Cynthia Busuttil
Family doctor visits 'should be free'
Canadian physician Helen Batty believes the government should foot the bill for patients' visits to their GP, which, she believes, would strengthen the primary healthcare system. Photo: Darrin Zammit Lupi
A Canadian family medicine specialist believes it is a mistake for patients to have to pay for their GP visits and argues that their fees should be footed by the government.
Helen Batty, a family doctor and professor at the University of Toronto, strongly believes retaining the present system, whereby patients pay out of pocket for GP visits, will weaken the revolutionary reform of primary healthcare being pushed by the government.
"People who need to go to the doctor are usually the poorest and the sickest. I think you will lose some of the strength of the system if they have to pay to see their family doctor," she said during a short visit to oversee medical students' exams.
When questioned about this, Health Parliamentary Secretary Joe Cassar said doctors did not want to become government employees.
"They do not want to be paid by the government for the service. They shot it down in 1987 and they will shoot it down now," he said.
Last month, the government launched a consultation on the much-awaited reform that gives more powers to family doctors and pivots around a system in which patients will register with a GP. Registration will be free but patients will continue to pay for visits, although there will be a means-tested mechanism to identify those who cannot afford to pay.
Moreover, the 49-page reform document proposed that people with chronic diseases, who go to health centres for follow-up care and repeat prescriptions, would be able to obtain this service from their family doctor, with the visit subsidised by the government.
Prof. Batty believes the government should pay for everyone's GP visits, a system that has been in place in Canada for four decades.
Her reasoning is based on international research, which found that a strong primary health system reduces the need for hospital admissions and cuts healthcare costs.
In fact, the local consultation document pointed out that studies have shown primary care improves the health outcomes of a population and contributes towards the long-term sustainability of healthcare provision.
Prof. Batty believes results will start being seen after five years. "If you put more money in primary care, the hospital expenditure will go down because people will not go unnecessarily and won't stay longer than they need to," she said, adding that a strong community care system was also important.
The physician highlighted the importance of building a strong doctor-patient relationship, which is possible through the registration system that exists in Canada.
"We know the healthcare outcomes are much better when there is a strong relationship between the patient and the doctor," she said, adding that family doctors see patients as a whole person.
She explained that in patients with multiple conditions, the treatment for one disease might exacerbate another.
But a family doctor could find a tailor-made programme for the patients, leading to a better outcome.
She emphasised the importance of round-the-clock coverage by family doctors, a system that operates in Canada and is included in the local reform.
"A lot of small things can be solved through a five-minute phone call in the middle of the night, which avoids a visit to the emergency room," she said.
Prof. Batty believes healthcare protocols should not be set by bureaucrats but by the doctors themselves.
"As a professional, I feel the government should trust me. If I say that a patient needs a particular test, it is because I believe it is necessary and am willing to defend the decision," she said.
In Canada, the government foots the bill of such investigations, although patients pay for medications, mostly through insurance.
The local reform recommends that part-time doctors or those working reduced hours will only be able to work within the system as part of a group practice.
Prof. Batty believes part-time doctors should not be discouraged from being part of the registration system, even because they might want to have reduced hours temporarily. She stressed that family doctors were highly specialised and it would be a pity to have a number not included in the system because they could not work full-time.
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16 Comments
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J. Debono
Jan 27th 2010, 20:56
I did not comment on whether a GP should be paid by the government or not for his home visits.
I commented on the reason why CURRENTLY, GPs do not want to work for the government.
If any of you have read the reform, the Government has no intention of ever paying a GP to do a home visit!
How come Dr. Joe Cassar knows that GPs will shoot down such a proposal?
By comparing the situation with 1987!!!! Whom is he kidding.
If and when he offers it, then we'll discuss whether GPs want it or not,
Of course all of us people will be in favour.
emanuel miggiani
Jan 27th 2010, 20:15
E.Miggiani @M.Formosa. If I had not been living in Canada for 43 years I might think your comments about Canada`s free and best heathcare system in the world are valid. Why don`nt you repatriate to Malta and stay there till you`ll need a doctor, or needing any serious operation ? Then you may end up like most in Malta, where eighter you wait for many months, even years for your turn to have your operation (unless you die by then) or you will have no choice but to go to a private hospital where you end up forking a lot of money, instead of having it done for free, like we do here in Canada!!l
Kevin Zammit
Jan 27th 2010, 19:37
@W Galea
In Canada there is no such thing as private healthcare except for dentistry, eye, ear and I am almost sure chiropody. These are all excluded as far as I know from Canada's free health care. Which means those that mostly target the old. I used to find that quite hypocritical in fact because to me it was blatantly obvious that the conservative government of Mike Harris was targeting the old NDP supporters not his young and middle class supporters. BTW this is the same guy who in my mind and that of others thanks to his irresponsible cutbacks and privatisation caused the death and injury of some 200 people in Walkerton through ecoli infected tap water.
What profs Batty does not realise is that as was stated polyclinics are free and 24 hours (in Canada all doctors are 9 to 5 anyway and you only get 10 - 15 days vacation!) and since it is small less than the size of the GTA that means more within reach free clinics within reach than even Canada. As well due to its size a faily doctor would chare me 15 euros but not a hard up family or single mother
C.Scerri@M Formosa
Jan 27th 2010, 19:31
Finally, right from the horses mouth - this shouls shut up all those that complain on our health system, which is far from perfect, but at least it functions pretty well!
Thanks Mr Formosa for this info.
Galea. L
Jan 27th 2010, 19:13
C.Scerri
Nowhere did I hit the professionals below the belt. In fact it is the contrary because I said that they do not want to join the scheme because God only knows when they will be paid by our incompetent government. And having a "free" health service is the best one can get whether it is from a socialist perspective or not. And by the way it is NOT "free" because we pay it through our taxes and VAT has been increased by a massive 20% to make good for the MDH and the health services.
