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Thread: My Prescription for Better Health Care

  1. #1
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    Default My Prescription for Better Health Care

    As a physician, Leader of the Official Opposition and a concerned citizen, it infuriates me to see how Conservative mismanagement has damaged the quality, efficiency and accessibility of our public health care system.

    Nearly every day my office receives letters, calls or emails from patients or health care professionals about how dysfunctional the system has become. But we can turn everything around with a plan that includes regional delivery, rebuilding trust and reinvesting in primary health care. This will take a combination of consultation, common sense, stable leadership and a transparent plan for the long run.

    Premier Stelmachís only response to the chaos his policies have created is to throw an additional $2 billion at the problem. While public health care will always require significant investment, this is not the way to address the issues plaguing the system. We already spend more per capita on health than any other Canadian jurisdiction, but our health outcomes are worse; we arenít getting value for our money.

    Albertans have a right to expect a well managed, accessible, quality public health system. But data from public surveys and the Health Quality Council show that the Stelmach administration isnít delivering. In less than twenty years, Conservative administrations have imposed knee-jerk, unplanned, major restructuring three times Ė and each time, they have thrown the system into chaos, creating incredible headaches for health care professionals and poorer outcomes for patients. As a result, there has been a major breakdown in respect, trust and understanding between the government and the health care professionals charged with making the system work.

    This respect, understanding and trust must be restored if Albertans are to enjoy the quality and accessibility they deserve. But beyond that, we need a government that understands the fundamental importance of primary health care.

    Every Albertan needs a family doctor. Thatís the cornerstone of my approach to fixing public health care. If every Albertan had a family doctor, wait times would be reduced, health outcomes would improve, costs would come down and more space would open up in our clinics and hospitals. A greater focus on preventative medicine would further reduce costs and improve outcomes. Right now, the system is heavily focused on treating expensive chronic illness. We need to expand the scope of public health care with a range of preventative programs: safeguards for water and air quality, as well as support and education for lifestyle changes such as better nutrition, more exercise, smoking cessation and so on. This will keep Albertans healthier and less reliant on catastrophic care.

    You canít create the thousands of health care professionals Alberta needs overnight. Aside from family doctors, Alberta needs more nurses, more homecare, technicians, EMTs and all the rest. This will require a long-term investment in public education, at both the secondary and post-secondary level. Not only do we need to create more spaces at universities and technical schools to train health care professionals, we need to start promoting these careers to young Albertans. Alberta is awash in raw talent; itís foolish to depend on recruitment from outside Alberta when so many talented hands and bright minds exist right here within our borders. If I were Premier, Iíd add the needed spaces to post-secondary institutions across the province, anticipating demographic changes to avoid disruptive staff shortages.

    Alberta has all the tools in place to maintain a world-class public health system, accessible to all, affordable for taxpayers. What we need is a government that will manage that system based on principles, evidence, consultation with professionals, and a vision for long term excellence.

    -- David Swann, Leader of the Official Opposition

  2. #2

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    ^David Swann is right, change is needed. It is hard though, as so many people have ignorant fears of change. It is time to look at the best health care systems in the world (i.e. not the US but rather Europe), and model our system on that. We need a second tier, other than the de-facto option right now to cross the border. With competition from non-profit bodies (which private insurers often are in other countries, a group you join and own), there will be more opportunities for health care workers, and more choices (other than flying south) for Albertans. The second tier, which will be paid for by Albertans who choose it, will also make the buck go further in the public system for those who don't (as fewer patients to care for), meaning a better public system.
    Last edited by moahunter; 19-04-2010 at 11:34 AM.

  3. #3
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    another thread taken down the privatization path...

    A system in trouble needs fixing, not replacing. As long as public education dollars educates doctors, nurses, and all other health staff and public funds build public hospitals, there should never be a for profit "tier" as it will splinter the resources.

    David's suggestions are surprisingly spot on with what I had written in the latest thread on "sensible solutions for public health". We need family doctors. More of them and well educated. Get their training levels closer to what the Internists do. Not two years of residency, but two years of family plus a year of internal to get their skills up to the needed level. Then compensate them well. Mandate a minimum amount of time to be spent with a patient. Value nutrition, active life style and oter counselling on a par with a procedure. Increase the value of an anual physical exam. That is a good start at fixing the system.

