Attorney-General David Eby promoting two-tier medicine, something NDP normally opposes

By on 02/05/2019

Dr. Stephen Wiseman

Much has been said about ICBC’s new payment caps for so-called “minor injuries,” and the recent withdrawal of settlement offers that many believe will increase litigation costs across the board. As a physician, I was surprised recently by another related change — when in my annual college renewal form I was asked if I wanted to become a “Registered Care Advisor” for ICBC.

An RCA provides rapid second opinions to doctors who are unable to make a clear diagnosis or whose injured patients are facing delays or complications. An RCA must have competence in musculoskeletal injuries, acute and chronic pain and/or mental health and other psychosocial issues. The idea is that a patient is referred to a chosen RCA within 90 days of the accident and must be seen within 15 days.

The kicker? The Insurance Corp. of B.C. will pay $380 for this expedited assessment. For perspective, an orthopedic surgeon is paid about $106 for a regular waiting-list Medical Services Plan consultation. In psychiatry, my much-longer MSP consultations pay $239.

Welcome to two-tiered medicine, NDP style.

Everyone knows that early intervention is key to a successful outcome after any injury — especially one involving pain, functional impairment and additional psychological complications such as depression or post-traumatic stress disorder. For ICBC, overall payouts and the ultimate bottom line will be helped considerably if more injured clients get rapid and accurate diagnoses and treatment.

In essence, Attorney-General David Eby has just created a rich and enhanced new tier of medicine in B.C. We now live in a province where if you fall down the stairs and receive a concussion and whiplash injury, you will languish in pain and off work on seemingly endless waiting lists. With the very same injuries in a car crash you will now be able to see a specialist with no questions asked within 15 days of your doctor’s request.

That specialist will be paid far more to see you than for seeing the next wait-listed MSP patient. There is nothing to prevent a popular and competent RCA doctor from doing dozens of expedited ICBC consultations and ignoring new MSP requests entirely. It’s certainly in that doctor’s financial interest to do so.

I believe in early intervention, so I actually like aspects of the RCA even though I’m not signing up. However, the smell of hypocrisy coming from our government is now utterly overpowering. We have Health Minister Adrian Dix doing all he can to shut down any small piece of private health care he can find in B.C. and lecturing us about “jumping the queue.”

On the other hand, we now have Eby creating a new tier of rapid-access consultation, with enhanced fees to pull doctors out of the public system. The reason? His ICBC “dumpster fire.”

So, you can jump the queue just fine if WorkSafe B.C. and now ICBC thinks investing in your health will help their bottom line. But it remains illegal, and increasingly so, if you want to invest in your own health by paying for an expedited assessment or imaging yourself. Do citizens injured at home really deserve less access to care than those injured at work or in their cars?

Well-planned, well-regulated private health-care choices operating in parallel with a robust public system don’t strip out valuable resources but offer enhanced possibilities and off-load growing pressures. Offering such choices in a sneaky, piecemeal fashion designed solely for government benefit will not lead to such success, and is fundamentally unfair. If paying for expedited care is allowed to help Eby, surely it should be allowed to help us all.

Dr. Stephen Wiseman is a psychiatrist who does both MSP and private work in Vancouver.