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Looking for Solutions in Health Care for 2006 and Beyond

Our health care system needs to change to accommodate new demographics, new technologies and new pharmacologic advancement.

The roots of compassion and caring in health care should not change however, and it is with this in mind that the dialogue of change should be had surrounding health care.

How can we adapt to different needs that emerge as our population ages?

How can we  find sustainability in the midst of so many new advancements?

How can individuals become more empowered in serving their own health care needs?

What role does the individual have in enabling the  health care of others  beyond paying taxes?

Many questions like these need to be answered and if we are willing to look with open minds at the problems within our health care system, and beyond political posturing, then we can find new  solutions to take us further into this century. 

 

 

 

 

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Wednesday
Dec132006

The Big Picture and Why I Can't Go Along Willingly

Where is the current agenda of healthcare change headed you ask?

Let us stand back and look at the big picture rather than our little kingdoms and let us look without blinders on and without cheerleading and posturing from politicians.

The Conference Board of Canada , an Ottawa-based, non-partisan think tank whose mission is to bring business people and policy makers together, has spent three years assessing where Canada is headed which will influence the sustainability of our universal healthcare.

In January 2007, the Conference Board’s Canada Project will release its report “Mission Possible: Sustainable Prosperity for Canada”. This research program has taken the rose-coloured glasses off and hopes to provide an honest assessment of Canada’s future.

Sure, Ottawa keeps racking up budget surpluses and our currency is strong but we are slipping in global rankings compared to other G8 countries.

“No one has been talking about our economy being adrift, but it’s an absolute fact,” says chief economist Glen Hodgson of the Conference Board. “The things Canadians cherish-our standard of living, our natural environment, our health care and public education systems-will become unsustainable if we don’t act now.”

“Mission Possible” set out five key areas for improvement and one includes addressing our aging labour force, which of course in my opinion, should include physicians. We need more seniors at work and we should be doing everything possible to keep our highly skilled and highly trained physicians working with as much support and incentive as possible.

I do say this without bias. I say this as a daughter of aging parents, as an aging individual myself, and as a mother to my children. As much as I appreciate what other healthcare providers offer, or even what complementary health care can offer, they do not offer the skill or expertise of a physician.

The first wave of baby boomers is about to turn 61, an average age for retirement for Canadians. Next year, 2007, will be a big retirement year where boomers are likely to be retiring in droves, physicians included. (Perhaps by coincidence, my eighty year old father’s physician is retiring in January with no one to replace him, not even me, as it is unprofessional to treat one’s own family and one risks the reprimand of physicians’ regulatory bodies.)

According to Hodgson, we have only about 10 years before the wave starts to undermine our economic performance and social well-being.

“Mission Possible” points out that immigration alone cannot come close to making up for the impending shortfall.

We will undoubtedly see that the numbers of IMGs being recruited from other countries will not make up for the physician shortfall in Canada. Also of interest, is the net migration of physicians to other provinces, mostly Alberta and BC, leaving Ontario with a net loss of physicians in 2005 as shown by CIHI.

Other countries are now doing more to enable older workers to extend their careers, including financial incentives, training programs, placement services, phased retirement programs and pension reforms. “Mission Possible” says Canada should do the same.

So why are physicians, particularly in Ontario and Quebec, seemingly under attack by government and its “transformation agenda” when our aging physician workforce should be supported and enabled?

Is it because other groups have managed to position themselves in the political arena and physicians have been too busy caring for the sick while others have found the most advantageous political seats? We have put veterinarians in charge of closure of hospitals, few physicians sit on LHIN boards in Ontario (except in rare instances in which I will not elaborate in this public forum) and we see more nurses taking on more prominent positions within the transformation hierarchy while physicians seem to be shunned.

How is this a balanced approach to finding solutions to provider shortages in healthcare, access shortages, and funding issues?

Instead of blaming medical workers for healthcare expenses, or creating more groups to scrutinize and regulate, we should be talking about how patients can contribute; how we can empower our providers to keep working; how we can allow market forces to help dictate numbers of physicians and other providers; how we can find other acceptable ways for Canadians to purchase healthcare, electronic medical records or other items that would contribute to more efficient healthcare.

Some say that physicians should just lump it and accept the transformation as it is unfolding; that it is a done deal.

I say that accepting this transformation is a big mistake and that more compromise is needed, more realism is needed and more understanding that sharing the facts with the Canadian people is necessary.

I guess time will tell, time we may not have.

As always, I am interested in the perspectives out there, particularly regarding non-physicians who might have something to say regarding contributing individually to EMR’s, to contributing to co-operatives, to how they might support their medical manpower.

Because ultimately, you don’t know what you’ve got ‘til it’s gone.

Reader Comments (69)

Just in from the "back 40" where I saw 18 patients this morning (haven't looked at the afternoon yet, and I have all these damned RX's to endorse back to the pharmacy). GC phoned up to say he'd be late this morning because his cows got out, and I came into some guy sitting in the treatment room with his ear in his hand; seems he tried to worm his horse on too short a bridle, and the critter reared and sheared with a hoof. [MFO, I am not emulating my former FFS practice pattern; these are just the pressures of all these sick and injured people, and no doctors for about 20,000 of them in my area...] So that's pretty much what what my daily working life is like -- pretty far removed from all this high-toney economic and policy stuff.

And now I have to put this stuff into the EMR. I read semi-rural doc's note with a bit of sadness. I understand the soul-sucking part in respect to the amount of time spent on paperwork and data entry. Computerization does NOT make life easier or faster.

But, Sybil's post under the last opinion piece was right. Good information systems and good information are key to better care.

Realist, you are preaching to many of the converted. The stuff above is motherhood. But, we have to live with an eye to the realities around us. And we are going to have to deal with the LHIN's and "the plan" whether we want to or not. Perhaps along the way we can encourage some bending and tweaking that will have good effect in the longer term.

So, can we perhaps begin by focussing on something that will draw us into more productive discourse in this session? What are some concrete things, reasonable, achievable things, that might be done soon to make a small first step toward improving our lots, patient and provider alike?

Can we start with what I, a simple rural provider would find helpful for myself and my patients?

(1)

December 13, 2006 | Unregistered CommenterHayseed Docs
Thanks Hayseed Docs. Please continue.

I also worked rural and still recollect driving to make housecalls to one house where the family lived off the grid.

Fascinating how they managed and their expectations were so reasonable.

Also recollect the minister who managed to cut off a piece of his ear somehow...came to the office bleeding profusely. I told him he would need a plastic surgeon but he told me to do the best I could and I did and he was grateful.

Unfortunately, gratitude seems to be in short supply these days.

Perhaps I'll ask Santa.

