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?

Wednesday, November 22, 2006

Ted Morton, Pluses and Minuses on Healthcare

Ted Morton has got one thing right for sure: Equal access to a waiting list, is not equal access to health care”. Has anyone seen a study of the death rate per thousand people on a cardiac wait list (risk list), compared to the death rate of a similar age group per thousand who are not on a cardiac “wait list”? If there is such a study, I have not seen it in the MSNM. The point is that waiting lists are, by definition, a group of people who have been identified as a group at risk and/or in need. But the identification of this group is only the preliminary step in a multi-staged system. Addressing the needs and risks of this group is the next essential step without which, the first step simply points at the inadequacies of the system. The Supreme Court of Canada has said as much!
For that matter, we are not even doing the first part right. Seventy five percent of the people at risk for heart disease and stroke in Alberta have either not been identified, or are not being treated adequately. If we truly believe in preventative medicine, doesn’t it make sense to identify this group and intervene before they are on a cardiac “intervention” wait list? Don’t get me started! I’ve ranted on that before, so let’s look further on what Mr. Ted Morton has to say.
It would seem that Mr. Morton recommends that Canada follow the European example of a blend of a private and public system. In his home page he recommends:
1) More opting out of insured services to the private sector.
(It should be pointed out that this has been going on for many years. The basic arrangement between physicians and the government is this type of an arrangement. Most physicians in Alberta are functioning as a private small business. The Alberta Medical Association and the government have negotiated the amount of money that would go to physician’s services on an annual basis-----basically contracting out physician’s services to the public at large. Almost all abortions in the Calgary region have been contracted out to the “abortion clinics” for the past eight years. There is nothing new in this policy; and the only money that is saved is the use of downgraded facilities, which may be appropriate, and an assembly line type of turnover. Don’t misunderstand me; I think this is a useful process, but standards of care must be carefully safeguarded.)
2) Attract more investors to build more medical facilities and purchase more diagnostic equipment. (If the government allows a private parallel system, the government/taxpayer will not have to spend one cent on recruiting investors. The health care pot in Alberta for “covered” services is over 10 billion dollars. If only 10% of the population obtains insurance, the incentive is considerable. In addition, the private sector will be actively doing research to find ways of delivering services more effectively and at a lower cost to invite more “contracting out” by the public sector.)
3) Affirm the freedom of Albertans to choose their health care. (You can pay for your pet’s operation and have it done in 24 hours, but you wait in a queue for weeks to have your child’s surgery. There is a problem with this picture!)
4) Allow doctors to work in both the public and private systems (This is particularly true for those physicians that are doing procedural medicine. Surgeons, cardiac interventionists, imaging and other diagnostics, etc, but it will do nothing for family physicians, internal medicine, neurology, psychiatry, etc. The only way these areas would be helped would be to have aggressive recruiting programs in other countries for both our private and public systems. By recruiting for two systems we would be more competitive on the world stage for the best physicians world wide).
5) Requires doctors to work a minimum number of hours per week in the public system. (Basically, I do not agree with this system. Brazil was doing this thirty-five years ago and the public felt it was a disaster. No-one is happy working where they do not wish to be, and if you’re not happy in your work place, you’ll do a crummy job. Surveys show that only five percent of Canadian physicians would prefer to work only in a private system. The majority prefer to work in both areas. Besides, making the public system compete in their treatment of their health care providers and the work environment, will “hold the governments “feet to the fire”, which is not the case now. As a consequence, there has been a steady drain of health providers to the U.S. and other countries).
Mr. Ted Morton also has included a speech on health care that he gave some months ago. Included are points that we have discussed above, but also included is his position that health care in Canada as it is cannot be sustained, and that Canada has been dropping in measures of health care outcomes. We do not “have the best health care in the world”, and rank in the bottom third of industrial nations when measuring outcomes. He mentions five tiers in our existing health care system, but left out the huge “tier” of patients that pay chiropractors and physiotherapists to treat their back pain, naturopaths to treat systemic symptoms, optometrists to treat their eye problems, etc. Many patients cannot afford these alternate services. So, Ted Morton, there is another tier you can add to your list.
Overall, from my perspective, Lyle Oberg and Ted Morton are the only ones thinking outside of the “Canada Healthcare Box” and consequently the only ones that may bring about change. My biggest criticism of Mr. Morton regarding health care is that he does not address, in any way whatsoever, an approach to preventative health and chronic disease. Perhaps he feels that saying too much opens one up to more criticism, but significant change means a more aggressive approach to getting the right treatment to the right patient at the right time, and from where I stand, this does not just mean the people on waiting lists. It includes the thousands of people who are at risk for diabetes, and those that are at risk for strokes and heart attacks. It includes an approach to the epidemic of obesity in general, childhood obesity in particular, and life styles that invite consumption of health care dollars and decrease quality of life. This is the true responsibility of government and its leaders-------identification, education, and intervention on a population basis. As individuals, once identified and provided with the information and available interventions, it is our responsibility to act appropriately. And we should have a choice in living up to those responsibilities.

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