Area Doctors are Opting Out of Medicare!

[lmam88]

I just saw this on the headlines on KXAN. I wonder how long it is going to take for our other doctors to follow her lead. Where in the world is this going to leave our seniors? That train wreck is getting closer and closer...
http://www.kxan.com/dpp/health/local-doctors-opt-out-of-medicare

[tarheel]

I was in to my doctor a month ago, for a routine physical. He told me there is no way they can afford to treat Medicare patients. He further said that they haven't received any money due from them since January.

Along the same vein, for those who were thinking how great the medical care is in Canada, look here now that the bill is coming due.

Soaring costs force Canada to reassess health model | View Original Page (http://news.yahoo.com/s/nm/20100531/hl_nm/us_health_3)
TORONTO (Reuters) – Pressured by an aging population and the need to rein in budget deficits, Canada's provinces are taking tough measures to curb healthcare costs, a trend that could erode the principles of the popular state-funded system.
Ontario, Canada's most populous province, kicked off a fierce battle with drug companies and pharmacies when it said earlier this year it would halve generic drug prices and eliminate "incentive fees" to generic drug manufacturers.
British Columbia is replacing block grants to hospitals with fee-for-procedure payments and Quebec has a new flat health tax and a proposal for payments on each medical visit -- an idea that critics say is an illegal user fee.
And a few provinces are also experimenting with private funding for procedures such as hip, knee and cataract surgery.
It's likely just a start as the provinces, responsible for delivering healthcare, cope with the demands of a retiring baby-boom generation. Official figures show that senior citizens will make up 25 percent of the population by 2036.
"There's got to be some change to the status quo whether it happens in three years or 10 years," said Derek Burleton, senior economist at Toronto-Dominion Bank.
"We can't continually see health spending growing above and beyond the growth rate in the economy because, at some point, it means crowding out of all the other government services.
"At some stage we're going to hit a breaking point."
MIRROR IMAGE DEBATE
In some ways the Canadian debate is the mirror image of discussions going on in the United States.
Canada, fretting over budget strains, wants to prune its system, while the United States, worrying about an army of uninsured, aims to create a state-backed safety net.
Healthcare in Canada is delivered through a publicly funded system, which covers all "medically necessary" hospital and physician care and curbs the role of private medicine. It ate up about 40 percent of provincial budgets, or some C$183 billion ($174 billion) last year.
Spending has been rising 6 percent a year under a deal that added C$41.3 billion of federal funding over 10 years.
But that deal ends in 2013, and the federal government is unlikely to be as generous in future, especially for one-off projects.
"As Ottawa looks to repair its budget balance ... one could see these one-time allocations to specific health projects might be curtailed," said Mary Webb, senior economist at Scotia Capital.
Brian Golden, a professor at University of Toronto's Rotman School of Business, said provinces are weighing new sources of funding, including "means-testing" and moving toward evidence-based and pay-for-performance models.
"Why are we paying more or the same for cataract surgery when it costs substantially less today than it did 10 years ago? There's going to be a finer look at what we're paying for and, more importantly, what we're getting for it," he said.
Other problems include trying to control independently set salaries for top hospital executives and doctors and rein in spiraling costs for new medical technologies and drugs.
Ontario says healthcare could eat up 70 percent of its budget in 12 years, if all these costs are left unchecked.
"Our objective is to preserve the quality healthcare system we have and indeed to enhance it. But there are difficult decisions ahead and we will continue to make them," Ontario Finance Minister Dwight Duncan told Reuters.
The province has introduced legislation that ties hospital chief executive pay with the quality of patient care and says it wants to put more physicians on salary to save money.
In a report released last week, TD Bank said Ontario should consider other proposals to help cut costs, including scaling back drug coverage for affluent seniors and paying doctors according to quality and efficiency of care.
WINNERS AND LOSERS
The losers could be drug companies and pharmacies, both of which are getting increasingly nervous.
"Many of the advances in healthcare and life expectancy are due to the pharmaceutical industry so we should never demonize them," said U of T's Golden. "We need to ensure that they maintain a profitable business but our ability to make it very very profitable is constrained right now."
Scotia Capital's Webb said one cost-saving idea may be to make patients aware of how much it costs each time they visit a healthcare professional. "(The public) will use the services more wisely if they know how much it's costing," she said.
"If it's absolutely free with no information on the cost and the information of an alternative that would be have been more practical, then how can we expect the public to wisely use the service?"
But change may come slowly. Universal healthcare is central to Canada's national identity, and decisions are made as much on politics as economics.
"It's an area that Canadians don't want to see touched," said TD's Burleton. "Essentially it boils down the wishes of the population. But I think, from an economist's standpoint, we point to the fact that sometimes Canadians in the short term may not realize the cost."
($1=$1.05 Canadian)
(Reporting by Claire Sibonney; editing by Janet Guttsman and Peter Galloway)

