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What Exactly Is Meant
by Two-Tiered Medicine?

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 18 in the January 17-18, 2004 issue of
The Mississauga News under the feature: Health & Wellness, Doctor's Corner.
Dr Peter W Kujtan portrait

There is nothing more confusing to me than people making references to two tiers in health care. I am totally confounded by this term and it seems to only apply to MRI machines, ignoring the other 99% of medicine. The provision of health care in Canada already occurs on at least seven different tiers that I can think of. We tend to console ourselves in the belief of our socialized system. We even have a national set of laws termed "The Canada Health Act" that was meant to guarantee the same medical care to all Canadians. It was well intentioned when enacted, but with time, we overwhelmed our ability to provide state of the art medicine and the price of advanced technology was too great to provide for all. No matter how wealthy or poor, Canadians all get the same level of care. Or do we?

In Ontario, most residents are covered by a provincial insurance plan called OHIP - Ontario Health Insurance Plan. It pays bargain basement prices for the provision of certain defined services, but does not guarantee access to the services or the latest technology. If you are living here as a tourist, you can purchase quicker access or deluxe versions of these services which, by law, Ontario residents cannot. But that is not totally true either. Some services such as physiotherapy are OHIP covered, but you can also privately purchase them and avoid the wait. Are we on the same confusion level yet? Those who are covered under OHIP, but wish enhanced services or quicker access and have the dollars to spend, travel. More than 80 percent of us live in close driving distance to the USA, where medical services can be easily accessed and purchased at market prices. There is also a sub-class of Ontario citizens whose employers finance private insurance plans that provide many services not otherwise obtainable. Then there is the federal level. The Canadian federal system has its own separate medical system and hospitals. It provides care to federal employees and native people alike, but not to the rest of Canadians.

And there are yet other tiers that we should not forget. When a system cannot provide acceptable levels of service and the latest technologies, the resourceful find other ways to cope. Rumors of bribery and underground enhancements to gain timely access to services have begun to appear. In immensely complex systems where the individual feels that they have no control, cannot find administrators to hear and act upon their concerns, fear takes over and they opt out completely. And this too is a tier. People turn to alternative methods in the hopes of finding cures while maintaining a semblance of independence and control.

In the end, I am still a believer of socialized medicine. It is nice to know that I can treat patients without having to measure the thickness of their wallet. But I also accept the reality that treatment occurs on many different tiers, and to make decisions believing that we all exist on a single tier is indeed naive. It is most ironic that a federal law meant to give us all equal access to the best of care, now ensures that we all have access to the same level of shrinking resources and no more! Reducing the system to two tiers would be nice, but I cannot see it happening any time soon.

See also:

Two-tier health care from Wikipedia, the free encyclopedia.
Canada Considers a Two-Tiered Health Care System
Knee-Jerk Rejection of "Two-Tiered Health Care" Serves Canadians Ill
Less Health Insurance and Better Health Care: Two-Tiered Health Benefits Models - Watch the Event in Real Video (1 hr. 25 min.) from Cato Institute, Washington, DC.
Risks in a two tiered health system - from CHOICE: magazine of the Australian Consumers Association
"Canadians' Thoughts on Their Health Care System: Preserving the Canadian Model through Innovation" - A Review of Public Opinion - from Commission on the Future of Health Care in Canada.

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