Tuesday, September 22, 2009

Perfecting Alberta, Part 1: Health Care

Nation, this type of thing is exactly what makes Blogs so much more powerful than the print media... the ability to have an interactive discussion.

Over the next while, I'm going to be using this space to facilitate a discussion among the millions of faithful members of the E.S. Nation about a variety of policy areas, all targeted towards one goal: Perfecting Alberta.

To better facilitate something resembling "real time" conversation, I have (after much hesitation) disabled the "moderated comments" function on the blog, so your comments won't live in cyber-limbo waiting for me to check my email. Don't make me regret it. :)

What I DON'T want is this: Attacking a contributor because of the political party you believe they support. Personal attacks. Partisan hackery (e.g. "my perfect Alberta: no liberals", or "to fix this, we just have to elect Brian Mason").

What I DO want is to hear the best ideas, from all sides of the political spectrum. We have an opportunity, through this medium, to come together as engaged citizens and re-make this province.

All ideas are on the table. I don't want to hear about what's wrong... I want to hear about how we FIX it.

First topic open for debate on the floor of the virtual legislature: Health Care. It's up to you, Nation. All legal options are on the table. How would YOU fix Health Care in Alberta?

17 comments:

Kirk Schmidt said...

When I was out doorknocking last fall, one constituent talked to me about the benefits of community health centres, where a number of different health-related establishments can band together to provide local, accessible, and diverse medical care.

One such "example" would be in Royal Oak, where there is an optometrist, dentist, physiotherapy, and some other natural centre. Obviously the addition of a medical clinic would be welcome in such an area.

The general idea being that they share the cost of land/parking/etc, can cross-promote each other, and provide a site where people could go to in order to satisfy multiple health needs.

I really have not done a massive amount of research on it, but perhaps someone with thoughts/experience could enlighten us to whether or not it is cost-effective, if it provides positive externalities (for example, keeping people out of the emergency room for non-emergencies), etc.

Anonymous said...

We in Canada, in Alberta do a reasonably good job of providing basic, repeat basic, health care. There is always room for improvement and that improvement is sometimes subjective rather than objective. We need to be objective in our evaluation and expectations of our system and of our own individual roles when we are being treated by that system.

We are not the only jurisdiction where we constantly hear about shortages of trained medical staff (doctors, nurses, lab and x-ray techs), the need for more beds, long waits in emergency rooms. I have witnessed these same complaints newspapers in Dallas, in Vancouver, in Toronto that I have in our local media. It is, therefore, given that there is a universal shortage of trained medical professionals and that movement between jurisdictions is merely poaching from each other. Expanding positions in our post secondary institutions for training these professions are not cheap, but they need to be supported, perhaps with a re-direction of exisiting post secondary spaces and dollars.

As the spouse of a nurse who trained at a hospital school of nursing, I think we should re-examine the use of our hospitals as direct training locales. Student nurses served a valuable source of 'cheap' labor and when we did away with those schools, that labor source disappeared and had to be replaced by paid staff.

And while on the topic of nurses, the working conditions of this female dominated profession need to be adjusted to work with those who choose to have families. The definitions within any labor arrangement with the nurses of 'casual', 'part-time' need to be reworked where job sharing is more available. I do acknowledge that this is the same across other roles, such as lab and x-ray techs, and similar considerations need to be expanded for them as well.

I agree with Kirk that the delivery of health care needs to be physically moved into the community, but I would go further and submit that the 'bricks and mortar' of such facilities need not be paid for through the public purse. I would strongly suggest that, assuming the continuation of publicly funded basic health care, those monies be preferentially put to running programs, not the construction of those locations where the programs are delivered. P3s or other arrangements should be pursued, with stringent construction and operating protocols being established for such buildings.

Oh, and what we need to have enter into the conversation is care of health, not care of disease or condition or accidental bone breaks. Perhaps we should look at re-introducing physical education and making it absolutely mandatory in our school system.

This is not a comprehensive reform manifesto for our system, but the elements talked about above are aimed at not expanding the funds we already put into health care.

Alberta Altruist said...

I think fist off get rid of the superboard. How can someone in Edmonton possibly know what is required in say Ft. MacMurray?
Second I like having the money follow the patient. Having health care paid by the amount of patients being treated will hold the facilities more responsible for efficiency. This will reduce wait times and eliminate red tape for their spending.
Nadeem Esmail did a report for the Frasier Institute that has many good suggestions and has put the research into this topic. I suggest you give it a read.

calgaryrants.com said...

What? We have a problem with healthcare in this Province?

