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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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Thursday
Sep082016

B.C. Courts will bring into Focus the Hard Questions about Canada’s Health Care System

 

Canada’s health care system has been called many things including a “jewel” and “the very essence of what Canada is all about”. It has also been called “sclerotic”, “archaic” and for politicians it has become “a sacred cow”. For many Canadians, our health care system has become a mirage. Aside from the illusory notion that our health care is “free”, many cannot explain how it works and how it is financially sustained. Many cannot access the care they need.

However, this mirage is going to be drawn into clear focus in the weeks and months ahead as the B.C. Court is hearing a case put forward by surgeons and patients that accuse the B.C. government of denying them their rights to timely medical care.

Perhaps the B.C. case will allow Canadians to begin the necessary discussions about how our health care must change to address the serious systemic shortfalls within it. We have a strained health care system due to an increasingly aging population, more pharmaceutical options, more medical technology with associated potential interventions, and emerging science that requires more medical research and money.   

For people waiting for care, or denied care, or whose disease is treatable elsewhere but not here, the limitations of our current system have become numbingly clear.  We should walk a mile in patients’ shoes to understand the importance of the B.C. Charter Challenge for those who have been denied timely care. While the outcome of the case is important at an individual level, it will also resonate at a societal level – throughout our country.

Some people choose to frame the case as a “private vs public” health care battle and foresee the destruction of Medicare if B.C.’s provincial health care service loses the case. However, at a foundational level, the case is a challenge about the rights of Canadian patients in a system that denies timely care.  What rights does a patient have? What recourse should a patient have? What suffering can the government health insurance plan fairly impose on an individual patient, if any?  (In a country that has recently witnessed the Supreme Court of Canada rule in favour of an individual’s right to die, one might expect that it would also rule in favour of an individual’s right to live.)

Now is the time to ask the difficult questions about what we want from our health care system that was designed for another era and which, despite transformation, is a laggard in the developed world. Many of us who have been part of the on-going debate about patients’ rights and the short-comings of the system recognize that we can and must preserve what is fair and equitable about Canada’s health care system and move forward to improve what is not.  

There are some important questions that must be fully discussed.

Must we pit patient against the system? What is more important, the patient or the system? Can we not all agree the system must exist for patients? So, the question then becomes “How to provide more care to more patients?” In that context, how is it ethical to preserve a system that cannot meet patient demand despite almost fifty years of trying?

How comprehensive a system can we afford? Do Canadians want modern health care that keeps up with change, or do they want an archaic system designed for fifty years ago? As pharmaceuticals become more and more prominent in treatment options, many Canadians want to include pharmacare in our country. However, the cost of Canada’s government funded system makes it difficult to move forward in publicly funding other areas of care such as eye care, dental care, and newer pharmaceuticals for cancer and other previously untreatable diseases.  How can a better balance of services be achieved that will meet our expectations for an advanced health care system?

There’s the important issue of “Universality”. Do Canadians want universal health care coverage in theory or in reality? The term “universal” does not mean “government funded”. It simply means coverage for everyone. There are many ways to provide coverage for everyone in a truly universal system that creates access instead of imposed rationing. Many other countries have hybrid systems for medically necessary care and manage to achieve universality at lower cost and with better outcomes. Why aren’t we looking at and learning from other better performing systems? And, what of portability of care in Canada? Do Canadians want a system that provides similar services across the country, or do they want the system to be determined simply by the degree of rationing required in each province?

What is to be done about the under-utilized infrastructure and medical workforce? What do Canadians want, more government rationing of care or more ways for more patients to access care? Canada has less than the average number of physicians per capita compared to many developed countries yet we cannot fully employ our medical workforce due to costs associated with utilization of government funded services. Operating rooms and surgeons sit idle, hospital beds may exist but are “unfunded”. Hybrid systems of other developed countries have more providers, more hospital beds, and better access to medically necessary care at lower cost than Canada’s health care system.

Canadians must have this honest and difficult discussion about our health care system if we are to create a truly universal system with quality health care that addresses patient need. I believe the B.C. Charter Challenge will help in this dialogue. Contrary to rhetoric about the case being an attack on Medicare, it is not. Given the history of our country, Medicare will continue, but we must acknowledge its faults. A more robust health care system is needed, one that is truly universal, comprehensive, and accessible and not so negatively impacted by government short comings both in funding and in vision.