As for the "better care" we all hope for: Information systems are costly, they must be maintained and updated and they will cost lots and lots of cash (not to mention the possibility the contracts that might go to insiders or the extra cash that might get spent on somebody's relative's IT solution)....cash that is in limited supply as my Conference Board references try to point out.

Not trying to be fancy and preachy...just trying to show that there are realities that must be faced.

Maybe Santa can provide all the tax money needed...but I sure hope he doesn't leave a lump of coal in my stocking instead.

December 13, 2006 | Unregistered Commenterrealist
Sorry, I couldn't finish this. Duty calls in the form of a sick infant.

More later.
December 13, 2006 | Unregistered CommenterHayseed Docs
Glad to see that attention is being paid to the "big picture". In theory, that what "central" does also.

Looking at the "big view", means that health may not be able to do as well as all believe it should.

More health care, or save autoworkers jobs.

More health care, or cut back on pollution.

It is not an easy balance - that's why 25% increase in pay is needed immediately ( sorry - bad joke).
December 13, 2006 | Unregistered Commentermovingforwardontario
That is why the public must be free to purchase healthcare that they feel they need.

Benchmarks and measured wait times for a few favourites will not do the job in the next decades.

Nor are EMRs or infoways likely to free up enough cash.

Let us start now to discuss smart cards which people can use for a variety of procedures and services. Each time they use their card a corresponding amount will be deducted from their account. If they have no chronic illness identified they then begin to have to pay a co-payment.

The public can join co-operatives where their fees can be pooled to provide electronic access to their charts and even subsidize nurses (or doctors) to be available to answer concerns and questions on line. No government involvement.

Communities come together to fund the education of physicians and nurses for their areas in return for a contract to provide service for a specified amount of time.

Communities are already in competition for providers, paying them bonuses to come and gov't paying for northern recruitment.

Why shouldn't communities be able to fund their medical manpower or their IT networks?

Why does gov't insist it is the only entity that can provide these services?

Is it that it does it so well?
Is it that it keeps power in the hands of a few?
Is it that they cannot think originally?

Why does gov't deserve to have a monopoly when their are other ways to fund care?
December 13, 2006 | Unregistered Commenterrealist
Interesting subject, the “no-computer” virus, which infects our trade. It has been mulled over by many, for over 15 years in Canada, but no successful answer to the problem has been found, yet.

I’m not a fan for the option of subsidizing EMR installation. That approach essentially gives a tool without describing the job that the tool needs to do. With that approach, there will be many busy docs sitting, doing data entry, and feeling that their time and skills are being wasted.

An alternative approach, is for real value to be placed in the data which an EMR can liberate. If the data has real medical value, and is now given tangible value, then we might decide to set up the tool (IT) to collect the data and report it. Data which might have real value to the system might include; knowing who all your diabetic patients are, and knowing how that group are doing on their outcomes. Similar data value might come from the desire to screen for disease, or provide preventive immunizations.

If Ontario says this data has value (if it is collected and delivered) then lots of smart docs will collect and report the data with an EMR which now has an understandable use (beyond just data entry).

The nice thing about this concept, is that it has already been tried successfully. All that is required here, is the political will and budget.
December 13, 2006 | Unregistered CommenterOtherGS
Realist:

Aside from looking at the "other" issues pressing on the public purse' there are 2 "internal" issues that affect how policy develops 1. is the internal"gaming" that goes on within the MOHLTC to get access to control the "good' projects that do develop and are a 'priority" for the higher ups. 2. The MOHLTC gets "lied" to all the time from those seeking access to the tax pool. If physicians feel that the former audit system was unjust to them, the other areas don't even have audits of resources provided and appropriate services done.
December 14, 2006 | Unregistered Commentermovingforwardontario
Realist,

It seems that you are relying heavily on the definition of 'health' as simply the absence of illness..i.e. if you go in to see a someone who has "the skill or expertise of a physician." and there is "nothing wrong with you, that you don't deserve the free payments that someone with a "bona fide" illness deserves...sounds like a bit of a slippery slope to me, but maybe I misunderstood. Can you comment on that...
December 14, 2006 | Unregistered Commenterlifelonglearner
"If physicians feel that the former audit system was unjust to them, the other areas don't even have audits of resources provided and appropriate services done."-mfO

Not sure what you are driving at mfO. Are you referring to areas outside of healthcare or within healthcare?

OtherGS:
Don't get me wrong. I like the idea of EMR and infoways...it is just that I recognize there will be a large price tag attached and the opportunity for insiders to make big bucks off the public purse with the possibility of escalating costs that may not result in significant improvement in outcomes.

I think we tend to forget the human factor in healthcare over and over. We look for solutions in EMRs and infoways and we forget the human component.

When a physician has 1000-1500 patients, it is far easier to remember mrs. d with the brittle diabetes, or mr. c with his colon CA. A physician will recall the family details, understand the support mechanisms (or not) they may have, understand the underlying mental fragility that might affect their outcomes or the outcomes of their family, etc. etc.

This can only be done with consistent and direct contact with sufficient numbers of providers to have a decent ratio of provider/patient.

EMRs are nice to generate data and information. But let's be honest, there is a lot more data than we'll probably ever be able to use floating around out there.

If I'm sick, I want to see someone who knows me, who remembers me, who understands me as a person with all the social complexities that come attached.That means alot to me.

I'd rather not be patient #5,730 at visit #9 who had to see the NP one visit, the social worker visit #2, the dietician visit #3, with chronic disease x documented on my chart with EMR all at great public cost.

I don't want to be treated like a widget in a healthcare machine...because I don't think it is good for my health and I think I should be able to pay a small co-payment to have the service I think is important to me.

And so EMRs and infoways may be wonderful things, but they don't replace a provider who cares, or the manpower necessary to care meaningfully for patients.

There are intangible components to healing and they are as important as prescribing the appropriate medication or churning out gobs of data.

If you have ever been on the receiving end of healthcare you may understand this. If not then perhaps you operate differently than I do, but it should be an individual preference that I can satisfy somehow. Government says it is its way or no way. This can't be right.
December 14, 2006 | Unregistered Commenterrealist
"Government says it is its way or no way. This can't be right. "

Actually the OHIP fee for service is take it or leave it.
December 14, 2006 | Unregistered Commentereklimek
lifelonglearner:

Thanks for the question and opportunity to clarify.

With growing costs of healthcare, I don't believe that the answer is to reduce access to physicians which is what gov't did by cutting back medical school enrollment in the 1990s and what it does by rationing care.

I would prefer to see a more shared responsibility for healthcare between physician/patient/hospital/bureaucracy.

I believe the answer is to help people understand that they have social obligations (as well as the providers) and financial obligations for their use of the system.

Much of the argument against co-payments is that they penalize people with diseases that are not of their own making or penalize people who must use the system on a regular basis for chronic disease.