If it needs to be fixed, it needs to be treated and run like a business. You know, with budgets, managers and staff that actually care about saving the company money. When the culture involves having unlimited amounts of money thrown at it and the employees embedded with a sense of "lifelong"
employment, there is not much incentive to improve.

Do I have the answer? No... But start with Staff Morale... Start at the ground level, change the entire culture and work your way up.

Or..keep throwing billions of dollars at it. That seems to be working well.

Shane

Kirk Schmidt said...

Shane, I love your comments.

I think you make a good point about ground up. A good way to get morale up and a good way to save money can be done at the same time; Include those who see the work being done everyday have input into better processes.

Anyone who has worked on the ground level of a job knows that often processes are over-bureaucratized and can be improved. You often see waste, inefficiencies, etc.

I hate to throw around the word "empowerment" because often empowerment is an illusion - but being able to include these people in an environment where their comments are not going to put them in job danger, and allow them to be part of the solution, can both help trim waste and improve morale.

Enlightened Savage said...

Thanks for the great comments so far, all...

One issue that's been pecking at the back of my brain for the past while is this: What, exactly, are our hospitals FOR? Or, more exactly, what is their IDEAL purpose?

Is a hospital a "health mall", where anything from scheduled routine physicals to walk-in patients with the sniffles to emergency heart surgery should be performed?

Is a hospital a "core health facility", where only trauma patients and those who may require the expertise of multiple physicians and experts should go?

Is a hospital a place where the elderly, the infirm, and "people with lived experience" (the new term for those with psychiatric issues) should be housed and treated? If so, for how long?

It seems like everyone thinks, under our current system, that no matter what your issue is, if you need to see a doctor you are somehow owed front-of-the-line access to a private room in a hospital.

Likewise, I see a lot of debate as to whether a hospital is an appropriate place in which to teach young physicians and nurses.

I think that by deciding first what our hospitals should be used for, and what sort of medical professionals should be stationed there, we can then take a look at what other types of facilities we need to provide.

The South Calgary example is an interesting one... they're building this giant Health Campus in South Calgary, which is going to have any number of different facilities. Is having them centralized a good thing? It probably makes good economic sense - but does it improve access to health services, or limit access, by taking that optometrist out of, say, Douglasdale and moving them next door to the Radiologist's office in the Health Campus?

Further, we have the example in Calgary of the South Calgary Health Centre in Sundance - a NON-hospital with an Emergency Room open 7 days per week, from 8 am to 10 pm. Speaking from personal experience (having an accident-prone fiancee), the addition of this facility has resulted in fewer people sitting in the Emergency waiting room at the Rockyview Hospital with a twisted ankle, broken arm, or "really bad headache" at 7 pm on a Sunday night... Do we need more facilities like this, which would then allow the hospital ER's to be used exclusively for life-and-death emergency care?

Mark Taylor said...

If you are going to talk about Health Care, then start calling it what is really is.... SICK CARE. There is some good discussion going on already about the facilities that treat the sick.

But we don't build hospitals to treat the healthy. If we are seriously going to revamp the system to make "the perfect Alberta", then you need to address how do we keep people out the sick care system in the first place. With less self-inflicted illnesses clogging the system, you can allocate more to the emergencies, etc.

Its the old adage.... a ounce of prevention is worth a pound of cure.

Enlightened Savage said...

Mark: I was hoping someone would go there.

The last time I heard a lot about preventative care was during the PC leadership race - one of the candidates had some great ideas.

Do you have further thoughts on the issue - having a background in the area yourself (as I recall)?

Is educating people about how to make healthy choices enough? Do we need "sin taxes" on things like cigarettes and junk food, to pay for the "sick care" that results from their consumption?

Ian said...

Why "the business" idea? In Canada we are not looking to make a profit or have corporations make a profit off our sick, weak and poor. The end result of health care is not dollars and cents, its lives. Following that I reject anything from the neoliberal Fraser Institute that is bank-rolled by private health insurers and large pharmaceutical companies.

My suggestions?
1. Disband the superboard, and re-establish local health regions that can provide care tailored to the area they represent. The current superboard is a glutenous corporate executive structure that funnels cash into salaries and bonuses of people who've never held a scalpel.
2. Establish a pharmaceutical plan to provide drugs cheaper to people. If the province bulk buys drugs we can save a fortune. The province then sells them to the people at affordable rates (varying by means to pay).
3. Ban the private clinics that are popping up. They undermine the public system and cost more (corporate executive bonuses over doctor and nurse salaries).

And I'm sure there's many more solutions, but running health care "like a business" is not something that's going to make health care accessible for more Albertans (unless that's not the goal...)

Jeff J. said...

