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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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Saturday
Dec302006

Different Strokes for Different Folks

 Two areas of the country are experimenting with new approaches to healthcare. Quebec and BC are leading with vision and whether their vision is good or bad depends on who you talk to.  But they are allowing evolution to occur within healthcare. One cannot say the same for Ontario, where the status quo is retained at the population's peril where there is an attitude of "short term safety, for long term pain".

Quebec has always been a little heavy handed with its medical practitioners. Probably because it understands many will stay because of language and cultural issues but this is changing. So it is not surprising to see that Queb ec tried to cap specialists wages at about 60% of what their colleagues earn in the rest of the country. "The Special Bill", Bill 27 inspired Quebec specialists to respond and they did, suing the government and encouraging its members to effectively work to rule until the government came back to the table.  Time will tell whether Quebec physicians regard their cultural identity as more important than their ability to earn a living on par with other provinces as talks resume.

Quebec is also attempting to respond to growing medical need of its population by opening  the doors for more private experimentation which seems to be quietly accepted by much of the population. Even Paul Martin used Montreal-based Medisys, an executive wellness centre, whose CEO is Dr. Sheldon Elman, the former PMs personal physician.

Quebec's Bill 33 was slated to pass this fall.  The Bill establishes a role for private healthcare delivery in the public system. It gives doctors permission to run publicly funded, privately owned, for profit medical centres. It will create a wait list management system in public hospitals to determine when overflow patients must be sent to private clinics. It ends the absolute ban on private medical insurance which will allow hip, knee, and cataract procedures. Non-hospital surgical centres (affiliated medical centres) may be allowed to expand into other areas acting as "safety valves". These changes are in direct response to the Chaoulli decision's requirement to improve accessibility to public healthcare.

 As always not all doctors (or patients) agree, but something has to be tried and it is possible that by bringing these centres on in a controlled way  the fear mongering may be assuaged regarding the "private care boogeyman".

In Victoria BC, a new private health clinic has sprouted up called "Options Health Systems". It opened in November and has been criticized for collecting an annual fee for a range of "executive" style health services. It claims to be the first clinic in Canada to bring affordable "executive" care to average Canadians with a fee-based mix of GP services with complementary medicine and alternative medicine. Service fees are $300 a month for year one then $200 a month each subsequent year. Patients get a minimum half-hour visit with guaranteed same day appointments.

As mentioned previously on this blog, boutique practices are springing up quietly but executive care has been around for years. Why should the elite executive have access to more care than the average senior? Why should a person who chooses not to spend their retirement income on a car, be refused the liberty of spending their money on an annual fee to provide themselves with more time with their physician and more medical attention?

Interesting that Don Copeman, founder of the Copeman Clinic in Vancouver, tried to establish similar clinics in Ontario but was held off by the MOHLTC.

 In some parts of the country, patients are allowed to spend their money on healthcare, while in other jurisdictions the same clinic is banned.  So much for consistency across Canada.

 Quebec and BC may differ in their approaches, but at least they are willing to try new approaches on a small scale and see where it leads. Ontario seems to want to keep plodding, afraid of it's public shadow.

Not a bad plan to evolve and respond to the changing medical climate; just remember what happened to the dinosaurs and how more agile and adaptable organisms managed to survive.

Let's hope Ontario figures it out before its too late. 


 

 

 

 

 

 

Friday
Dec222006

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.

Wednesday
Dec132006

The Big Picture and Why I Can't Go Along Willingly

Where is the current agenda of healthcare change headed you ask?

Let us stand back and look at the big picture rather than our little kingdoms and let us look without blinders on and without cheerleading and posturing from politicians.

The Conference Board of Canada , an Ottawa-based, non-partisan think tank whose mission is to bring business people and policy makers together, has spent three years assessing where Canada is headed which will influence the sustainability of our universal healthcare.

In January 2007, the Conference Board’s Canada Project will release its report “Mission Possible: Sustainable Prosperity for Canada”. This research program has taken the rose-coloured glasses off and hopes to provide an honest assessment of Canada’s future.

Sure, Ottawa keeps racking up budget surpluses and our currency is strong but we are slipping in global rankings compared to other G8 countries.

“No one has been talking about our economy being adrift, but it’s an absolute fact,” says chief economist Glen Hodgson of the Conference Board. “The things Canadians cherish-our standard of living, our natural environment, our health care and public education systems-will become unsustainable if we don’t act now.”

“Mission Possible” set out five key areas for improvement and one includes addressing our aging labour force, which of course in my opinion, should include physicians. We need more seniors at work and we should be doing everything possible to keep our highly skilled and highly trained physicians working with as much support and incentive as possible.

I do say this without bias. I say this as a daughter of aging parents, as an aging individual myself, and as a mother to my children. As much as I appreciate what other healthcare providers offer, or even what complementary health care can offer, they do not offer the skill or expertise of a physician.

The first wave of baby boomers is about to turn 61, an average age for retirement for Canadians. Next year, 2007, will be a big retirement year where boomers are likely to be retiring in droves, physicians included. (Perhaps by coincidence, my eighty year old father’s physician is retiring in January with no one to replace him, not even me, as it is unprofessional to treat one’s own family and one risks the reprimand of physicians’ regulatory bodies.)

According to Hodgson, we have only about 10 years before the wave starts to undermine our economic performance and social well-being.

“Mission Possible” points out that immigration alone cannot come close to making up for the impending shortfall.

We will undoubtedly see that the numbers of IMGs being recruited from other countries will not make up for the physician shortfall in Canada. Also of interest, is the net migration of physicians to other provinces, mostly Alberta and BC, leaving Ontario with a net loss of physicians in 2005 as shown by CIHI.

