In this era of short-term fixes, business-based solutions and profit-centred thinking, the bankers, retired CEOs, Bain capitalists and Fraser 'Institooters' are making weekly forays into health care advisory services.
Without any evident med school or nursing experience, they are brimming with answers based on their experience in making money in the private sector. Do they really have magical MRI vision into health care provision, or are they fiscal quacks? How are we to know?
To begin with, none of us should forget that Canada once had for-profit health care. My father was a Vancouver physician in the prior era, and I can well remember the end of month struggles as he and my mother reconciled bank statements, balanced cheque-books, and tried to figure out how to recover delinquent accounts. My memory is of a fair degree of forgiveness, because of the Hippocratic oath. Ethically and honestly, care came before profit. My father never made anyone submit to a wallet biopsy before care was provided. He often commented that, "Physicians who are in medicine simply to make money should have become land developers."
When the majority Conservative Diefenbaker government (with all party approval) passed the Hospital Insurance and Diagnostic Services Act of 1957 (building on the prior work of Premier Tommy Douglas and the Co-operative Commonwealth Federation government of Saskatchewan), Canada became a world leader in re-thinking the health care encounter, making it both more efficient and fair to all.
Since then, Canadian researchers, with a focus on patient health outcomes, have pioneered innovations in diagnostic assessment, scheduling and treatment, and team-based approaches to health care delivery. The University of British Columbia and the University of Calgary in particular have contributed significantly to these efforts. The diagnostic assessment and treatment centre movement, philanthropically funded family accommodations (like Ronald McDonald House), care-by-parent programs, day-care surgery procedures, and evidence-based health care design are all outcomes of this research.
To understand the importance of this work, consider the situation of a young family from the North with a multiple-handicapped child, say with a cleft palate and associated speech defects. Imagine their difficulty under the old profit-based system of flying their child into Vancouver or Calgary, finding motel accommodation near and far from a multitude of referred doctors and other specialists, cabbing or bussing about the city to uncoordinated appointments, and trying to make sense of multiple diagnostic assessments and individual treatment plans. That system served the individual docs well, but cost the family and the sick kid dearly.
Under the diagnostic assessment and treatment centre system, developed in the Canadian west under Medicare, that same family arrives in the big city, obtains housing next to the diagnostic assessment and treatment centre in philanthropically provided facilities, and receives services at one location from a specialized health care team. Case-based economic research has demonstrated the fiscal efficiencies of this team-based and child and family-centred approach.
With a coordinated treatment plan in hand, cleft palate restorative surgery can be planned, scheduled, undertaken, and speech therapy begun in an efficient and effective manner. For little children far from home, care-by-parent services enable mom and dad to assist with surgical recovery, and help keep nursing costs reasonable.
The outcomes of that health care delivery philosophy favour a triple bottom line: one that is socially understanding, clinically progressive and financially responsible. Families appreciate the streamlined care provided; doctors, speech pathologists, psychologists, dentists and social workers appreciate team collegiality and treatment efficiency; and all of us appreciate value for money.
As we struggle with the health care needs of the aging Boomers, we need more research and real world testing of team-based clinical approaches that build on the historic and current Canadian research. We need to re-think the health care system encounters of an aging society in order to increase health care delivery efficiencies.
To be fair to Medicare's critics, change is certainly needed, especially to correct and retool administrative processes and boondoggles often associated with mature bureaucracies. Creative and cooperative administration is key to decreasing wait times and enabling faster access to programs and services.
We need to remember that Medicare was premised on sound administration without profits. When you enter the world of for-profit medicine, you add profit to administrative costs, and that is why Americans pay so much more for their healthcare. Do you want to pay this premium in Canada too?
Mike Robinson, Troy Media Corps.
