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. 







 The federal government has fined BC a total of $29,019 for contravening the CHA. According to an article in the Globe and Mail by Lisa Priest June 7, "B.C. Health Minister George Abbott estimated that the fine levied against his province for user fees and extra billing at private surgical clinics would fund the province's health-care system for 65 seconds."

Alastair Sinclair, spokesman for Health Canada (I wonder if he is any relative of Duncan Sinclair-the veterinarian who led the health servies restructuring a few years back...you know the program that closed hospitals) is concerned about how private MRI services relate to the CHA. I have to add that his concern ought be about getting patients the care they need in a timely way and in a sustainable way...which the CHA doesn't seem to take to heart  either.

If the CHA was to guarantee universally, accessible, portable health care then it certainly hasn't accomplished it, particularly for vulnerable patients and people with autism or cancer or rare diseases. Some provinces fund autism treatment, others don't. Some provinces fund some kinds of cancer medications, others don't.  Some provinces (and some cities) have long wait times for some procedures, others don't. Some cities have plenty of MRIs and short wait times for diagnostics, others don't. (I guess this just shows where the necessary votes are coming from eh?!)

So I wish our politicians could get over the CHA, it was created by man...it wasn't sent by God -- although some people wouldn't think that  should matter either. It can be altered.  It should be altered. It needs to reflect the realities of 2007 and beyond. It doesn't.

Health care in Canada is not accessible when you can't find a family physician or access primary care because the government has rationed care to such an extent. Health care in Canada is not portable when patients cannot get equal care in each province for their needs. Health care is not universal and will not be sustainable under the status quo.

The CHA needs updating to allow for controlled private care and for sustainability. Right now it is a farce.









The More Things Change....

 The more things change, the more they stay the same!

Check out the Deloitte report-Provinces in Transition. Apparently reforms have to move faster!

Also check out the Chaoulli Group....Jacques Chaoulli is exerting external pressures once again and is a catalyst for change. And of course the Canadian Health Coalition spokesperson Michael McBane doesn't like it one bit.

I'd post the links but a small computer glitch seems to be preventing me from doing so....but I'm sure you'll find them.  Google away! 






Build it and......?

 Build it and they will come.  Maybe not.

From the CMAJ, volume 176, No. 11  May 22, 2007 :

Family Practice a Tough Sell


Family medicine residencies remained the toughest fill during the 2007 residency match, as some of the 108 of 987 available slots were left vacant at the conclusion of both iterations of the process.

By contrast, only 36 medical specialty slots remained vacant at he conclusion of the annual match run by the Canadian Match Service (CaRMS).

 Only 29% of medical graduates chose family medicine as their preferred option, compared with 32% in 2006 and 28% in 2005.

 Banner also adds that overall, the CaRMS match and other matching processes in other provinces (Alberta, Saskatchewan, Nova Scotia and Quebec) will result in a record 2337 graduates commencing residencies on July 1. She says "That bodes well for the continuing growth of the medical community in our country."

We need to ask: How will these services be paid for if we are already having difficulties with the health care budget in Ontario...and please don't say that capitation is the cure....there is no evidence to my knowledge of increased efficiency or productivity in capitated models. 

But there will be more providers. Where will they go?  






Patients or The "System"?


Privatized health care infringes on Charter rights
The Ottawa Citizen
Published: Friday, May 11, 2007

Re: Real health care, May 4.

A Charter challenge to Ontario's public health insurance system, announced last week by the Canadian Constitution Foundation and applauded in the Citizen editorial, represents yet another push to privatize the Canadian medicare system and is based on a distorted reading of the Supreme Court's Chaoulli decision in 2005.

Only three of seven judges who ruled in favour of Dr. Jacques Chaoulli found that Quebec's ban on private health insurance violated the Canadian Charter. Contrary to the evidence accepted by the trial and appeal courts, the three Supreme Court judges concluded that the problem of health-care wait times could be solved by allowing private health insurance.

The Chaoulli decision was widely condemned for its failure to recognize the costs and inefficiency of allowing two tier-medicine in Canada, and for ignoring the health rights of those Canadians unable to obtain private health insurance, because they are a bad risk or because they can't afford it.

Legislation such as Ontario's Commitment to the Future of Medicare Act is necessary to protect and promote the Charter health rights of all Canadians and not merely those who can afford to buy private care. The three dissenting judges in Chaoulli agreed that a ban on private health funding is a rational and legitimate measure to protect the integrity of the medicare system, which benefits all Canadians.

In light of widespread condemnation of the Chaoulli decision by health law and policy experts alike, a second Chaoulli-type challenge in Ontario is, fortunately for us all, unlikely to succeed.

Martha Jackman, Ottawa

Professor, faculty of law,

University of Ottawa



See the bigger picture for health care

The Ottawa Citizen

Published: Tuesday, May 15, 2007

Re: Privatized health care infringes on Charter rights, May 11.

Letter-writer Martha Jackman writes that "a second Chaoulli-type challenge in Ontario is, fortunately for us all, unlikely to succeed."