This is in part true, but I must add that people using the system are benefitting from their access to care and that should have a price attached to it. Those who pay taxes but don't use the system still have to pay for the rest who do. Fine, but shouldn't those who use the system have to pay a little more because they are benefitting from their actual access?

But there ought to be a way that prevents people with chronic disease who have to access healthcare frequently, from paying excessively.

Using a smart card each time for a visit that is debitted each visit, and perhaps a biannual print out that shows how much healthcare the patient has consumed, would help to tell the patient that their healthcare isn't free. This is consistent with Tommy Douglas' vision in which he disagreed with patients believing healthcare was free.

If one has one of the costly chronic diseases (ie cancer--which will become a chronic disease in many cases with new developments in treatment and meds), lets say the "big five" (diabetes, hypertension , OA, CA just for example) just like the big five procedures that get special treatment now (cataracts, cancer treatments, cardiac care, hips and knees...and diagnostics) then you will be exempt from paying a co-payment even after you have used up all the room on your smart card.

A smart card used in this way would encourage the "worried well" to educate themselves and be educated about the use of their healthcare resources so that you don't get patients with sore throats for 24 hours coming in to the ER or doctor's office but it gives them some room on their smart card at no additional cost if they really have significant illness.

This is less "slippery" in my opinion that reducing access by stealth, which is what gov't is doing by bringing in healthcare teams, by wait lists, by limiting access to lifesaving meds because of cost/benefit ratios not being met.

Bottom line is, these discussion, difficult as they are should be had now, before 2013-2020 so that we can actually be prepared when the demographic crunch comes.

We are not prepared.



December 14, 2006 | Unregistered Commenterrealist
Hello, from pastureland. I sort of fell off the blog map there with the unscheduled arrival of that sick infant in the middle of blogging. And the rest of the day was pretty much the same. (The guy with the detached ear – now reattached -- chose not to go to the hospital to have Plastics look at it --- hardy stock , these farm folk.)

Before I logged off, my point was going to be this. There are things that the grunts like us in the field need that, tiny as they may be, are building blocks to the better general system we all aspire to. And they are simple, too. For minimal starters:
1. Immediately reduce the waiting time for turnaround of LU’s from 60 days or more to the two or three weeks it used to take
2. Immediately amend the regulation that requires the physician to handwrite the LU code on the Rx
3. Immediately stabilize Home Care (not simple, I know, but urgent)
Now, if we really believed in Santa, we would be asking for
1. ANOTHER PHYSICIAN, PLEASE!!!!!
2. School Boards and employers, stop asking us for sick notes
3. Banks and insurance companies, stop saddling your clients with requests for paperwork from us with deadlines that are not humanly reasonable in this day and age (unless we were a Park Avenue private practice with scads of staff, one of whom is a physician whose sole practice consists in dealing with all the paper work for the rest of us)
4. patients who are compliant so that our time and the taxpayers’ dollars are well spent
5. patients who can afford it, stop asking us for access to subsidized pharmaceuticals, goods, and services
6. and don’t call us if you have a cold or something your mother could help you with
7. STOP THE PHARMACEUTICAL COMPANIES FROM DIRECT MARKETING
8. …und so weiter…

We start with the small things because they are doable. If the grunts in the field at the primary level don’t have what they need to provide their patients with decent basic services from a reasonably collaborative and cooperative system, then, the rest of the system is built on a sandy foundation. ( Just look at the result of putting hospital restructuring before reorganization of primary care. ) It would be a mistake to trivialize the starter list above or any other simple, and, we hope, more elegant solutions that others might suggest for this level.

Probably the single greatest thing we could all do with a view toward working our way to dealing with the macro-level issues is even simpler, and within all our capability, no matter what sector we come from and what our issues are – be kinder to oneathother and work at the interpersonal aspect of our relationships. Relationships build systems, and the informal systems are critically important in times of transition from one culture to another. Someone has already pointed out the general demise of common civility. We can restore this.

MFO: You have suggested that the unhappy among our numbers take the money and be happy. For many, perhaps even most, of us, (yes, we are the “geezers”) it was never about the money. It is about a way of life that one has known and loved. A way of life that many have poured themselves into and fought for with passion and dedication. And that will also have been true also of many in the Ministry itself who worked for what they believed in – and may still do. So please find another mantra.

To simply go with the flow as you suggest like a pack of unthinking lemmings because this is easy may not be to the best advantage of the patient or the system. A constructive critical approach always has a place.

Realist: In relation to the scenario you draw with the smart cards, the cost/benefit of that would be so high-risk and the payback so long, that a movement of this kind, while ideal, would never survive the polls. We agree that patients should be made aware of the cost to the system. And patients who persist in failing to maintain healthy lifestyle should, in fact, be made to pony up for the unnecessary costs to the system. We could go on. In relation to this, can we perhaps look now to some small, incremental and doable things that are compatible and consistent with your vision?

The notion of tying a period of service or forgiveness of debt to funding through medical school is good. The trouble seems to be that we have raised a generation of children (yes, they’re ours) that dismissed this kind of commitment as not a preference. Our children think in terms of preferences, and this is reflected in their life choices to a far greater extent than I think was an option for us. I could be wrong.

To turn to the EMR and the prospective costs: Yes, this is going to cost money, but we don’t have to spend it all now. We are engaged in incremental steps toward building a solid primary care data base with the slow spread of the provincial IT initiative. That is a critical piece of measuring health because, if one wants to do that at the primary level, one needs a denominator. This has always eluded us who do research, and, we live in hope of seeing this before we die.

What is not helping the initiative is some of the OntarioMD policy barriers that impede a physician’s ability to access funds if a colleague signatory to a contract leaves before the funds are released. (I think someone else mentioned this.)

Also not helpful is any CMS’s limited capability to produce exception reports in aid of identifying patients in one’s practice who have gone without a particular test or service related to chronic disease management. Their general ability to assist one to manage one’s roster administratively is also limited.

In the interest of keeping IT costs to physicians down, the province is attempting a provincial ASP. While good in concept, it would appear that the implementation is less than smooth and the software somewhere south of ready. In the meantime, if one is not yet ready to sign on to the provincial version, physicians who are in groups can reduce their costs by going to a thin-client, central-server-based solution with the server placed either in a responsible provider’s office, or, as in our case, within the IT department of our local hospital – if the vendor of choice supports an “enterprise” edition of their software. Not only does this accomplish economies of scope and scale; this also moves toward rendering the primary care record accessible to the ER and to consultants who might want to have a look at medication lists etc. And to researchers with whom one might be working at different points in time. Of course, one has to be within a secure network environment to achieve this. We also get access to the hospital patient care record on our desktop should we wish it.