    Also, stop downshifting responsibilities from physicians to RN's or pharmasists to LPNs and pharmacy assistants, to volunteers. RNs have their work to do and the physicians have theirs.

    Everything else is a window dressing.

  4. #4

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    Quote Originally Posted by grish View Post
    Everything else is a window dressing.
    Anything less than choice for health workers and Albertans, like that provided in Europe is window dressing. I am sure if the Guest Columnist has done some thorough research beyond the North American pro-Canada system, pro-U.S. system rhetoric he will understand this, but political reality probably makes the truth unpalatable for most parties to present.
    Last edited by moahunter; 19-04-2010 at 12:44 PM.

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    Quote Originally Posted by grish
    another thread taken down the privatization path...

    A system in trouble needs fixing, not replacing. As long as public education dollars educates doctors, nurses, and all other health staff and public funds build public hospitals, there should never be a for profit "tier" as it will splinter the resources.
    Virtually every other Western nation allows various forms of private health care delivery, and none outright ban it. Canada and the US are on the complete opposite ends of the scale when it comes to health care policy, while other Western countries reside somewhere in between.

    Just like US political discourse on health care has just devolved in to mudslinging out socialism, the political discourse here devolves in to mudslinging about privatization that completely ignores the fact that 30% of health care spending in Canada is ALREADY "private", and that most of the ones doing the mudslinging (ie: politicians) almost all have gone to private clinics for treatment.

    There absolutely should be a place for greater private delivery within our current system. Red tape and bureaucracy are out of control.

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    grish
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    but private delivery will do nothing to cut out bureacracy and red tape. If anything it will create more to oversee the private health delivery and to communicate between private and public.

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    I am curious if Dr. Swann has a single idea of how to control costs, other than hoping that preventative measures will result in a healthier society. I'm all in favor of adding more doctors but I fail to see how adding "the thousands of health care professionals Alberta needs" will bring down costs as he claims. As far as public health programs he promotes "safeguards for water and air quality, as well as support and education for lifestyle changes such as better nutrition, more exercise, smoking cessation and so on" we have been inundated with these programs for years, I would like to see some details as to exactly what more he would do in these areas. He complains about Stelmach throwing money at health care but all he seems to propose is to throw more.

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    Quote Originally Posted by grish View Post
    but private delivery will do nothing to cut out bureacracy and red tape. If anything it will create more to oversee the private health delivery and to communicate between private and public.
    What evidence do you have of this? Once again, every other Western country other than Canada permits private delivery of health care and indeed some European countries have health systems more akin to the US than ours and they perform very well.

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    Quote Originally Posted by Marcel Petrin View Post
    Quote Originally Posted by grish View Post
    but private delivery will do nothing to cut out bureacracy and red tape. If anything it will create more to oversee the private health delivery and to communicate between private and public.
    What evidence do you have of this? Once again, every other Western country other than Canada permits private delivery of health care and indeed some European countries have health systems more akin to the US than ours and they perform very well.
    Have you compared their "red tape" to ours? Just because they have parallel systems, does not mean they have less red tape. Germany, for example, at the very least requires each individual to belong to a health plan. Keeping track of that is a piece of red tape that we do not have.

    I am sure at the legislative level, a private health plan would have to be registered and monitored. Additional legislation to prevent people from being barred from a health plan for being too sick needs to be introduced. Conflict resolution needs to be addressed.

    Let us say that contrary to your claim that there will be less red tape, there will be at least the same. Likely more. But I'll agree at "same". As in, "cutting red tape" myth is not the reason enough to approve private health delivery. There needs to be a more compelling reason for it.

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    As far as a compelling reason for private delivery how about saving money?
    The govt. will have figures about what it costs to do a certain procedure, for example hip replacements.
    It would cost next to nothing for the govt. to put out a request for proposals for a private firm to do the operation. If the proposals come back with a significant savings then there is an opportunity to save money. If the proposals come back with too high a cost then we don't have to change anything.
    We have ridiculous waiting lists for virtually every procedure but any idea for change is met with a huge scream of anguish mostly coming from unionized health care workers.

  11. #11
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    but then I ask who are the doctors and nurses who will perform the hip surgery? Sure they may offer a "competitive" rate. However, if this means that there are fewer health professionals in the public system increasing the shortages and wait times, requiring extra training spaces to be opened up, and so on will there really be savings? Who will deal with the consequences of the operation gone wrong? If all people requiring routine procedures were to go to a private hip clinic that only performs one easy procedure, but all the complications were to go to the public hospital, again will there really be savings? You cannot break up the whole health care system by procedure. In a human body everything is connected. The strong public health system should be interconnected as well.

