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. 






Ontario Election 2014

I must admit that it is somewhat mindboggling how the Liberals might still be in power June 13....but it will be Friday The 13th by the time the scandal-riddled-Liberals limp over the finish line with a little bit of doping from the Unions. If they manage a minority then let them wear their mud a little longer. If they manage a majority then the unwitting public is in for a big painful surprise as credit rating agencies begin to flex their muscles. The Liberals won't be looking very fresh at that point.

For the PCs, a win  will be a double-edged sword. The loud mouth unions will be out in full force at every turn. If the garbage truck is late, it will be Tim Hudak's fault. If a storm knocks out the electrical grid, that will be Hudak's fault too and if the growing ranks of people with acute on chronic disease show up in droves at the ER, that will be Tim's fault too...

It almost makes me think that a couple more years of the Wynne government would be worthwhile only if it is to show what a terrible muddle she and her big spending government have created. The downside is that Ontario will be driven further into debt and further hardship for Ontarians will be the result and I have difficulty supporting that.

What is striking in this election is the level of disengagement of the electorate. Advance poll numbers were down by about 6%..and with the first game of the FIFA World Cup on the tele I expect many areas of Toronto and Ottawa will have low voter turn-out numbers.

What kind of society do we create when the Union propaganda successfully deceives and the self-indulgence weakens the electorate?

What kind of society believes that the best election platforms are the ones that promise it goodies without any trade-offs?

Somehow, a culture of complacent, non-voters has been created. Their usual excuse is that it doesn't matter which party takes over, the result is the same. Why bother? 

How wrong they are.

I hope you manage(d) to vote today or in the advance polls and I thank you for your ongoing support!



Courageous People Changing Health Care

While union backed protesters decry the end of the Health Council of Canada and complain that the federal health transfers are not sufficient to provide the provinces with what they need to fulfill their political promises, other people are working hard to create more sustainable change.

I'm not talking about the individuals who are entrenched in more bureaucratic and systemic convolutions that add to the cost of care by creating expensive and more complex coordination such as Family Health Teams and Health Links.  I'm talking about people like Dr. Robert Bell of the University Health Network in Toronto and Dr. Brian Day of the Cambie Surgical Centre in Vancouver.

Dr. Bell has  recently been appointed as Deputy Health Minister in Ontario and is leaving a hospital network that encourages medical tourism, allowing patients from other countries to be treated at UHN by paying for their own care. This makes a lot of sense. Currently there are unemployed and underemployed specialists to the tune of approximately 16% of all new graduates. There are operating rooms that must close for weeks at a time to allow hospitals to balance their budgets to meet provincial accountability agreements and hundreds of thousands of patients across Canada waiting in queues.

The revenue generated by having out of country patients pay for procedures and care at the UHN allows hospitals to spend resources on patients who are not paying. This has a certain symbiosis that could be a win/win/win, for out of country patients, for Canadian patients and for employment at many levels for Canadians. Despite this, various groups are already lining up to request that this service be stopped. Not only should it NOT be stopped, I believe it should be made available to Canadians as well so that both health human resources and infrastructure can be used maximally as well as creating a source of revenue for hospitals and even for government, not to mention the primary goal of allowing more patients to get the care they need.

Dr. Brian Day is another health care expert who is courageous in his attempts to advocate for vulnerable patients forced to wait in Canada's failing single payer system. He is bringing a legal challenge to the laws that prohibit individuals from paying for medically necessary care. You can find more information at the following site:

  Charter Health

 As our aging population requires more services and more care and with relatively fewer workers to provide the tax base in the future, we need to be open minded about how to allow more people to access more care in ways that are acceptable to them.

There are times when the unions and the media and the "entrenched" drown out reasonable voices on health care change. I hope that the voices of Dr. Bell and Dr. Day will be heard at many levels, and that change will occur to support sustainability of a Hybrid health care system that combines a robust public system with private options for medically necessary care.

It is challenging to stand out from the crowd to say and do what is necessary. Please support sustainable change where you can. Thank you.



Hospital Mergers and Transformation-Who Should Pay?


With permission from ELB, I introduce our first Guest Journal Entry:

Even Donald Trump would say that this is "huuuuuge".

