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A new study on patient empowerment in 31 European countries has found that there are great disparities in how healthcare consumers are treated among the different countries, in areas ranging from access to test results and specialists’ opinions to the frequency of under-the-table payment for medical care.
Why is this study of interest to Canadians? Because, from a Canadian perspective, what is most noticeable is a lack of a similar study of our own provincial healthcare systems.
Undertaken by Europe’s Health Consumer Powerhouse, a Brussels-based think tank dedicated to measuring healthcare quality from the perspective of the patient, the report finds that the patient empowerment movement in Europe, while far ahead of that in Canada, still has much work ahead of it.
For example, while a number of European states, unlike Canada, have patients’ rights laws, these laws aren’t always honoured within the medical profession. Cultural barriers against full participation of patients in their own care mean that, even where patients are entitled to a service or to information, they don’t always receive it. A true partnership between healthcare providers and consumers would make healthcare more effective and equitable and, while this is the explicit goal of many European governments, it hasn’t yet been achieved.
The study places Denmark at the top of the list for empowering patients within its medical system. Danish patients are guaranteed access to their own medical files, and also to a second opinion from a specialist, and these rights are enjoyed by most other European residents.
In Canada, by contrast, while patients are free to request a second opinion, the likelihood of gaining access to a second specialist is slim, especially considering the wait associated with specialist appointments nationwide even for a first opinion. And while Canadians have the legal right to view their own files, ownership of the documents remains with the doctor, who often charge a fee for providing a patient with access to his or her own medical record.
Other dimensions of patient empowerment studied are totally foreign to the Canadian medical system. Letters from specialists, for example, are forwarded to patients most or all of the time in much of Europe, a practice unheard of in Canada, where doctors still have an informal monopoly on information. Similarly, many European countries have a registry of credentialed doctors, often with information about their professional histories, so that patients can make a truly informed choice about their healthcare provider. In Canada, very little comparable information is available, although preliminary work on the performance of hospitals in each province is underway.
Mobility is another major factor addressed in the study, and again, the differences between Europe and Canada are distressing. In Europe, patients have a high degree of choice of doctor within their own countries, and many states allow patients to travel within the EU to receive medical treatment. In Canada, by contrast, choice within a particular health region is constrained by short supply and, when it comes to elective and preventative medical care, Canadians have no mobility between regions or provinces.
While portable healthcare means that those who relocate to a different province will not be denied care, out-of-province patients are usually asked to pay up front and then request reimbursement from their home province. Permitting Canadians to choose between different specialists and family doctors in their own region, those in a different region, or even in a different province, would be a revolutionary change. It would empower Canadians to take charge of their own health, while also exposing our healthcare infrastructure to some long overdue market pressures, all within the constraints of a public system.
Canadians tend to dwell on how healthcare is financed, rather than on how it is structured and oriented, and how well it serves us. It’s certainly the case that informal payments, in which patients give extra money directly to a doctor for faster or better care, virtually never occur in Canada, whereas they take place frequently or occasionally in much of southern and eastern Europe. The European study also considers co-payments to be a sign of patient empowerment, while most Canadians would see them as a sign of inaccessibility and inequity, rather than a positive feature of healthcare. But analysts who dwell on only the financial aspect of healthcare are missing the broader picture.
For centuries doctors have understood that the first step to solving a problem is to diagnose it correctly. There is no question that many of the problems in Canada’s healthcare system are cultural – we have a healthcare culture that gives bureaucrats and doctors vast authority over decision-making and information, and very little to the Canadians who rely upon the system as patients and fund it as taxpayers. Until we start asking questions about patient empowerment in Canada, as the Health Consumer Powerhouse does in Europe, we won’t know how sick our healthcare system really is, let alone how to fix it.