Although most of us would like to keep the current system of Canadian public health insurance if possible, what may be truly unfortunate for us in the long term is to fail to understand the bigger picture of health care requirements of the coming decades. Health care takes decades to change in any meaningful way, and if we are to be prepared to meet the needs of the population past 2010 including technology, pharmaceuticals, long-term care, new diagnostic methods and treatments and sufficient provider numbers, then significant changes must start now.

 Health care occupies 46 per cent of Ontario's provincial budget. With hundreds of millions of dollars being poured into health care pre-election, one is left wondering how high this percentage will go and how this rate of funding can be sustained.

Unfortunately for some patients, including those who are waiting in queues, which are not all measured; for those who have been denied care in their own country because their treatment has been deemed by the powers that be as "not cost-effective"; for the patients with genetic diseases with new expensive treatments not covered by the Ontario Health Insurance Plan, we should hope that the Charter challenge to Ontario's public health insurance system is successful.

Maybe then the weakest and the most vulnerable can get the care they need in a timely way. If private health care coverage was required by law for minor medical problems up to a specific dollar value, then more resources would be available for catastrophic illness. Of course, those individuals who could not afford coverage would be supported by the state as they currently are for many other areas.

Let us hope that there are more brave patients such as Lindsay McCreith, the patient at the heart of Ontario's Charter challenge, who are willing to fight for the rights of all patients when they are at their most vulnerable and in the most need.

Merrilee Fullerton, MD


Which is more important....the patient or the "system"?

If a patient can save him/herself should he/she be denied this right in the name of the "system"?

How is a system egalitarian if it attaches more worth to some individuals' lives than others?

At what point is a motorcycle accident patient's life worth more than a cancer patient's life or a patient with autism or a patient with an inherited genetic disease? 

These may sound like terrible questions to ask, but if Medicare is going to stay a monopoly provider then they will have to be asked. Maybe not now, maybe not in 3 years.....but very, very soon.

How many Supreme Court Judges does it take to turn off a patient's respirator? How many cancer patients does it take to turn their backs on George Smitherman to get noticed at Toronto's Trillium Centre? How many patients with rare diseases does it take to have a voice loud enough to be heard?

Mostly we should be trying to find ways that patients can get the care they need.....one way or another.







Fancy Drinks

So just when the posts are getting interesting some of you want a new journal entry.

"Koolaid" keeps getting mentioned and although I'm sure it is a great drink for many people it doesn't rank high on my list of favorites.

But the concept of individuals at the helm of any organization being tainted in some way or being manipulated in some way concerns me. My involvement with the OMA has not driven me to be a koolaid drinker and I should say here and now that my views on this blog are my own and do not represent the views of any other organization to which I belong. Perhaps I should have a disclaimer of sorts on the first page....

The koolaid reference brings me to think of leadership and leadership brings me to think of a book by Ram Charan called "Know-How- The 8 Skills That Separate People Who Perform From Those Who Don't".

It's a useful book as far as I'm concerned and the most intriguing chapter for me was the last one, "In The Court Of Public Opinion-Dealing with Societal Forces Beyond the Market."

Now you may think this has nothing to do with health care in Canada, or maybe you do, but it is insightful and shines a light on a very relevant issue of how businesses (and we docs do run businesses in health care) operate in a complex societal and political milieu. Getting on the wrong side of an issue can create immense damage from special interest groups who seem to be well organized, get access to the media, and form coalitions (as in the Ontario Health Coalition).

How to deal with special interest groups is the question in an era of "moral liability" .

The response to the case outlined in the National Post and supported by the Canadian Constitution Foundation regarding Lindsay McCreith is one example of how groups like the Ontario Health Coalition get vocal rather quickly in response to challenges to the status quo.

What I'd like to see more often is balanced discussion and not entrenched ideological stances that don't give patients the care they need or the care they are waiting for.

So in the end the solutions to health care will be found in leadership. The leadership must seek balance.

Ram Charan's insight into the "real content of leadership" includes:

Positioning(and when necessary, repositioning) your business by understanding the customer's needs (in health care the patients' needs) and how to make a living (ie make a profit).

Pinpointing patterns of external change ahead of others.

Leading the social system of the business to shape how people work together.

Judging people by getting to the truth of the person.

Developing goals that balance what the business can become and what it can realistically achieve.

Dealing creatively and positively with societal pressures.

One more thing before I log off and let you post whatever you feel is relevant: Charan mentions traditional media and changes empowering newer types of media like blogs which do not require significant financial muscle.

"But the growth of the Internet has made it possible for virtuallly anyone to become a media maven via personal blogs. While most of the millions of blogs get little or no readership, those that do attract an audience are often cause-related and often target a company or an industry. The reporting may not be as thorough, accurate, or unbiased as that done by national newpapers or magazines, but it can be more devastating, particularly when the blogger either works in a company or has sources in it."

Should I open this blog up to the public fully via a web-site? It is a tough call.

As always, let me know what you think....about leadership, about communications, about Lindsay McCreith's legal challenge, about drinking koolaid or other fancy drinks.

Enjoy the day.