[freedom]

The fallout from this bill is already being felt......in a bad way. I have 2 successful doctors in the family that are in private practice. They both are taking steps at shutting down their businesses. There is no way they are going to continue to work with the pay cuts that have already started and the bigger cuts headed our way.
On a side note my dermatologist is going to retire early also (10 years earlier that she planned) because she is fed up with what is happening.

Go nobama go, you are destroying our wonderful country one step at a time.

[curious]

The fallout from this bill is already being felt......in a bad way. I have 2 successful doctors in the family that are in private practice. They both are taking steps at shutting down their businesses. There is no way they are going to continue to work with the pay cuts that have already started and the bigger cuts headed our way.
On a side note my dermatologist is going to retire early also (10 years earlier that she planned) because she is fed up with what is happening.

Go nobama go, you are destroying our wonderful country one step at a time.

It is obvious BO's mission ios to "destroy the infidels" from the inside-out. America will not fall from an outside attack, rather an internal cancer. :banghead:

[lmam88]

I do know the doctor from our area that they interviewed does not except private insurance either. The "contracting" with senior citizens program that she spoke of is a joke. Seniors have PAID FOR their Meidcare benefits and should be able to use it plain a simple. They are not going to sign a form agreeing NOT to file their claims if a doc will not accept the form of insurance that they paid for especially since also under the "contract" they will be paying full price for the office visit which is around $75 min! Most Seniors are on fixed incomes and cannot afford fees like that. It is crazy! Wonder if opting out of accepting private insurance is next?

[Brian]

What we are probaly going to see more of are a type of "medical spa." Basically the doctor will take an annual amount of, I have seen $1500-2000, and that will cover all your visits in their office. This of course won't cover your big hospital needs, but the routine things would be covered in their office. The MD's then limit their patient load to around a certain amount 2-4-500 patients, depending. So they get a great income still and don't have to deal with the insurance game. I have heard most of these docs are also making house calls too.

[whiteorchid]

I saw a list in some community booklet that showed the doctors in this area and whether or not they took Medicare. I was really surprised to see how many that did.

With all the retirees and seniors in this area we're in big trouble if doctors quit taking Medicare. People are going to have to work until they die just to pay medical costs.

[BubbasGeek]

Topic should be area doctor opts out.

[pbright]

I've been going to this particular local doctor for several years. To my knowledge, in that time, she has not taken Medicare or any other insurance. I don't think this is a recent decision for her.
You go in. You pay very reasonable fees for attentive, friendly care. You pay cash. You go home.
I like it.

[curious]

Practically none of the local dentists take insurance anymore. You pay them, up front; and then, you try to recover from you insurance company.

[Brian]

I totally understand why docs would get out of the insurance game, the amount of paper work, test required, then appeals to the insurance company for denials and at times to the state insurance regulators, just to get paid. You can take care of a lot more patients without getting bogged down with all ins crap. If they can still make a living more power to them. They shouldn't have to be forced to take insurance, just because we have it. My family actually has great insurance, but we choose to go to Dr. Madrigal, just cuz she is great.
As well I had a buddy that was a dentist, everynight after work he would come home with a foot and half tall stack of files, so he could write reports for the insurance companies. He switched to all cash and actually got busier, since he had less paperwork his fees were reduced, which made him more affordable to many, plus very few dental plans are worth having anyway, same goes with eyes too in my opinion.