Other countries are now doing more to enable older workers to extend their careers, including financial incentives, training programs, placement services, phased retirement programs and pension reforms. “Mission Possible” says Canada should do the same.

So why are physicians, particularly in Ontario and Quebec, seemingly under attack by government and its “transformation agenda” when our aging physician workforce should be supported and enabled?

Is it because other groups have managed to position themselves in the political arena and physicians have been too busy caring for the sick while others have found the most advantageous political seats? We have put veterinarians in charge of closure of hospitals, few physicians sit on LHIN boards in Ontario (except in rare instances in which I will not elaborate in this public forum) and we see more nurses taking on more prominent positions within the transformation hierarchy while physicians seem to be shunned.

How is this a balanced approach to finding solutions to provider shortages in healthcare, access shortages, and funding issues?

Instead of blaming medical workers for healthcare expenses, or creating more groups to scrutinize and regulate, we should be talking about how patients can contribute; how we can empower our providers to keep working; how we can allow market forces to help dictate numbers of physicians and other providers; how we can find other acceptable ways for Canadians to purchase healthcare, electronic medical records or other items that would contribute to more efficient healthcare.

Some say that physicians should just lump it and accept the transformation as it is unfolding; that it is a done deal.

I say that accepting this transformation is a big mistake and that more compromise is needed, more realism is needed and more understanding that sharing the facts with the Canadian people is necessary.

I guess time will tell, time we may not have.

As always, I am interested in the perspectives out there, particularly regarding non-physicians who might have something to say regarding contributing individually to EMR’s, to contributing to co-operatives, to how they might support their medical manpower.

Because ultimately, you don’t know what you’ve got ‘til it’s gone.

Tuesday
Dec052006

Priorities, Wait Times and Patient-centric Health care: Compatible?

 The Wait Time Alliance graded the provinces' performance on wait time benchmarks and commitments earlier this month with grades from A to F.  So there  IS movement forward  in the Big Five, even if small, which is good. While government should be applauded for  acknowledging the need for  more funding and trying to improve it , we need to ask how far does $5.5 billion (earmarked for wait times) of the $41 billion (from the 2004 federal/provincial health accord) go to making a difference for the patient who requires an expensive medication for a rare disease/cancer or the patient with Alzheimers or the patient that doesn't fit these 5 favoured groups. Are the priorities outlined by the five wait time areas geared to patient centred care or not? Given the facts, it doesn't look like it.   We need another solution, a long term solution.

One in four Canadians will be older than 65 by 2031. We will be managing the health care of 9.3 million seniors in the relatively near future. At current rates, 744,000 Canadians will be afflicted by Alzheimer's or related dementia with associated costs of care, medication and infrastructure.

Canada's aging population will create a steady rise in the number of people developing cancer. In 2005, it was estimated that 149,000 Canadians would be diagnosed with cancer-thousands more than the previous year. Over the next 20 years, an estimated 3.6 million Canadians will develop cancer. The federal gov't has unveiled a national cancer plan with $260 million to improve cancer care which amounts to a few million per province.  This may be helpful for the time being but the long term picture isn't pretty.

In 1956, 39% of the population was under 2o, while 7.7% of the population was over 65.

In 2040, 20% of the population will be under 20, while 24.3% will be over 65.

According to Chief Economist Don Drummond at TD Bank, Medicare is getting hit hard by a double whammy of ageing population and expensive technology and by 2011 health care spending will be rising by 8-10% per year. Spending on health has been rising 6-7% a year, education 3-4% and all other discretionary spending has been flat or falling. 

People will need to work longer or more private sector involvement will be needed or taxes increased or use  co-payments to cover rising program obligations.  We already talk about working smarter and squeezing more out of a shrinking workforce but Canada is barely scraping out a 1% productivity growth recently....not really close to the 2.5% productivity growth needed to pay for mounting obligations.

If people are going to have to work longer and contribute substantial amounts of tax dollars to healthcare,  they should be able to get it when they need it  and it is not surprising that  the term "patient-centred" keeps cropping up.  It is  central to finding real solutions.

To have patient centric health care I believe we need three things:  adequate numbers of providers to provide the care required by the patient, adequate funding to treat and care for the patient and the funding to be attached somehow to the patient.

Personally, I don't think we have any of the above at this point and I don't think it can be achieved with the transformation agenda proposed to date. We will need more private sector involvement to provide the competition to create efficiency; we will need to openly discuss co-payments; we will need to discuss the use of co-operatives for healthcare; and we will need to consider a "last resort" insurance fund to send patients to other jurisdictions when the need arises  as the CMA has suggested.

Hope this post inspires some friendly and respectful debate by some familiar voices or new voices and I am privileged to have you all aboard. 

 


 



 

Sunday
Nov262006

Open and Honest Discussion

As a physician working in  Ontario's healthcare system for close to  twenty years, I have witnessed many changes. An aging population, an aging provider workforce and ever advancing technologies and pharmaceuticals are contributing to create a healthcare environment in which public expectations  may very well not be attainable.

At some point, we need to discuss what our publically funded healthcare system can provide and what it can't and find other means to provide the rest. We need the input from patients, from the providers and from the public in general. This should not be left to politicians whose careers are mostly much shorter than the time required to find viable solutions. This discussion is too important to leave to politicians.

 Please join me in this discussion and post your comments. Please remember that although there is much passion associated with healthcare opinions, respect for differing perspectives must always be maintained.

I hope you find my future posts enlightening and thought provoking. 

 

 

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