Public Engagement in Setting Health Care Priorities
First, I'd like to thank all of the contributors on this blog for their most informative and insightful comments. I am continually in awe of the knowledge and experience that exists 'out there' which makes me wonder why it is that we can't seem to manage to circumvent "the political stick in the spokes" of health care.
In this recent CMAJ article from July1, 2008, "Public engagement in setting priorities in health care", which I will hopefully be able to provide the link for in the comments section, it is clear to me that a significant degree of innocence exists in some academics' minds. The University of Toronto Priority Setting in Health Care Research Group (how's that for a long acronym: UTPSHCRG!) reports on the value of public engagement, perceived barriers, ways to increase public engagement and cautions and realities.
Although the researchers do admit, " It is important that the requests for public input not be overtaken by advocacy groups. In our current system, there is already ample opportunity for disease-oriented groups to engage in political lobbying and, although their voices should be heard in public-engagement exercises, it is the "unaffiliated public" who have the least say in decision-making, with important societal implications."
Now folks, you've heard all of this before, right here on this blog on numerous occasions and I did not receive a research grant or command a salary...or even receive a golf membership for my efforts. I certainly agree with the researchers' understanding of the importance of this. The funny part, or not-so-funny part depending on how you look at this, is that they seem to think that the public can engage in priority setting without this happening.
"All deliberations made with public input need not be conducted in public. There can be great value in an appropriately constituted decision-making body meeting in private, but then publicly disclosing the results of deliberations. This is analogous to the private deliberations of juries in our legal system, which allow them the opportunity to discuss freely, question and argue to arriveat the best decision."
Yikes.
It would seem that this research group is entirely missing the point that the person caught up in a legal problem has the opportunity to pay for their own lawyer should they wish to.They are not required to accept a court appointed lawyer. Sure, ultimately the lawyer will plead their case to the jury if there is one, but to think that public priorities can somehow be set behind closed doors without some political intervention is a very innocent perspective. This will improve trust and "confidence in the health care system"?
The idea that the Canadian public can determine the priorities for all of us without taking into consideration the unique needs of individuals which may or may not be met in a publicly driven system is tantamount to ignoring the needs of minorities.
I'm not against public involvement in health care priority setting, but I've been around long enough to know that politics will always be part of publicly funded priorities---make no mistake about this .
Merrilee Fullerton
125 Comments
Reader Comments (125)
http://www.cmaj.ca/cgi/content/full/179/1/15
Published Peer reference supporting our approach:"There can be great value in an appropriately constituted decision-making body meeting in private"
Supervisor appointed who "knows" the right answers.
Money to flow to KGH to increase care.
All is good.
Have a nice weekend.
What I don't understand is how this blatant pharmco grab at market share can make it to national TV (and a lead item no less).
This stuff never ceases to amaze me.
The most obvious contributing factor, at least in North America, is obesity...which, in turn, is escalating...Type II Diabetes is being diagnosed at earlier and earlier ages in children, Diabetes accelerating the ageing of blood vessels.
I certainly don't think that this is a 'Big Pharma' conspiracy...young children are developing blood vessels of much older adults with the inevitable medical sequelae.
Certainly schools should get rid of the soft drinks and the garbage offered as 'food'...in the 50's , as a child in Europe, we had a raisin bun and a bottle of milk mid morning and a proper hot lunch...although I don't want to see liver and onions, faggots and peas and Irish stew ever again...but when one is hungry one eats...also one walked to and from school...so the price of petrol might help there...and everyone HAD to play sports, there was no avoidance...and when I say sports, I don't mean the pathetic 'exercises' that the Ontario schools seem to offer.
Eat less, eat better and healthier food, and exercise more...much more and perhaps the trend towards obesity and ageing blood vessels might reverse...but if Ontario does not...put statins in the water supply and get ready to place defibrillators in kindergarten.
School dietary and exercise/sports programmes should be a health care priority.
This said, I think of 'constituent assembly' models used for various public consulation purposes in recent years (constitutional reform and electoral reform in Ontario) and how they tended to do a pretty good job of moving things along in ways that largely reflected public attitudes. I think it noteworthy that the assembly's favoured electoral reform model (proportional representation basically) did not move the vast majority of citizens and fell to the side.
