Tuesday, April 10, 2007

Told ya so.

The Star has an article today (here) which confirms what I blogged about yesterday vis-a-vis the False Creek clinic. Namely that once for-profit clinics are allowed to offer more money to physicians, those physicians will, more often than not, take the bait and leave their current jurisdiction. The Star describes the same phenomenon happening across the Canada-US border (not to our favour, shockingly). How can it possibly be a good thing to have the same thing happening across the inter-provincial borders?

2 comments:

undergroundman said...

Because otherwise these physicians might leave the profession altogether?

Let physicians earn their market wage.

Lately I've been persuaded that much of the healthcare crisis is caused by the price illusion and overconsumption of over-covering people. When people think healthcare is free, people overconsume. I still like the idea of the HSA, which makes it easier to target the poor if you want to subsidize healthcare while forcing the rich to pay. It has better incentives.

If I was a doctor in Canada and I had any skill, no doubt I would move to the United States.

ADHR said...

That first sentence made me laugh. They go through four years of med school and their residency and then they're going to quit? Come on.

As for "market wage", physicians already earn that. The fact that the wage is set in Canada by the provinces is neither here nor there. What gets unfair is the poaching of physicians by rich (or urban) jurisdictions from poor (or rural) ones, as that deprives those who can't compete for physician services. Which means that the poor and rural -- and, if we allow it to happen across international borders, non-American -- end up with substandard healthcare services. It's one thing if we're talking about widget production, but healthcare's just a tish bit more fundamental than that.

I'm not convinced that people overconsume healthcare. If anything, I think they underconsume: they tend to wait until they feel sick, which means treatment has to be more interventionist, which costs more. If people consumed more healthcare services, then the focus could be on preventative medicine, which tends to be cheaper.

HSAs, as I believe I've said already somewheres, assume that people can calculate in advance what their healthcare consumption is likely to be, within some margin of error. I'm not opposed to the idea of making people pay for a service out-of-pocket if they really didn't need it (e.g., people who go to emerg for colds instead of taking over-the-counter Sudafed), but I am opposed to the idea that people are sufficiently rational to foresee what healthcare costs they're going to need to bear in the future. If they guess wrong, then someone else has to pick up the tab anyway, so why not just pick it up from the get-go?

And yet, not all do. Indeed, some go to the US for training, and come back to practice in Canada. Why d'you suppose that is?