feature The Current Fiscal Crisis An opportunity for chiropractic he economies of western nations continue to be characterized by debt, deficits and desperate solutions. Most of them now have the worst levels of unemploy-ment since the Great Depression. With low growth rates, the prospect of rapid change is nil to small. Most nations are looking to monetary solutions, where more money is being printed to lend cover for past and current spending. This grim economic and fiscal picture may hold unprecedented opportunities for chi-ropractic. Why? A renewed emphasis on cost-cutting and cost-effectiveness has already begun and the profession is perfectly equipped to respond to this. Almost everywhere, the current fiscal crisis threatens health-care programs and insur-ance (especially public) plans. Governments can no longer simply throw more money in the health-care pot, and appease the monopolies heretofore retained by such powers as medical doctors, dentists and pharmaceutical corporations. Up to now, governments have all but cowered before these groups, and thus were reluctant to make substantive health-care reforms – indeed the more significant the reforms, the more reluctant they have been – pushing marginally important reforms merely as window dressing. Worse, they undertook counterproductive reforms such as cutting chiropractic coverage and benefits from their insurance plans. Accountability for this activity has not been required – governments are not required to show that such cuts were sensible and worthwhile. Both Canada and the United States are engaged in addressing their economies and funding schemes for health care. Canada is currently engaged through the provincial-federal discussions and is likely to alter the Canada Health Act. (The resulting document will become the “2014 Canada Health Accord”). The United States continues its legis-lative battles intended to provide various levels of insurance for uninsured Americans. Whether we examine the 2014 Canadian accord, or the eventual U.S. legislation reform, we find that both simply increase the supply of money being spent on existing health-care strategies – whether this results in something like the quantitative easing of past mistakes through bailouts remains to be seen. We think not and expect better. Both countries now seem to recognize that an efficient heath-care system is integral to their economic success in a highly globalized and competitive world economy. Chiropractic represents a major opportunity for provinces and states alike to reduce a major contributor to growing annual government budgets. These are primarily provin-cial budgets in Canada but both federal and state budgets in the United States. But, since all governments are facing dire fiscal stress, we need to aim at influencing both levels of government, granted with a more concerted focus on provincial governments because they feel the rising health-care expenditures more acutely and immediately than does the federal government. We do not detail here what our case can be based on, since this is well known and has been repeated many times and in various venues and sources. It is sufficient to say there is abundant evidence in favour of pushing for reform that involves chiropractic. Dr. Pran Manga is presently a pro-fessor in the Telfer School of Man-agement at the University of Ot-tawa. He is the author or co-author of many articles, monographs and books on health economics, health policy and bioethics. He has held senior positions with both the fed-eral and the Ontario governments, and has contributed to several Roy-al or similar commissions of inquiry. T Pran Manga, PhD, M. Phil. Dr. Don Nixdorf has been the ex-ecutive director of the BCCA since 1985, was BCCA and BCCC presi-dent from1982-1985, governor and secretary-treasurer of the CCA from 1987 to 1989 and served as chair of the Commission on Chiro-practic Education (Canada) from 1994 until 1999. From 1982-1991 he was staff chiropractor/consul-tant to the Workers’ Compensa-tion Board of B.C. and has been a participant in National E-Claims Standards since 2001. He is a for-mer committee member of the BC government Health information Standards Council. Dr. Nixdorf is also co-author of Squandering Bil-lions: Health Care in Canada, which analyzes the causes of the crisis in health care and strategies for its survival. He can be contacted at [email protected] EXTENDING PRIMARY HEALTH-CARE DESIGNATIONS We do think it is time to stress that we can relieve the burden on the system by being recognized and utilized as primary health-caregivers. Shifting a cohort of patients from medical doctors to chiropractors will yield the health benefits documented in the extant studies, while immediately increasing the supply of medical doctors available to address other health-care needs and having a major effect on wait times for care. Indeed, and similarly, freeing up medical doctors may also be attained by allowing a greater scope of practice for nurse practitioners – both initiatives have massive and immediate payoffs. However, the truth is the system cannot be reformed significantly unless we, as a society, get away from the anachronistic notions that support mainstream medicine’s dominant hold on the health-care turf, and its role as the sole gatekeeper. The authors suggest that increasing the numbers of groups considered as primary health-caregivers is a truly www.canadianchiropractor.ca Don Nixdorf, DC 14 • CANADiAN CHiROPRACTOR | FEBRUARY 2011
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