If such a model were adopted to look into our health care system, it may well be that a semi-closed door phase (involving a duly appointed assembly) would be needed to gain some traction and focus. A fully public approach unfortunately runs the risk of early distraction and lobbyist domination to the detriment of the mission.
A fully public phase would have to be included as the exercise matured if any benefit were to be realized. I would personally welcome a referendum on a few key questions arising from such a process. It might force a few weasles into the open for a better shot.
So today marks the kickoff of lab medicines efforts to gain admittance to the "big seven" and get more prefential funding because of its increases with chronic underfunding and poor management.
A couple of points:
National Standards: Won't happen, if national standards means provincial funding falling under federal control. It's our 45 billion and we will not allow the feds to control any of our money.
Is there a problem? No evidence that labs in Ontario are any worse than any where else, so they doesn't appear to be a need to act. At worse (again) it is a few patients at the margins being adeversely affected by poor results. prolonged turn around times, or unavailability of high end tests. We are probably OK on this one. Likely won't hit the big "eight" - looks like long term care might.
Remains a realtively quite summer, so central has another 7 weeks of rest until labour day. Then we get started again.
Notice how the ED issue is gone. Money helps.
The plan is good.
One Prof. Peter Sandman, a highly regarded risk management guru, holds that organizations/business open themselves to danger when they proceed based on the simple formula:
Risk = Hazard
He argues that the astute understand that the formula that usually applies and needs atention is:
Risk = Hazard + Outrage
Thinking of the patient getting messed-up lab results leading to injury/death: MFO, are you suggesting,on balance, that MOH applies the first vs the second or the alternate?
Sandman tells the true story of a highway engineer speaking to a citizen meeting dealing with increased highway speeds to be anticipated when certain road improvements take effect.
One person asked about impact on the many children who had to cross over the roadway daily when speeds increased. The expert quickly responded saying 'We've calculated the incidence of pedestrian/car accidents this type of road design generates in detail and determined the rate of child related injury/death to be 1 per million vehicles passings'.
The audience erupted with outrage at the experts apparent cold indifference to the expected death of even one of their children. The project went to the back-burner better design features were available. Heads did roll.
Sandman makes a very good living teaching people in roles such as the highway engineer (or their opposition) how to minimize and respond to/manipulate the outrage factor. I'll leave it to those interested to check out his model.
For my part, I do not recognize any or many of Sandman's techniques applied by MOH so I am assuming they work with the simplistic
Risk = Hazard formula and thus will always pay the political price demanded when outrage suddenly (really?) emerges.
Risk = Hazard + (Public Outrage - absence of transparency)
It's is a political formula
With all due respect, the MOHLTC hasn't got a formula for anything and we both/all know it.
Call it what you want: seat of the pants/managmement by stumbling around/stick a finger in the air/how will this play on the front page of the Toronto Star kind of leadership that we have come to expect from successive governments all trying to put their own unique stink on a bureaucracy that continues to withstand the test of time.
This too (read LHINs) shall pass.
Sorry. Did I say that out loud?
Nevermind.
In defense of central, this is a political formula - if the public don't find out. we are safe.
http://healthzone.ca/health/article/461224
Ombudsman Andre Marin says his office will look into whether the governing Liberals are holding nursing homes to account and ensuring they meet provincial standards.
http://www.health.gov.on.ca/english/public/pub/ministry_annual/annual_rep08_09/annual_rep08_09.html
If I'm reading table 2 correctly, the forecast for fiscal 2008-2009 is 14 billion for physician services (OHIP vote) and 20 billion to the LHINs (hospitals, etc) for a 6.8 percent net increase over the previous fiscal.
Buzz term of the moment is 'results-based planning', better add that one to the list......
"Results based" of course is not new - we are copying the UK NHS plan.
With OHIP and now LHINs , in essence, capped and budgetable, all chnage will only be occuring through MOHLTC directed program money with opportunity for change still exists.
Within both LHIN and OHIP some will get more than the 45 or 2.9% but others will get less, to keep all in balance.
It is amazing how quickly LHINs have been capped with fixed expenses lower than actual needs. The LHIN folks are beginning to cry out with their pain.
