When trying to sort out "where do we go from here", it is a helpful exercise to look back on the various trends that government health policy has emphasized as solutions for the challenges that hound Canadian health care. Take a few minutes to review:
Since the mid 90's we've seen MDs blamed as the cost drivers and saw their numbers cut in medical school only to result in continued escalation of overall health care costs and then a rapid influx of Internation Medical Graduates most recently and a doubling of medical students soon to begin practice (maybe not here). With provincial governments squeezed for cash across the country and a federal government equally strapped for cash now and for many years ahead it is not surprising to see new specialist graduates unable to find work. Sad but true despite Canada having less than average number of MDs per capita than most other developed nations.
We've seen the government and many government funded groups promote interdisciplinary care as the way forward to create quality care and as a way to stretch health human resources but I believe it hasn't made much difference and the costs significantly higher than Fee-For-Service. There are still hundreds of thousands of people in Ontario with no family doctor and across Canada the count is in the millions. There are reports of MDs in teams seeing less patients and working fewer hours and I wonder how this strategy of increasing the numbers of providers in health care will play out as the work force shrinks relative to dependents in the next 10-20 years. How do we fund more expensive health care teams with fewer tax payers and sluggish productivity especially when the outcomes aren't any better than what we had for fewer dollars?
There has been the eHealth spending to the tune of billions and billions of dollars in Canada but new reports seem to indicate errors associated with EMR are a reality only different from paper charts. I have no doubt that developing Health IT provided jobs during a significant recession and I don't begrudge any government for providing them but let's be honest about it: EMRs will not save any tax dollars from the health care vortex. Are they necessary for the complexity in health care that is coming? Yes. Will they save money? No.
We've seen efforts at using a public air ambulance system to generate private dollars but with very questionable oversight from its Board the whole plan crashed and burned--leadership at its worst at many levels and it seems government not willing to be accountable for creating the entity and then letting it run wild.
Managing queues more efficiently and centralizing referral systems was going to reduce wait times and create efficiency. I hazard a guess that with multiple groups doing wait time analysis and studyng how to keep patients from accessing expensive care, the cost is likely in the billions and we are still treading water with queues for various treatments and procedures.
Ontario comes out better than most provinces in terms of its wait times but the cost has been high and now as a have-not province, Ontario risks having its credit rating driven down so it will cost more to service its debt which means the same service will cost the province even more in the future. It would be ironic if Ontario's good-hearted money dumping to reduce wait times eventually makes them worse because it will cost more to provide the same service.
The ALC problem has nagged Ontario and other provinces for some time. Patients languishing in hospital beds when what they really need is long term care are now seeing action by hospitals and local health integration networks to move them out as quickly as possible. However, the supply of long term care beds and nursing home beds provided through government funding have not kept up. Elderly patients in the community who are frail and who have managed to avoid hospital so far are not a priority and it is only a matter of time before they end up needing acute care too. Despite this, hospital beds are being "closed" and unstaffed as hospitals are desperate to meet accountability agreements required by law. Nurses are laid off. Services are slashed in order to come in on budget and Ontario's Minister of Health Deb Matthews says "it's OK"...we'll move services to the community....only that isn't happening.
The queue jumping inquiry in Alberta serves to show us that despite relatively exhaustive efforts across Canada to reduce waits, it simply isn't working. With colonoscopy wait times measured in years in Alberta, "queue jumping" appears to have become fairly common. No surprises here because if you have a loved one that is suffering or at risk for nasty health problems, wouldn't you do what you could to help them if you knew someone who could help you? It happens all the time and it shouldn't become a witch-hunt to the tune of millions of dollars. Open up the system to those who are willing to pay for the service. Keep the medical specialists in the province to do the work they were trained to do. We all know there is plenty of patients needing care. If there were no queues and if there were reasonable wait times, there would be no substantial queues to jump. Let us be transparent and honest and allow people who can pay to pay.
Last but not least is the newest trend toward moving hospital services to the community. I've heard it all before. I've heard it for over 20 years and it does not happen. If it happens this time, nobody should expect it to be cheaper because all of the smaller facilities will have to have government support OR they will be set up by private groups who will then be paid by the government for public medical services provided. If hospital beds are cut at the same time as services are provided in the community how exactly will savings be achieved? Patients are more complex than in the past with growing ranks of elderly with dementia and chronic disease. I predict that there will be no savings from moving services from hospitals to the communty.
Where do we go from here?
There must be a way of creating private options for care in Canada and especially in Ontario.
What would it look like?
How would funding for a private hospital be created?
How many insurance companies could be allowed to offer medically necessary services? One? Two?
How would a private hospital or private clinic interface with the public system?
We need to have an honest and open and reasoned discussion about where we go from here--because queue jumping witch hunts, outsourcing care, EMRs, and teams just aren't going to make health care more efficient or cost less.