Last Updated:Friday - 09/24/2010
July 26, 2004
Real vs. pseudo health reform
The Alberta government says it wants to hold a debate this fall on health-care "innovations" that will help pay for what it says are unsustainable increases in costs. These innovations would include annual increases in health premiums so that they always cover 20 per cent of insured health services costs. (Currently premiums cover 13 per cent of costs.) They would also include an annual "deductible" paid by Albertans who go to the doctor or the hospital. (This would be a user fee added to one's income tax.) A third "innovation" would be to allow for private clinics to perform hip replacement surgery.
These suggested reforms deal with how Albertans pay for the health care system, not about how the system is run. The first two proposals are not health care reforms; they are an expansion of taxes.
The third proposal aims at reducing waiting lists for hip replacement surgery. Most likely, it would eliminate waiting lists for those able to pay and increase waiting lists for those who aren't. The new private clinics would drain resources from the public system, creating a two-tiered system and giving low and middle-income people the short end of the stick.
A real reform is one the government announced at the same time as its more controversial proposals - it will fund a centralized intake system for joint replacement surgery. This plan will cut waiting lists and is touted as also cutting costs.
For any government interested in getting a handle on health care costs and inefficiencies, this unglamorous route is the road to travel.
Studies have shown, for example, that as many as half the people in hospitals could have their health care needs met in other, less costly settings. More beds in non-profit assisted living facilities and better-funded home care would go a long way to empty out acute-care beds in hospitals and, ultimately, to empty out over-crowded emergency rooms.
More palliative care would not only offer people a better death, but also one that reduced the strain on health-care budgets. Coordinated efforts to help patients better manage chronic diseases, such as asthma and diabetes, would result in fewer hospital stays and in better health for those suffering from those diseases.
Community health centres with teams made up of physicians, nurses, other medical professionals and medical assistants could, at least to some extent, replace the expensive and inefficient fee-for-service model of payment which is a holdover from another era. It would enable patients to get the treatment they need and allow doctors to focus on cases which most need their attention.
Dr. Gabor Maté, a Vancouver physician, wrote in The Globe and Mail, "Our fee-for-service medical system actively punishes doctors who spend time with patients and financially rewards those who practise superficial medicine in profit-motive walk-in clinics, who see minor problems and refer more challenging cases to the emergency ward."
And then there is the whole issue of social reform. A society that ensured that all people had access to work, decent affordable housing, adequate nutrition and good schools would be a physically healthier society. When people come before profits, society benefits.
These are real innovations that would give us a better health care system and likely one less expensive than the current model. Moving in this direction would be a whole lot better for everyone than the tax-and-spend mindset from which too many of our governments are refusing to budge.
In the words of Sister Elizabeth Davies, a health care expert from Newfoundland: "We have to shift our focus from treatment to prevention, from isolation to networking, from competition to collaboration, from the status quo to innovation, from curing to healing, from being physician-centred to being patient-centred, from institutional resources to community resources, from a focus on the material to a focus on the spiritual."
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