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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The Attitude of Gratitude vs. Entitled to Entitlement

Premier Dalton McGuinty has admitted that three years after promising to reduce wait times, cancer surgery wait times have gone up.

A quote from the Ottawa Citizen: “It is absolutely true that we have some real challenges with respect to our cancer procedure wait times….The fact of the matter is cancer surgery wait times are up overall by 6.2 percent,” he told the legislature.

Now, to be fair, the Liberals did set up reporting of wait time data so that we can actually measure what is happening in a few areas but it is my understanding that this was tied to receiving more federal funding and part of what the 2004 federal money was earmarked for. One could say that the province felt some pressure to come up with the wait time reporting.

But in any case, what happens now?

In general, you don’t hear people congratulating the Premier for his most excellent “measuring”. People should be able to see positive results with all those billions of dollars pouring into healthcare.

Are they grateful? Well, it depends on who they are. If they are in the group that needed access improved for angiography or angioplasty then they are grateful. If they are the individuals waiting for cancer care access then they are probably somewhat worried and hopeful but grateful might be a bit of a stretch.

We will see more silos popping up on the healthcare horizon as various groups battle for funding not only from gov’t coffers but from donations. Cancer groups are competing with general hospital groups, pediatric hospitals, and cardiac institutions. We see hospital lotteries in direct competition with each other not only within the same city but from other cities as well. The fundraising turf is getting crowded.

People give out of gratitude and they need to have more access to donating mechanisms. Currently, patients cannot be approached during their hospital stay for donations when they and their families would be most grateful. Is it wrong to give money to show one’s gratitude? Is it wrong to ask? Are the patients so entitled to their care that providing an opportunity for patients or they families to make a donation is unethical?

As a society, Canadians seem to have a great deal of difficulty equating money with healthcare. People can manage to avoid donations to healthcare with the excuse that they “already pay lots of taxes for healthcare” and “if I need serious healthcare, I’ll just go to the States.”

More and more, healthcare institutions will be relying on donations. How can we make it easier for grateful patients to give. Or are they entitled to their entitlement?

My suggestions:

1.) Provide patients with websites and internet accessible donating sites.

2.) Create an environment in healthcare which includes an understanding of costs and money involved.

3.) Educate the public regarding the need for acute care and urgent care required in their own cities and the dangers of “outsourcing” lifesaving care.

4.) Educate healthcare providers that the care they provide costs money and government will not always be able to provide all that patients require.

Merry Christmas and Happy Holidays.

Reader Comments (35)

From another site and credible:

"One ER doc was telling me about a fourty year old female patient, mother
of two youg children, who was advised by xxxx to go to Bufflo for
subarachnoid hemorrage because there was no neurosurgical bed in
ontario. The xxxx also advised him to tell the husband that in case
she dies there , family will be responsible for the expenses to transfer
her body to Toronto .."

December 22, 2006 | Unregistered Commenterrealist
Another post from another credible source:

"... I saw a case of xxxx and he was transferred to Rochester, New York again due to neurosurgery bed shortage !!

He was a retired xxxx, a veteran in dealing with the public and admits that the current tragic situation needs OUR help to wake up our politicians to these unnecessary patient transfer to hospitals outside of Ontario !!!!"

December 22, 2006 | Unregistered Commenterrealist
Realist: A good blog for the american debate -- aspects of which are so much our own.

December 22, 2006 | Unregistered CommenterSybil
"As a society, Canadians seem to have a great deal of difficulty equating money with health care. People can manage to avoid donations to health care with the excuse that they “already pay lots of taxes for health care” and “if I need serious health care, I’ll just go to the States.”"

Because of the intentional disconnect between payment and service, we all have accepted that health care is free and accessible to all. For the majority, that is what they see, earning $55,000 a year, with a family, but essentially no medical costs, and much gets done by the system well. Those in the system, who are older, don't like the changes, cutting the frills associated with care, waiting lists, and an gradual acceptance of "this is how it works now". Those at the top, now running the system are relatively happy, well paid and little or no personal responsibility for patient care, and with enough money to "buy" any health care that is needed.

Historically this is the usual Canadian oligarchy. It is our system.

We won't much much to the US model in that it is foreign to our culture, we will adopt a mixture of european and other countries approaches as our immigration numbers continue to rise (as they must, to maintain any culture).