Read Healthcare, Guaranteed: A Simple, Secure Solution for America - Dr. Ezekiel Emanuel.
Article @ http://www.alternet.org/healthwellness/91609/?
Many inherent Canadian system problems
could be positively addressed (especially the political gamesmanship thing) despite the models American context.
Essential distinction is that all health care funding (additional 'extras' available) would be derived from a VAT (Value Add Tax) base fully independant of government treasury touch/policy. Funds used to provide a global coverage plan sold by closely regulated/monitored insurance companies based on issued fund vouchers b y one of 12 geographic authorites (LHINS?). State and federal tax expenditures on health care would come to an end.
Article addresses many of the questions that might come to mind for you.
Essentials components-- must not be compromised -- in Dr. Ezekiel's plan:
1. High-quality, affordable health care for everyone, regardless of health status or income
2. Effective cost controls that make the program affordable and sustainable by relying on unbiased comparative effectiveness research to spotlight overpriced products and services that are not adding to the quality of care
3. Coordinated care with government oversight that fosters the infrastructure, information systems and financial incentives for high-quality health outcomes, and that holds providers accountable to achieve them
4. Choice of health insurance plans, doctors and hospitals as well as the option to purchase additional benefits
5. Funding that requires all Americans to contribute their fair share to funding the health care system via VAT
6. Reasonable dispute resolution to replace the current malpractice system
These approaches are reasonable, and by and large rational, but they ignore the innate power based gain by "central" by having unrestricted access to tax resources. Central will not move towards a system that debases its power and attempts to provide autonomy to the patient.
Sorry nice try but the politics won't change.
The plan is good.
If this model were to ever be brought into public consideration here it would not be at the behest of the political class I agree.
Fact is, the $ demands will eventually exceed supply at some point and the 'pay-off; let's move on' thing will no longer be a useful doable option by politicians and their courtiers. The inability of Americans (in huge numbers) to pay for their health care access represents their major $ demand driver as I see it.
So the plan is good.....for now.
Some LHIN leaders are very concerned that the bureaucracy will 'retake the hills' they gained under the previous minister.
Ah, the subtle dance continues...
Ain't politics grand!
So much money - so little value.
Doctors and nurses will migrate to wherever they are appreciated the most and where the pointy headed disrupt their vocations the least...the younger doctors, thoroughly indoctrinated by Kantians in Canadian med schools, are turning out to be the most materialistic and least willing to sacrifice themselves and their loved ones for the 'common good'...the unappreciated old time geezers who were so productive and did sacrifice themselves are rapidly looking for greener pastures to spend their last years in medical practice.
The MOHLTC resembles Hitler's bunker more and more...moving about non existent divisions to block the advancing allies as their defensive positions crumble, with soldiers dropping their weapons in disgust and trudging away towards their homes and loved ones.
With respect to the LHIN administrators, give me a break. Sure the public face was, yes, this is a good idea to distribute the money to the regions, so they can decide what region-specific things they want to spend it on. Sure, but everyone knew the REAL purpose was to control spending regionally. Any LHNIN administrator that thought otherwise should have his/her head examined (at public expense of course).
http://www.edmontonsun.com/News/Alberta/2008/07/18/6192476-sun.html
All was predicted and what is happening is the reality of the mess is hitting the LHINs
Fortunately, it is summer and central is clsing until after labour day - when the the games will resume. The further "rationing" will occur, while PR will express how all is fine.
Having exceeded my expected budgeted vet bills and dentist bills many times over in the past two weeks , I can say first hand that there are some things you just ought to pay for out of pocket and not expect others to fund.
The dog experience was due to my husband's refusal to pay heed to to my very good advice to keep the dogs on leashes when outside and my son's dental bills, while perfectly avoidable and preventable, related to the act of living and playing sports. Such is life. Great cardiovascular health perhaps at the expense of other parts of one's anatomy.
But it brings me to the conclusion that in both instance the parties involved knew better. In people health care, somebody bails you out. The tax payer. If you act badly and make poor decisions and survive then society bails you out.
In both circumstances in my family recently the job of bailing fell directly on the shoulders of those involved and there is great motivation to learn from these mistakes, put more effort into prevention and think before acting.