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    These same doctors work at Medi-centers as well as the public system now. There is nothing to prevent them from working in two places. You're not increasing the overall number of procedures or creating a new demand, you're just doing the same work as is done now only for less money.

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    These family physicians have always run their own private practice. They are paid according to the funding formula set by the province. What they charge the province and what every other physician performing the same service charges the province is exactly the same. As far as public money is concerned–we pay exactly the same and not a penny less. Where are the savings in having the Medicenters? Perhaps the overhead amongst the physicians is shared, but the public does not see a cent in savings.

    The physicians at medicenters have an insentive to see as many as possible just like all family doctors in the province. But this is still publically administered and funded health care.

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    Quote Originally Posted by grish View Post
    but then I ask who are the doctors and nurses who will perform the hip surgery? Sure they may offer a "competitive" rate. However, if this means that there are fewer health professionals in the public system increasing the shortages and wait times, requiring extra training spaces to be opened up, and so on will there really be savings? Who will deal with the consequences of the operation gone wrong? If all people requiring routine procedures were to go to a private hip clinic that only performs one easy procedure, but all the complications were to go to the public hospital, again will there really be savings? You cannot break up the whole health care system by procedure. In a human body everything is connected. The strong public health system should be interconnected as well.
    on the other hand, everything in an automobile is also connected and each piece is related to how long the car will last and how much it will cost you per km... but you still have the engine serviced by a mechanic, the exhaust replaced by a muffler shop, the paint done at a body shop, and the tires rotated at your local tire shop (or at walmart or costco or canadian tire for that matter).

    which is just the same as when you go to your gp for your physical (which gets billed to medicare) and to an optometrist to check your eyes (which is often provided as a "free" service by your eyeglass vendor) and to a dentist to look after your teeth (who will bill either you or your privately acquired insurer)...
    "If you did not want much, there was plenty." Harper Lee

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    I would hazard that the public sees a huge savings because of private offices and Medi-centers. I shudder at the thought of Alberta Health or any other govt. body running all of the doctors offices in the province.
    If a fee for service works for check ups, why wouldn't it work for hip replacements? The govt. can set the rates for surgeries just as easily as it does for eye exams.

  16. #16
    grish
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    we are in real trouble when we compare health care to car maintenance. this is just as scary as thinking that health, education, and judiciary should be run as a business.

    Quote Originally Posted by ralph60 View Post
    I would hazard that the public sees a huge savings because of private offices and Medi-centers. I shudder at the thought of Alberta Health or any other govt. body running all of the doctors offices in the province.
    If a fee for service works for check ups, why wouldn't it work for hip replacements? The govt. can set the rates for surgeries just as easily as it does for eye exams.
    the province spends what it does no matter how the doctors organize their practice under the current state of affairs.

    however, we don't know if it was not going to be more cost-effective for the province to build and maintain public medicine clinics (Polyclinics) evenly spaced within the province on a density and space/ access basis. Such clinics would house the family physicians, specialists clinics, psychologists, nutricionist, labs, public health nurses and officials, etc. with health care practiconers occupying the space based on vacancy, need, preference formulas. Since the physicians and other health practicioners would save on the overhead, the province would be able to pay them less. What the province would spend on maintaining these clinics, they would save in paying for services and an improved health care with everything conveniently located in one place and integrated.

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    Do you seriously think the closure of all private clinics, cutting doctors fees per service and replacing it all with government run "polyclinics" located "evenly spaced within the province on a density and space/ access basis" would improve health care outcomes?
    The inevitable atmosphere of a "Polycenter" would be that of a huge medi-center.
    I could go on for page after page about how bad an idea that is, but I honestly don't think even you believe in it.

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    Quote Originally Posted by ralph60 View Post
    Do you seriously think the closure of all private clinics, cutting doctors fees per service and replacing it all with government run "polyclinics" located "evenly spaced within the province on a density and space/ access basis" would improve health care outcomes?
    yes... access to family doctors is one of the biggest challenges we have. instead of going for a routine check, people wait and wait until a small problem becomes a life-threatening one. Preventative medicine is what we need. We cannot aford people running to emergencies after letting their condition deteriorate.