It will be interesting to watch.
We will likely concentrate our efforts on the 90-95% of minor care that is esay to do; and those in the 5% fringe will have a harder time; overall ,however, it will stay "free".
December 23, 2006 | Unregistered Commentermovingforwardontario

p25 of the report is best. 80% are satisfied with overall system, but 80% want fundamental change.

No wonder we all just meander down the road.
December 23, 2006 | Unregistered Commentermovingforwardontario
With the hospital accountability agreements being finished off; the report on roles and responsibility of team members (http://www.health.gov.on.ca/transformation/fht/guides/fht_inter_team.pdf), and readdressing of the new colleges and the roles of "disruptive" behavior in the achievement of "control, the year has ended will for the "plan".

Almost all now is in place for the LHINs to begin the "big" transformation.
December 27, 2006 | Unregistered Commentermovingforwardontario
MFO: So are we headed for Orwell's 1984? The Twilight Zone? The grasp of Cardinal Richelieu?? Oracular utterances, to which you seem given, seldom bode well.
December 27, 2006 | Unregistered CommenterDiogenes
The accumulation of facts and documents allows one to come to your own conclusions.

In a centrally run, top down managed system, the conclusions seem to be those reached by all other systems created in the same fashion. Don't see many of those surviving - maybe Ontario will buck history.
December 27, 2006 | Unregistered Commentermovingforwardontario
The CPSO's handling of the "disruptive" in the medical ranks will be interesting--- the Orwellian and Kafkaesque environment in the health care field will act as a deterrent to those self exiled medical practitioners, some 9,000, to return to Canada to solve the shortage problems created by previous government policies and will drive out many of the remaining---what will be the definition of "disruptive"...anyone who doesn't kow tow to the superior wisdom of the all knowing big brother at the MOHLTC? To the little Napoleons at the LHINs?
December 27, 2006 | Unregistered CommenterAndris.
MFO was quite correct a while ago when s/he indicated that the horizontal and vertical systems integration the LHIN's represent is not new -- in fact, was started almost 20 years ago now when systems integration was the holy grail of hospital reorganization in the late 80's and a positive religion in Toronto. We lived through the mergers of the huge hospital complexes there, at least one of which is now being undone (the Sunnybrook Wellesley merger). While deceptively conceptully neat in aspect to those who plan, but do not work in the grassroots, the implementation is anything BUT that...and the second law of thermodynamics can be seen to play out in organizational terms as entropy increases...we can hardly wait for the LHIN version.
December 27, 2006 | Unregistered CommenterHayseed Docs
You are all correct it seems to me.

LHINs are not the answer...they are merely a sad attempt to copy what other jurisdictions have tried...and even though gov't insists that they are not "regionalization"....they are in every sense.

But the best LHINs can do is remove the direct political connection between healthcare and the governing party. They don't really have a hope of controlling costs, not from what I can tell anyway.

Alberta has had regionalization for some time now and it is having troubles...despite being flush with cash. They have embraced pharmacists prescribing, health teams and NPs..and guess what?..., they are short hundreds of docs.

And five years ago around the time Romanow was doing his schtick and Kirby too, Mazankowski put out a report . It called for true innovation (not just deskilling of healthcare "providers" and bombardment of ads to recondition the public into accepting other providers) in the form of increased private delivery of publicly funded care and opening new revenue streams.

But only increased premiums were adopted, much like Ontario's Healthcare Premium (what wonderful original thinkers we have here in Ontario!)

And Albertans can measure wait times on-line (I wonder if they are more reliable in Alberta than in ONtario).

The Maz called for medical savings accounts and significant de-listing of services. Didn't happen and won't happen while Ed Stelmach is in charge.

And so we will have to wait for Alberta to take the next step when things get really bad, hope it is a good one, then wait for Ontario to copy.....and then 'round about 2015, when healthcare is really falling apart, Alberta (or BC) will have the guts to take the next step and bring Mazankowski's report back to the drawing board.

Who has the vision?

It is not Ontario....because you don't get quality healthcare be driving providers elsewhere.

But you can always go to your chiropractor or alternative healthcare provider, pay for your "live blood cell" analysis done by someone trained at a healthfood store in a few weeks, have some unregulated "remedies" recommended at significant cost, and believe you are getting great care because you paid a lot for it.