The B.C. case will bring our health care system into much clearer focus. It will drill to the core of the debate. If we are to give patients the dignity and respect they deserve, then we must acknowledge that they are part of the solution and give them the necessary freedoms that are currently lacking.

Reader Comments (556)

"prescription drugs, physiotherapy, dentistry, and ambulances, etc. — which are excluded from medicare because they are inaccurately and arbitrarily labelled by bureaucrats as not “medically necessary” "

A Hybrid system means more comprehensive and more accessible health care.
September 8, 2016 | Unregistered CommenterMerrilee Fullerton (realist)
"the most common demographic of a patient treated at private clinics like Cambie Surgery Centre is that of a unionized worker"
September 8, 2016 | Unregistered CommenterMerrilee Fullerton (realist)
"Strangely … patients treated at our private clinics include leaders from the very groups that are going to court to make sure others can’t receive the same benefits that they have enjoyed."
September 8, 2016 | Unregistered CommenterMerrilee Fullerton (realist)
"the lowest socio-economic groups in Canada suffer the worst access and have the worst health outcomes. This is the opposite of what Douglas’ plan was initially intended to do."
September 8, 2016 | Unregistered CommenterMerrilee Fullerton (realist)
Will the Prorogue in Ontario allow the Ontario government to cement the present dysfunctional Ontario health care system, preventing it from transforming into a world class ( hybrid) system...reintroducing Bill 210 and somehow imposing it on the province during the prorogue without going through the legislature?
September 8, 2016 | Unregistered CommenterAndris
Andris, I believe that the scenario you posit would not be possible in a parliamentary government, particularly as the Bill requires amendments to 19 existing Acts.

It appears that existing Bills will be brought forward and - if I understand it correctly (huge assumption) - the governing party would only have to re-introduce Bill 210 for a new first reading.

As the Bill had only gotten to first reading this would not represent a large delay given the current majority.
September 8, 2016 | Unregistered CommenterExecutive Lead Blogger
What Canadians fail to realize is that we already have a hybrid system: however the hybrid system is poorly balanced and they believe the side they have to pay for does not contain anything of importance.

Until they have to pay for it.

The public also thinks it has some modicum of control on the publicly funded side - of course they do not.

The public does not even care that they have absolutely no engagement or control on the non-public side, either.

The prevailing prediction is that the Supreme Court of British Columbia is going to side with Dr. Day. This will naturally be followed by appeals to the Supreme Court of Canada which will agree with the provincial decision.

There will be coast to coast to coast haughty unrest.

Then in its ultimate wisdom (and without a shred of knowledge about how to implement change) the Supreme Court of Canada will also order the creation of a hybrid system across the country in some ridiculous timeframe (as they did with medically assisted death).
September 8, 2016 | Unregistered CommenterExecutive Lead Blogger
thanks ELB,
What's your best guess as to how long it will take to reach the Supreme Court of Canada ruling?
September 8, 2016 | Unregistered CommenterMerrilee Fullerton
I suspect that both electricity and other energy costs AND health care issues were responsible for the by-election loss of the Liberals in SRR.

It is important to consider they are tightly linked as almost all health care provision will be made more costly due to poorly considered Liberal energy policy.

The rising cost of energy will make health care even harder to provide.
No doubt about it, the Liberals are making living in Ontario harder and harder.
September 9, 2016 | Unregistered CommenterMerrilee Fullerton
Meanwhile with electricity more"means:" testing coming. Funny how means testing can redistribute energy fairly,but means testing in health can't. Issues are turning up in means testing,which Central is ignoring.Humans have an amazing ability to manipulate any system to their true needs.
September 9, 2016 | Unregistered CommenterMovingforwardOntario
Electrical means testing?

Rationing of electrical power?

Should we be buying electricity generators?

