britain has significantly reduced wait lists because the government is spending more money on health care. But the competitive nature of the current funding system means hospitals no longer collaborate or share information about special techniques.
Day calls his critics fearmongers who are merely muddying the debate over much-needed reforms that could better meet Canadians' health-care concerns.
Dr. Jacky Davis, a British radiologist, said Day is misguided if he thinks Canada should adopt a system that has failed so miserably.
"It's easy to say the wait lists have come down here because they have but the government has doubled the spending," Davis said from London.
She said even the British Medical Association - the counterpart to Day's group - has panned the payment-by-results method of funding as unworkable and its future is now in doubt.
"We've got hospitals here whose only duty is to run a profit," Davis said.
In some cases administrative costs have spiked up to 18 per cent from six per cent of total budgets because hospitals are now buying advertising to compete for patients, she said.
Davis said Britain's current funding scheme has introduced more private clinics, which profit most when it comes to government funding being diverted from the National Health Service - the public provider.
Scotland and Wales have decided to do away with the payment-by-results model and people in England want to do the same, said Davis, founding member of a lobby group called Keep Our NHS Public.
"It really is egg-on-the-face time," she said, referring to the British government.
Many Britons don't want to shop around for a hospital when they're seriously ill but would rather have their family doctor make that decision, Davis added.
Davis and other British doctors from various specialties, belonging to the National Health Service Consultants' Association, have sent Day and his colleagues a letter that will be circulated at the Canadian Medical Association's meeting next week warning doctors about the pitfalls of Britain's funding scheme.
"Our hope was that our colleagues in Canada could learn from our country's mistakes and reject market-style policies leading to privatization," says the Aug. 15 letter, released to The Canadian Press.
"Health-care turmoil in the UK has escalated with private-sector involvement causing much of the chaos we predicted.
"Neither payment by results, the increased use of the private sector, nor the patient choice agenda have proved their worth. On the contrary, they have resulted in a destabilized and damaged public service."
Day said Britain's payment-by-results model, which he would call patient-focused funding, is workable for Canada "with an initial outlay of $10 billion for the country."
"They made some mistakes early on and they've learned from their mistakes," he said of the British system.
"I'm not saying the British model is the exact model for Canada."
Day said people are wrongly saying he's a proponent of the British funding model simply because of the privatization component of that plan.
"I don't like this for-profit stuff because it distracts from the real problem and the real problem is the system we have is not working," he said.
"This kind of polarization of the public versus the private (system) is non-constructive. In fact, it's destructive to real reform; it puts fear in the hands of politicians who are afraid to move away from the status quo."
Canada's focus on reducing wait times in five key areas - cancer treatment, cardiac care, joint replacement, cataract surgery and diagnostic imaging - hasn't improved access much despite millions of dollars in funding to the provinces, Day said.
But Dr. Danielle Martin, spokeswoman for the Toronto-based group Canadian Doctors for Medicare, said innovative reforms in every province are reducing wait lists in some areas.
In British Columbia, for example, centralized clinics for hip and knee replacements have been hugely successful, allowing doctors to perform more of the procedures, she said.
According to the B.C. Health Ministry, wait times for hip replacements dropped to 13 weeks from almost 17 weeks. People who needed knee replacements waited an average of 20 weeks, down from 25 weeks a year after a centralized program was introduced.
Martin, a family doctor, said more team-based primary care practices across Canada are dealing better with chronic conditions such as diabetes, high blood pressure and emphysema so patients don't end up in hospital and create longer wait lists.
Team-based care allows people to see doctors who work with nurses, pharmacists and other health-care providers and get access to after-hours and weekend care so they don't clog emergency departments, Martin said.
Her group, formed about a year ago, is trying to educate doctors and patients about the perils of the British funding model that Day is advocating, she said.
In the fall, the group will roll out a national physician education program with a series of presentations on health-care reform in Canada and other countries, Martin said.
While wait lists are a problem in Canada, as in many other countries, Day's funding prescription won't be a cure-all based on Britain's experience, she said.
"If we're looking at reforming our system, why would we move towards what appears to look like a failed experiment from another country?"