    "cutting doctors fees" is a very, very, very bad paraphrase of "Since the physicians and other health practicioners would save on the overhead, the province would be able to pay them less."
    A better one would be: Since the province takes over the overhead costs, they can pay less per service, yet doctors keep more of their earned fees.

    The inevitable atmosphere of a "Polycenter" would be that of a huge medi-center.
    I could go on for page after page about how bad an idea that is, but I honestly don't think even you believe in it.
    are you not the one citing Medi-Centers as a successful model of private health care. Meadowlark Mall has created similar health center. There are many more examples where medical professionals organized themselves into mini poly-clinics. The only thing that I suggest is that the province takes the model and expands on it by building and operating proper medical facilities with the necessary equipment, air exchange, and space for physicians and other health professionals to do their work. A converted office space is not necessarily a good environment for provision of health care. The province can also be selective with the location of these clinics making sure there are health professionals within easy access of communities that need health professionals the most.

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    This idea is utterly ridiculous, and doesn't justify further comment.

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    Quote Originally Posted by ralph60 View Post
    This idea is utterly ridiculous, and doesn't justify further comment.
    of course not. why would you want to discuss things in an on-line discussion forum Mr. I Could Go On For Pages But Have Nothing to Say so I'll try to run and hide and pretend I said nothing

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    Quote Originally Posted by grish View Post
    we are in real trouble when we compare health care to car maintenance. this is just as scary as thinking that health, education, and judiciary should be run as a business.
    What do you have against business? You do realize most doctors are in business for themselves, and that it works fine?. All I want is to have choice in Canada, for patients, and health care workers. That doesn't mean an end to, or a lessing of universal health. Per the european examples, it will free up funds for universal health. It is almost fascist that the state refuses to allow us to spend our money on some types of health care in Canada, if we so choose.

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    some of the most common complaints about physicians in family practice is the conveyor belt medicine when patients are churned over at blazing speed in the name of seeing the most to cover the overhead. this practice is yet another reason why business and health care should not be mixed. family physicians should be compensated well and in a stable way so that they are able and should be required to spend sufficient amount of time with the patients, to listen to more than one problem at a time, and to look things up if they have to when they are not immediately sure about the course of action.

    As for choice– you have a choice. You can go to doctor Able or to doctor Zumma or any other one in between. They only thing that limits you is whether or not they take on new patients. That is what you could also expect under any other system.

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    Quote Originally Posted by grish View Post
    family physicians should be compensated well and in a stable way so that they are able and should be required to spend sufficient amount of time with the patients, to listen to more than one problem at a time, and to look things up if they have to when they are not immediately sure about the course of action.
    You are basically advocating Cuba's health care system, where doctors earn less than the people who work at bars in tourist resorts (which is the natural conclusion once other things as well are done by government because "business" is bad).

  24. #24
    grish
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    I am not sure you have understood this line:

    family physicians should be compensated well and in a stable way

    "well" does not mean "less than the people who work at bars". Well means good, Well means appropriate. Well means fair. Well means attractive (not in a good looking kind of way, but in "incentive to come to work" kind of way).

    Other than that, yes, Cuba's system. Sure.

  25. #25

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    Quote Originally Posted by grish View Post
    family physicians should be compensated well and in a stable way
    So it doesn't matter how good the physician is at controlling costs in their business, or managing employees, or choosing cost effective treatments and equipment, they won't care about that stuff anymore, for Canada Inc. will pay for all the inefficiency that results, with an unlimited cheque to waste money (or, if there are checks and balances, a complicated burecratic mess like we have right now in many hospitals). You are basically advocating taking the worst of our unaccountable system and pushing it out to one of the few things that works.
    Last edited by moahunter; 21-04-2010 at 04:51 PM.