Will a hybrid /Black market electrical system evolve?
September 9, 2016 | Unregistered CommenterAndris
Andris, if you happen to live among the 3,000 people who live in downtown Toronto's CityPlace apartments that have endured four power outages in two weeks, I'd start thinking about a small balcony generator or micro-nuclear plant to ensure electricity continuity.
September 9, 2016 | Unregistered CommenterExecutive Lead Blogger
Dr. Fullerton,

My best wild a** guess would be nothing sooner than 2018-19 to get the case before the Supreme Court of Canada.

It took Dr. Day ten years to get to the Supreme Court of BC, right?
September 9, 2016 | Unregistered CommenterExecutive Lead Blogger
Thanks ELB,
That seems about right. I'm not sure how Supreme Court cases are queued.....
September 9, 2016 | Unregistered CommenterMerrilee Fullerton (realist)
Never mind UK. Here is a local struggle.
-----------------------------------------------------

Patient Pressures in the Emergency Department

We are reaching out to you for your kind help. Our ED's, especially at the SCS,
have been experiencing significant patient pressures resulting in over 90% of the ED stretchers being occupied by admitted (or soon to be admitted) patients. A
compounding factor is that today is Friday and we are heading into the weekend when inpatient flow is usually limited all the while ED utilization is at peak.
This is a time when our collaboration is of special importance. We kindly ask that
you give extra attention to any possibility of patient discharges or transfers
today, and through the weekend. Any amount of flow capacity, anywhere in the
system, will be a great help to assure access of the community to our emergency
services.
September 9, 2016 | Unregistered Commentereklimek
Thanks eklimek.
The problem here is very real.
Patients are being discharged earlier and earlier.
The effect of fewer hospital beds and more patients needing "acute on chronic" care will not be changed by adjusting current patient flow. We have a Volume problem in terms of demand and a Capacity problem in terms of delivery.
September 9, 2016 | Unregistered CommenterMerrilee Fullerton (realist)
The ER issue is the pointy end of the problem. There is more...

Niagara Falls MPP Wayne Gates ....

"One of the things I didn't understand, and didn't get a real good answer for, is that we just built a brand new hospital at a cost of $1.2 billion…you knew you had a problem with MRIs, why would you have not bought another scanner at that point in time?

"(It was) a problem you knew was only going to grow because you cut down on the number of hospitals you have in Niagara."

http://www.stcatharinesstandard.ca/2016/09/09/gates-meets-with-nhs-over-mri-wait-times
September 9, 2016 | Unregistered Commentereklimek
As physicians and nurses get taught to "choose wisely", I hope the CMPA "invests wisely" , prepared to defend these cases where there was no excuse for not ordering the scan or ensuring the patient was stable before discharge home.

I have been involved personally in several cases where the patient was sent home from ER for severe headaches, no scan ordered, and outpatient investigations in my clinic revealed a pathologic finding or tumor. It's a hard sell to the patient as to why they don't need the MRI, and it's not going to be me who says no. I'd rather be receiving thank you cards from my patients instead of subpoenas.
September 9, 2016 | Unregistered Commenterdocinthepark
Until science and evidence can tell exactly which group a patient will be in ( no pathology vs pathology) MDs should act in the interests of the patient and not in the interests of saving the system $. If the system is not designe to do this then it's time for a redo.
September 9, 2016 | Unregistered CommenterMerrilee Fullerton
Monday:

1.More means testing to qualify for electricity cost relief.
2.Health care is find,no major issues to be addressed.
3.The plan is good, trust me.
September 10, 2016 | Unregistered CommenterMovingforwardOntario
Cold feet:

As more and more within central,push for central taking over all health care management,the legal arm is pushing back,putting out,the more direct management central takes on,the more liability it owns. Thus Bill 210 is required to establish local regional boards who contract with local providers,and own the "abuses" that may crop up. Big growth for insurance and liability companies, and big growth for ombudsman's groups(each regional board will require its own "locally flavoured" ombudsman's system. Lots of central jobs coming! No health care, but lots of "process"improvement systems, if you can eventually access a haelth care access point!
September 10, 2016 | Unregistered CommenterMovingforwardOntario
And to add, the most narcissistic of our peers will rise to these positions and come across as "physician leaders", hope they have sufficient liability coverage.
September 10, 2016 | Unregistered Commenterdocinthepark
Appointed physician leaders,will, eventually be granted "crown privilege", meaning no liability for their actions.The public , then,is screwed. Decisions made with no accountability ,at all.
September 10, 2016 | Unregistered CommenterMovingforwardOntario
Kings Fund CEO tweets out this article:
https://www.theguardian.com/society/2016/sep/10/hospitals-on-brink-of-collapse-say-health-chiefs
September 11, 2016 | Unregistered CommenterMerrilee Fullerton
"Chris Ham, the King’s Fund’s chief executive, said: “The clear message from the NHS leaders, doctors and nurses I’ve spoken to is that they are increasingly unable to cope with rising demand for services, maintain standards of care and stay within their budgets.