Please remember, too, that many of our communities, and those, also some of our neediest from the health care point of view, cannot afford copayments, contributions, etc. That is not to say this arrangement cannot be tried successfully in some venues; multi-factorial solutions will be the norm in the future with different approaches fitting different areas. But you know this.

Another GS: Anyone can subsidize my IT costs anytime they want. I will accept the OntarioMD contribution and its purchasing power for my clinic. My personal funds are going into my RRSP. Oh, by the way, Semi-Rural Doc, who lamented the time spent on the computer, is one of the most computer –literate individuals of our acquaintance. She prefers patient interaction and writing with her fountain pen to soulless communion with cold equipment.

LifeLongLearner: Pathology pays. Whether it’s the health care system, the legal system, the society of accountants, a manufacturer with a product everyone is dying for, it all pays. We pay for the assuagement of a perceived and sometimes real itch. Capitalism seems to me to be predicated on that concept, lack. And our sense of lack in Canada appears to know no bounds as the spirally costs of the system and the ODB attest.

In economic terms, I guess, this means that all the money is thrown at non-equilibrium if we look at the standard economic equation. Noone spends money when equilibrium is achieved…

Back to Realist: I look at “the plan”, or, as much of it as I can see or intuit, and I see a process not unlike what The Economist this week in its special forecast for 2007 examines as the process of unification. Now, this is applied in the article to the unification of parts of the globe into larger economic blocks, but the analogy is cogent to a point. The chief point to be made is the price of unification. It drives a kind of regression to the mean which essentially points to winners (those in the mainstream) and losers (those in the margins who will likely be further marginalized0. So, when we look to the LHIN, we expect to see something of the same phenomenon. The arena of competition will be largely political; the rural populations we have to advocate for will require a good deal of our time, away from patient care, spent in lobbying for recognition of the unique needs of this environment.

Our impression of ou r own LHIN at this point in time is nebulous at best. The LHIN did not invite any of the ten or so rural practices in the catchment area for consultation in relation to the draft strategic plan -- except for the one that is attempting to be a FHT. Yet, we received a letter from the CEO thanking us for our input. Go figure.

Like Julius Caesar, we prefer to plan and negotiate on the march in practical and immediate terms. We will pick our battles if battle cannot be avoided and await opportunity for victory.

Our working lives and our relationships with the Ministry and with our hospital, agency, and academic colleagues are relatively good. But we do not necessarily represent those “many happy doctors” to which MFO referred who have learned to live within the system. We get on in many cases inspite of the system.

Our choice of practice venue, out of the mainstream, to some extent guaranteed a quality of life different from the thick of things on University Avenue in Toronto. We recognize that our specialist colleagues do not have these kinds of practical choices if they wish to remain in the specialty of choice. The quality of some of their days may be very different from ours as we hear from Andris and Dr. Klimet. We cannot help them directly, but, we can offer them a sympathetic ear and understanding of their points of view.

December 14, 2006 | Unregistered CommenterHayseed Docs
So I found some stragglers on one of the other threads and one of the issues seems to be "doability".

Sybil believes that the changes to our healthcare need to be "doable". She/he is right.

Let me quickly say that there are many things that were said to be impossible and which came to fruition...ie going to the moon, sailing around the world and not falling off the edge etc.

So changing healthcare in Canada shouldn't be impossible. But it has to start with an understanding that the current system is very likely unsustainable into 2020.

And it has to involve honesty and character and values and an understanding of individual freedoms.

I don't want to be promised what gov't can't deliver. I'd like to be responsible and independent and satisfied that as an individual I have a role as a patient that is more than just paying taxes to a gov't that wants to tell me how I should run my life andj how I should spend my resources.

Doable requires honesty.
Doable requires character.
Doable requires courage.
Doable requires determination.
It doesn't require playing shell games or preserving one's political skin out of self-interest.

December 14, 2006 | Unregistered Commenterrealist
Thanks Hayseed Docs. While I was writing my last post on doability you were onto the same thing.

Two things: We need many small steps to help providers help patients. Agreed.

But we also need some kind of catalyst that will show just what a fragile system we have. Without that catalyst, I'm afraid we will keep going down the LHIN road to nowhere at which point we will all turn to each other and say: "What on earth did we come here for and who led us and why did we listen? This isn't where we want to be as patients or physicians. Get us out of here!" But it will be too late because the Big Picture isn't being looked at. Political survival trumps real solid healthcare solutions.

It shouldn't be this way. How to change it so we don't all go down this ridiculous path to nowhere that has been created?

Not sure. But at risk of being preachy, it does start with being honest.

You expect honesty from a politician?
Maybe from Peter Kormos who got booted out of the legislature for complaining about the 25% pay raise politicians were going to vote for themselves. Perhaps he would have been safer just to have taken the pay raise and kept his mouth shut. But he has character and courage and even though I don't vote for his party, I can say he is an admirable man.

And by the way, the reason for the 25% pay raise for provincial politicians is so that provincial politics will stay "attractive" to potential candidates, not just those who are independently wealthy.....But I guess the same thing doesn't apply to physicians...or does it?
December 14, 2006 | Unregistered Commenterrealist
I’m actually in agreement with much of what Realist said earlier about EMR and infoway.

If the strategy is a “big bang” solution where all information flows between providers seamlessly, and the patients needs are there at the touch of a button…we need a martini or two to come back to reality. Big dreams are often far removed from reality.

Small incremental advances, which are shared and copied are more likely to result in steadily improved performance. Policy needs to reflect that dynamic.

The other thing about IT that I hold as a truth, is that it really only works when it is a reflection and support to how the people in the system work. If that is true, then the differences we see in different practices, should have different support systems (IT). Did I just say “one size doesn’t fit all” in a very long winded way?

One other thought about how to subsidize IT into the primary care office. I guess everything we do is a sort of subsidy (MoHLTC says I get “subsidized” an A007 for the patient I just saw). The choice facing policy people is what do you subsidize in order to get IT in the FP office…do you subsidize the tool (IT) or do you subsidize the job that IT needs to do? Both options result in an EMR on your desk, but by subsidizing the job, you also end up with the advantage of having a clear objective for your efforts.
December 14, 2006 | Unregistered CommenterOtherGS
You make some interesting points GS, particularly the one about different types of practices having different IT needs.

Let's look at Alberta currently. Ninety percent of Alberta is covered by a regional information system. Seven health regions can exchange patient information through The Regional Shared Health Information Program (RSHIP). This is a single system that adds health info of 1.2 million Albertans to the provincial system.

Will LHINs do this? How much will it cost?

But regarding physician office systems, that is another story. The Physician Office System Program has expired. Thousands of Albertan docs had received $740 monthly payment for keeping patient information on electronic databases. No more.

Once again, EMR and information transfer methods are great ways to improve patient care, but they come with a cost that must be borne by somebody and in all other countries, physicians have not been able to take this on by themselves.