[lmam88]

I've been going to this particular local doctor for several years. To my knowledge, in that time, she has not taken Medicare or any other insurance. I don't think this is a recent decision for her.
You go in. You pay very reasonable fees for attentive, friendly care. You pay cash. You go home.
I like it.
She stated in the interview that she had to make changes and chose not to accept Medicare any longer. So she apparently did accept it some where along the way.

Why pay out extra money for insurance if doctors are not going to honor it? If they are going to do that then they need to come out with Hospital only policies. Not all people can afford the high office visit rates. Our ER's are going to become even more overloaded...

[lmam88]

Practically none of the local dentists take insurance anymore. You pay them, up front; and then, you try to recover from you insurance company.
Yes, another example of money wasted on insurance!

[lmam88]

I totally understand why docs would get out of the insurance game, the amount of paper work, test required, then appeals to the insurance company for denials and at times to the state insurance regulators, just to get paid. You can take care of a lot more patients without getting bogged down with all ins crap. If they can still make a living more power to them. They shouldn't have to be forced to take insurance, just because we have it. My family actually has great insurance, but we choose to go to Dr. Madrigal, just cuz she is great.
As well I had a buddy that was a dentist, everynight after work he would come home with a foot and half tall stack of files, so he could write reports for the insurance companies. He switched to all cash and actually got busier, since he had less paperwork his fees were reduced, which made him more affordable to many, plus very few dental plans are worth having anyway, same goes with eyes too in my opinion.
I would love to go to Dr. Madrigal because I have seen first hand what a great doctor she is (she saved my mother in ER one day) however we simply cannot afford her rates. This why we have insurance and cannot go to any doctor out of network or they won't cover the bills. We have good insurance as well but with that comes boundaries and limitations that are put on us too.

[Brian]

Someone made a good point to me the other day, he said basically if this whole health care deal goes through, we are going to have two classes of health care. The rich will have the best doctors since the best doctors will most likely be able to go cash only, while it will only be the rich that can afford to see them. The rest will have to accept who is given to them.

[ladybutton]

If you have health insurance, and you go to a doctor who doesn't accept health insurance, the doctor's office will still code your billing for you, and you can apply to your insurance company for reimbursement. It doesn't make your health insurance worthless. It just means that you, instead of the doctor, carry the burden waiting for the insurance company to cough up. Don't blame the doctor; blame the insurance company.

pbright: I'm with you. It's cheaper for me to pay the doctor than to pay for health insurance. I have no health insurance because I can't afford it, but I CAN go to the doctor when I have to.

[manyoublah]

There are some good things in this health care bill. There will be thousands of children who will have coverage in September that would've been denied because of a pre-existing condition, and help for Seniors to reach the donut hole in Medicare Part D prescription. There are some other things that I think need to be fixed/amended, but there's no denying there are some good things in this bill.

[Sabrered]

Ladybutton, there will come a time when your bank account can't support your need for medical care, and if it does, you most likely will be forced into bankruptcy. One serious illness or accident would have devastating costs to you. I'm glad that I have and can afford health insurance, but my initial cost was higher than you will ever have, as I carry the scars from the Vietnam War.

[lmam88]

pbright: I'm with you. It's cheaper for me to pay the doctor than to pay for health insurance. I have no health insurance because I can't afford it, but I CAN go to the doctor when I have to.[/QUOTE]

Then you are very blessed because there is some of us out there that cannot without doctors honoring our insurance!
I would imagine the elderly are facing the same plight if their Medicare is not accepted by docs as well.

[ladybutton]

Sabered, I FREQUENTLY can't afford to go to the doctor when I'd like to. However, I'm much more likely to be able to pay the doctor $100 occasionally when I just have to have somehelp, than I am to be able to pay $400 each and every month for health insurance. Even when I DID have insurance, and had major surgery, the insurance didn't cover it all. I pay monthly -- and pay and pay and pay and pay and pay. I am still paying medical bills from 2006 (and 2007 and 2008 and 2009). Heavier than the doctor bills are the regular prescription bills for meds needed for chronic conditions -- drugs I'll take for the rest of my life, $300/mo, but still less than $4-500 for health ins.. How can I possibly pay for health insurance AS WELL? I can't. So I don't. And I'll take my child to the doctor before I'll go.

