Quote:
Originally Posted by Ziobrop
Not a health care person, but as i understand it that's whats been happening. Doctor shortages have caused things formerly done by dr's to be done by RN's and RN work to be done by LPN's.
Hospitals are expensive, and sadly are filled with people who really shouldn't be in hospital, but don't have elsewhere to go. Home Care, Assisted living and Nursing homes are more appropriate long term care, that can then free up hospital beds.
Hospitals only source of funding should be payment for services. Service should be marked up, and the profit reinvested to improve service at the hospital. that changes the budget exercise to how do i treat more patients, from how do i do everything with the pool of money.
Note, i dont think this will be cheaper, but will result in better outcomes for patients (As money will be spent on process and technology improvements). Also I am not advocating private care, where you pay a portion of the bill. this is a return to the Public Health insurance system.
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I was actually at a meeting with one of the VPs of the NS Health Authority early this week, and we got chatting about healthcare costs. The breakdown, interestingly, is that it is about 1/3 apiece for physician fees, operating hospitals, and buying drugs etc.
If you look at the year over year healthcare costs for roughly 2000-2010, it was about 7% a year, and NS was pretty indicative of the national trends. There is a NS Dept of Health report that shows that if that rate continued that every single drop of provincial revenue would have gone to healthcare by something like 2024. Because of that, however, healthcare budgets the past few years have been almost flat. Parts of the system are still costing more (and one can debate whether that is acceptable or not), and so what that has meant is other parts of the system suffer. Given that health authorities legally are barred from running deficits and from carrying any debt, this is how we end up with crumbling infrastructure. Health authorities cannot build new infrastructure. Only the government can. But no politician wants to touch replacement of the VG with a 10 foot pole because there is massive pain to be had trying to fund that, while it is almost certainly a different government who will someday stand in front and cut the ribbon. Meanwhile administrators at the health centres are trying to deal with a public who understandably wants access to the best and most modern healthcare that they can get, while dealing with the fact that there is no additional money to do so.
People at the health centre who 5 years ago probably had never heard of an Incremental Cost Effectiveness Ratio are now walking around mumbling about how the ICER for therapy must be evaluated relative to standard of care bla bla bla. I actually don't think that that is a bad thing, but regardless it is certainly a big change.
It is easy, and understandable, to point to large union negotiated contracts as "the thing" that is the issue in our system. The bigger picture, however, is that there needs to be more public engagement and decisions made as a society as to what is the amount we are willing to pay for an incremental quality of life year? Is it $10k per patient per quality of life year? $100k? $500k? It is exactly that information that can, should, and will guide administrative decision making when it comes to spending money on healthcare. That is where the onus needs to start being on the users (us) to decide how much we are willing to let these end of life decision affect the budget. Doing so has a far greater impact on our provincial budget than whether we can afford a new CT scanner.
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