I find it amusing how Canada is ranked 23rd in the world by the UN in terms of Health Care, why don't we look at the Top 10 countries and model ourselves after them? Better yet, let's take the #1 country in the world in delivering Health Care, the Netherlands, and let's steal some ideas from them...

Fact: The Netherlands Health care system is 100% private.

There's your answer Dave, Canada's health care system is failing not because of problems with Morale, or superboards, but because of ideology. Until we accept that we need to change everything we will continue to get worse. The NDP, Liberals and Friends of Medicare may think being 23rd int he world is good enough, but not me.

Let's tear it down and start over. Let's model ourselves after a country who gets it right, a country who has an abundance of doctors, short waiting lists, and every single citizen is covered by insurance.

Simple fix to a complex problem.

Unfortunate that it will never happen.

Anonymous said...

I think Alberta should investigate and discuss financial incentives to encourage people to live healthy lives. I dont want to punish people with sin taxes or punish people who through genetics have problems with weight but I think we can encourage people through financial means to eat better, reduce stress, and exercise. This could be done through the tax code either directly to the individual or to the business that provides the benefit to the employee. I am sure there are numerous ways to do this. There is a discussion of this currently in the American debate on health care

Anonymous said...

The Alberta Altruist (should I say - the anonymous Alberta Altruist) is completely out to lunch. The superboard saves money and enables government to control costs.

Again showing the hypocrisy of the Wildrose Alliance!

Anonymous said...

First off, let me say I just stumbled onto this blog and I thinjk it is one of the best I've seen!

Healthcare:

We need to insert some form of consumer principle into the system. I think we have an excellent system.....once you get access to it. What I mean is there needs to be a better way for folks at the front end to see their doctor for the simple stuff like presecription refills, ear infections, those pesky things you need a little antibiotic or penicillin for. Maybe it is becasue I have too much experience in rural Alberta, but getting an appointment to see your doctor for something like that is usually a 2 week wait. Anyone who has dealt with an ear infection knows you can't wait more than a day or so before the pressure drives you crazy so the alternative is go to the local emergency room...wait 1,2,3, maybe more hours and then be on your way.

How do we start making the patient feel like a client or a customer instead of a number and an irritant to the system?

Should we look at some form of dollars being controlled by the patient? Some way to encourage the medical profession to want our business?

I think we should always have the public system there to cover emergency and catastrophic injury or disease. Maybe a way can be found to allow the market system to serve the rest of healthcare.

More questions than suggestions!

Enlightened Savage said...

Anon at 12:35 - thanks for your comments. To pick up on something you mentioned...

Would it make sense to add another "level" of health care professional, somewhere between nurse and doctor? A "public health nurse", who could see you for your ear infection, give you your vaccination, take a look at your rash and determine if more senior attention from the area doc was warranted? Or is that just adding more hassle than service?

My only problem with letting market forces determine which clinics are sustainable is simply that if one clinic drives another out of business (superior service, marketing, whatever) then that's one fewer clinic that sick people can GO to. That makes me nervous, because now we've got a system where the best docs are head-hunted by the most successful clinics in the most populous areas with the promise of more money (because there are more patients), and the "have-not" clinics in rural areas get the worst docs, with no chance of attracting better providers because they don't get enough patients. At what point are these clinics just glorified hair salons? "Jack's Medical Centre proudly welcomes Dr. John Simpson and his patients - warmest stethoscope in North-Eastern Alberta".

Is the problem the unions? Is their utter refusal to accept any remodelling of this system going to result in its ultimate collapse, under its' own weight?

Anonymous said...

Enlightened Savage further to your comments to my market forces post.....

I agree that theoretical free market would or could create a system that you describe with the best doctors at certain clinics and poorer ones at others. To combat this, you would have to find a way to open up the system to make it easy and attractive to compete. More doctors, more opportunity and more reward for their work. I don't have a road map for making that system work, and there is rsik in trying it.

On your point of another level of care giver.....I suppose "Dr. Lite" could be an option, risk is the occasional misdiagnoses of something that is more serious and the consequences associated. We as society would have to accept that risk.

I think you comment that the "system", unions included, are most resistent to any change that they don't control is bang on.

heeedcase said...

Here's an idea, how about an income sensitive, consumption based health premium levied through the income tax system. The idea would be for AHS to issue something similar to a T4 for health services consumed by each individual. Then based on their consumption of health services charge a premium capped at a certain amount based upon their income.

I think many people look back at the ending of health premiums as a bad decision, but it could be an opportunity to institute a better design.

TheMonitor said...

Trying to come up with a better "plan" for delivering health care is missing the point: central planning does not work. Food and clothing are essential needs, yet we don't insist that the government should run all grocery stores and provide everyone with free t-shirts. Health care should be privatized.