The government doesn't OWE me health care. 100 years ago, I'd have died with my first major surgery, at age 4, because very few appendectomies were survivable in 1910. I'm grateful that there's medical care available, but I'm not entitled to it if I can't pay for it.

[lmam88]

Sabered, I FREQUENTLY can't afford to go to the doctor when I'd like to. However, I'm much more likely to be able to pay the doctor $100 occasionally when I just have to have somehelp, than I am to be able to pay $400 each and every month for health insurance. Even when I DID have insurance, and had major surgery, the insurance didn't cover it all. I pay monthly -- and pay and pay and pay and pay and pay. I am still paying medical bills from 2006 (and 2007 and 2008 and 2009). Heavier than the doctor bills are the regular prescription bills for meds needed for chronic conditions -- drugs I'll take for the rest of my life, $300/mo, but still less than $4-500 for health ins.. How can I possibly pay for health insurance AS WELL? I can't. So I don't. And I'll take my child to the doctor before I'll go.

The government doesn't OWE me health care. 100 years ago, I'd have died with my first major surgery, at age 4, because very few appendectomies were survivable in 1910. I'm grateful that there's medical care available, but I'm not entitled to it if I can't pay for it.
We DO pay for it by having insurance coverage and that's the point. Use to be that people that had insurance coverage were considered to be the elite. Now even though we pay out of our pockets for it and expect services to be rendered for what we pay for then we are quickly becoming the indigent. I too do not have insurance so that my kids can. I go to the doctor only when I absolutely HAVE TO (once every 2yrs.) because we have a child with chronic illnesses. We have insurance because he needs constant medical attention for that condition. We do not expect it to pay for EVERYTHING but we do expect something for the money we pay for that coverage.

Sabered, I do know the cuts the Vets have been getting and it is a disgrace the way this country is treating men and women who have put their lives on the line.

[snoopyshipper]

Uh, we all pay for it now by paying taxes. Who pays for Medicaid? Who pays for indigent health care? Who pays for VA medical care? Does the money for these programs fall out of the sky? NO! They are all paid for out of our POCKETS one way or another. We all pay for Medicare every paycheck. Who is going to pay for all these kids being on Medicaid? Obama? Will he just print money to pay for it?

Don't kid yourselves. It's going to be the way BO wants it cause if he doesn't get his way, he will buy the votes or change the rules. If you don't buy the mandatory policy (and how does the working poor pay for it?) then you pay the fine (with what????) What about the seniors with fixed incomes? What sacrifices will you force them to make for Obamacare? Many already have a choice of food or medicine, electricity or co-pays on their existing insurance. God forbid that one of these law-abiding, taxpaying citizens need some special care that might cost some money. A bunch of bureaucrats will approve or deny. My mom is in her 80s and just had her hammer toes fixed after MANY years of discomfort. Is some suit going to deny her pain relieving surgery becuase of her age? What does an 80 year old woman need to walk for anyway? It isn't like she has a job anymore! (I am just glad she has insurance to take care of it!)

Kids need medical care yes, but can any of us afford the bill?

[tonigking]

Folks this will all go away if the GOP/Independents take back the House and Senate,as well as the Presidency. Remember this doesn't even kick in for 4 years.

However, having said that, fraud must be stopped, Ins. Companies must stop practicing medicine and even consider non-profit operations. Paperwork has to be streamed lined and above all we MUST stop providing free health care to 12 million + illegal aliens.

We need to keep non-critical healthcare out of the ER , by supporting free clinics for the indigent. These must be supported by both the insurance companies, on a risk pool basis, and private donations, etc. Pre-existing conditions must not be a consideration.
All the Docs need to stay home and take care of their communities instead of galavanting all over the world giving away free care.
I could go on but I am sure you get the picture.

