Dr. Merrilee Fullerton on Healthcare

I have said many times that encouraging patients to be more responsible for their health and health care is about the only way we are going to find any version of sustainability for our public health care system....if we'd only let them.

Overall, giving patients access to their records isn't easy currently and there are many groups vying for a foothold in this area. We've talked about them here under various headings but mHealth deserves to be brandished and waved about because it is a relatively inexpensive way to bring about a cultural shift so badly needed. Government does not need to be the payer for this.

Empowering patients to take more control of their chronic disease such as diabetes or hypertension or renal disease is a complicated task but it doesn't require spending billions of dollars on eHealth strategies that are entrenched for the benefit of many who are not patients at all.

How do we steer away from  enormously expensive eHealth programs?

Some say we should just keep shovelling. I say it is time for a remake,... a redo...a major revision to our thinking and a change in focus toward mHealth.

Some say mHealth can't exist without a robust eHealth system and I disagree.

mHealth can exist on its own and as the disruptive technology of  smartphones evolves, hopefully  the short-sighted mantra of  "spend, spend, spend" at eHealth will fade. What is the likelihood?

EHealth will not save money in my opinion and there is growing evidence that it won't.

MHealth on the other hand has enormous potential to get patients off their government dependence and provide improvement to outcomes.

I have taken the liberty of attaching an article by Christina Spencer at Sun Media on a report regarding private options that seem to be favorable to many people.

Kudos to Christina for bringing light to this.

Just in case you are feeling bombarded by my mHealth messaging, I promise to write about something different next journal entry.  To be honest... it probably won't matter since we usually come back to recurring themes. That's OK...it means we are "distilling" and the common themes that emerge are the issues that do need attention.

Thanks again for reading. Do try my twitter link as well as checking out some of my twitter brethren...Dr. Barry Dworkin's site is a "must-view".

Once again, I 've been remiss in keeping up with my journal entries. Thanks to all of you who keep this blog going.

One of the interesting things about the H1N1 pandemic here in Ontario is that it points out how our health care system has barely been hanging on. We've cut beds and providers over theyears and the powers that be are still on a binge of decentralizing care (seems we did the "centralizing" binge a decade or so ago and now it is time to reverse the process!)

All those alternate level care patients...OUT. All those dialysis patients...OUT. All those cardiac pacemaker patients...OUT. It seems keeping everybody "out"  of hospitals and tertiary care centres these days is the solution for at least a few LHINs trying to manage budgets that are not realistic. I guess nobody told the LHIN chiefs that the cost of off-site infrastructure is likely to be higher than centralized care...but nevermind...Meanwhile the feds and provinces claim that eHealth will amount to billions of dollars in savings for health care annually---not likely.

Lorrie Goldstein of the Toronto Sun has written an excellent article in the November 12 paper. He describes how successive governments have  managed to avoid providing the resources necessary for public health to do its job well. So far with H1N1 we have managed to avoid the bullet but he makes a serious prediction.

Yes, public health needs many more resources as germs evolve and Mother Nature challenges our abilities to maintain our population health during various outbreaks inside or outside of health care institutions.

The solution is to revamp the spending pyramid. Patients should be paying more for lesser health related problems through tax free savings accounts and private insurance while government spends more on public health and catastrophic care. Miscellaneous pieces of health care should be funded in a greater proportion by individuals.

I've provided the link to Lorrie Goldstein's piece as I did not want to copy it in its entirety...and it deserves to be read in its entirety.

Thanks Lorrie.

Lots of talk about fiscal restraint by Ontario's Liberals. Too little, too late. When Smitherman was setting up his expensive Family Health Teams and spending oodles and oodles of cash to transform Ontario's health care system into a consultant-happy- bigger black hole than it was, people said "we can't afford not to do it!"--- A dangerous sign of things to come.

Our politicians stand before us and tell us that now is the time for difficult decisions (that time was long ago) but it is difficult to make difficult and possibly initially unpopular but necessary decisions when one's political life depends on telling people what they want to hear.

I will acknowledge that the Ontario Liberals are caught between a rock and a hard place and no matter what they do they will hear complaining from one camp or another. But at some point, it is important to do what is necessary. That doesn't look like it is coming any time soon since Dwight Duncan tells us recently that continued spending increases will occur in health care. Strange thing that comment since rapidly rising health care expenditures are what is driving spending in other necessary areas to be cut.

