What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Monday, January 09, 2006

Health Regions Fiddle While Health Care Burns

During the /80’s and /90’s many attempts were made to control costs, often not well thought out. I was one of the many primary care physicians who would get a letter almost annually reminding me that my profile for ordering investigations on my patients was two standard deviations above the norm. I never received an answer when I inquired who my peer group included and if doctors that were two standard deviations below the norm were also receiving a letter! Obviously this was an attempt to decrease patient investigations and cost.
The Alberta government then thought educating the public on their consumption of health care dollars would curtail usage. A statement was sent out annually to individual Albertans itemizing the costs paid by the government on the patient’s behalf. This was discontinued after a few years for three reasons: it raised issues of confidentiality, it wasn’t working, and it showed how little of health care costs actually went to physicians. My patients would often say: “You mean to tell me that while I was in the hospital I ran up a bill of $5,000.oo, you saw me every day and you only get $129.oo? The bottom line, the program moved public support towards the doctors and didn’t help during negotiations with the profession.
As previously mentioned, the investigation of patient’s complaints was one of the large consumers of health care dollars. The Calgary Regional Health Authority approached the problem by actually becoming a part owner of the labs in Calgary. This gave them considerable influence and before long many of the smaller laboratory outlet services were shut down. Soon long line ups developed in the remaining laboratories. By controlling fees for diagnostic imaging (X-rays, ultra sounds, etc.), governments soon forced the owners of these services to close their smaller operations and centralize as well. Waiting time for these services grew.
The above change in services in the community had a profound effect that was not anticipated by the Region. I, as a physician, no longer could send my elderly patient suspected of pneumonia down the hall for a blood test and chest x-ray. They may well have to travel miles and occasionally to different addresses. Instead of having results in minutes it would take hours or days. Injuries also could not be dealt with quickly because we no longer had X-ray facilities on the premises. For compassionate and good medical practice reasons, primary care physicians began sending more and more of our sick elderly patients, our injured patients, and our urgent and semi-urgent patients to the emergency departments of the hospitals. As access to specialists and investigative modalities worsened, emergency department became swamped. Was this predictable? Of course it was! How are the health regions dealing with situation? They are developing medical clinics (Health Region owned and managed) with laboratory and diagnostic capability and hire physicians to work in them. These new clinics offer the same services that were provided by the physician run clinics-----they just cost twice as much to run!
Re-inventing the wheel at twice the cost is now described as the solution to health care sustainability.

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