This past year has been an interesting one. We have a newly elected Liberal government at the federal level coinciding with three more years of an Ontario Liberal government.
What does it mean?
First, let me congratulate the posters on this blog for their continued interest in the health care challenges facing us now and in the future. They have been correct on many fronts over the past decade and have earned a gold star for predictions so far. I do feel honoured to have such insightful and accurate contributors to this site.
So a big "THANK YOU!" to all past and present posters! I value the perspective they bring. It is refreshing to read comments that tell it like it is.
At times we have been accused of nihilism by other lurkers and posters but I think it is more a result of facing challenges in a realistic way that others may not find "hopey-changey" enough. If that is the case then so be it. I shudder to think what would happen if we all underestimated the challenges ahead and sat quietly, afraid to voice concerns and ideas.
Hope is fine and well but what we really need is realism coupled with courage along with support for individuals and groups that are willing to provide diverging perspectives from the status quo that is in such need of change.
Enough said. I will spare you my comments on the OMA at this time.
Let's look at the challenges ahead with a simple list:
1. Aging population with increasing longevity requiring more care of all kinds
2. Relative economic stagnation partly resulting from aging population but also from global circumstances
3. Flat-lining fertility rate which is contributing to generational imbalance
4. Increased immigration that is not necessarily contributing to GDP
5. Rising expectations of public for more "free" health care and more "free" social supports
6. Scientific advances that are increasing costs of many treatments and contributing to longevity
7. Pressures arising from Hospital and Pharmaceutical demand
8. Inability of provincial governments to fund all necessary health care and social supports
9. Inability of the federal government to balance its own budget while accommodating provincial demands
10. Inability of the public to understand current and future financial pressures as debt rises across provinces and at the federal level
Now let's look at what has been tried over the past twenty years to attempt to address the cost pressures resulting from the issues above:
1. Primary care transformation- so far a failure to either reduce costs overall or to reduce waste
2. Electronic Medical Records- to date have failed to reduce costs or overall adverse events or errors.
3. Interdisciplinary Care- has not resulted in reduced costs or better outcomes. It will contribute to rising costs of care as relatively fewer workers will drive up labour costs in the future.
4. Efficiencies-for every efficiency found there are more new discoveries and complexities that drive up health care costs
5. Telehealth and HealthCareConnect- have not resulted in decreased use of ERs of primary care. They drive UP costs
6. Centralized Referrals- no evidence of more timely access to care overall. Current cuts to health care in Ontario have a very real likelihood of driving up wait times that will not be measured as specialists refuse to add more pts to their lists
7. Community Care Programs-these have not reduced costs and recently information relating to the cost of CCACs demonstrates the high administrative costs associated.
8. Aging at Home programs-these are akin to holding back the floodwaters as years of Boomers will be aging behind our current frail elderly. An accordioning of elderly will occur as people cared for in the community come to need more institutionalized care
9. Remote care- hopes that remote monitoring may prevent hospitalizations is yet to be seen. Will it result in increased visits similar to many screening modalities that do not confirm disease but simply lead to further investigation or unnecessary interventions?
10. Rationing of care by Health Ministries using the "value for money" efforts-no doubt that rationing does reduce costs but it creates pentup demands later. This is well-known.
11. Choosing Wisely Canada-efforts to reduce unecessary testing and treatments have been limited in success. New understanding of precision medicine based on an individual's unique genetics and epigenetics will be problematic for such programs.
12. Pay for Performance- these programs are turning out to be problematic. Clawbacks for hospital readmissions appear to be mainly cost savings oriented and not truly related to the quest for quality care. They are just an excuse to reduce funding to health care providers and institutions.
13. Cuts to MD payments and Nursing layoffs-these are cyclical and not solved by any transformation efforts to date.
Given the challenges outlined and a smattering of politically correct efforts already tried, here are some predictions for the next five years:
1. PM Trudeau will be met with financial obstacles to funding the provinces and territories with more billions for health care but will do it anyway. He will achieve nothing tangible. Health care is a black hole for government funding.
2. Minister Hoskins will step down in a year.
3. OMA's Charter Challenge will require more funding from Ontario's MDs. OMA will move forward with the Challenge while quietly hoping it could just find some comfortable solution with government onside. How else will the OMA presidents manage to find nicely paid government funded positions post presidency? Past OMA presidents will suggest that bargaining with government is very hard on them and that the membership has no idea what it entails.
4. Patients will continue to see wait times grow.
5. Elderly people will continue to be denied resonable levels of Home Care.
6. Pharmaceutical costs will not come down overall as some manufacturers are squeezed and sell off various lines to other companies who then readjust and repurpose the old medication but at higher prices.
7. Federal Liberal government drives up the national debt by running annual deficits for at least the next four years. The aging population is unable to rally with more productivity and the debt balloons.
8. Ontario is unable to spark its business sector since energy costs have been driven through the roof and the infrastructure expansions do not improve gridlock because more people including new immigrants choose to live in Toronto. More money spent with limited to no improvement.
9. Assisted suicide morphs into Duty to Die
10. Pot is legalized but the tax revenue is insufficient to balance the reduced productivity related to booze, gambling and drug addiction coupled with an aging population
11. A small segment of the population remains productive but is penalized for the hard work through increased taxation and increased inheritance tax.
12. More costs for water and gas and electricity and increased property taxes drive many seniors out of their homes and the Aging at Home program fails and fails spectaculary.
13. Hospitals are grid-locked
14. No national seniors strategy is capable of solving local health care need. Feds provide money but it evaporates...maybe goes to Teachers unions in secret payments ---could happen!
15. Ontario continues to ration MD income insisting that it is THE problem for sustainability and MDs are easy targets. Young MDs change their practice pattern and find other ways to create income beyond providing health care. Older MDs retire. Middle-aged MDs become more overburdened and less efficient.
16. Nurses take on more adminstrative roles in the province and are hired to consult on medical care. Kathleen Wynne's nurse daughter is hired as a Primary Care Group authorization expert at the behest of Baker-Price and controls MD licenses (not likely but still worth a chuckle...who knows, stranger things have happened in Ontario Health Care Lite!)
17. Dr Day's Charter Challenge is finally heard and goes all the way to allowing patients to access care they need without government obstructing them.
18. By 2019, fed government has driven up debt so high that credit rating agencies are giving Trudeau a talking to. Ontario has added another 100 billion to its debt and "Central" is ready to allow Private health care options along with Regulated Extra Billing started by Quebec's Health Minister.
19. Canadian Doctors for Medicare is as strident as ever and getting lots and lots of press by The Medical Post.
20. Public finally realizes that a Hybrid medical system's time has come. Some citizens are happy, some are not.
What do you think?
Have your say!
Thanks to all who lurk, linger, and enlighten!