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, May 29, 2006

Health Care Capacity

My wife pointed out to me the other day that in my discussing aspects of the provision of health care, we often use terms that we assume every one understands. Specifically, she pointed to the term “capacity” within the health care system. Today, with the rain confining me to the indoors, I thought some discussion of “capacity” would be appropriate.
Most of us are familiar with capacity in the physical sense. A five gallon pail holds approximately five gallons. In health care, a hospital has perhaps five hundred beds and can therefore accommodate approximately five hundred patients. This physical capacity can be exceeded (unlike a five gallon pail) through changes in the hospitals “functional” capacity. When this happens, it may draw public attention. The most recent examples of this at a simple level, is the “co-ed” rooms and the placement of patients in hospital hallways when there is a bed shortage (which is becoming more and more frequent). The more complex aspect of a hospitals functional capacity has to do with programs such as transitional care, assisted living care, and long term care, in which the Health region has effectively taken the beds of other traditional health care providers and made them an extension of the hospital physical “capacity”. To some extent this was a very necessary change since many people occupying acute care beds were better served in other, less expensive facilities. The concern is primarily the lack of monitoring of outcomes that occurs (or doesn’t) in these “extended” facilities.
The most notable change that has occurred has been increasing the functional capacity of the hospital system by introducing and aggressively promoting home care. This could be considered a policy that extended the walls of the hospitals and its physical capacity to the community, effectively a hospital without walls; the beds of the patients are used as surrogate hospital beds, and the care givers are the loved ones of the patient. Again, to some degree this change in function was needed and welcome, the concern is that there is little or no monitoring of health outcomes in the community, and certainly doesn’t have the attention of the news media compared to the Acute Care Sector (hospitals and emergency departments). As a consequence of these changes in the “functional capacity” within our system, there has been a continual rise in the acuity of illness within the hospital system, the other health care institutions, doctor’s offices, and the community at large. The above changes in both physical and functional capacity within our health care system have been both significant and alarmingly, poorly monitored. Acute care beds dropped from 3.3 beds per thousand population to 1.7 beds per thousand at the present time. It is difficult to quote a figure on long term care beds since now they have different designations at the present, but the bottom line is that there has been little or no change in physical capacity of our long term health care facilities in Calgary over the last 15 years. This means more patient care has been assumed by the patients themselves and their loved ones. Still, the advocates for the present system say more tweaking along similar lines is the answer.
The last and probably the most important and most limiting capacity in our health care system is the “manpower capacity”. I believe salaries comprise approximately 80% of the health care costs in the Calgary Health Region. Although, as mentioned, acuity of illness has increased across the board in our hospitals, health care institutions, and in the community at large, there has not been an increase in staff to patient ratios, and certainly there has not been an increase in training criteria to work in the various institutions. Recent headlines indicate a loss of operating room time this year because of a shortage of surgical nurses. The region states it will be seeking 30,000 more health care workers over the next few years. Calgary Region is apparently short 300 family doctors. Primary Care networks are being heralded as the answer for the shortage of family doctors (a system where your care may be provided by a nurse or someone other than your family doctor). But doesn’t that simply take a nurse or other health professional out of some other part of the health care system?
So the Health Care System can build more hospital beds and operating rooms (increase physical capacity), they can tweak the “functional capacity” a bit more, but the real crunch for the future is the “manpower” (personpower?) capacity. And since this capacity constitutes the majority of the health care costs, don’t tell me that more money won’t help!.


Anonymous Anonymous said...

There has been money thrown into creating more spaces at nursing schools to address this "personpower" shortage, however, many schools this year have unfilled spaces, since there just isn't enough interest to go into healthcare. Maybe it's time for an "ER" or "Grey's Anatomy" style TV show that focuses on Nursing and other healthcare professions to get the kiddies interested?

31/5/06 11:08 AM  
Anonymous Anonymous said...

My husband is a family doc in BC. Last week, suffering from pneumonia, he dragged himself off to work every day. Why? We can barely makes ends meet. With expenses climbing (overhead taking over half...can you imagine if our m.o.a.s were paid union wages?), gas prices through the roof, etc., etc., we just keep digging ourselves deeper and deeper. (Okay, we have 9 kids, but I can assure you they do not wear designer clothes, eat fast food, nor attend private schools.) We often dream of taking more than 2 weeks vacation, and wouldn't it be great to have a pension to look forward to? Paperwork is my husband's evening entertainment. There's no money in doing charts; just time away from home. Recently, we had a trademan come in to install a pellet stove in our basement. He charged out $550 FOR LABOUR ONLY for 2 hours work. The plumber last week hit me up for $60 to fix a leaky tap. Now, I can tell you, my boys are not looking at medicine as a career option. The trades are looking pretty good to them. Their friends' fathers are, for the most part, blue collar workers and appear to have it all - boats, cabins, big houses, vacations, and weekends off. Do I think the doctor shortage is going to improve in the next few years? Not in your life!

31/5/06 1:08 PM  
Blogger Al said...

The Health regions arn't really helping the situation either. Whenever possible they try to hire nurses just short of the hours necessary to get benefits in the contracts. One of my friends lived 45 minuites drive to the Foothills hospital. She would get a call at five A.M. asking if she could be there at seven A.M. On several occassions as she was going out the door an hour later, they would phone and say they wouldn't need her after all.
As for family doctors, my wife always said the doctors should have nothing to do with negotiating or dealing with the government; the doctors wives should comprise the negotiating committees and any other committees that interacted with government. Doctors are in a conflict of interest. Their empathy for the patient and their dedication puts them at a huge disadvantage. The wife does not have that problem, and more times than not, has to raise the children, balance the books, and in many respects, take on the role of a single parent. I frequently regret my missing much of the time that my children were growing up. Thank god for wives!

31/5/06 5:12 PM  
Blogger michie said...

You can't pay me enough to deal with peoples' various bodily fluids every day. Yikes.

All joking aside (even though it wasn't totally a joke), a big reason I didn't go into medicine is because of the huge responsibility for other people's lives. Doctors are forced to spend hours and hours looking at charts and getting paid nothing, because if they overlook something, it's someone's LIFE we're talking about here. If a plumber doesn't fix a leaky tap properly, then you put up with a leaky tap a little bit longer. Big deal.

Out of all the professions and trades that are in demand, physicians simply don't get compensated for their time, effort and responsibility.

31/5/06 6:57 PM  
Blogger Stephen Taylor said...

Hey Al!

You should join Blogging Tories.

Check out what we're about here:

Sorry for the spam-like comment but I couldn't find your email address on your blog. And... you can delete this comment after you've processed it!

1/6/06 3:36 AM  
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5/6/06 11:12 PM  

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