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环球华报：姚永安：引入私营医疗，你真的不介意？
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姚永安：引入私营医疗，你真的不介意？
姚永安 2007-08-17 10:09 环球华报
主张引入私营医疗的市民常常说，他们不介意让愿意付钱的人插队，插队的人若果光顾私营医疗，公营的轮候名单便会缩短，令无法负担私营医疗的市民受益。
我们先不谈当中所涉及的价值、原则和平等公道等问题，我想提出的质疑是，他们真的不介意吗？如果他们知道插队的並非少数富户，而是数以十万、百万计的人时，是否依然不在意呢？
在加拿大，无论是政府公务员、大企业的雇员，还是工会工人，多数都有额外的医疗福利，因此，届时插队的除了富户，还有為数众多拥有私营医疗保险的人，剩下没有额外医疗保险福利的，一般是低收入、自雇、失业和退休人士，很多移民家庭都属於这个行列。私营的门一旦打开，市民便会自然而然分为两个等级。
谋利的私营医疗保险业將会迅速澎胀，美国公司将大举迁入开拓市场，我们的医疗体系从此便会增加另一个庞大架构。正如美国的实践一样，这个架构会吸收大量的医疗金钱资源用在行政、管理、市场推广、法律诉讼、游说政府和利润上，它亦会以本身的利益為出发点，影响政府的医疗政策，从而营造出最有利的赚钱环境。例如，私营医疗会把復杂昂贵的治疗留给公营医院，又或许寻求利用公营医院的设施进行私营手术和治疗。
私营医疗还会对公营的医疗体系造成重大压力。首先，它会吸纳大批医疗人员，令现时已经人手不足的情况更加严重；第二，為了爭取医疗人员投身私营，它会提供比公营更优厚的薪酬。在只有公营的制度下，政府可以利用本身的能力决定和控制医疗人员的薪酬，但在公私并营的情况下，政府將丧失这项能力。医疗人员的薪酬大幅增加，政府只有两种选择，要么大幅增加医疗开支，要么削减服务，结果是医疗人才流失、服务质量下降，重新调整的混乱再加低落的士气，公营医疗将面临整体水平下滑的局面。
加拿大的公营医疗体制是人人平等价值的基石，是人民的基本权利，也是我们重要的商业竞爭力，它令企业员工的医疗开支费用比美国低得多，《时代周刊》最近便有专题报导，指出沉重的医疗负担让美国的车厂陷於困境。GM车厂是美国购买医疗保险最多的企业，现时该公司的每1名工人要支持3位退休员工，GM的生意估值是180亿美元，但该公司用于员工退休福利（包括医疗）的款项却是1000亿美元。可以肯定，私营医疗的引入必然会大大增加卑诗省的商业成本。
全民医疗保健曾经是加拿大人的梦想（今天也是美国和中国人民的梦想），当年道格拉斯（Tommy Douglas）要在沙省推行全民医疗保健制度，受到北美洲医生的联手对抗，经歷了超过一个月的全省医生大罢工，最后才获得胜利。沙省的成功经验，后来被引用到全国推行。如今，加拿大医学会重新要求引入私营医疗，从医生的角度来看，引入私营医疗有助于提升他们的收入，但对于广大市民来说又有甚麼好处呢？
在美国，有四成人的破產因医疗费用所致。这个全球最富裕的国家，花费14%GDP在医疗上，却有4700万市民没有医疗保健（加拿大是9%GDP），难道我们真要打开大门引入美式医疗体制吗？
与文章作者共同商榷以下这个论点,
"在只有公营的制度下，政府可以利用本身的能力决定和控制医疗人员的薪酬，但在公私并营的情况下，政府將丧失这项能力。"
举个例子,
Dear Mr. Don Slinger,
You sound like a man of action, so this letter is coming to you. If that's not your department, I'm sure you will send it to the right place.
Enclosed is a copy of a letter received from my doctor. He explains why he is leaving his practice. I felt the well-put reasons might be useful when confronting the government.
This is the THIRD doctor we have lost in about the last 12 to 15 years. Kitchener/Waterloo Ontario needs more doctors and specialists. Here's hoping the CSA can do as good a job in this area as they have in others.