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    Quote Originally Posted by moahunter View Post
    Quote Originally Posted by grish View Post
    family physicians should be compensated well and in a stable way
    So it doesn't matter how good the physician is at controlling costs in their business, or managing employees, or choosing cost effective treatments and equipment, they won't care about that stuff anymore, for Canada Inc. will pay for all the inefficiency that results, with an unlimited cheque to waste money (or, if there are checks and balances, a complicated burecratic mess like we have right now in many hospitals). You are basically advocating taking the worst of our unaccountable system and pushing it out to one of the few things that works.
    on the other hand, maybe we would be able to limit the number of locations where those cubanesque poly-clinics would need to be built by having special cars attached to our high speed trains...

    make an appointment, have the procedure, see the province while you're at it - we'd get more mileage from our health care dollars than any other jurisdiction in the country.
    "If you did not want much, there was plenty." Harper Lee

  27. #27
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    moa:
    you are correct. the quality of the physician should be left up to the training and licensing bodies, and to the people who will vote with their feet, mouths. We need to ensure that training is appropriate, that physicians continue to stay current on the medical research, and to train enough physicians so that people can go to the one they like.

    Under the current system, those family physicians who run the most successful practices are not necessarily the best doctors. They are adequate doctors who have perfected in seeing their patients fast and selecting for the most part the health patients that they can see them fast. Under the current system, the business side of family practice gets in the way of good medicine.

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    Quote Originally Posted by kcantor View Post
    on the other hand, maybe we would be able to limit the number of locations where those cubanesque poly-clinics would need to be built by having special cars attached to our high speed trains...

    make an appointment, have the procedure, see the province while you're at it - we'd get more mileage from our health care dollars than any other jurisdiction in the country.
    yet another perfectly incompetent post from you. thanks for coming out. hope you get your next head exam at the nearest electric system car shop.

  29. #29

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    Quote Originally Posted by grish View Post
    Quote Originally Posted by kantor View Post
    on the other hand, maybe we would be able to limit the number of locations where those cubanesque poly-clinics would need to be built by having special cars attached to our high speed trains...

    make an appointment, have the procedure, see the province while you're at it - we'd get more mileage from our health care dollars than any other jurisdiction in the country.
    yet another perfectly incompetent post from you. thanks for coming out. hope you get your next head exam at the nearest electric system car shop.
    At least grish is coming up with answers to the health care question.
    All you have done is rant (on more than one thread today)
    Don't have an answer but I'll moan anyway.
    Gone............................and very quickly forgotten may I add.

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    ^I fail to see how forcing all doctors to work for an employer who Andy pointed out recently hardly anyone enjoys working for, by not allowing any who want the joy of working for themselves to do so, is a solution that is going to inspire another generation of the talented to become doctors.

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    From what I understand about grish's point of view is that grish doesn't care how much money it costs to run the greatest socialized health care system in the world, just that we should set it up and do it, no matter the price.

    Part of grish's belief is that if everyone has better health care (faster, more doctors, more nurses, more accessibility, shorter wait times), costs will come down and balance it out.

  32. #32
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    in a bit of a reverse order:
    Quote Originally Posted by MrOilers View Post
    Part of grish's belief is that if everyone has better health care (faster, more doctors, more nurses, more accessibility, shorter wait times), costs will come down and balance it out.
    yes, particularly at the primary level care such as family doctors and community health nurses, and during emergencies. I have also said improved training of family doctors. More of other doctors may not actually be needed.

    Quote Originally Posted by MrOilers View Post
    From what I understand about grish's point of view is that grish doesn't care how much money it costs to run the greatest socialized health care system in the world, just that we should set it up and do it, no matter the price.
    I don't "care" how much it would cost to set it up. We need more doctors and health professionals. That would be even if tomorrow we approve private health clinics, hospitals, and so on. We just don't have enough at the moment to provide good quality health care.

    We need to attract new, bright individuals into the profession of caring for people, not running a private business. To attract such doctors, the province (maybe the whole country) needs to compensate them well enough and to train them well enough so that family doctors do not churn over patients at 5min per visit. A proper visit to the doctor takes time and includes taking good history, performing a good physical exam, doing some life style and health care counselling. At the same time as establishing proper rates of compensation (and potentially taking away the hiring of staff and worrying about the overhead costs of seeing a patient a few extra minutes), there should be an established guideline for appropriate practice and the minimal reasonable time for seeing a patient.

    I believe that investing what it takes into the first level family care, proper nutrition counceling, and preventative medicine in general will pay off in the long run. This is not an unfounded vision.

    So, "no matter the price" only extends as far as creating a proper system with sufficient number of well trained doctors and accessible to all health care. Sort of like–here is my business analogy for the day–you need to invest and spend to reap the rewards.
    Last edited by grish; 22-04-2010 at 08:49 AM.

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