Quote:
Originally Posted by sailor734
It also makes me wonder if increased spending is the solution to healthcare issues in Canada or if the problem is the system itself? I've often wondered what would happen if we took an honest and objective look at the top 10 countries in the world in terms of healthcare access and outcomes with a view to stealing any and all good ideas.
I think we need to put everything on the table. How the system is structured, how it is managed, how it is staffed, how staff are remunerated, how the system is funded, how the system is accessed etc. etc..
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The health care system is, has been, and always will be expensive.
This is because healthcare is highly specialized, requires an educated and technical workforce and is vary labour intensive. It cannot be automated. It has to be delivered in a compassionate manner to an ill and frightened client base. You can streamline, but you cannot rush health care. It requires time for the patient to heal.
Having said this, there are a few things that can be done to make the system more efficient.
1) -
Build more nursing homes. Bed blockers are the biggest choke point in the hospital system. At the Moncton Hospital, about 1/3rd of our beds are occupied by patients who are medically discharged and waiting for nursing home admission, They can wait for months in an environment that provides them with little mental stimulation, and places them at risk of exposure to contagious disease. This situation means accelerated mental decline and shortened life spans. It is intolerable both for the bed blocking patient and for the patient in the ER waiting for admission. If you want to reduce ER waits, then the most effective way to do this is to make more nursing homes available.
2) -
Build urgent care centres away from the acute hospital setting. About 80% of patients presenting to the ER do not have to be there. The ER is meant for acute trauma, acute stroke, acute MI and complex medical situations requiring specialist intervention. An outpatient treatment centre staffed by ER physicians equipped with basic imaging and laboratory serices can deal with most urgent (non emergent) health care situation - lumps and bumps, suturing, colds and flu, prescription renewal etc. These urgent care centres can be located in shopping centres with abundant parking and easy patent access. If these were built, ER overcrowding would disappear overnight.
3) -
Build more collaborative care clinics. Most physicians do not oppose such clinics. In fact, most younger physicians prefer this option which allows you to practice in a team based environment. For patients this may mean that you no longer have a personal physician, but you will have reliable access to A physician or NP in your neighbourhood clinic with expectations of being seen in a reasonable time.
Do these three things and the crisis in primary/emergency care would disappear overnight.
Would this make health care less expensive- no, and, costs would likely increase somewhat, but, public satisfaction would improve immeasurably.
Hospitals would still exist, but the system would be decompressed, and there would be no need to build new hospitals. Existing facilities should be sufficient to deal with an aging population with increasing health care needs.
As for compensation models, I think it would be difficult to do anything substantive to decrease costs. They are already offering alternate payment models for primary care physicians, and many younger FPs are opting in.
Fee for service remains the primary way to pay for specialist services This encourages throughput and efficiency within the system. As for the "rich doctors", these are mostly specialist and subspecialists who have 13-15 years of training, don't enter clinical practice until this early to mid 30s, have a truncated workspan of 30 years or so, are expected to be on call at night, working 60-80 hours per week, have no benefits and no pension plan. It is rewarding and intellectually stimulating work but entails a great deal of sacrifice. If specialists were salaried, they would require defined hours, a pension plan, benefits, and overtime pay. I don't think saving would be very much.
I think some savings could be had by making sure the least qualified person person was performing the appropriate task in a hospital or nursing home situation, Most nursing tasks can be handled br LPNs or RNAs. Managerial positions and specialist nursing postions in the ER, OR and ICU would require full RNs. This is generally what happens now anyway. In nursing homes, you could have patient care attendants and orderlies doing most tasks rather than LPNs, but, it should be remembered that you get what you pay for. Do you really want to dumb down the system too much?
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