Costly lessons to learn and no lives lost but in our own health care system, people make poor decisions daily and expect everybody else to be responsible. This isn't a great way to foster responsibility.
Lessons learned. Bills paid. Responsibility enhanced.
As far as public input goes, there are so many advocate groups that it would be impossible to have impartial input.
The best that can be done is to provide patients the opportunity to spend their own tax free savings on their individual care.
As someone once said...it seems the only way we can have 'universal health care' is to keep it inaccessible for many things and many patients.
In this vein, I hope to be doing an interview with FOX tv tomorrow to be aired Wednesday...on Canadian health care with a couple of patients to be interviewed as well.
I expect that together we'll only make up 2-3 minutes of air time but hey, something is better than nothing.
I hope the Americans know what they are getting into.
One question...if almost 5 million Canadians don't have access to a family doctor and millions more wait on wait lists across the country, is this better proportionally than the "45 million" Americans without health insurance?
Just asking.
Doesn't all of Canada's population fit into California's population?
If there were 5 million patients waiting for care in California with a program of universal care, would that be better than the system California has now?
Just asking?
The UK's NHS is going to pay bonuses to doctors for saving lives...hope it comes to Canada with back payments ...I've been "saving lives" for over 41 years and could do with the cash....I have no idea what my UK colleagues have been doing in the same time frame.
Can't see many going into geriatrics or caring for the terminal and being deprived of bonuses...difficult cases will be less likely accepted by internists and surgeons lest they lose the bonuses....those on death's door will be tossed around like hot potatoes lest they die on one's watch and so become bonus denied.
Put simply, this is probably what should have been done as part of the HSRC back in the late 1990s and subsequent to the 'work' (and I use the term in its loosest connotation here) done by former Minister Dennis Timbrell. There is probably a bronze ceremonial plaque on the doors to a Florida condo somewhere thanking a previous government for that appointment.
Some people might have suggested that the recent showdown between the teaching hospital in Kingston and the local LHIN was a seminal moment for the latter.
Heck no. The teaching hospital CEO knew exactly what the outcome was going to be before he even pulled the trigger...and at the end of the day the facility will see its pot of gold at the end of the rainbow. We did not need a LHIN to do that...regional offices were perfectly configured to pull that kind of chain.
I know some people will disagree and exclaim outrage ("once again, they're rewarding the wrong behaviour"). Sorry, but this ministry tends to go with what it knows. And removing a CEO through the appointment of a supervisor is good news copy. "Look at what your government is doing for you...we are taking action and after we right this ship you will see improvement...coincidentally around the time of the next election."
The LHIN in this situation did not distinguish itself from its partial predecessor, the RO.
Niagara will be different and it will be the real test for the LHINs. Because it will have to support this logical system- and sustainability-based clarion call in the face of huge political (municipal mainly) support for the status quo.
Already some local pols have tried exercising their best Charlton Heston/National Rifle Association impressions out in the media response to the 311 page report..."You'll pull this emergency department out of my community through my cold dead hands!"
How many have ready the report in its entirety? Too few to mention, probably.
The LHIN with the longest name will be challenged to do more than what the former Niagara DHC attempted to do...and it has to set itself apart from the eschewed 'advice to the minister mode' in order to prove its value beyond what the old DHC did.
The most interesting aspect is the appointment of Dr. Jack Kitts as the special advisor. Ottawa is not exactly a shining example of decentralized care...will people worry about that?
And the local Liberal MPP? Get the butter out...the guy's toast come October 2011.
Denis and the Timbits came to smother the previous departure of the CEO and religious-public turf-money issue. Can't say more, wasn't invited.
Jim Bradley, now MTO minister, is the local MPP. Great guy, If his seat were in jeopardy this would have been resolved and the hospital already built. So most of us know he didn't cause this. And he sure can't fix it.
The last time government came to help us with the HSRC still hasn't settled. We still have 8 buildings under 2 corporation in 4 ridings serving everything to the US border south and east of Hamilton.
Since then seems that every retired Torontonian has discovered the vinyards and township number 1 of Upper Canda. So the average age is now so high they don't care too much about schools but, mess with the hospital, they all claim to be connected.