Money woes disrupt Scarborough-Rouge Valley hospital merger
A $3-million grant from the province falls well short of what Scarborough Hospital and Rouge Valley Health System say they need to cover upfront merger costs

In short, the hospitals believe that the integration would cost about $30M. The Minister of Health and Long-Term Care offered $3M. The same Minister who just bailed out Thunder Bay on Friday to the tune of $14M.

Honestly, if you were looking for transformation, wouldn't the Scarborough-Rouge Valley merger look borderline orgasmic? And from a political perspective, without doing the formal research I am confident in saying that there are more seats in GTA East than Northwestern Ontario. Heck there are less the 250,000 people in the whole region. That fits on one Scarborough RT train - or at least feels (and smells) like it!

But I digress.

So mfO, riddle me this one: since when is Scarborough on the margins and Thunder Bay is at the core? Or does this officially mark the beginning of silly season?

And finally, a similar merger happened not too long ago in GTA West, i.e., Trillium Health Partners (Credit Valley Hospital, Mississauga Hospital, and Queensway Health Centre). There must have been some government support for this transformation: either from the Ministry or the LHIN.

Can someone explain why Central is not giddy with excitement and tripping ll over themselves to make this happen?


■ Does Central think that this is nothing but a cynical hospital cash grab?

■ Are there not enough Liberal seats to maintain or win or is GTA East hardened PC territory?

■ The Liberals had the chance to support this and hesitated. Which party jump out on Monday morning and declare that if elected they will support this?

Would love to see the Minister's briefing note on this one.

That's enough for now.



Private Health Insurance in Sweden, Unemployed Canadian Specialists, and the Rand 

Rigid health care zealots full of intolerance for the needs of people who do not fit their definition of "vulnerable" are damaging the lives of Canadians across the country.

These are the single payer supporters who would have you believe that they are noble supporters of the public, the poor, and the sick. They are not. They perpetuate the status quo that is leaving many people behind including autistic children, elderly dementia patients, and patients waiting years for elective surgery.

The truly vulnerable amongst us who need public health care support are being denied timely and appropriate care while the Unions maintain their self-serving power and workers are forced to join their ranks only to be out of jobs as the economy fails to support ever increasing Union demands.

Despite Paul Martin's Federal Liberal Party's attempt at a "Fix for a Generation" a decade ago and 41 Billion dollars later, patients continue to languish on wait lists.  Despite Premier Wynne professing "fiscal" responsibility, the Ontario Liberal Government has misspent billions of tax payer dollars on eHealth, ORNGE, gas plant cancellations, and failed green energy initiatives. And on and on it goes.

The social responsibility that is so deeply ingrained in Canadian culture is being distorted. We spend more and more on measuring and monitoring in accountability agreements in attempts to respond to government need to demonstrate "efficiency" which remains sufficiently elusive so as not to make a dent in waits or budgets.

Meanwhile, front line care suffers as funds are shunted to providing government optics. Even "value for money" will be an ethereal goal since value very much depends on evidence which is never complete and on the perspective of the evaluator--patient or politician or provider.

Don't misundertand me. I do believe in accountability but only the real kind.

So what does this have to do with Sweden, unemployed Canadian specialists and the Rand?

Canada is the last remaining country in the world to cling to a single payer health care system. It has some of the worst indices in many comparisons with other developed countries. Even socialist Sweden permits is citizens to purchase private insurance. 

From "The Local-Sweden's News in English":

* One in ten Swedes has private health insurance with some giving the reason that this makes more sense than waiting in long public queues for care.

* The insurance plan guarantees that the patient can see a specialist within four working days, and get a time for surgery, if needed, within 15.

In Canada, graduating surgeons including orthopedic surgeons are unable to find OR time to provide much needed service to patients waiting in long queues measured in months and years. Despite having less than the OECD average of physicans per population, Canada is graduating many kinds of specialists who cannot get work in their area of expertise due to lack of public funding and lack of public health care infrastructure.

News of Canadian surgeons travelling to the Turks and Caicos with their patients to access OR time and surgical care requirements has emerged recently from Alberta. Lack of Operating Room time, hospital beds, and nursing and tech support are discussed publicly.

