The Impact Of Cost Containment Policies On The Patient’s Informed Consent For A Medical Treatment: A Lesson From The Canadian Single-Payer Health System With A Comparison To The Saudi Multi-Payer Health System

نوع المستند : المقالة الأصلية

المؤلف

جامعة الملك عبد العزيز King Abdulaziz University

المستخلص

Due to the increase in the budget of countries in the health sector,  the increase in budget leads to confront it by applying cost containment policies. These policies play an essential role in the physician-patient relationship which is based on confidentiality, integrity, loyalty, and good faith. The physician-patient relationship obligates physicians to disclose all relative information that constitutes a motive for the patient to proceed his or her medical treatment. Among the information that is important to the patient to make a decision to complete, replace, or start a medical treatment is information related to the financial constraints, treatment costs, alternative medical treatments, less expensive medical treatments, or more expensive medical treatments. However, the physician’s duty may be influenced by cost containment policies from a third party, such as hospital administration, insurance companies, or others. This situation may prevent physicians from practicing their profession freely, and may affect their duties towards their patient, which may lead to a medical malpractice in case of breach the standard of care and the duty of disclosure. Accordingly, this paper first addresses the physician-patient relationship, its provisions; then, the duty of disclosure, and informed consent. It also addresses the standard of care, medical necessity, conflict of interest, and third-party influence. Also, this paper considers some proposed suggestions to confront and limit the influence of third parties on the physician-patient relationship. This paper follows a comparative methodology between the Canadian law as a single-payer health system, and Saudi law that relies on a multi-payer health system.
 
نظرا لتزايد ميزانية الدول في القطاع الصحي مما أدى إلى مواجهة ارتفاع الميزانية بسياسات لاحتواء التكاليف، والتي بدورها تلعب دورًا جوهريًا في علاقة الطبيب مع المريض التي تقوم على أساس الخصوصية، والنزاهة، والإخلاص، وحسن النية، والتي تلزم الطبيب بالإفصاح عن جميع المعلومات الجوهرية التي تشكل دافعًا للمريض لاستكمال علاجه. من ضمن المعلومات التي تهم المريض لاتخاذ قرار استكمال العلاج، أو استبداله، أو البدء به هي المعلومات التي تخص تكاليف العلاج، والطرق البديلة للعلاج، أو الطرق الأقل تكلفة، أو الأعلى تكلفة، إلا أن التزام الطبيب قد يوجه عن طريق سياسات الاحتواء التكاليف من طرف ثالث مثل إدارة المستشفيات، أو شركات التأمين، أو غيرها مما يجعل الطبيب لا يمارس مهنته بحرية، وقد يؤثر على التزاماته تجاه المريض مما قد يؤدي إلى خطأ طبي في حال لم يتم الإفصاح للمريض عن المعلومات المتعلقة بسياسات احتواء التكاليف. تتطرق هذه الورقة في البداية إلى علاقة الطبيب بالمريض، وأحكامها، ومن ثم الإفصاح، والوصول إلى الموافقة المستنيرة للمريض، وكذلك تتناول معيار الرعاية، والضرورة الطبية، ومن ثم تعارض المصالح، وتأثير الطرف الثالث، ثم تتناول بعض الحلول المقترحة لمواجهة والحد من تأثير الطرف الثالث على علاقة الطبيب بالمريض. تتبع هذه الورقة المنهجية المقارنة بين كلاً من القانون الكندي باعتباره نظام دفع من طرف واحد ، والقانون السعودي الذي يعتمد على نظام الدفع المتعدد في النظام الصحي.

الكلمات الرئيسية

المراجع

  1. References:

     

    Legislations:

    1. Act Respecting Health Services and Social Services, R.S.Q. c. S-4.2.
    2. Canada Health Act, R.S.C. 1985, c. C-6.
    3. Code of Ethics of Canadian Medical Association, Ottawa (2004).
    4. Code of Ethics of Physicians, R.S.Q. c. M-9, r.17.
    5. Health Insurance Act, R.R.O. 1990, Reg. 552 (the regulation) of Ontario.
    6. Saudi Health Law, issued under the Royal Decree No. (M/11) of 2002.
    7. Saudi Law of Practicing Healthcare Professions, issued under the Royal Decree No. (M/59) of 2005.
    8. Saudi’s Patient Rights and Responsibilities of 2019.
    9. Saudi Health Professionals Ethics Guide of 2012, 3rd

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    Thesis:

    1. Caulfield, T. The Last Straw: The Impact of Cost Containment in Health Care on Medical Malpractice Law (LL.M. thesis, Dalhousie University, 1993).

    Websites:

    1. Canadian Public Health Association, Duty of Care Checklist, January 2019, available at:

    https://www.cpha.ca/sites/default/files/uploads/resources/play/duty-of-care-e.pdf .

    1. Canadian Institute for Health Information, 2023

    https://www.cihi.ca/en/national-health-expenditure-trends .

    1. Saudi Government Budget, Saudi Arabia’s Budget Statement, 2024,

    https://www.my.gov.sa/wps/portal/snp/aboutksa/governmentBudget#:~:text=%D8%A7%D9%84%D8%B5%D8%AD%D8%A9%20%D9%88%D8%A7%D9%84%D8%AA%D8%B9%D9%84%D9%8A%D9%85%3A,%D8%A7%D9%84%D8%B1%D9%81%D8%A7%D9%87%20%D9%84%D9%84%D8%AC%D9%85%D9%8A%D8%B9%20%D9%81%D9%8A%20%D8%AC%D9%85%D9%8A%D8%B9%20%D8%A7%D9%84%D8%A3%D8%B9%D9%85%D8%A7%D8%B.

    1. Sara Allin, Greg Marchildon, and Allie Peckham, The Commonwealth Fund, available at:

    https://www.commonwealthfund.org/international-health-policy-center/countries/canada#cost-containment .

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