With about 15 or 17 million dollar annual deficit and a much delayed P3 hospital in the works, the HIP emerges. LHIN or not, don't see how this makes much sense.
Can't make this puppy run now, how will new construction be cheaper? Unless, oh, unless it gets smaller and services are redistributed to existing buildings in Hamilton.
Sadly, it will fail.
It is a defined geographic area, the demographics are well defined, no major teaching hospital blocking forwrad thinking, etc.
Plan should be:
Properly funded regional hospitals with specialized and needed services within reasonable geographic access to the population.
Defined ED/walkin services that meet local needs, yet allow for effective transporation to regional hospital services as needed.
Ambulance/paramedic services properly funded for effective needed transport.
Travelling mobile clinics, staffed by NPs, to provide local care for diabetes, elderly care, home visits as needed.
Regionalized MD appointments to hospitals such that providers can move seamlessly to provide services at hopsital as schedule needs.
What will evolve is: same old same old.
I have to wonder how long the government can go just keep throwing money at more areas...certainly it silences the groups that are clamoring for more funding but it doesn't really address the root problem which is that the only way to have universal health care is to make it inaccessible some of the time for some things. A strange combination.
Interesting how the neurosurgical issues and ER shortcomings have quieted now that they are earmarked for more funding.....those involved are satisfied in the short term not thinking much about the long term. Human nature is such I guess.
Taking a look at extra ER funding we see that it is a complex issue and not easily solved with a few million here and there...but what the funding actually accomplishes is to quiet the whistleblowers. Wonder what Andre Marin will have to say. I doubt very much that his silence can be bought.
Of the 109 million in special disbursements to tackle ER waits, 40 million will go to home care services; 40 million will go to computer enhancements and staff coaching; 22 million goes to the LHINs to spend as they wish; and 9 million to nursing initiatives in the ERs and LTC facilities.
Yes, ER wait times are complex and multi-faceted and a few million will drown out the little fires....for a while.
Wonder what would happen should the walk-in clinics shorten their hours? Oooooh. Watch the ER times grow overnight.
Not knowing your son (assuming only that he is like most other teenage boys) I'll venture to suggest his behaviour (contact sport passion) will continue despite the injury and despite your cost issues. He might have learned to wear better protection but since you paid the bill (not him) the behaviour will not change much in all liklihood. He's lucky to have affluent parents who support his passions. Many of us are not able to do so for our kids but that is a different story.
As you point out, the health benefits derived from physical activity cost something (time, membership fees, travel cost, repairs). Sports and recreation also have important social beenfits that assist us in our work lives. Of course, there is also benefit to preventative health care in and of itself and that costs too.
The working-poor (where has that middle-class gone anyway?) struggle to pay the mandatory life bills let alone the additional costs you think they can somehow save for. Just not a realistic option realist.
Are they to forgo even more of community life (children's sports and school extras) in order to save for that physician bill that becomes 'their responsibility'?
I've asked you in the past to point to a place in the world where the net out-of-pocket health care cost levels you think are doable exist in order to look at net results. I ask again.
The solutions needed will not be found down the path ideology (any kind) drags us. People recognize the practical and fair when they see it.
I think we have agreed in the past that the system is underfunded on a net basis. We continue to fail in agreeing on the means of dealing with the problem. I grow more convinced than ever that the answer lay in a major shift in approach of some sort (possibly a VAT funded plan as mentioned previously). Perhaps it will be a 'user-pay' driven system along the lines you prefer. Should that be the case, I fear for us all on a number of levels.
The government must be absolutely underwhelmed that today's $741M diabetes strategy is being widely reported merely as an "insulin pump program" and garners no more than 210 words in the Toronto Star.
HH,
There is no question in my mind that my dear son has learned as much from his injury as we have.
As for the middle class and working poor, our universal system will struggle along strategically spending resources that will garner the most votes and satisfy the most patients. All fine and well except if you don`t fit the favored groups. Alas, we have had this conversation before....BUT....at some point patients must be able to spend as they see necessary.
I come from a middle class background and lived in the North and experienced how people live in poverty.
The most important message I have learned from the above is that when people are motivated to change they can. When they are motivated to have more control over their lives, they can be empowered. And I learned that when you make people dependent, they stay dependent. When you treat people like powerless victims, they stay powerless victims.