The key issue is to get rid of this outrageous Healthcare Package that will only serve those who are already getting free health care.

The solution is at the Polls; vote,vote,vote or pay,pay,pay !:soapbox:

[lmam88]

Folks this will all go away if the GOP/Independents take back the House and Senate,as well as the Presidency. Remember this doesn't even kick in for 4 years.

However, having said that, fraud must be stopped, Ins. Companies must stop practicing medicine and even consider non-profit operations. Paperwork has to be streamed lined and above all we MUST stop providing free health care to 12 million + illegal aliens.

We need to keep non-critical healthcare out of the ER , by supporting free clinics for the indigent. These must be supported by both the insurance companies, on a risk pool basis, and private donations, etc. Pre-existing conditions must not be a consideration.
All the Docs need to stay home and take care of their communities instead of galavanting all over the world giving away free care.
I could go on but I am sure you get the picture.

The key issue is to get rid of this outrageous Healthcare Package that will only serve those who are already getting free health care.

The solution is at the Polls; vote,vote,vote or pay,pay,pay !:soapbox:
The only part I don't agree with about what you said is that pre-existing conditions must not be a consideration. If it is not a consideration that right there is going to make the medicaid program go into major overload. Now that I think about it that is probably one of the problems of why people can't get away from having to use it. Chronic illnesses are considered to be pre-existing. It would be putting a whole lot of folks out in the cold and it could literally cost them their lives!
Just saying...

[tonigking]

LMAM,
My point in " pre-existing conditions " not being a consideration, meant just that.
In otherwords lose it from vocabulary and don't allow Ins. Companies to discriminate against who have such.
Again it all falls into the risk pool so everyone can have insurance.
If the Ins. Companies don't like it so be it. Let the non-profits have it.
The Feds control everything else why not the Ins. Companies?

[ladybutton]

I'm with snoopyshipper.

[tarheel]

Here's the problem with preexisting conditions. Many people will simply go without insurance since nothing expensive is going on. Then, as soon as they find out they have something expensive, they'll go get insurance, since it cannot be denied to them. They'll pay a few premiums, get their expensive surgery, and then drop the insurance.

It is kind of like being able to buy car insurance after you've already had the wreck.

[lmam88]

Here's the problem with preexisting conditions. Many people will simply go without insurance since nothing expensive is going on. Then, as soon as they find out they have something expensive, they'll go get insurance, since it cannot be denied to them. They'll pay a few premiums, get their expensive surgery, and then drop the insurance.

It is kind of like being able to buy car insurance after you've already had the wreck.

What about all the people who were laid off and finally find work only they find out that family members pre-existing conditions will not be covered by the new insurance?
Understand what you are saying though but there are always going to be people out there abusing the system. I just do not believe the whole population should be heal accountable for their actions.

[tarheel]

What about all the people who were laid off and finally find work only they find out that family members pre-existing conditions will not be covered by the new insurance?

Aye, there's the rub. Of course, that is what COBRA is for. You can buy insurance after you have been laid off, but of course not many can afford insurance if they're not working.

Unfortunately, I disagree that there won't be many abusing the system. Not only that, but I think organizations like ACORN will be right there showing them how. After all, it wouldn't even be illegal, it would just be considered clever.

[JakRussll]

Here's the problem with preexisting conditions. Many people will simply go without insurance since nothing expensive is going on. Then, as soon as they find out they have something expensive, they'll go get insurance, since it cannot be denied to them. They'll pay a few premiums, get their expensive surgery, and then drop the insurance.

It is kind of like being able to buy car insurance after you've already had the wreck.
No doubt, there will be plenty of abuse Tarheel. But here is a question for you or anyone who might know the answer.

If the insurance company HAS to offer coverage with your pre-existing condition, is there anything in the legislation that restricts what they can charge? If so, I haven't found it. Say you have a chronic disability that is certain to require a high level of medical maintenance (cancer survivor, heart stents, transplant recipient, etc.), the insurance company may be legally bound to extend coverge, but what's (or who's) to say that they cannot charge an outrageous premium (say, $5,000 per month)? If they really don't want your business (liability) can they just price you out of the market?

