One issue per visit: A health-care inefficiency

When you have a public health care system (as we have in Canada), it can lead to inefficiencies.Carleton University's Health and Counselling Services provides a great example of this (hat tip to my fiancée, Laura). They have a rather strange policy: "Only one issue per visit will be addressed."

Let's say I have two issues I want to discuss with a doctor. Perhaps I'm concerned I have strep throat. Since I'm going to the doctor anyway, it would probably make sense to discuss a refill on a prescription that is expiring soon. Is it more efficient to tackle both these issues in one visit or in two separate visits?

Placebo effect of cigarettes?

Cigarette packages in Canada come with horrifying images and statistics about the damage they can cause to an individual's health. The picture below shows a graphic picture of mouth disease on a cigarette pack with a warning that cigarettes do indeed cause mouth diseases:

Une bonne idée pour la santé

The Quebec government is mulling over an excellent idea that could improve public health care: deductibles.

In Canada, medical care is free, in that you don't have to pay when you go to the doctor. Some provinces (including Quebec, starting on July 1) charge a mandatory tax specifically for health care, but it's either a flat tax or dependent on income. The difference with Quebec's proposal is that it would be based on how much an individual uses medical services.

More moral hazard

Since I'm on the topic of moral hazard, here's an interesting study from 2009 about the moral hazard of holding health insurance: it'll make you more unhealthy.

In the aptly-titled working paper Does Health Insurance Make You Fat?, Stanford's Jay Bhattacharya and three co-authors looked at results of an experiment where Americans were randomly given different levels of health insurance (or no health insurance at all). They found that people with health insurance tended to gain weight. Private insurance policies increase the average person's body mass index by 1.3 points, while public insurance increases it by 2.1 points.

Life or death economics

The health authority in Hamilton has come up with a formula to determine who gets a flu vaccine and who doesn't in the event of a shortage during a pandemic.

Health care workers, police and firefighters get vaccinated first. If there's enough left, people who caught the flu at work get it. If there is still some left over, people who care for children get next dibs. Then children and "young people" themselves. Finally, if there is still some left over, people who are most likely to survive their particular flu strain get vaccinated. Otherwise, you'll be out of luck.

According to the article in the Hamilton Spectator, the formula was developed by "front-line staff, doctors, ethicists, lawyers, human rights experts and the hospital's board."

Interestingly, it appears no economists were consulted.