There will always be some people that the state must support. So be it. I accept that as a compassionate person but I do not accept that this is the majority of Canadians.
The more the state becomes responsible for all Canadians including the middle class and higher earners, refusing to allow them to pay for their own care when necessary, the less funding will be available for patients who are in poverty.
and now you will ask how is this possible if there is a shortage of providers...and I will say that once more docs and nurses are in the system this point will be moot....and the courts will have an impact on health care politics.
I don`t buy the concept that all Canadians are unable to take care of themselves or make decisions that are important to their own circumstances. Sorry we disagree.
"If this is the best the NHS can come up with, then the real solution seems clear -- change the administration and the board of the NHS. The people of Fort Erie and Niagara should expect nothing less from the current government."
http://www.scstandard.com/ArticleDisplay.aspx?e=1124354
Actually, on this statement, we can agree but so what. The mechanisms I understand you favour would lead to too much negative for too many and leave the net government bail-out challenge very large indeed. That is my problem. But your right, a lot of people would be well positioned to utter 'but I'm alright Jack.'
You make it sound as if the number of people having to be gov't assisted would be few. Where is that evidence?
The 'people with means' class and their institutionally based advantages (private insurance, health 'clubs',good credit, high savings rates) would naturally have the power to overwhelm people of lesser means in the health economy. The less affluent would try to join 'the club' at great risk to their financial health in order to provide the best they can for the family with grave consequences. The for-profit health sector institutions would welcome these folks heartily and be just as quick to bring ruining consequences about as with schemes like 'sub-prime' mortgage scams permitted only after government got 'out of the way' in 1980. ( The Democrats did it by the way)
To me, in the context shared, such an outcome would be a form of usury and that, last I looked, is a sin for most major world faith groups.
Usury, to be clear, is rich people taking advantage of poor people by providing them goods/services on terms that are sure to make them fail and dependant. Ironic given your objective of having us all become independant souls.
Again we agree in small part but the deal you offer most of us is too high a price to pay. There are better models.
We can leave it at that.
If that's a first step, it will need to be followed by several giant leaps, to make that 2015 deadline, I would suggest.
As Churchill put it " the inherent fault of Capitalism is the unequal sharing of blessings; the inherent virtue of socialism is the equal sharing of miseries"...our socialist central planners can't get even that right...the miseries are not shared equally across the province with Niagara getting the short end of the stick in so many ways....the region remains shackled by the central planners, the bean counters and the ideologues overseeing the dysfunctional system overall....only the free market could release those shackles...but there seems to be no chance of that untill that day when the house of cards falls down...which it will, tottering as it is today.
Nothing wrong with the current model of centralized decision making for me, and all Ontario residents about what is best for me, and how central should spend my tax money on its views of what is good for my health. "We knwo what is good for you."
However, with such a philsophy, the next honest step would be a transparent compensation and accountablity process for those who aren't help by centrals wisdoms.
A clear victory for central's philsophy would be a public announcement that central can have culpability and central will pay for its mistakes, instead of the current ability to dodge the accounatblity bullet by saying "we are the Crown, and thus aren't liable".
Step up and go the next step in rational state planning, and remove the safeguard that isolates central from the death and morbidity to individuals caused by its rationing system.
Until that occurs, it is just another bunch of people garbbing and money and power for personal gain.
"Step up and go the next step in rational state planning, and remove the safeguard that isolates central from the death and morbidity to individuals caused by its rationing system."-mfO
As I mentioned to the reporters, in Canada you can pay dutifully all your working life to the tax coffers (and hence the provincial insurance plan not to mention the federal taxes as well) only when it comes to the time you really need care, you may not be able to get what you need and to top it all off you may even have deleterious health consequences due to inadequate funding of the system whether it be inaccessible primary care or ineffective infection control techniques.
It can't all be blamed on lack of hand washing I'm afraid.
Americans must be very careful not to allow their system to become so politicized that the minority in a "universal" system are left behind and forgotten.
Here are some tips on how to access the FoxTV news report on health care:
I was told it would be aired from Wed from 6-7p.m. on the Special Report w Brit Hume. Fox is doing a whole week of stories on the medical system apparently.