When you collapse or have chest pain or develop Alzheimers or diabetes, will the "live blood cell" analysis person provide you with real medical care?

Probably not.

I'd like to see a set up where in each home a computer can be hooked up to a BP cuff, ECG machine and a patient's info (maybe even blood work done with a finger prick)fed to a local medical office where physicians can assess and advise the patient on their next course of action. But a fee would have to be required for this convenience.

It may sound far fetched...but it is likely to come in some way...much like diagnoses made from a distance using webcams etc.

But somebody has to pay for the price of the technology and for the convenience of avoiding the ER.
December 27, 2006 | Unregistered Commenterrealist
WRT Federal Report on Healthcare Indicators-2006: Of the three themes of which Quality was one, it was evaluated by "patient satisfaction in the way the service was provided" for example.

But one is left wondering if patients would be equally satisfied with the "live blood cell analysis" provider even though there is no scientific proof of its benefit. Does it somehow have credibility or value if the patient is pleased with the way it is delivered? Why should this be a measure of quality healthcare? Many patients simply do not know if what they are receiving is quality care.

A snake oil salesman could do equally as well, with little or no real health benefit and even perhaps deleterious effect. Anybody measuring the effects of side effects from unregulated herbal products?

As for the 62.2% of Canadians over 15 years of age reporting themselves to be in good health....kind of a skewed statistic since most people between the ages of 15 and 40 are generally in good health with few chronic problems. Problems start occurring in general with age and the 62.2% quoted is a bit misleading I think.

I suppose the federal report is an attempt but I wonder if it is truly an honest attempt.

A truly honest attempt would ask patients over 65 how well they were able to access the care they needed...because this might give us a little glimpse into our future.

A truly honest attempt would ask for some provider feedback and some objective ways of measuring healthcare..ie number of diabetic patients reaching recommended targets for serum glucose etc...

Asking people how they rate themselves in terms of wellness cannot be an indicator of quality healthcare since it is measuring a perception....or perhaps I have missed the point....is our healthcare system all about Perception rather than real healthcare Outcomes?
December 27, 2006 | Unregistered Commenterrealist
Realist: Yes, it is very much about perceptions and spin and promoting a positive national image of our collective health. If we really wanted to go after the meat of the matter, we would hire Sheilah Fraser.

I note that noone today has commented on the 25% increase on the transfer payment dollars going toward Public Health that was announced. It seems some of the downloaded stuff is being uploaded back to the province. Another really good step would be to provide the CCAC's with the same infusion so that Home Care could actually come within reasonable shooting distance of its mandate.
December 27, 2006 | Unregistered CommenterHayseed Docs
The pleasant thing about all of this, is that much is not new. It is just the recycling of political agendas and tax money.

Whatever the percentage, 80, 85,95 percent of health care is "not needed", in that with time most "cures" itself. The problem is, the death and morbidity associated with the "missed" serious stuff. That, politically, is the great value of the ED structure in Ontario. In the end, one can get seen and serious disease treated. That protection will always remain as the safeguard for the political survival of a "health care system".

The planners need to try to divert that 90% of unneeded care to lower cost sites - NPs, extended NPs, FHTs.FHGs,APPs, and all other providers now being added. Additionally, one can sneak in "co-payment" and "uninsured" services at the this provider level, easier than at the ED and above level.

The group undergoing the most change, those older fee for service physicians who have been caught in the transition to "controlled" budgets. The current scheme is to control cost - it is not to provide best care at any price - it is to provide the cheapest care, that keeps complaints at central MOHLTC to an absolute minimum. Right now that is working.
December 28, 2006 | Unregistered Commentermovingforwardontario
How is it that the planners don't understand that:

The cheapest care has been provided by family physicians in an expedient way by seeing significant numbers of patients in a day...the "easy" stuff is taken care of in a few minutes vs the "tougher" stuff taking longer.

Trouble is there is more of the "tougher" stuff as our population ages and less of the "easy" stuff but how a nurse practitioner added to the equation who sees 6-7 patients a day (compared to roughly 30 patients a day for a gp) will cost less is beyond me.