Alas, we are tied to the mast of the health ship that is taking every other sector down with it while politicians hold hands and will leap just as the going gets rough, just as they always do. 

Definitely, I am sounding cynical today. The public is led to believe that health care is their God given right and they are soon to find out the repercussions of such thinking.

The leadership vacuum persists. There is no independent body to speak to the public with cold hard fact. Health Council of Canada does little if anything except spout the political health care dogma of the day persistently. Nope, no leadership there either. The OMA seems bound to government so tightly it can't breathe a breath of fresh air into the whole mess either. The CMA tries but will have difficult times ahead as its soon to come leadership may turn out to be regressive.

The media fails because of its largely left wing tilt and because it sees more payment and responsibility for individual health as evil--apparently better to keep us all dependent. But new media sources are coming on stream and the traditional private care hating journalists have probably had their day in the union sun.

At least in Alberta, politicians are trying to tell it like it is but the public denial may turn out to be too strong.

Perhaps the real catalyst for change will be a dose of reality, delivered to the public from non-health care related sectors.

Some facts, if you didn't already see them in the headlines today:

* Ontario deficit to hit 25 Billion-up sharply from $14.1 Billion in March

* Action plan to be revealed in 2010 (doesn't sound like action to me)

* Leaner and more efficient provider of quality public service to come (!!)

* Ontario is spending 4.8 Billion more this year than predicted

* Tax revenues falling dramatically- about 6 Billion less that predicted last spring

* Corporate tax revenue is about one third lower than predictions-2.65 Billion less (a hefty drop)

* Ontario's massive deficit is heightened by the growing size of the health care sector, expected to account for half the budget as early as 2015-Pascal Gauthier, TD Economics

*deficit budgets for years to come

* projected deficit of $21.1 Billion in 2010-2011

* projected deficit of $19.4 Billion the following year (wanna bet it will be more?)

*and how 'bout that eHealth spending, and hiding Tepper', McLeod's and Sapsford's funding deep in hospital budgets to top it all off?

The public may have to find out for themselves the hard way...just like my teenagers.

Not so long ago, I think ELB asked for a new topic.....was it on "prospective" payment for physicians a la New England Journal of Medicine article? Let me know ELB and we can fit that one in somewhere along our conversation route.

But it gets me to thinking, that we are in a new world of health literacy not only for physicians just to understand what prospective payment means but for the public and patients to understand their role in their own health care.

Granted, not everyone will be able to become literate in their own health care but I hazard an educated guess that the majority will. Trouble is, many physicians, politicians, health policy types and administrators tend to see patients as illiterate or pretty close. This is all very unfortunate since people are going to need to become more aware of how to manage their health care.

This starts with health literacy.

Empowering and educating patients in their own care will require an understanding of health terms and how to use the system including medical social networking sites and mhealth. Forget Michael Decter's book on how to navigate the Canadian health care system-that was obsolete before it was published. Just look at the ease with which anybody under the age of 75 manages a mobile phone, sends photos electronically and surfs the internet.

The majority of the public can do this and those who can't will need government support. Fine, but to think that government can spend billions and billions on failed eHealth strategies because of the government centralized one-size-fits-all-especially-the-consultants approach, well, we would be doomed to fall and fail endlessly.

Social networking sites are likely to take on a significant new role in health care but establishing reliable sites guided by the medical profession or another respected source will be the real catch.

How long will it take for the health care leadership in Ontario or Canada to figure this one out.

By the way, I hear that an auditor's report on the federal version of Ontario's eHealth, Canada Health Infoway, will be out in early November. It should be interesting.

I'll post some links in the comment section and don't forget to visit the twitter link if this sort of thing interests you.

Welcome to our newcomers and thanks for the fascinating contributions from all of you.

To be honest, I am getting tired of seeing Sarah Kramer's photo beside every article on eHealth and its lack of accountability. She may have been sharing the helm but the rot goes much deeper than that. I suppose her name will forever be associated with the scandal and others will slink away only to surface in another government agency or as some kind of consultant.

And lo and behold, we see Gail Paech mentioned again...and again...and again.

What is it about government bureaucracy that allows the same old, same old to keep being recycled? A little new blood is a good thing from time to time but government should attract them before they are thoroughly brainwashed and banging their heads relentlessly against the same health care wall or health care bible depending on how you look at it.

I provide a link below to an article in the Toronto Star today. Go for it!