Thursday, August 02, 2007

Double Dipping: Wrong With Chips, Wrong With Doctors

Clement takes cautious--but necessary--stand on "double dipping"

Any voters swayed in past elections by an alleged "Conservative hidden agenda" on health care should probably be scratching their heads today, wondering, "what was the fuss about?"

On 30 July, the Canadian Medical Association released a policy paper suggesting that allowing physicians to work simultaneously in the private and public systems--a practice commonly referred to as "double dipping"--would help to reduce wait-times by acting as a "safety valve".

Today, Conservative Health Minister Tony Clement replied, "no dice."

"Any collection of doctors are entitled to their opinion and there are many things we agree with them on, but on the issue of physicians having a dual practice or two-tier system, we're not going down that road," Clement said.

Clement admitted that "double dipping" is good for doctors financially, "It's quite lucrative for physicians to be partially in and partially out because they can in effect top up a guaranteed income with a private income as well."

According to Canadian Healthcare Coalition coordinator Michael McBane, it's not so good for public health care. "If we allowed doctors to have a dual practice, there would be no incentive for them to fix the public system."

"That's a conflict of interest," he added.

The entire matter really underscores the primary dilemma of parallel-system health care delivery: how to ensure that quality of care in the public system remains on par with that of the private system. Allowing doctors to "double dip" would allow them to devote a disproportionate amount of their time toward their private practice, while only using their public practice when the private practice is slow.

It quickly becomes clear that any attempt at building a parallel-delivered health care system would have to be heavily regulated. However, regulation essentially requires bureaucrats, and that's something Canadian health care could stand to have fewer of.

There is also an ethical bridge to be crossed for "double dipping" doctors. Less scrupulous doctors could potentially defraud the public system by billing it for work already performed and paid for through the private system. While most doctors wouldn't do this, some are bound to give in to temptation, and the last thing the Canadian health care system needs is another serious scandal.

Until a satisfactory regulatory framework can be discussed and drawn up, "double dipping" is probably best left as something looked down upon at parties.


  1. Anonymous7:13 AM

    I agree with Clement on this. Now if he could only do something about what is already happening in Quebec with regards to doctors...

    We already have that "double dipping" system in many areas and the care does suffer...

  2. The Canada Health act does allow for private care. Doctors should have the right to choose whether or not they will practice in the private or public systems, but to allow them to waver back and forth is risky.

    Truth be told, I've been thinking about parallel delivery systems, and the only one that I can think of that seems like it should be safe is one in which the government still retains ownership of facilities, still employs the personell, but contracts out the management of a limited number of hospitals to private firms, then strictly regulates and monitors them to ensure that care doesn't suffer.

  3. So much for the "Tory's hidden agenda." However, one thing that struck me about the CTV story was this: Grinspun said she wished Clement would be equally forceful in responding to private clinics which she said continue to proliferate in Canada, offering medically necessary services such as diagnostic imaging. Grinspun makes a very good point, though I wonder where she and her ideological soulmates are when it comes to private, for profit, abortion clinics. Since abortion is legal, then shouldn't the same standard be applied to that procedure?

  4. If doctors want to choose to work privately, they have that right.

    We can either allow them to do it here, or they'll emmigrate to places where they can.

    Should they choose to practice privately, they aren't allowed to practice in the public system. That's how it should be.


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