Don't kid yourself. The physician resource calculations have been so badly bungled that NPs are seen as a quick fix. There aren't enough physicians and Canada compared to the rest of the OECD nations has significantly fewer physicians thanks to our monopoly system.

As for controlling costs....please tell me how bringing on a myriad of other providers (whose "efficiencies" remain untested) with benefits is going to save costs...

Is this a joke? I am not laughing.
December 28, 2006 | Unregistered Commenterrealist
1. NPs and other team members will work from "care plans" that determine how and when services are provided. Deviations from the plan could be "disruptive" to the team plan. Thus costs are budgetable. Disruption to the team could cause lack of access to OHIP until "complaint" is resolved.

2. "Intense care" will get transferred to hospital setting where budgets are already fixed.

3. Out of hospital care (CCACs and others) are budgetable.

4. Services that are needed but can not be paid for in a timely fashion will go to wait lists. Wait lists will be addressed if enough complaints are voiced.
December 28, 2006 | Unregistered Commentermovingforwardontario
Health care by cost accounting algorithm. And the patient is the ham in the sandwich. What a wonderful thing the political process is.

MFO's outline is nothing new. I think someone has already discussed CMG's and DRG's. This is also related to the rollout of the of the great MIS which is in turn related to the great integration. Remember what a fisaco putting Home Care on a cost-per-case basis was? And it have never recovered.

Not all the effects of a more relatively standardized approach to health care will be bad. The trick will be to know when to exercise and fight for those issues requiring shrewd intelligent clinical judgement -- which will, of course, fly in the the fact of "the plan".

Since the Hayseeds would inevitably wind up with Orwell's Book People in this scenario, we think we will just stay out here and do what we can in the most efficient effective way we can for our patients, working with "the plan" where it benefits the patients, and working around it when it doesn't..
December 28, 2006 | Unregistered CommenterHayseed Docs
...plus ca change...
December 28, 2006 | Unregistered CommenterSybil

hayseeds have seen the plan - and they know the plan is good. "This is also related to the rollout of the of the great MIS which is in turn related to the great integration"

As we adopt the big MIS through the EMR system we can and will achieve the "great integration". With the noble GREAT INTEGRATION, budgets can be planned. The plan will not be disrupted.
December 28, 2006 | Unregistered Commentermovingforwardontario
Sybil, "plus ca change" is right.

Almost seven years to the day, January 12, 2000, I wrote in the Ottawa Citizen that the "shortage of nurses is only the tip of the iceberg".

At that time, many nurses had fled for the US as they saw their training programs and full time positions cut in Ontario. Medical school positions had been cut severely several years earlier by the NDP government in 1993. This was government's attempt at controlling health care costs to the monopoly public system.

"The fewer hospitals we will have in years to come will not function well if there are few nurses and doctors to staff them. The government has promised more home care for patients who can be maintained medically outside the hospitals. I think these promises are lagging."

That was 7 years ago. There has not been substantial improvement. There are worse physician shortages than before, longer wait times in many areas despite billions of more dollars and full time nursing positions that are lacking. Home Care still lacking in resources for the multitudes that need it.

How to solve this?

Some say EMRs are the answer. I say they are only a small part of the solution.

Other solutions exist in enabling patients to access reliable medical advice through the use of the internet using their EMRs.

But currently the cost of instituting EMRs on a widespread basis is cost prohibitive for gov't or for physicians' offices. Patients would need to contribute themselves but this would enable them to have their records available when they need them
for specialists appointments or emergency room care.

Why shouldn't patients be able to contribute to maintaining their EMR?

Or should they be "entitled" to this? And if they are entitled, who should pay? And if government pays for this, what area of healthcare should it take the money from? Should it take it from healthcare at all...maybe the funding should come from elsewhere in the Ontario budget....even if the healthcare budget is eating up 46% of the total Ontario budget already and rising?

Co-payments are a solution to those who don't like the idea of more outright privatization.

Healthcare savings accounts are an option.

More private provision within the public system is an option.

Co-operatives are an option.

More philanthropy is an option.

Refining the bureaucracy is an option.

More patient responsibility is an option.

More provider responsibility has been the option used in the past with claw backs for physicians, earning caps, hospitals in the red only getting more cash bailouts when a government appointed consultant says they need more.

Raising taxes year after year and asking for more government funding is not an option. It hasn't worked for a very long time and isn't likely to.