Sixteen percent of graduating Canadian specialist physicians are essentially unemployed in their fields despite growing demand for care due to an aging population with all of its associated health issues and due to a growing population from immigration. Some of this specialist/infrastructure mismatch is due to older physicians staying on longer but the real issue is an infrastructure short fall for ORs and hospital beds and also lack of long term care beds.

Consultants call for more measurement and more coordination/integration within the health care system but the system is already brittle with inherent interdependency that stymies innovation and flexibilty. More coordination is unlikely to work in a complex system such as health care. We need resiliency in a new health care system that can be enabled to adapt quickly to unprecedented change and uncertainty.

There are some simple approaches that can be taken to allow resiliency to develop.

The first is to remove or change legislation that prohibits private provision of medical care such as Bill 8 in Ontario.

The second is to "de-Rand" the Ontario Medical Association. Even though the OMA acts more as the right hand of government nowadays to implement government policy, it does have a role in fee setting which it has less capability to do as funding models become more complex and removed from fees. It is no longer fulfilling its role as negotiating body for all physicians.

Innovation in health care funding that can provide more care to more people in a timely way will only happen when people are given the freedom to change. We have a decade left to move to a Hybrid health care system. We need to start now.

I'd also like to thank all the very supportive contributors here who have kept the discussion going. I am learning first hand about the lack of resources in the community to deal with dementia patients and sometimes my efforts are spent elsewhere.

I'm looking forward to a smoother 2014! Best wishes to All and many thanks!




Health Reports: Bias or No Bias?

There is no shortage of organizations and institutions reporting information on the status of Canada's health care system. Journalists, CIHI, ICES, Statistics Canada, OECD, and The  Commonwealth Fund come to mind but there are many "institutes" and "centres" that gather data on how long patients are waiting, what they are waiting for and how provinces compare.

What's curious is the huge variation in the conclusions. Some say that aging of our population will not pose a problem. The same organizations report that public health care is fully sustainable.  We just need to be smarter about how we use resources. Big Data is going to be the saviour.

Other organizations use data to show that wait times are increasing and that the aging population will cause social entitlements to buckle, including pensions and public health care. Their conclusion is that the public system is unsustainable and that just about every option should be on the table including copayments and private options for medically necessary care. The message I hear from these organizations is that we need to look ahead and prepare for changing times.

Can the public sift through the barrage of information to find the truth?

Is there bias, unconscious or conscious, by journalists and left or right leaning organizations that report on health care?

Answer to the first question is that people judge the health care system by their own anecdotal experience. If things go well for them or their loved ones, they believe the system is just fine. They do not see what is happening to other patients in their own region or elsewhere. The reality is the vast majority of citizens are not waiting in queues. They simply do not know what the reality is for others.

Answer to the second question is that bias is quite likely. It's fairly clear that some groups start out with an end point that they want to prove using data. Unfortunately, the data can be selected and is not complete. I often use the analogy of health care as a balloon. If you squeeze one area, another will bulge-you just may not see it if all changes in the health care system cannot be simultaneously evaluated.

As I've said many times here, the unintended consequences of government health care decisions are not usually apparent at first. They occur over time with the result that the decision that prompted the change elsewhere is difficult to link. Health care is truly a complex system.

The Mowat Centre, a left leaning think tank initially created by Dalton McGuinty with five million dollars in provincial seed money, reports that the "doomsayers" about sustainability are wrong.

The Fraser Institute, a right leaning think tank, raises the issue of unsustainability and makes various recommendations for changes.

What are the risks of siding with one or the other?

If you subscribe to the "just work smarter all will be well" camp, there is a distinct possibility that this prediction will be wrong. It is not possible to know what the changes in a complex system will create. It is also impossible to predict sufficient efficiencies for the future that is unpredictable.

If you subscribe to the "act now to create more ways for patients to get care" camp, there is a  chance that the flexibility created will drive free-minded innovation and that the need for accurately predicting the outcomes of various programs will have less significant impact if the predictions are wrong.

Governments can regulate. They can fund provincial public health care systems, but there is danger in wishful thinking. Let us prepare for the worst case scenario. Let us be prepared.

On another note, I would like to thank you all for your contributions especially in the past few weeks. 

Cheers to you!







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