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?

Tuesday, February 19, 2008

Healthcare Top Issue, Canada and USA

“Doctor Shortage Makes Health Top Election Issue”; this is the headline in Today’s Calgary Herald (Feb 19/08).
So I read the article, thinking I would encounter some thought stimulating innovative platforms from Alberta’s political parties on Alberta’s Healthcare system. Unfortunately, the only ideas put forward by all four parties are the same ones that we have heard over the past twenty five years (promises) and that got us to this present day state; or ideas that are totally irrelevant or counterproductive such as eliminating healthcare premiums. Would someone please tell me how decreasing the government’s revenue stream is going to help provide more family physicians to the citizens of Alberta? Now, if they had said they would increase the threshold of annual income before paying premiums and increase premiums for high risk life styles, at least some discussion would be precipitated.
All four parties claim they will increase long term beds, increase the numbers of graduating docs, etc, etc, etc. Haven’t we heard this a thousand times before? If the number of graduating docs that choose family medicine continues to shrink, how in heaven is graduating more plastic surgeons, dermatologists, etc, going to help? And if we can’t retain in Canada the physicians we in Canada graduate in the various specialties including family medicine, are we not simply providing well trained physicians (at the tax-payers expense) for the United States, Australia, New Zealand, etc?
The reason none of the political parties want to get into the healthcare issue is that they all realize that at present in Canada and Alberta, healthcare costs are being controlled through rationalization of services; not through legislated restrictions, which would be politically onerous, not through direct fees that would be politically onerous, not through private insurance options that are PERCEIVED to be politically onerous, but through restricted access to healthcare personnel and technology by virtue of scarcity, the politicians greatest ally in our present system in controlling costs.
The article in today’s Herald states that “the experts” say there is no simple solution for what ails the health care system, and Dr Glenn Comm, President of the Calgary and Area Physicians Association says “there are no quick fixes” and “We got into this mess over a long period of time”, but my question is: How about some quick STARTS to fixes, how about at least looking at some options other than those that “Got us into this mess over a long period of time”, how about some real discussions without special interest groups trying to STOP discussion. Any solution has to address increasing costs and at the same time offer the population better access. It would have been nice to see at least one of the political parties identify itself as real change (an opportunity for the Alliance Party)
in the area of healthcare, a party willing to look at options on both the left and the right of the political spectrum. A simple example would be to bring in a registry system with intensive intervention in the area of chronic disease (an idea that many would think intrusive and too “left-thinking”), coupled with private insurance availability and facilities for those that can shop the market for the best coverage (an idea that is strongly rejected by the “left” and considered to be “right wing”).
Alas, all the parties avoid any open discussion of healthcare like the plague. Perhaps they all agree with one of Canada’s somewhat notorious Prime Ministers when she stated that an election is not the time to discuss substantive issues. Mind you, she was voted out resoundingly in that election.


Anonymous Lanny said...

Unfortunately, as we've said before, special interest groups like the "friends of medicare" (who are no friends of mine as a patient) and the crew who yell "United States, United States" are not open to any discussion and nothing is ever done. It has been political suicide. Every year, more and more Canadians run into problems with the system and every election year, I hope this will be the year that politicians can raise possible improvements without committing political suicide. I guess not this year....

19/2/08 5:46 PM  
Blogger Al said...

Apparently not this year, at least not in progressive Alberta. I understand Quebec is looking at a number of initiatives including allowing physicians to work in both the private and public sectors, in addressing healthcare issues there. It's kind of ironic that the province that tends to thumb its nose at many things "Canadian", have now moved to include our sacred national "healthcare", the very healthcare system that "defines" us, as the next Canadian institution to be axed. Viva La Quebec!
(or something to that effect!). It would appear that they will actually be the saviors of Canadians and their healthcare.

19/2/08 7:25 PM  
Anonymous Anonymous said...

hi its rose posting anonymously, because I'm signed into another acct.

I am all for user fees, but doesn't Alberta already charge a monthly user fee? From what I remember it was steep, at least for my income at the time. With all the money Alberta has, I am surprised that more hasn't been done to improve healthcare.

Perhaps providing incentives to doctors going into family medicine would be a place to start (ie, paying their tuition if they decide to go into family medicine and stay put for at least 5 years). From those I know, the prospect of paying off $120,000 bank loan making $50,000 a year as a resident sends people I've known fleeing Stateside. Probably just a band-aid solution for the most part, but its a start. I'd personally have given up my Ralph bucks for that! In my opinion, its the money thats going to keep the doctors, and from what I hear, Alberta has tonnes of it.

Or am I naive to think that throwing more money towards family doctors will improve things? I guess if things are that bad in Alberta where the economy is really strong, and probably only slightly worsein NS, where the economy is crap, then perhaps money is not the solution. I could concede to private insurance and private healthcare as long as there are limits on a doctors ability to practice in that setting (ie. 20/80 private/public) so that the dreaded "two tier" system doesn't develop.

Perhaps unloading some services onto Nurse practitioners and midwives and community support would be another option. I mean, in Doctors offices, a nurse could triage patients based on their complaints and those with something innocuous like a cold/bladder infection/flu could see the nurse practinier instead. I'm pretty sure a nurse practitioner could have swabbed my throat and prescribed me antibiotics since I probably could have done it myself. Wouldn't this take some pressure off family doctors and make it a more desirable field? As well, midwives and even dietitians working closely with physicians could help administer care to diabetics and pregnant women. If such clinics could be opened where a team approach is used, and obviously, dietitians and nurse practitioners are paid less, then doctors could be paid more per visit, while reducing the number of patient visits per day and stress on the doctor.

haha, you are probably laughing at my naivity. sigh.

20/2/08 9:51 AM  
Blogger Al said...

Hi, Rose. Alberta does not have "user" fees. User fees are not allowed under the Canada Health Act. We have premium which are about $45 dollars a month for singles and about $90 amonth per family. The province rkes in about 800 million a year from this source.
"Training the student in return for years of service is not a new concept. In fact the millitary and navy were doing that way back in the 50's and 60's. I think ths governments think it is cheaper to bring the docs in from Africa, etc.
The multi professional approach that you suggest is the thing that is being flogged now. Besides the fact that there are shortages of nurses and nurse practitioners to help the concept (robbing Peter to pay Paul manpower wise), i truly believe that the system will be more costly in the long run. My experience in caring for people is that the more caregivers involved, the more issues are raised that require time and cost to sort out. The school nurses referred many young people to be checked out for scoliosis years ago and many of the parents of those children wanted not just my reassurance but the reassurance of a specialist. Phys Ed teachers would suggest someone needed a CT Scan of their back and it was difficult to convince the patient that the test is not to be done for the sake of getting back to Phys Ed and relieving the Phys Ed Teacher's anxiety and sense of responsibility. Interestingly enough, as people accept more responsibility, they usually expect more pay. I would expect the vision that you and the governments have will increase diagnostic and consultative utilization, increase demand for medical personel, and increase salary demands overall.

20/2/08 3:28 PM  
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