How low will healthcare sink before the public is ready for other options?

December 28, 2006 | Unregistered Commenterrealist
EMR= Electronic Medical Record
FHT= Family Health Team
APP= Alternate Payment Plan
FFS= Fee For Service
FHG= Family Health Group
FHN=Family Health Network
CCAC=Community Care Access Centre


realist= Dr. Merrilee Fullerton
December 28, 2006 | Unregistered Commenterrealist
MIS=Management Information System
December 28, 2006 | Unregistered CommenterHayseed Docs
For those of you who have not yet seen today's Globe and Mail, there is an interesting article on just how wide-spread private money in the health care sector is becoming -- quietly -- as in, if you don't draw attention to yourself as an entrepreneur, the MOHLTC will stay out of your face. The Province knows that private sector has its place as long as the CHA is not violated.

More and more "boutique" medical practices are springing up to which one can belong by virtue of paying an annual fee which covers services that are not medically necessary nor are they even Third Party billable services. In principle, there is nothing wrong with this. In a market as tight as this one is for medical manpower, though, if one cannot gain access to the physician except by virtue of paying the fee to join the clinic, this raises potential ethical issues of restricting what some folks see as an essential service in times of service "famine". Now, these physicians do not charge for those services they deliver to their clientele which are covered by OHIP. But, if you cannot get to the physician for those services UNLESS you pay the "joining" fee and annual maintenance fee for those other services, that is a kind of restricted access to service.

More and more young physicians are setting up "boutique" practices - if they are going into practice at all. And we can expect to see more of it precisely because it represents a more manageable approach to health care. And, if one is specializing in the health of the elderly, for example, in this kind of practice, one has the time and the opportunity to do all those little things and provide the counselling, access to other services, etc. that conventional practice is less likely to have the time and the opportunity to provide. And, there is some satisfaction in seeing something for one's effort in a more controllable environment.

Last night, at the local After-Hours Clinic, after my day's work, I saw another 45 patients (13 of whom did not have family physicians). Of those 45, perhaps 15 actuallyt needed to see a physician. Of those, a number were some of those without a physician and who had quite serious chronic problems.

My point is that we are seeing more and more of this last kind of patient in the margins of the system, that is, the walk-in clinics and the after-hours clinics. (The ER's and the After-Hours Clinics are what they have. And the Lord knows that the ER's in this city did not have the capacity to see anyone who wasn't brought in on a stretcher this week.) This is serious. And it gives me pause, I confess, when I see that these are not the patients the "boutique" practices are going to want to touch. Where are they supposed to go?

There will be a similar problem if the Province decides to try cooperatives or reciprocals of any kind. Those risk pools will be self-selecting, and will not want those who really need the care. The premiums will be unacceptably high for those who really need the benefits of the system. So, these forms of "insurance" will be just like any other insurance pool and function in the interest of the "mean" or "standard" insuree.

The answers are not easy.

Yes, a percentage of capacity could be freed up if patients made rational choices about how their lifestyles and how they use the system. (Like that's going to happen anytime soon.) NP's are NOT an answer; give me a good primary care RN anytime. And yes, if the system permitted physicians to practice something other than defensive medicine, more resources could be freed up and perhaps better allocated. But that free capacity will not in itself suffice to meet the physician manpower shortage. That is real. And not necessarily because there are not enough physicians -- the expatriate physicians are unlikely to return in this climate, and those graduating just don't want the headaches of working in this current climate (and why should they when they can go to the local ER and make $1,000 a day with no paperwork?). And here is the catch-22: the OHIP pool would be in REAL trouble if they did decide to come into the fold.

My random musings for the day.
December 28, 2006 | Unregistered CommenterHayseed Docs
Hayseed Docs:

But you are right: boutique care allows the self selection of those patients and providers who want "out" and have the resources. Problem will be if the "boutiquers" get really sick (which will happen); they'll need to be aligned in some fashion with a teaching hospital. So you'll begin to see, donations from "boutiques", so that an "under the table" relationship will occur to get the "sick" into institutional care, when needed.

Trouble with the plan; it ignores the capacity of those with sufficient resource, to figure out a way around the plan.