“The government must be honest with the public about what the NHS can deliver with the funding it has been given. It is simply not realistic to expect hard-pressed staff to deliver new commitments like seven-day services while also meeting waiting-time targets and reducing financial deficits.”"
September 11, 2016 | Unregistered CommenterMerrilee Fullerton
Honesty is not a characteristic of the politico/ bureaucratic class.

Politicians , in particular, have such a reputation for avoiding speaking the truth that the public has learned to discount much of what they say....so that even if they told the truth about the state of our health care system it would be not believed by a vast segment of the citizenry.

As it is Hoskins is following Mark Twain's dictum " Get the facts first, then you can distort them as you please "...he is busy distorting the facts , doing everything other than facing the brutal facts....the facts remain as facts despite their distortion and denial....and , as collectivist health care systems inevitably discover, it hits a brick wall of reality as Venezuela is experiencing today and ours will inevitably hit as well unless the government experiences an epiphany and opens the door to a hybrid health care system and stands aside.
September 11, 2016 | Unregistered CommenterAndris
Andris

Until the public leads, no political party follows. I don't see the "collapse" as inevitable nor impending. As long as the majority remain unaffected there will be no change.

The constitutional challenge will serve as a historical marker of a divergence of opinion. Even so, if the majority permit sacrificial injury or death to maintain the staus quo, the government will make very effort to oblige the electorate. The safety valve the courts will most likely impose will be confined and limited. Useful small step but not revolutionary in scope. We should be grateful for the pubic exposure the system will receive. It is bankrupt.
September 11, 2016 | Unregistered CommenterEklimek
DrK is correct. No collaspe. The majority, with no contact with the health care system, remain convinced it remains the best in the world. It is, unless you must use it.
September 11, 2016 | Unregistered CommenterMovingforwardOntario
You are speaking of a Potemkin health care system....
September 11, 2016 | Unregistered CommenterAndris
It works well,unless you use it. Thus, it works.

Very similar to tomorrow's throne speech. All is fine,but we need to readjust some things.

The GDP needs to be at 4% to change and enhance programs.It is at 2%.Don't worry, the plan is good.The new federal infrastructure money will solve it all. Trust us.
September 11, 2016 | Unregistered CommenterMovingforwardOntario
With the collapse of the national Energy Board, today's rebooting of Ontario has no teeth to it.This is not looking good The new subsidies will increase debt,with no long term plan.

No solution to health is on the table.
September 12, 2016 | Unregistered CommenterMovingforwardOntario
World markets are taking a beating. Forget 2 or 4% GDP , we'll be lucky if we stay out of the red. Having said that, will this proposed federal infrastructure money dump (if it even happens) be based on debt or taxation or some combination of debt and taxation?
September 12, 2016 | Unregistered Commenterdocinthepark
DITP...I have similar fears...deflationary fears, it seems that all the governments' Kinesian helicopter money dumping has been unable to reverse it.

Where negative interest rates are concerned...there are countries such as Sweden and Denmark where mortgage holders are being paid interest by the banks who hold their mortgages.

Imagine if Toronto's mortgage owners were being paid interest on their massive mortgages by the mortgage lenders?

The world is turning upside down.
September 12, 2016 | Unregistered CommenterAndris
<<No solution to health is on the table.>> - mfO

Sadly, no truer words have even been presented on this blog.
September 12, 2016 | Unregistered CommenterExecutive Lead Blogger
Trust is ebbing.
September 12, 2016 | Unregistered CommenterMerrilee Fullerton
Decisions made in the energy portfolio and the greening of Ontario are emerging. Gee it's nice to be green, isn't it? No one wants to pay for it or the mistakes of government.