If a wealthy province like Alberta has cut off support for physicians' office record systems, how do we expect a province like Ontario to foot the bill...seems to me I recollect some whining about equalization payments not being fair.

Maybe Dalton should just take his lumps and go along with the program?





December 15, 2006 | Unregistered Commenterrealist
Realist:

In your effort to change things, which I do support, there are a few key points that do slow the progress. These are the systemic issues that need to be understood as some key barriers to progress. You may know them but:

1. In the last 30 years, there has been, in Ontario, a complete flip in the "ownership" of health - whereas before, the major relationship was between the physician and the patient (treat the issue, worry about cost as you work on treatment); to the current relationship which actually is between the physician and the state (treat the patient using these defined tools which have been deemed to be "enough"). This, of course, is an extreme simplification, but helps illustrate that their really has been a social shift involve.
2. Change approved today takes years to implement on a systemic level. The LHIN shift wasn't created by the current government, it's been shifting around within the MOHLTC for years. Part of it does make sense and is needed; part was a guess and could be a real mess.
3. In the end, there are self interests. The recent "pay increase" to the MPPs should be viewed as what drives us all. Also the treatment of Peter Kormos should be viewed as what it is - a "whistle blowers" treatment for speaking up. Fortunately, he appears to be one of those people who has the "hide" to take it - most don't.

In moving to our state owned system, we're going to have to figure out how to use the "tax" system to reward no access to the system to help "control" costs. That way, the bulk of us will be able to see the personal incentive to "not" get care in a responsible fashion.
December 15, 2006 | Unregistered Commentermovingforwardontario
Thanks mfO for the confirmation on these points.

Yes, previous governments saw healthcare panacea as nurse practitioners. Elizabeth Witmer clearly believed primary care reform was the way to all things beautiful.

I think it is George Smitherman's bluster and passionate discourse that leads many to think the responsibility for the coming disaster is his government's responsibility. Clearly it was blunders along the way including the NDP's short-sighted and fallacious decision to cut medical school enrollment (apparently founded in an expensive and extensive study which evidently turned out to have some rather negative effects), then the Conservative's Common Sense Revolution with a very short time line to implement drastic cost saving cuts (cuz they knew they would get the boot, or had to have known).


Snake Oil salesman used to be very successful too.

But I do think BC's Premier, Gordon Campbell has it right. Perhaps because he has one of the most aged populations. He has begun to take difficult questions to the public, including such questions as "are private healthcare services already part of your everyday resources and are you for or against it? What do words like "medically necessary" and "publicly administered" and "universality" really mean and how do we achieve them? Why is sustainability not one of the Canada Health Act pillars, when it is perhaps the biggest challenge facing medicare this century?

He wants regular people to get involved.

He says that the problem in healthcare delivery is not a matter of "waste"-most everything is cut down to the bone-but of systemic issues that need fixing. He is urging individual doctors to participate in new thinking and problem solving.

"What we do in one area has an impact somewhere else-so until we start thinking of the whole we won't make good decisions. That is why it is so important to get input from people at the grassroots level where disconnects are most obvious," he said

Now our provincial government is still in denial (or just afraid) but the OMA is getting the word out.

Its Campaign for Healthier Care has begun and attempts to educate the public about the real dilemmas in healthcare have started.

Or we can just keep denying.

December 15, 2006 | Unregistered Commenterrealist
" During times of universal deceit, telling the truth becomes a revolutionary act" [Orwell]
December 16, 2006 | Unregistered CommenterAndris.
Andris, since time immemorial, s/he who sees and/or tells truth is condemned. Truth is not popular. It requires us to draw a meaningful distincion between seeming and being. In the world of seeming, truth has a nasty habit of being relative and a function of time. So it has ever been. Read the opening chapers of Book III of Thucydides' history of the Pelopennesian Wars. Tell me whether you don't hear and see the same things from Parliament Hill, Queen's Park, and CNN.
December 16, 2006 | Unregistered CommenterDiogenes
Diogenes, you took the name of one of my heroes...are you referring to the Mytilanaenian fear of being allied to such a power as Athens, whose previous allies had found themselves enslaved by the Athenians?

I always admired Periclean Athens...a relative democracy in contrast to the totalitarian Spartans...the Sophists , unfortunately, undermined the Athenian will to fight.

What part of Book III does strike a particular chord in you?....the supposition of the assumption of mutual unselfishness in negotiations....a laughable assumption in the modern era.
December 17, 2006 | Unregistered CommenterAndris.
Dear Realist:

While keeping my happy face on, I ran across this site. Must be "positive" as we transition to the new ways.

http://www.raredisorders.ca/

Read Forum 1 - a real eye opener about how Canada handles complicated issues about drug therapy. We apparently rank BELOW Bulgaria in our "openness". Geez.
December 17, 2006 | Unregistered Commentermovingforwardontario
Andris, I wonder whether either of us would have really liked or approved of either Diogenes or Pericles, although we can certainly understand them as creatures of their day.

The comment about the Sophists is not one that I can fully subscribe to, but would be happy to pursue in an alternative venue should you wish to continue.

The debate at Mytilene illustrates what I was really referring to, the stasis at Corcyra, an analytical view of what constitutes statis, and the outright confounding of the values that constitute the fabric of meaningful life in the community (the polis).

What the debate at Mytilene does demonstrate is political "spin" par excellence. And we think our world is tough -- the Realpolitik of the perilcean period and the late Roman Republic was just as tough or worse.

And, remember that the periclean stragegy of bringing the Athenians within the walls of Pireaus gave pesturela pestis the last word.
December 18, 2006 | Unregistered Commenterdiogenes
Can we just go back to the relationship between good information (i. e. good uptake on implementing IS, in particular, at the primary care level, good software, and good data entry practices) and the eventual economic applications? We acknowledge this will be expensive. I guess the longer-term ROI is the issue, not the accounting bottom right-hand corner. The ROI will be some years away and indirect.

A real problem for the measurement of health is the inablity to get a decent handle on morbility and comorbidity. There is no denominator. There is no denominator because IS at the primary care level is not yet at a place where we have the conditions mentioned above. The provincial ASP contemplates this, I believe. If we can get that denominator, then, we can make the above measurements. That could have potentially huge health care economic application with its predictive value. Of course, it will be fraught with all the ills of any undertaking of this kind and many oxes will be gored... but we need it.
December 18, 2006 | Unregistered Commentersybil
Dear MFO: We have whole genetic kindreds out here full of Huntington's, thalassemia, Tourettes, etc. No money to pay for what might be available in most of these households. We still have the battles ahead of us that were fought below the border to reduce patent holding times,etc. and all those good things.