Anyone else notice the appearance of the Cleveland clinic in Toronto - note the rapid non response from the MOHLTC.
December 28, 2006 | Unregistered Commentermovingforwardontario
MFO: I myself would not set up a "boutique" practice unless I already had an adjunct appointment to the local Faculty of Medicine, and priviliges, admitting or courtesy, at the local tertiary or quaternary care facility. That is part of the continuity, especially if your "boutique" is geriatrics, paediatrics, or sports medicine. And I would already have my network of specialist consultant contacts lined up, if not affiliate members of my boutique. The professional world still runs to a large extent on personal relationships, and, thank heaven, for those of my patients I refer out of the LHIN area, it does.
December 28, 2006 | Unregistered CommenterHayseed Docs
hang on a minute

Physicians have practiced charitable care for many many years and still do.

I often wave fees for reports and paperwork that I know patients cannot afford. But unfortunately, in our current system, there is no way for me to recoup my losses except to look more to third party billings or cosmetic procedures etc. which means I would have less time time to spend on OHIP medicine.

If there was a mechanism by which physicians could stay in general family practice, providing real necessary medical care, my bet is that most would try to do it because it is why we go into medicine.

If physicians simply wanted to make lots of cash, they would not have chosen medicine...at least not in Canada.

So how to keep physicians practicing and supported in the community who will in turn support the patients of the community?

First, we need to address what has happened to the sense of community in many areas and how to engage people in helping themselves and maintaining their medical resources.

Mostly what people know is that they pay lots of taxes and expect to have a decent level of health care service when they need it. But that isn't necessarily the reality.

LHINs (local health integration networks) have been established in an attempt to regionalize healthcare but they don't go far enough in engaging local populations.

If we want empathy, caring and compassion in healthcare then it must start locally, even down to arrangements between the patients and the providers.

We cannot expect to pay taxes to some distant bureaucracy and have it trickle down efficiently to meet all of our needs. It doesn't and it eliminates people's input in the process and keeps people from really getting involved in the healthcare in their communities.

We are going the wrong direction by creating more bureaucracy within LHINs.

You want to know why some docs set up "boutique" practices...because the system drives them into these areas and the personal involvement and expectation and support from local communities is gone.

Can it be regained? How to foster a culture where people help other people on a direct basis? I'll tell you where not to find it: in a large, government directed bureaucracy. You also don't find compassion or empathy there either as far as I can tell.
December 28, 2006 | Unregistered Commenterrealist
also look for the Mayo clinic with connections in Canada...and this will be good, all good.
December 28, 2006 | Unregistered Commenterrealist
Realist: Yes, "boutique" medicine is, in many ways, the counterfeit of what "community" used to be. The "boutique" community is defined mainly in terms of some kind of pathology -- and also by the generally urban setting in which it is found where the individual is the unit of focus, and not family and community in the traditional sense. A "boutique" would never make it out here where we are (thank God) because it is wrong for the structure and culture.

And, yes, if we could see only patients who were really sick and do our pre- and post-natal child care etc., and our preventitive and health maintenance stuff, we would be VERY much closer to why we chose medicine.

Out here, the community has a greater expectation of being "engaged" as you put it than it would in downtown Toronto. And there is a core of community leaders who do try to take care of and plan for the resources on behalf of those who cannot, and those who are indifferent (but who are glad enough to have the service when needed).

But we also have a population of young people and "urban" types who simply do not wish to be engaged in what used to be termed "the therapeutic relationship". They simply want the application of technical expertise on demand in impersonal terms. It probably makes little difference to some of them whether I do it or the janitor does it as long as the FEEL their need has been met. It's like ordering fast food at midnight when the whim strikes.

As for pro bono work, yes, we all do it. And, even in the OMA master contract for all the acronymns, there is absolutely nothing to stop any of us from charging "block" fees or "club" fees; the contract is silent on this. So it's legal to do. But there are those who are going to have a problem with the optics of that if the practitioner in question will not take them on as patients, even for the OHIP-paid basic health care services, unless they agree to join the "Club".
December 28, 2006 | Unregistered CommenterHayseed Docs
"But there are those who are going to have a problem with the optics of that if the practitioner in question will not take them on as patients, even for the OHIP-paid basic health care services, unless they agree to join the "Club"."-Hayseed docs

What is the difference if I do paperwork pro bono or insurance forms pro bono or see patients who cannot afford to support their physician....those who can pay and feel the need to support their medical community will do so. Those who cannot will still be seen.