The monthly hydro bill is the irritant. If the bill must be paid, the solution is to bury or shift the hydro costs to other or less visible forms of taxation.

If there was an itemized monthly bill sent to consumers for all services, (education, health care costs, debt servicing) the outcry would be similar.
September 12, 2016 | Unregistered Commentereklimek
Agreed eklimek.
The costs are being hidden. Transparency is needed.
September 12, 2016 | Unregistered CommenterMerrilee Fullerton
There can not be transparency. Then the general public would need to understand that long term debt, is a future burden on the children, whose future may be being jeopardized, and the current entitkements need to reined in.
September 12, 2016 | Unregistered CommenterMovingforwardOntario
As discussed, subsidies for electricity in throne speech.plus more child care.appeals to the social justice agenda.Further digs about "highest billers" in the throne speech!. That polls really well at central, with over 80% support. The public wants free health care to continue,and if in jeopardy, will make the doctors give back precious resources! Urban GTA and Ottawa overwhelming support the plan.

Next, get Bill 210 passed, and transfer MD accountability to local boards.Will take 10 or more years, but deal is done., comrades.
September 12, 2016 | Unregistered CommenterMovingforwardOntario
Some animals are more equal than others.

A George Orwell Throne Speech
September 12, 2016 | Unregistered CommenterStephen Skyvington
mfO,
Nothing in Bill 210 will reduce health care costs or demand for care.
Problem remains.
September 12, 2016 | Unregistered CommenterMerrilee Fullerton (realist)
...so the government plans to cut wait times for patients to see spacialists.

How, without utilizing force?

Many of the surgical spacialists can't get the patients they see into the OR to deal with their problems as it is ....so as the waiting time from seeing the specialist to getting onto the OR table becomes ridiculous ...the specialists simply close their practices to accepting new patients...what would be the medico legal implication for the specialist if he or she sees a patient but has no power to do anything about it, being left holding the hot potato...as it is they don't accept them , leaving the hot potato in the hands of the FP who gets burned and blamed, with the government standing there, looking in the opposite direction, hands in its pockets , casually whistling a tune.
September 12, 2016 | Unregistered CommenterAndris
Andris

So far lack of adequate resources has not been an adequate defense for an individual poor outcome. Let's see if this is the turning point.

Can deterioration while awaiting care be defended?

Has the waiting list defense become legitimized?

Should Surgery for known cancer exceeding "acceptable " delay become the standard of care?
September 12, 2016 | Unregistered CommenterEklimek
So HST on electricity was added in 2010. Now it can be removed. 7 years of added revenue for central, now to be relieved? So whom is driving the demise of the "middle class"?

No wonder the populace is cynical. Seven years of acknowledged over taxation (there's lots more there).

Meanwhile,the "highest billers" are there, and are causing all the problems in healthcare. Avoiding accountability, and targeting groups. Not the way governments shoud function.
September 13, 2016 | Unregistered CommenterMovingforwardOntario
So HST on electricity was added in 2010. Now it can be removed. 7 years of added revenue for central, now to be relieved? So whom is driving the demise of the "middle class"?

No wonder the populace is cynical. Seven years of acknowledged over taxation (there's lots more there).

Meanwhile,the "highest billers" are there, and are causing all the problems in healthcare. Avoiding accountability, and targeting groups. Not the way governments shoud function.
September 13, 2016 | Unregistered CommenterMovingforwardOntario
"as it is they don't accept them , leaving the hot potato in the hands of the FP who gets burned and blamed" -Andris

Page on call consultant, document outcome if they even bother to call back, document and name names, (which often ends in send to ER or "I only see patients if in ER"), when in doubt send in to ER. The hot potato keeps getting passed, where does the medico legal hammer drop?

I'd say more likely with the ER doc., I've been witness to a college complaint where the ER doc refused to image the patient and neglected to refer to the specialist on duty and bad things happened. That's a very tough job for sure, and I'm not sure where the rationing pressures are in those moments, (Hospital admin?)
September 13, 2016 | Unregistered Commenterdocinthepark
The hammer lies on the last person whom accepts the patient.
September 13, 2016 | Unregistered CommenterMovingforwardOntario

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