A while back some bright light (it was probably close to an election) suggested that there should be a national drug policy, sort of like, a mutant ODB, except open, and everyone should get everything free (now there's a made-in-Canada approach for you). Who knows what he/she was smoking when that suggestion was made, well-intended as it might have been. One thing that could be done is a national policy on "orphan drugs" with a provision for financial assistance (after the issues of patent life, development costs etc. have been settled) with that assistance on a scale tied to income. Those who can afford to pay should. Economic discrimination, you say? Yup.
December 18, 2006 | Unregistered CommenterHayseed Docs
mfO,

Thanks for the link. One of the many dilemmas in healthcare.

Sybil,

No doubt that EMR's could enhance healthcare and potentially save some cash but healthcare is not static so measuring morbidity, co-morbidity is somewhat difficult.

New diseases evolve, new treatments evolve. How to measure if the variables keep changing?

But the bottom line is that people suffer when wait times are too long, when access to new meds is denied, when treatments are denied based on cost-effectiveness or when treatments are denied because gov't cannot afford them in our "universal" system where there is supposedly equality for all.

Take Cystic Fibrosis for example. A well-known disease but not exactly an orphan disease either. No known cure but lots of expensive meds to take and lots of time spent in the medical community.

A new vest has come out that frees up parents and care providers from doing hours of physio on the patient's chest-- basically a vibrator for the chest that helps to liquify the mucous. Many CF patients say it works great. Their illness seems to improve, they have less bouts of CF related illness. It costs $15,000 per vest, out of the reach of most families. Government won't pay.

So here we have something that definitely improves the life of the patient, improves the nature of the disease, improves the life and stress of the parents or caregivers but which gov't won't fund.

Why shouldn't gov't defray the cost in our universal healthcare system where there is equality for all? How is this different from an orthopedic procedure or a cancer treatment?

One reason might be because there are only several thousand CF patients in Ontario and their political power is not significant.

No intent to sound snide, but the idea that millions of relatively well individuals can access healthcare "free" while others who are truly in need must pay is a bit bizarre.

Philanthropy must play a role, but gov't must also step back and allow individuals to help themselves when they are able, to be more self-reliant when it comes to shouldering the cost of healthcare so that the truly needy can have more support.

Hayseed docs is right and the examples are endless.







December 18, 2006 | Unregistered Commenterrealist
Realist: Like you with your smart card, I dare to dream. If we can develop the complex calculation to measure,monitor,tweak, and report on the GDP, with its myriad of dynamic factors,we can certainly do this for health care. The denominator of which I spoke is critical to measurement of the morbidity of the general population. That is what could go on your smart card, an application of which could be to measure the expected quantity and rate of health care resource consumption. If some profit depended upon this directly, you can bet this would have been the first thing to have been done and would have been done long ago. The health economists will be at our disposal to assist with this, and there are some excellent ones out there.

It would be to our detriment not to work on this while we try to get a handle on wait times. I see us working on several parallel tracks, the outcomes of which will probably be differential in timing.

The original post was on waiting times. What have you in mind for us to do about this now, other than lobby locally? (Some of our wait times are horrendous, but, in some cases, even if there were money to throw at it, there are not the specialists to hire out there.) We would welcome any suggestion.
December 18, 2006 | Unregistered CommenterSybil
Sybil,

Actually, I think measuring healthcare is more complex than measuring the GDP because healthcare is personal. One's health is attached to one's beliefs, one's perception of well-being, one's personal experiences, one's expectations. Hardly so for the GDP.

Health is definitely something that an individual should be able to control to some degree not only through careful choices but also wrt allocation of one's personal resources. It shouldn't be for gov't to tell me what it will spend my $4,400 on...while my own family's health needs go unaddressed by gov't because they don't necessarily fit the usual profile.

All I can say for my contributions to GDP is that I try to be productive and not consume too many resources. I don't really feel in the driver's seat for the GDP but I should be able to be in the driver's seat for my health and the healthcare access I think I need.

You can have the best wait times in the world for five procedures, but if you have something less "popular", your needs are not necessarily fulfilled by gov't agenda.

It could be said that knees and hips trump gallbladders. Cancer treaments trump autism, etc. etc.

You mention profit and I think you are right. Profit is a driver and introduction of competition through private enterprise has the potential to bring down wait times.

If there is a need for more procedures, treatments, facilities because of our aging population, then we need to train many more physicians and yes, nurses, NPs etc...even pharmacists (who btw are likely to be able to prescribe in Alberta without keeping a medical record of their visit with the patient!).

But if gov't can't afford their fees (or salaries) then what would be the point? To have cutbacks to medical school and nursing school again? Doesn't make sense.

Revenue must come from private provision of healthcare and from private and public provision via philanthropy.

Wait times could be solved when co-payments are introduced to provide more revenue for healthcare..then we can provide the providers required and more treatments (mind you, the pharmacological expenses will still mount)

And I don't buy the concept that the average person can't afford a $10 co-payment. They can afford cell phones, competitive hockey, gas for their trucks and SUVs, money for the tanning parlour, ear piercings, belly button piercings, tattoos, DVD players, the internet, manicures, pedicures, body waxing, hairspray, hair goop, martinis and new winter coats.

No co-payments for seniors. None for kids under 5. The rest, a co-payment.

Now you've got me thinking about my next post: The Attitude of Gratitude vs. Entitled to the Entitlement.

December 18, 2006 | Unregistered Commenterrealist


Also suggest visiting www.healthiercare.ca
December 18, 2006 | Unregistered Commenterrealist
Realist: I am on your side. And congratulations on the choice of your next post. That's where the consumer rubber hits the road, the attitudes about health care as a resource we are privileged to have, and health care as my right to have unlimited quantities of whenever and wherever I want it --my choice of toppings and 30 minutes or free (stolen from Pizza Pizza in Toronto).

As for the GDP analogy, we already have these calculations for the CMG's and DRG's that have been costed. So, it's possible to have our calculation for the denominator. And I myself feel quite in control of all the things I do, driven by my beliefs, preferences, and choices, that go into my GDP contribution.

I think what might be the crux of the issue here is personal immediate health-care-related choices and all the qualitative things that go with that. We are emotional about our health in ways that we are about few other things in our lives owing to the relative vulnerabilities involved. But enough of this.

What should our approach be to the following scenario? A patient who has historically shown insuperable aversion to health lifestyle choices and practices. Who has abused every substance known to man. Whose every organ is now packing it up and is on dialysis at the moment. How about now developing gangrene in the extremities? I could go on. This is, in its way tragic. But, how would we propose allocating resources in the case of those who will not help themselves?
December 18, 2006 | Unregistered CommenterSybil
"But, how would we propose allocating resources in the case of those who will not help themselves?"

Sybil, we share similar concerns.

In a compassionate society, we must help those who will not or cannot help themselves. There is no question in my mind about this.