Jak

[tarheel]

If the insurance company HAS to offer coverage with your pre-existing condition, is there anything in the legislation that restricts what they can charge? If so, I haven't found it. Say you have a chronic disability that is certain to require a high level of medical maintenance (cancer survivor, heart stents, transplant recipient, etc.), the insurance company may be legally bound to extend coverge, but what's (or who's) to say that they cannot charge an outrageous premium (say, $5,000 per month)? If they really don't want your business (liability) can they just price you out of the market?

Jak

I suspect that rates will be regulated, but we'll see. There is no reason it can not be handled by an assigned risk pool, like car insurance. If you're a bad teenaged driver, nobody wants to insure, you can still get insurance through the pool. Bad drivers are assigned to an insurance company and that company must insure them. It becomes simply a cost of doing business in that state.

All that is no help if you can't afford any insurance at all. The best solution to that may be free, or nominally priced, clinics for the indigent. There are many ways it could be run. You might, just as an example, say that all doctors wanting a license in this state must serve two years in such a clinic.

There are so many ways we could have attacked and improved our healthcare system without socializing it, as is being attempted right now.

[curious]

"There are so many ways we could have attacked and improved our healthcare system without socializing it, as is being attempted right now."

You are exactly right, and the American public is rising up against it. Obama knows this, and has hired a "tax exempt" organization to try to advertise and sway the public the other way. He knows he has cost alot of Democrats their career, and is resorting to emergency measures to try to recover.

[lmam88]

A friend of mine alerted me to this article this morning and I wanted to pass it on. If you have parents, grandparents in Nursing Homes they will be taking the hit hard. Nursing Homes cannot survive without the residents having Primary care Physicians so the doctors opting out of Medicare is not just going to affect office visits! There has to be signed doctors orders on EVERYTHING (walkers, gait belts, trapeze to name a few)for residents as well as to address their medical needs of course. Private sector MAY not be hit as hard but chain owned and the ones owned by management companies will definitely be in the fight to survive.
http://www.ksat.com/health/23879079/detail.html

[JakRussll]

A friend of mine alerted me to this article this morning and I wanted to pass it on. If you have parents, grandparents in Nursing Homes they will be taking the hit hard. Nursing Homes cannot survive without the residents having Primary care Physicians so the doctors opting out of Medicare is not just going to affect office visits! There has to be signed doctors orders on EVERYTHING (walkers, gait belts, trapeze to name a few)for residents as well as to address their medical needs of course. Private sector MAY not be hit as hard but chain owned and the ones owned by management companies will definitely be in the fight to survive.
http://www.ksat.com/health/23879079/detail.html
So, it looks to me like Obama is asking the Republicans in Congress to bail him out of this mess. Asking for Billions of dollars more to mitigate the 21% medicare payment reimbursment decrease. Did he just now figure out that there would be a major uprising in the medical establishment?

Here is an excellent local news article on Doctors in the Texas Hill Country who are dropping Medicare patients, and even leaving the profession.

http://www.kvue.com/news/local/Why-are-so-many-Hill-Country-practices-dropping-Medicare-96472304.html

[lmam88]

So, it looks to me like Obama is asking the Republicans in Congress to bail him out of this mess. Asking for Billions of dollars more to mitigate the 21% medicare payment reimbursment decrease. Did he just now figure out that there would be a major uprising in the medical establishment?

Here is an excellent local news article on Doctors in the Texas Hill Country who are dropping Medicare patients, and even leaving the profession.

http://www.kvue.com/news/local/Why-are-so-many-Hill-Country-practices-dropping-Medicare-96472304.html

The speakers on my computer are being stubborn. Is there any doctors leaving the profession in our immediate area, JakRussll?