Communities who are short on medical providers have paid head hunters who dream up ways to attract physicians. What is the difference if the community agrees to support their physicians through direct lump sum payment or through "block fees" for those who feel the need to contribute or fees to support the physicians' office overhead?

As for people not caring who treats them, I disagree. Most people want to be treated by a competent care giver who cares who they are and treats them respectfully...just an opinion I have come to over many years, working in many settings.
December 28, 2006 | Unregistered Commenterrealist
Ending the year on a positive, the decision yesterday by the Ontario Superior Court against The Scarborough Hospital (TSH) Corporation, again, gives support to the struggles against central's plan.

TSH, like most hospital corporations in Ontario, has a process of election to the hospital Board that assures no involvement of the public. It was challenged in court, and lost, with the court clearly recognizing that the intent of the corporation is to not change to engage the public.

It is interesting that virtually each time central is force to account through the judicial system for its actions, it loses. Sadly, the cost and time required to initiate legal action exceeds the capacity of most. As a result, compromises generally occur between "vested" intersts that strive to maintain the status quo. There are however, these occasional glimpses of hope that the "public system" could actually be publicly managed, if only central would allow it.

Maybe if we gave the public access back to controlling their "own" money we could see real change.
December 29, 2006 | Unregistered Commentermovingforwardontario
Realist: First, I have not said I am arguing against the payment of block or any other kind of fees. My point was that there is nothing legally wrong with it, and, if the traffic will bear it, with the actual implementation. But, we are living in a difficult climate and the optics might matter.

Second, I was not speaking about "most people" when I made my point about who seems not to care much about the kind of provider who sees to their needs. I was in fact quite specific about to whom this impression applies.

Hope this is clearer.
December 29, 2006 | Unregistered CommenterHayseed Docs
Sorry Hayseed Docs. I did not mean to give you the impression that I was attacking your statements....just wanted to show the other side.

"Maybe if we gave the public access back to controlling their "own" money we could see real change." mfO

I think that you give a very clear statement of where we need to be headed.
Now everybody knows it is hard to build your own road with your own money..it really needs to be built by pooled resources through taxes or ,dare I mention, even P3s, but when it comes to many kinds of healthcare, there is no reason why patients shouldn't be able to control their "own money" and direct it to the type of healthcare they feel they should have.

Some people may choose to do this and others may not but it seems that these days with so many options available, that the patient should be in the driver's seat with a more direct link to the care they need. This would have the effect of reducing the "go between" bureaucracy that eats up so much cash with its inefficiencies.

It may be interesting to explore the "boutique" healthcare options expanding in BC that allow patients more time with their docs and better access. Patients get what they need and retain their physicians. Pretty good really....only the bureaucracy left out.
December 29, 2006 | Unregistered Commenterrealist
Realist: The "boutique" practices are right here among us! We could look at the ones in Toronto and the two new ones in Kingston that also made the papers.

The interesting this is that Appendix E of the OMA Master Contract makes it possible and even encourages disease-state-specific clinics around things like geriatrics (one "boutique" in Kingston is focussed on this)HIV, and I believe, primary-care-paediatrics. That is, you could be a small APP and have this kind of practice. Depending upon what case one might make to Central, there might be an argument for others focussed around the major disease states like diabetes. This is a micro version of the "focussed factory" approach since all these kinds of practices will have to have immediate access to the whole disease-state referral network for that patient. The Shuldice Clinic in Toronto has long since been applauded internationally for its excellence in this connection.

And, by the way, (you spoke of the Mayo), that is where all the docs here go for our primary care CME every second or third year. The program is excellent.
December 29, 2006 | Unregistered CommenterHayseed Docs
Hayseed Docs,

Can you name the boutique clinics that you knowof in Kingston?
December 30, 2006 | Unregistered Commenterrealist
Dr. Jennifer Hacking has set up the sports medicine practice (whether she regards it as a "boutique", I couldn't say); I don't know its name. Dr. Cathy Kilpatrick has set up Health for Life (I think), specializing in care of the geriatric population.
December 30, 2006 | Unregistered CommenterHayseed Docs

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