There are many people, and I would hazard a guess that it would be most people, who could rise to an expectation of responsible behaviour, if it is expected of them.

Trouble is, there seems to be little expectation by govt that functioning citizens should be responsible for their own health and healthcare. In fact, gov't doesn't allow patients to pay for their own medically necessary care.

And ultimately, this creates less funding for those who are truly in need or who cannot help themselves.

I am not an advocate of charging smokers or obese individuals higher premiums as has been suggested in other countries. A survey of American's views on financing and provisioning of healthcare showed 60% believe smokers should be required to pay more for their employment based insurance coverage. 29% believed obese should pay more (in California, 43% said the obese should pay more).

"Respondents indicated support for the concept of making individuals bear responsibility for certain types of behaviour".

But I have a problem with this because there are many people who do things that will damage their health, not just smokers and those who are obese. Why choose two areas to blame when there are lots more? What about the people who drive too fast or individuals who are careless in their sexual lives?

Better to have co-payments or even allow individuals to pay for their treatments if they can ...get ready for this.....get it faster.

Some people might be willing to pay to get their knee replaced a few weeks or months sooner or instead of waiting weeks for cancer treatment they get it in one week.

If gov't believes it has set safe benchmarks for the public queues then it should not matter to the health of those waiting in the public queue.

Co-payments could fund more physicians and services for the public system.

As Premier Gordon Campbell has said, "There are lots of choices, but if we don't quickly make some, we will see more and more that the health-care system isn't able to do everything for everyone and that there are limitations.

BCs website for conversation on health: www.bcconversationonhealth.ca and toll free: 1-866-884-2055.


December 18, 2006 | Unregistered Commenterrealist
and what is a CMG or a DRG?
December 18, 2006 | Unregistered Commenterrealist
CMG = Case Mix Group (more or less the equivalent of the American version which is..)
DRG = Diagnostic Related Group.

Both are managerial/cost accounting methods/tools for allocating budgetary resources, primarily in the acute care setting.
December 18, 2006 | Unregistered CommenterSybil
'If gov't believes it has set safe benchmarks for the public queues then it should not matter to the health of those waiting in the public queue'-realist

Seems to me this statement acknowledges (in a back-handed kind of way) that physician supply and access for the less flush in 'first pay,first come' health system is an issue to be managed. Good for you realist.

What are these 'safe benchmark' levels? Would they be stated in terms of 'x' number of GPs or specialists per 1000 pop? This is news to me so clarity is most welcome.


December 19, 2006 | Unregistered Commenterhedgehog
Realist: Congratulations!! The Fraser Institute has vindicated your general proposition about funding with its report released yesterday.

www.fraserinstitute.ca

Hedgehog: You probably know this stuff, but here are some places to look at for information you might be interested in.

www.health.gov.on.ca This gives you the party line on waiting times etc in Ontario in a special area of the web page.

www.oha.com The Ontario Hospital Association which has responses and position papers on relevant issues

For more research-related sites, see:

www.ices.on.ca The Institute for Clinical Evaluative Sciences, perhaps one of the most comprehensive and high-quality research banks.

www.cihi.ca The Canadian Institute of Health Information The nation bank of data and reports established by Michael Decter (also of reasonably high quality)

For the provincial and national efforts on II- and MIS-related issues:

www.infoway-inforoute.ca The Information Highway -- a private concern on whose Board site all the Deputy Ministers--whose mandate is consolidating useable legacy systems and shaping the future of IT integrating existing data with new initiatives -- an important step in our health care future.

Hope this helps.
December 19, 2006 | Unregistered CommenterSybil
Sybil

Thanks for the comprehensive list of research orgs. Are you suggesting one or more of these havs actually published threshold levels (doctor supply) needed to ensure access pressures do not pose a problem for the public. If you can narow my search that would be most helpful and thanks again for the time.
December 19, 2006 | Unregistered Commenterhedgehog
Citing the Fraser Report of December 18th, 2006 as the definitive report on Canada's health system, must be regarded in the same light as citing George Bush as a leader in stabilizing world peace: but there is a lot of good review in their report. It should be read.

Certainly, it can be legitimately quoted in supporting that, despite claims by advocates that all is well, there is great room for massive improvement.

Trouble is - where's the money to come from?
December 19, 2006 | Unregistered Commentermovingforwardontario
Dear MFO: I don't recall citing it as the definitive report on this issues; merely citing it. And one ought to read it if only to know what's out there.

Cheers!
December 19, 2006 | Unregistered CommenterSybil
Hedgehog: I would be profoundly surprised if some health economist has not done this. I haven't got time to do your search today; I can probably find some time tonight to look around. I will start with CIHI becuase they do have a report out on physician supply. More later.
December 19, 2006 | Unregistered CommenterSybil
Not to throw a monkey wrench into the discussion here, which is very interesting, and in a few cases innovative and thought provoking...but aren't we discussing adding further cost controls to an enhanced system with physicians as the gate-keeper? Any other innovative system-wide ideas out there that can service the population in an alternate delivery mode without rehashing all the fallacies of the FHT?? I keep thinking that with the obvious sheer brain power and wealth of experience on this blog that TRULY innovative ideas could abound...after all we have put people on the moon...

Maybe the topic of a separate thread...

My two cents, for what they are worth.
December 19, 2006 | Unregistered Commenterlifelonglearner
need to define whom you wish to have as "gatekeeper"?

1. Would the system be better, if 'patients" were gatekeepers? That is, in addition to "triggering" the consumption of money by presenting for care, they would receive incentives - to not present, in the way of tax reduction benefits?
2. by mandating that the Care givers act as gatekeepers, that automatically puts the caregiver in a conflict of interest.
December 19, 2006 | Unregistered Commentermovingforwardontario
We have never liked the term "gatekeeper" as applied to primary health care providers. We have always preferred the term "gateway". It's our job to advocate for our patients, and to ensure, as far as we can and are responsible for doing so, the proper care within the system is made available for our patients.

LifeLongLearner: Maybe I'm not reading this stuff the same way you are. At a glance, what I get out of recent discussions is some sort of agreement around the need for private funding. We don't have a problem with that as long as those in need aren't stiffed because they can't afford the care they need.

I guess that some cost controls are inevitable and even desirable if applied judiciously. But I don't see the solution as a simple one. "Multifactorial" is what's being whispered over my shoulder as I write this. And the FHT's are just another version of the HSO etc..I can't see them resolving much beyond a convenient payment mechanism for the LHIN.

MFO and other seem to be coming at this from different angles. MFO wants the patient to trigger the system. Well, in a way, I suppose the patient already does that. MFO also mentions tax-based incentives for NOT using the system. Well, over breakfast this morning, those of us who live under the same roof were mulling over a system whereby, as one receives a basic exemption from CCRA, individuals could receive a basic exemption for health care resources on an annual basis. This would cover the cost of your physical, any screens and tests that are part of the provincial chronic disease management process, etc. So everyone would have access to basic annual health maintenance and preventitive care at no cost. We didn't get beyond that. It was time to go work. We would have got stuck here anyway because, for one thing, roughly 20% of the population consumes 80% of the available resources.

