First orthopedic surgeon voted CMA president-elect calls for health care reform

The director of Canada’s first private hospital wants shorter wait lists, looks for alternatives.

The appointment of Brian Day, FRCS, as president-elect of the Canadian Medical Association stands out for two reasons: He is the first orthopedic surgeon to hold the post, and he founded the first private hospital in Canada.

Day, a former president of the Arthroscopy Association of North America, has long been an outspoken advocate for reform. He will become president-elect of the Canadian Medical Association (CMA) in August and is expected to assume presidency of the association in 2007.

Brian Day, FRCS [photo]
Brian Day

Day’s new position parallels a shift in public opinion regarding Canada’s government-funded Medicare system. In a recent CMA discussion paper, a poll of 1000 citizens revealed that 74% of respondents preferred some degree of private insurance, according to a CMA news release.

The country’s long waiting lists for orthopedic procedures have also put its universal health care system in the spotlight. And last year, Canada’s Supreme Court ruled in favor of a patient who sued Quebec regarding a long-awaited hip procedure.

“I think that I’ve never been someone to accept the status quo when it’s wrong,” Day told Orthopedics Today. “I mean that this is a system that our own Supreme Court in Canada has announced is unconstitutional in terms of the act that it allows patients to suffer and die on wait lists.”

Day’s push for an alternative system gained national attention when he opened the country’s first private hospital — the Cambie Surgery Centre in Vancouver, British Columbia — over a decade ago. The Liverpool native said he established the center partly in response to the limited operating room times and rationed medical services created by public-funded health care. “I think what that lead to was a political exposé and a political profile ... [showing] that the Canadian medical system ... has been deteriorating during the last 15 or 20 years,” Day said.

He also said that the public system has failed to fulfill its founding principles of universality, comprehensiveness, accessibility, portability and public administration.

“None of the first four [principles] are being kept right now,” he said. “So the government is not providing universal or comprehensive health care. The system is not portable. For example, from Quebec to British Columbia, you may not be covered, and clearly with long wait lists it's not an accessible system.”

Despite his criticisms, Day supports a mix of private and public health care.

“I’m not in favor of a fully private delivery or funding system,” he said. “But I’m against a public monopoly-type system, which is what we have now in terms of the physician services and hospital services.”

A system including 5% to 10% of private care would provide adequate competition to the government-funded structure, he noted.

During his term, Day’s main focus will on trying to eliminate Canada’s excessive waiting times for patients to receive necessary health care. “And I think it can be done, but the medical system needs to undergo significant reform,” he said.

Day noted that the World Health Organization’s World Health Report 2000 ranked Canada as 30th for overall health care performance.

“We need to look at the way health care is delivered in other countries that do not have patients suffering on wait lists,” he said, adding that reform measures should consider strategies used in higher ranked countries with universal health care, such as Austria and Switzerland.

“Political inertia”

However, “political inertia” may be the greatest challenge to instituting reform. Currently, Canadian provinces spend nearly 50% of their budget on health care, and experts estimate health care costs will consume Ontario’s entire budget by 2018, Day said.

“Clearly that cannot happen, but the politicians have shown inertia in their efforts to reform the system,” he said. “[One] of the roles that I would like to see the Canadian Medical Association take on is acting as a resource to help the government come to terms with the fact that it’s not good enough to maintain the status quo.”

Editors note: This article is taken from the June 2006 issue of Orthopedics Today, page 24.

For more information:

  • Steinbrook R. Private health care in Canada. NEJM. 2006;354:1661-1664.
  • World Health Organization World Health Reports can be accessed via the organization’s Web site: who.int.
  • Canadian Medical Association Web site: cma.ca.

The appointment of Brian Day, FRCS, as president-elect of the Canadian Medical Association stands out for two reasons: He is the first orthopedic surgeon to hold the post, and he founded the first private hospital in Canada.

Day, a former president of the Arthroscopy Association of North America, has long been an outspoken advocate for reform. He will become president-elect of the Canadian Medical Association (CMA) in August and is expected to assume presidency of the association in 2007.

Brian Day, FRCS [photo]
Brian Day

Day’s new position parallels a shift in public opinion regarding Canada’s government-funded Medicare system. In a recent CMA discussion paper, a poll of 1000 citizens revealed that 74% of respondents preferred some degree of private insurance, according to a CMA news release.

The country’s long waiting lists for orthopedic procedures have also put its universal health care system in the spotlight. And last year, Canada’s Supreme Court ruled in favor of a patient who sued Quebec regarding a long-awaited hip procedure.

“I think that I’ve never been someone to accept the status quo when it’s wrong,” Day told Orthopedics Today. “I mean that this is a system that our own Supreme Court in Canada has announced is unconstitutional in terms of the act that it allows patients to suffer and die on wait lists.”

Day’s push for an alternative system gained national attention when he opened the country’s first private hospital — the Cambie Surgery Centre in Vancouver, British Columbia — over a decade ago. The Liverpool native said he established the center partly in response to the limited operating room times and rationed medical services created by public-funded health care. “I think what that lead to was a political exposé and a political profile ... [showing] that the Canadian medical system ... has been deteriorating during the last 15 or 20 years,” Day said.

He also said that the public system has failed to fulfill its founding principles of universality, comprehensiveness, accessibility, portability and public administration.

“None of the first four [principles] are being kept right now,” he said. “So the government is not providing universal or comprehensive health care. The system is not portable. For example, from Quebec to British Columbia, you may not be covered, and clearly with long wait lists it's not an accessible system.”

Despite his criticisms, Day supports a mix of private and public health care.

“I’m not in favor of a fully private delivery or funding system,” he said. “But I’m against a public monopoly-type system, which is what we have now in terms of the physician services and hospital services.”

A system including 5% to 10% of private care would provide adequate competition to the government-funded structure, he noted.

During his term, Day’s main focus will on trying to eliminate Canada’s excessive waiting times for patients to receive necessary health care. “And I think it can be done, but the medical system needs to undergo significant reform,” he said.

Day noted that the World Health Organization’s World Health Report 2000 ranked Canada as 30th for overall health care performance.

“We need to look at the way health care is delivered in other countries that do not have patients suffering on wait lists,” he said, adding that reform measures should consider strategies used in higher ranked countries with universal health care, such as Austria and Switzerland.

“Political inertia”

However, “political inertia” may be the greatest challenge to instituting reform. Currently, Canadian provinces spend nearly 50% of their budget on health care, and experts estimate health care costs will consume Ontario’s entire budget by 2018, Day said.

“Clearly that cannot happen, but the politicians have shown inertia in their efforts to reform the system,” he said. “[One] of the roles that I would like to see the Canadian Medical Association take on is acting as a resource to help the government come to terms with the fact that it’s not good enough to maintain the status quo.”

Editors note: This article is taken from the June 2006 issue of Orthopedics Today, page 24.

For more information:

  • Steinbrook R. Private health care in Canada. NEJM. 2006;354:1661-1664.
  • World Health Organization World Health Reports can be accessed via the organization’s Web site: who.int.
  • Canadian Medical Association Web site: cma.ca.