There isn’t much doubt that the demand for health care providers is increasing at a time when the effect of government cuts to nursing and medical schools is beginning to be felt nationally.
It isn’t the cuts alone that have been detrimental to the supply of health care providers but also the day to day difficulties of working in a system that cannot provide what was originally intended.
You could solve the human resources problems by churning out many more nurses, physicians and various technicians for a price. But we need to keep them providing care to Ontario’s patients and Canada’s patients by creating a system that provides improved access and availability of technologies and treatments here that are already available in other developed countries. We shouldn’t be in the business of exporting physicians like Cuba or sending our home grown physicians overseas as Interhealth Canada was intended to do.
We need to find a system that competes against itself, that rewards individuals for their hard work and dedication and that provides patients with a way of optimizing their health by engaging them rather than just preaching, providing posters or advertising lame primary care ads on TV.
In the case of nurses, Calgary Health Region has a campaign to recruit nurses from across Canada. In response, Canadian Federation of Nurses Union president Linda Silas has said that poaching nurses won’t solve anyone’s nursing shortage.
She may be right but nurses do have the right to leave and begrudging them higher pay or full time jobs isn’t the way to keep them. Physicians are also free to leave and have done so over the years to the point that Ontario still had a small net loss of physicians in 2005. This at a time when we need to be retaining the physicians we have but also attracting Canadian physicians back and retaining retirement age physicians as well.
Co-payments are one way to generate necessary funding and this can be done fairly by charging individuals who use the system a small fee, as is done in Sweden and many other OECD countries. This is certainly much less complicated than establishing private hospitals as was eventually done in Sweden.
In Sweden, like Canada, there was an underperforming health service monopoly with long wait lists, overspending and questionable quality. To improve the Swedish system, 150 private providers were licensed to compete for health service contracts and then gradual privatization of primary care in 1998. In 1999, St. Goran’s (a public hospital) was sold to Capio AB, a private company, and has shown significant improvements over its performance as a public facility.
The Stockholm government compared costs in six medical specialties and found the cost of consultation to be lower in private practice. St.Goran’s costs for lab and x-ray services fell by 50% and overall costs 30%. Doctors in the private sector have reduces expenses to 15% lower than the same procedures in the public sector.
At St. Goran’s, the average wait time for heart surgery is 2 weeks compared to 15-25 weeks in Sweden’s average public sector hospital. The average wait time for hip replacement surgery is 10 weeks compared to more than a year in the average public hospital. St.Goran’s is now treating 100,000 more patients each year than it did as a public hospital but it is using fewer resources.
But here in Canada, the unions hold strongly to the belief than privatization is equal to Americanization and that it will be bad for their union members.
In fact, when Sweden privatized delivery, nurses unions initially resisted too. But then nurse’s wages rose 40% in some cases and one head of the largest nursing union had to admit that her assessment had been wrong. Nurses also did less administration duties with privatization and could focus on real care while clerks were hired to do the paperwork.
We must get past the belief that “privatization” means Americanized health care if we want real progress in keeping our human medical resources providing much needed care where it is needed.
Start with co-payments and move to small “experiments” with private care. Allow physicians and health care providers to innovate and prosper from their advancements. Allow patients to engage in their own care and share responsibility for costs beyond taxation. These are ways to improve human resource shortfalls. Pouring millions of dollars into the system around election time isn’t.