And, LLL, if we want to actually do something, we have to start in practical terms. Have you an idea of some kind? Please share.

And maybe I really didn't get your point. Can you say some more about your impression of the thread?

By the way, I got an email from somewhere in Central announcing the launch of a provider human resource portal. Haven't had a chance to explore it yet.

December 19, 2006 | Unregistered CommenterHayseeds
Hayseeds:

we can debate the numbers, but the 20% that consume the resources are primarily the sick newborns, and the aging. That's what the problem is; the most "vulnerable' consume the available resources, and there are more coming with the aging of the population.

We can't tax the newborns, and the aging feel they've paid their dues to the health club and now want the benefits.
December 19, 2006 | Unregistered Commentermovingforwardontario
MFO: There is truth in what you say although the breakdown of the percentages as you present them might require some refinement.

The aged built the system we enjoy in the post-war years and should have the full benefit of it without worry about ability to pay in the case of those who cannot. And only the Grinch would tax newborns.

What we need to get at is medical necessity in that part of the 20% (which could probably be raised to 25% or 30% depending upon whom one includes) consuming resources unnecessarily owing to, at the very least, indifference to their well-being, and, at worse, deliberate abuse. We all see this in our practices. These are the patients that consume time and resources at the primary level (--and upward as we refer them on).I took an oath that binds me to see to their needs. And I do.

That oath doesn't stop me from reflecting that, if they had to pay for some of the care the want in limitless quantity (and some can get pretty ugly if they are crossed), they would be less inclined to run in for "just one more little thing" which did not need to be dealt with here, or to be a no-show which means someone else whose need may have been greater did not get an earlier slot. It's really annoying when we get a report from a consultant, whose time is gold around here, saying that the patient failed to show up without cancelling or calling later with an explanation.

In one sense, Canadians attach great value to universal health care. Paradoxically, a signifcant percentage of them attach absolutely no value to it as a precious resource. It's a kind of bottomless well. And it seems no politician is going to call their cards on this.

As a first step to curbing costs and possibly increasing access for our huge practice populations, I would like to see some support from Central, in some sensible way, in meaingful awareness-raising measures for this piece of the patient population. You have written about incentives for NOT using the system. This is where your idea might have good application.

Well, enough.
December 19, 2006 | Unregistered CommenterHayseeds
http://www.cbc.ca/canada/story/2006/12/19/health-report.html

The report ranks Canada according to various criteria, including:

Doctors per capita — Canada ranks 24th out of 28 countries with 2.3 doctors per 1,000 people.
Access to technology — Canada ranks 13th out of 24 countries in access to MRIs, and 17th out of 23 in access to CT scanners.
Infant mortality — Canada ranks 21st.
Years of life lost to disease — Canada ranks ninth.

Not all of these correlates are relevant. Infant mortality must have little to do with the number of CT scanners in Canada, despite the fact they are 21st and 23rd ranking respectively.
December 19, 2006 | Unregistered Commentereklimek
"In one sense, Canadians attach great value to universal health care. Paradoxically, a signifcant percentage of them attach absolutely no value to it as a precious resource. It's a kind of bottomless well. And it seems no politician is going to call their cards on this."

HS

Until we can put incentives in to NOT use, we're in trouble.

Sinec, at this time, our system is unique in its monoply approach to care; the only thing we can use is the tax system as a break/driver. Credits for no use seems the only break we can give. First $1000.00 of health care not used is applied as a straight deduction, 2nd 1000, a 50% credit.
December 19, 2006 | Unregistered Commentermovingforwardontario
Thanks eklimek, you beat me to it.

from the article eklimek has provided the link for:

"Friends of Medicare's Roberts said the solution to the problem lies in making intelligent choices given the funding available."

Heard this before...I guess it only holds true if the "intelligent choices" include restricting access, restricting procedures and treatments, restricting pharmaceuticals, and restricting numbers of physicians and nurses.

"Intelligent" might be a debatable term in this case.

Seems to me I've heard various individuals claim this before and I won't mention them by name. But they should be disgraced by now.

If society is going to make these "intelligent choices" that this person refers to, then it must give the individual a mechanism by which he/she can purchase the care they need if it doesn't happen to be one of the "intelligent choices" eluded to. It could then be purchased by the patient, by the patient's family or purchased on behalf of the patient through philanthropic organizations...goodness knows these same organizations are propping up the aging infrastructure of our hospitals and diagnostic technology already.





December 19, 2006 | Unregistered Commenterrealist
In a more cynical moment, I would suggest these "intelligent choices" will be made for us by the LHIN's.
December 19, 2006 | Unregistered CommenterDiogenes
mfO,

I disagree about having to give incentives to NOT use healthcare resources.

Mainly my point is that if the healthcare resources were your own, then you might use them more carefully.

It is always easier to spend someone else's money.

And this gets back to values, character, responsibility, self-reliance....and NOT state dependence. Responsibility leads to a more productive society. Dependence, well, it seems to breed more dependence.

As much as many people love to hate Pres. G. Bush, he did bring in health savings accounts in 2004 and consumer-led health care is beginning to take off in the states.


Individuals can contribute into the accounts tax-free and can transfer to their retirement accounts. They can invest the funds in the market once they reach $2,000 US. They can withdraw the money tax-free as well. Congress raised the annual contribution limits just recently to $2,850 for individuals and $5,560 for families.

Now, please don't start up about the badboy US system. I know....we don't want their employer based insurance program, or their ambulance chasing legal system....

But we ought to be open minded about what things might work.

And to insist that we need only rely on the tax base we have (but it will likely be shrinking) and just be more "intelligent" about it, is a little like thinking you (and I use this term generally) can cross the Atlantic in a dinghy if you are careful and smart and efficient about it....but I guess you might still want to try.

But nobody should be expected to go with you.
December 19, 2006 | Unregistered Commenterrealist
from the Fraser Institute's report:

"In 1970, the year when public insurance first fully applied to services from physicians, Canada ranked second among countries ranked that year."

We now rank 24th out of 28 countries wrt physicians per capita.

Any doubt why there are access problems? And the access problems are going to get a whole lot worse very, very soon.

And if you think nurses will solve the problem, think again, because there is a shortage of those too. Don't forget, nurses were driven out of Ontario in the late 80's and early 90's as their fulltime positions were slashed. Many new graduates left. A recent study also rated burn-out high amongst those still in the field.

$$$$$$$$

December 19, 2006 | Unregistered Commenterrealist

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