C.Scerri@J.Galea and some of the rest
Jan 27th 2010, 17:49
And now they do not have enough GP's to take care of their "excellent" primary care! Most of the Canadian GP's are working across border in the US where the fees are higher. This is a real risk in Malta - becoming a Family Practitioner is a free choice, no one can force any MD to take sucha speciality and neither can anyone stop them from searching for greener pastures abroad.
Please stop this socialist trend of hitting such professionals below th belt - you shoudl thank God or whtever you believe in, that there are still persons ready to sacrifice theri life to help others. Today, contrary to aroun 30 years ago, the choice in University degrees is vast and with excellent opportunities to work both in Malta and abroad.
M Formosa
Jan 27th 2010, 17:45
From what I can remember, you can visit a doctor at any policlinic in Malta FREE. It is an individual choice whether one wants to use the government FREE health system or go private. I live in Canada and for me to see a specialist it takes months. Nobody cares if you are in pain everyday of your life, you just have to wait because you cannot pay a specialist and see him or her earlier. You are at the mercy of the Canadian health system. My latest visit to a hospital here in Toronto I had to wait over 14 hours until I gave up and went back home bleeding and in agony, nobody cares. So before Dr Patty judges the Maltese health system she should look long and hard at the system in her own country.
Joseph Galea
Jan 27th 2010, 14:22
@J. Debono: In Canada's system GPs 'do not work for Government' - they continue to operate their private practices. The difference is that they bill Government for their patient's visits. The reason why GPs here might not want to join such a system might be perhaps because then there would be a 'standard' charge for a visit and doctors would not be able to set their own fees.
If I remember correctly, there were lots of protests by doctors in Canada when Government stopped them from charging patients an additional fee (extra billing) to top up what they received from Government. Government legislation later made extra billing illegal.
P.Cassar
Jan 27th 2010, 14:06
BUT ISN'T THIS WHAT THE PL HAS BEEN SAYING AND THE MINISTER NEGATING. HOW COME THAT NOW HE IS AGREEING WITH THIS INJUSTICE AND WORSE THAN THAT, TRYNING TO JUSTIFY IT IN THE MOST BIZARRE WAY.
J Pace
Jan 27th 2010, 13:36
@J. Debono
I don't think the real reason is that. If the doctors' fees had to be paid by the government rather than the patient it would mean that the doctor would have to declare every visit he makes (or else he won't get paid for it). Bye bye tax evasion! Also, the fee would probably be a fixed fee negotiated with the government.
W Galea
Jan 27th 2010, 13:05
In the article, Professor Batty has stated much more important things about the importance of a good primary care system besides who foots the bill. Yet the author focused the title on whether the visit should be free at the point of delivery.
One should note the following: 70% of primary health care contacts in Malta today are in private practice and moreover there is NO WAY you can compare the affordability of fees charged in Malta to that charged in private practice in countries like the US and Canada.
Kevin Zammit
Jan 27th 2010, 12:53
I have lived in Canada fr a number of years and while primary health care is truly excellent the cutbacks in health care and shutting down hospitals especially under the conservative premiership has placed Canadian healthcare at below levels of even Malta.
So my question is how do we know whether the reductions in costs experienced in Canada were actually due to strengthening of primary healthcare or the systematic cutbacks that were made?
As well, I'm not sure whether primary healthcare in Canada is the province's, city's or federal responsibility in which case there could be the political reasons why Canadians have actually ended up with a stronger primary care system in te first place.
C.Scerri
Jan 27th 2010, 12:49
Prof. Batty is being somewhat economical with the truth as Private GP work in Canada is allowed in parallel with a Government paid system similar to the UK NHS system - so not much different from what the present consultation document is offering. In addition Canada is facing a severe shortage of family doctors and a long waiting lists for GP service!
This is an excerpt from a report that was published a month ago:
"17 per cent of respondents do not have a family doctor. That works out to about 4.1 million Canadians aged 12 or older.
Of those who do have a family doctor, about half said they were concerned about how long it can often take to get an appointment with their family doctor. Dr. Cathy MacLean, President of The College of Family Physicians of Canada, says that finding was interesting. "
This is the link: http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20091202/docs_091202?s_name=&no_ads=
So please let us not allow people that do not know our society so well to give us advice - just as a note, remember that the Maltese Medical Service is at least 150 years older than the Canadian counterpart.
Galea.L
Jan 27th 2010, 12:36
J. Debono
You forgot that they will be paid by the Government God knows how many years after they had seen their patients. It might also be that it is not they who are paid but their heirs. Ask those who are still to receive their overpaid income tax who have been waiting to be paid back for years on end without seeing the light at the end of the tunnel.
Adrian Cardona
Jan 27th 2010, 12:00
"People who need to go to the doctor are usually the poorest and the sickest"
What kind of quote is that?! Are you saying wealthier people don't go to the doctor because they can miraculously buy their sickness away?! The sickest, Dr Batty, stay at home and call the doctor, while the poorest go to hospital or the Polyclinics.
J. Debono
Jan 27th 2010, 11:53
"When questioned about this, Health Parliamentary Secretary Joe Cassar said doctors did not want to become government employees.
"They do not want to be paid by the government for the service. They shot it down in 1987 and they will shoot it down now," he said."
Dear Dr. Joe Cassar - have you ever asked "why" GPs do not want to work with the government?
The reason is simple enough - no career progression, miserly wage, no continuation of care, no respect from authorities and even less respect from patients, to name a few.