Quote:
Originally Posted by sailor734
Certainly not advocating a US style system. Most highly ranked systems seem to use some sort of public/private hybrid model. The problem in Canada is that whenever anyone suggests anything other than a full, universal, single payer, 100% government run system people accuse them of promoting US style healthcare. It's not a binary choice. I think we should be examining every system that provides strong results and see what we might cherry pick for our healthcare.
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100%. Most people are not aware that Canada's narrow focus on a completely publicly funded health care system is an outlier compared to the rest of the world.
Private options exist even in the UK (with the vaunted NHS), as well as in other advanced European countries such as France, Germany, Switzerland and in Scandinavia.
Canada's slavish devotion to absolutely universal 100% publicly funded and universally accessible health care is stultifying, overly bureaucratic and limits innovation. This is incontrovertible, and explains the current mediocrity in Canadian health care.
A blended system is best. Everyone should have access to free health care if they so choose, but, at the same time, for those with the means, or those who choose to have innovative options, a separate private stream should be available. This is akin to a human right. People should have the right to take charge of their own personal, individual health care if they should so choose. As it stands now, a paternalistic socialist system removes this individual choice.
I have been a physician for 41 years, and I have been a witness to the increasing centralization and bureaucratization of the system. As more and more layers of bureaucracy have been added, innovation has decreased, and the system has become less and less responsive to individual or local needs and concerns. A "one size fits all" system has arisen, which pleases and satisfies no one. Decisions have been made that actually limit and impede health care delivery.
Here is my own personal prescription for the health care system based on my four decades of experience:
1) - Public health care should be a right, but private options should exist, and should be encouraged.
2) - Specialist health care should be treated and funded differently from primary health care.
- I am a fan of the idea of
collaborative care medicine in primary health care. I think the old paradigm of individual private practice for family physicians is becoming untenable and should be discouraged. Most newly minted family physicians also think so. I believe
multidisciplinary clinics are the way of the future for primary health care. Such clinics would be comprised of a group of 5-6 family physicians, as well as nurse practitioners, physiotherapists, dieticians and perhaps other relevant health practitioners, even pharmacists or social workers, which would allow a more holistic approach to health care and problem management. In such a system, there would
always be an MD or NP available for urgent health care needs. Extended hours of operation would be possible (maybe not 24/7, but certainly evening and partial weekend hours).
Such a system would not be conducive to traditional "fee for service" payment for family physicians, but, other options exist such as salary, capitation or rostering. I doubt the government would want to pay physicians an actual salary (which also means pensions and benefits). This would give the government budgetary officers and actuaries the willies. Only a small number of physicians are actually salaried (pathologists, laboratory physicians and public health officers). Pensions for this small number of physicians are expensive enough (as far as the government is concerned). The other payment systems are based on variations of the concept of paying physicians based on the number of patients in their practice, perhaps with some allowance regarding how old, sick and intensive the care for individual patients is). In a group setting, this income could be split between the physician group, as all the physicians would be participating in the management of all the patients included in the practice.
Such collaborative care payment practices are not transferrable to specialist care (specialists are consulted, the patients don't actually "belong' to them), and fee for service therefore should remain the preferred payment option for specialists. Specialist care is more one-on-one, or procedurally based, and, specialists, while cooperating in on call arrangements, are more likely to have individual offices.
3) - Outpatient urgent care centres should be established in all regions of the province.
Emergency rooms are overwhelmed. The system is no longer tenable. At least 80% of the patients seen in the ER could have their needs met elsewhere.
The system could easily be corrected by establishing non hospital based urgent care centres in every city and region of the province. These centres would essentially be completely disconnected (but affiliated) satellite emergency rooms located away from the hospital campus. They would include reception, a waiting area, multiple exam rooms, and basic lab and imaging services so that people with non life threatening conditions can be treated closer to home, and away from the high pressure hospital setting. Such a centre would be staffed by trained ER physicians, nurse practitioners, regular RNs, LPNs, repiratory therapists, lab techs, x-ray technologists etc. It would essentially be a lower level emergency room, designed to treat anything not requiring urgent specialist referral or potential hospital admission. These centres would be more customer accessible, have abundant parking, and would be less stressful and would be much more popular with the public I am sure.
4) - Outpatient surgical centres and radiology clinics should be allowed.
ORs in hospitals are overwhelmed. Surgical waiting lists are astronomical. Medical Imaging is no better. Imaging services such as ultrasound and MRI have waiting lists of 6 months up to two years. Delay upon delay, leading to poorer patient outcomes when the definitive surgical procedure is finally performed. People are literally dying on waiting lists.
ORs in the hospital should be preserved principally for procedures requiring general anaesthesia and/or intensive post anaesthesia or ICU care. Similar to the above mentioned urgent care centres relieving the hospital based ERs, outpatient surgical centres could reduce pressure on the hospital operating suites.
Some outpatient surgical centres have already been established, notably for cataract surgery. They function well. Other surgical procedures could also be amenable to local anaesthesia, or low level general sedation that might require an anesthesiologist on site, but, only a short stay in a recovery room rather than an overnight admission. I'm thinking of some orthopaedic procedures like meniscectomy, and some plastic surgery procedures. This is otherwise known as "day surgery", and is currently performed in the hospital. There is no reason why the majority of day surgeries could not be transferred to off site surgical centres. If such centres were established, then hospital resources would be freed up to decrease the waiting times for more urgent complex surgeries requiring hospital admission.
Similarly, many radiology examinations could be done in standalone outpatient radiology clinics. There is already a private clinic in Moncton providing MRI and ultrasound services. It does mostly workplace safety, RCMP and military work, but, there are some private paying patients as well. The sky has not fallen as a result.
Imaging procedures amenable to the outpatient setting include general radiography, ultrasound, screening mammography, bone densitometry and some basic MRI services. Other imaging services belong in the hospital setting, especially fluoroscopy, nuclear medicine, contrast enhanced MRI, contrast enhanced CT and interventional radiology. Of course, hospitals would also require the full range of all the other radiology services to support inpatients and the ER.
Outpatient imaging centres, like the outpatient urgent care centres would offer patients accessibility, abundant free parking and a more pleasant environment than your typical hospital setting.
And, it should be notes that while outpatient surgical and imaging centres might be privately owned and operated, they could exist in an environment where the cost of the procedures performed there are
billed to medicare, and, as such,
the patient would not be out of pocket.
5) - For the love of God, build more nursing homes!!!!!
About 1/3rd of beds in most hospitals in the province are occupied by "bed blockers" - patients who have been medically discharged, but have nowhere to go. This situation will not be ameliorated until the province gets off it's fat ass and actually adds a couple thousand more nursing home beds into the system. This should have been addressed decades ago, but the problem persists. It is a provincial (and national) embarrassment.
In terms of the actual number of hospital beds in the province, we actually have enough. It's just that the beds are misallocated as pseudo long term care beds. Please note that all the remedies I am proposing do not require new or larger hospitals. I propose removing a large chunk of care from the hospital setting so that the pressure on the system is removed, and the hospitals can get back to the business of providing quality health care to all.
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