The show airs on The Fox News Channel. General cable doesn't get this channel. You might get it if you have a very extensive cable package.
However, there is another way to see the program. One way to see the piece is to download the podcast from the computer. In the event that no one has an ipod, a podcast is a broadcast of a radio or television program that you can download to a computer or a portable digital music player. You can view the episode from you computer. You only have to install itunes, which is easy to do, and the link below will give you steps to do so. The link below gives you links to all fox broadcasts to download, you need to select the Special Report with Brit Humes. They are usually posted on the site immediately, or up to 1 day, after the show actually airs on TV.
http://www.foxnews.com/podcasts/index.html
"Merrilee Fullerton from Canada writes: "Be damn sure, my kids won't make the same mistake I did. Get a simple cushy job and be done with it. Why be the sucker putting money into the system. Be the person taking money out of the system."-scamp
Well scamp, no wonder Canada has a productivity and innovation problem.
I do not blame people for this kind of thinking. The system we have fosters this kind of dependence. Sure, there are times when you are down and out through no fault of your own and I think that a compassionate society must provide for people in very difficult circumstances.
But to encourage a society that is increasingly dependent on government's deep pockets (which are not infinite) is a mistake in my opinion.
If we want to empower patients and the public in general, then they must be given the control over their own care. It is not control to have wait lists for care they cannot access. It is not control to be promised all kinds of care that cannot be delivered in the end. It is not control or patient empowerment to be told that your disease just doesn't rank up there with the big five because your disease doesn't have enough votes behind it.
For sure, we don't want the American system....but the dependence on Canada's system that has been created without allowing for other private options particularly in Ontario, is a dangerous situation indeed.
Want an MRI for your headache you've had for the past two weeks...sorry, you don't meet the criteria....and by the way, you can't purchase one here in Ontario either.....it is only for government and some "experts" who don't even know you to tell you what you need.
And when the experts are wrong and you have a brain tumor or aneurysm and die because they said you didn't fit the government created criteria to limit MRI use, then just too bad. Who does one sue?
Government isn't responsible. Ministers of Health are not responsible for poor patient outcomes....patient loses.
* Posted 05/07/08 at 8:15 PM EDT | Alert an Editor | Link to Comment
News in the Osprey press yesterday basically outlining results of an international study re: 5 year+ cancer patients. Shows pan-Canadian results very near the top of the heap across the board.
Study looked at 5 major cancer groups. Canadian researcher queried about possible drivers behind the Canadian results cited the 'universal' health care structure as the key contributor. As evidence, he pointed out the results looked very much like Australia's which has a similar unviversal coverage scheme.
American results were mixed primarily due to the relatively poor results among black patients compared with non-black subjects. (Wonder if that has anything to do with relatively low black-American income levels and the access to care barrier problem that links to that fact).
Hope this small bit of a positive story doesn't put too many readers off their day.
Canada does a good job in many areas of care but let's not pretend the care is universal or one tier or comprehensive or portable....because it is not.
Let us acknowledge what our system does well and try to get on with finding solutions for what it does not do well.
No need for black and white thinking.
http://healthzone.ca/health/article/465521
There is more at work here than just wealthy vs poor.
And I differ from the explanation that the ICES doc in the articles says it at the heart of the growing diabetes number....it is not restricted to poverty or genetics...in my area it is seen in young people who overeat, overindulge sit around too much playing video games....why? because they can. There isn't a worry about where the next meal will come from or how to pay for it. There isn't a worry about that extra beers consumed in the evening or the buying of street drugs contributing to unproductive youth. There isn't a worry about getting the munchies when smoking pot. There just isn't a worry of much at all other than what rave to attend.
I think if we looked at our youth population, we would be able to predict that the 741 million or 714 million, whatever, just won't be enough...not for diabetes, not for the knee and hip replacements, not for the back surgery or the cardiovascular stenting.
Sure, genetics play a role and so does inactivity and overeating....but maybe we should be asking WHY? Which will bring us back to people not feeling empowered, not feeling motivated, not having incentives to do more with their lives...
ban all the transfats you want pay for more pumps...and bring in high speed rail and bikepaths...it just won't make a difference if people feel adrift and don't know where or how to belong.