[tarheel]

As we charge headlong into socialized medicine, in Canada they're trying to find a way out. See following article:

Soaring costs force Canada to reassess health model | View Original Page (http://news.yahoo.com/s/nm/20100531/hl_nm/us_health_3)
TORONTO (Reuters) – Pressured by an aging population and the need to rein in budget deficits, Canada's provinces are taking tough measures to curb healthcare costs, a trend that could erode the principles of the popular state-funded system.
Ontario, Canada's most populous province, kicked off a fierce battle with drug companies and pharmacies when it said earlier this year it would halve generic drug prices and eliminate "incentive fees" to generic drug manufacturers.
British Columbia is replacing block grants to hospitals with fee-for-procedure payments and Quebec has a new flat health tax and a proposal for payments on each medical visit -- an idea that critics say is an illegal user fee.
And a few provinces are also experimenting with private funding for procedures such as hip, knee and cataract surgery.
It's likely just a start as the provinces, responsible for delivering healthcare, cope with the demands of a retiring baby-boom generation. Official figures show that senior citizens will make up 25 percent of the population by 2036.
"There's got to be some change to the status quo whether it happens in three years or 10 years," said Derek Burleton, senior economist at Toronto-Dominion Bank.
"We can't continually see health spending growing above and beyond the growth rate in the economy because, at some point, it means crowding out of all the other government services.
"At some stage we're going to hit a breaking point."
MIRROR IMAGE DEBATE
In some ways the Canadian debate is the mirror image of discussions going on in the United States.
Canada, fretting over budget strains, wants to prune its system, while the United States, worrying about an army of uninsured, aims to create a state-backed safety net.
Healthcare in Canada is delivered through a publicly funded system, which covers all "medically necessary" hospital and physician care and curbs the role of private medicine. It ate up about 40 percent of provincial budgets, or some C$183 billion ($174 billion) last year.
Spending has been rising 6 percent a year under a deal that added C$41.3 billion of federal funding over 10 years.
But that deal ends in 2013, and the federal government is unlikely to be as generous in future, especially for one-off projects.
"As Ottawa looks to repair its budget balance ... one could see these one-time allocations to specific health projects might be curtailed," said Mary Webb, senior economist at Scotia Capital.
Brian Golden, a professor at University of Toronto's Rotman School of Business, said provinces are weighing new sources of funding, including "means-testing" and moving toward evidence-based and pay-for-performance models.
"Why are we paying more or the same for cataract surgery when it costs substantially less today than it did 10 years ago? There's going to be a finer look at what we're paying for and, more importantly, what we're getting for it," he said.
Other problems include trying to control independently set salaries for top hospital executives and doctors and rein in spiraling costs for new medical technologies and drugs.
Ontario says healthcare could eat up 70 percent of its budget in 12 years, if all these costs are left unchecked.
"Our objective is to preserve the quality healthcare system we have and indeed to enhance it. But there are difficult decisions ahead and we will continue to make them," Ontario Finance Minister Dwight Duncan told Reuters.
The province has introduced legislation that ties hospital chief executive pay with the quality of patient care and says it wants to put more physicians on salary to save money.
In a report released last week, TD Bank said Ontario should consider other proposals to help cut costs, including scaling back drug coverage for affluent seniors and paying doctors according to quality and efficiency of care.
WINNERS AND LOSERS
The losers could be drug companies and pharmacies, both of which are getting increasingly nervous.
"Many of the advances in healthcare and life expectancy are due to the pharmaceutical industry so we should never demonize them," said U of T's Golden. "We need to ensure that they maintain a profitable business but our ability to make it very very profitable is constrained right now."
Scotia Capital's Webb said one cost-saving idea may be to make patients aware of how much it costs each time they visit a healthcare professional. "(The public) will use the services more wisely if they know how much it's costing," she said.
"If it's absolutely free with no information on the cost and the information of an alternative that would be have been more practical, then how can we expect the public to wisely use the service?"
But change may come slowly. Universal healthcare is central to Canada's national identity, and decisions are made as much on politics as economics.
"It's an area that Canadians don't want to see touched," said TD's Burleton. "Essentially it boils down the wishes of the population. But I think, from an economist's standpoint, we point to the fact that sometimes Canadians in the short term may not realize the cost."
($1=$1.05 Canadian)
(Reporting by Claire Sibonney; editing by Janet Guttsman and Peter Galloway)