We have been members for many years. Whenever I read the CSANews, my admiration soars for all the workers and negotiators.
Thank you for the good work. Being a very private person, I would appreciate remaining anonymous.
The reason for this letter is to further the cause for more good doctors in Ontario and all of Canada.
Letter from Physician
Dear Patients,
I am writing this letter to you to inform you of my decision to leave the practice of family medicine as of February 28, 2005. I announce this with little regret as this decision has been two years in the making. I can no longer practice medicine the way I was taught or would like to without suffering financial hardship. I have searched long and hard for reasons to be optimistic, that the working environment for family physicians in Ontario would improve, and have come up empty. There are many reasons why I am leaving family medicine and I will share some of them with you.
Poor Compensation – The average visit to your family physician pays your doctor only $17.30 - $28.50. A full annual physical earns your doctor $54.10. The fee paid to your doctor for counseling or psychotherapy is $50.45 per half hour of time. Many forms I have to do for free or am paid very poorly as per government regulations. To pay for rent, staffing and supplies costs me over $70 per hour. I do not have any health benefits, paid vacation or pension. What OHIP pays me to look after your medical care does not come close to what I should be receiving given my 11 years of university education, my work responsibilities and workload/complexity.
Government Control – Doctors are not protected by the Labour Relations Act and are not permitted to strike. In addition, we do not have access to binding arbitration in the event of an impasse in negotiations with the government. OHIP rigidly controls how much doctors are paid for their insured services, a situation not encountered by any other independent health care in this province. Dentists and veterinarians charge whatever the market will bear. Even chiropractors, when they were covered by OHIP, were allowed to charge extra fees to their patients.
Lack of time for my family – For most of the last 3 1/2 years I have worked 6 to 7 days per week. I have had one week off in that period and that was the week that my son was born. I spend at least two hours per night on paperwork and, at least twice per week, am up into the morning filling out or writing numerous government, insurance and legal forms and letters. The time that I have devoted to my career has left me worn out and has greatly impacted my role as a father and husband.
Access to Diagnostic Tests – Many times per day I deal with patients who need very quick access to ultrasounds, CT scans, MRIs or other tests in order to make a diagnosis and proceed with proper treatment. These patients often suffer physically, emotionally and financially while their conditions do not improve or continue to worsen. I witness their anguish and sometimes proper treatment is delayed while awaiting necessary tests.
Access to Specialist Care – There is a significant shortage of many specialists in Ontario that is not just limited to our community. This results in long waiting lists for referrals, often after a long wait for a diagnostic test. Even if I have made the diagnosis, often patients require specialist care that I cannot get them timely access to. The result is that I see these frustrated patients back in my office often and can bring little relief to their symptoms.
Family physicians are leaving their practices, retiring or moving out of province in growing numbers. In addition, fewer students are choosing to train as family doctors and those that do are increasingly not setting up family practices. For the last five years, I have been working in a deteriorating system that is not of my making, nor my responsibility. It is not my job to fix the system or subsidize it with my low fees and income.
Thank you for your kudos and your support. It would appear that the health-care crisis in Canada, let alone Ontario, is far from over. Lack of funding and support coupled with the bureaucracy that physicians have to endure in order to get paid is compounded further by the "brain drain" of opportunity just south of our border.
If our government would simply allow doctors to do what they are trained to do, help people and save lives, then perhaps the issue of being under-funded for services would be that much less of a burden on them.
As our population ages the demand for well trained experienced doctors will multiply exponentially. Currently 47% of our Canadian health-care budget is absorbed by persons over the age of 65. As the boomers age we will need more doctors and more funding in order to maintain the Canadian way of life that was envisioned when our national medicare program was created. It is obvious that we are not starting off on the right foot, and action to remedy the problem must be taken now!
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http://www.snowbirds.org/csanews/issues/54/8.html
从这个例子上可以让我们看出政府尽管有"能力"去决定和控制医疗人员的薪酬. 但政府却好象对这个问题的出现束手无策! 长此以往, 这个被很多人所看好和喜爱的医疗系统也就将无法正常运作了. 不知文章作者以为如何? |
狗仔卡
发表于 2007-8-18 23:28:36
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