The health care conversation continues. The new president of the Canadian Medical Association has invited Canadians to give their vision into the health care system. In May the Canadian Nurses’ Association added their voice launching a national inquiry into health care. Now that the Conservatives have formed a majority government, there is a fearful conversation about whether this government is firmly committed to preserving and funding universal health care when the current accord comes up for negotiation in 2014. We’re great talkers, but we don’t seem to be doing much. Our system has been studied to death.
The health care conversation is consistently hijacked down the predictable path of wait times, denied drugs, and doctor shortages. Canadians have such faith in the system we automatically believe more money is the answer. But is it?
The definition of crazy is doing the same thing over and over and expecting different results. Every year we pump more money into the system, but not a lot of Canadians are happy with the results. So is more money needed or should we look at a drastic change in how we spend it?
Of all the things we cut, administrative costs get a pass.
According to The Chronicle Herald health care administration in Nova Scotia is more than one percent above the national average while MRI use is 15 percent below the national average. It would seem we’re paying more for less. One percent could pay for a lot of front-line services. Instead we seem addicted to bureaucracy. In November, in an economy measure, South Shore Health laid-off six managers and one vice president. However, the day the lay-offs were announced, the authority’s website listed 21 job openings, including nine managers and four supervisors.
According to Canadian Business magazine, “If the Canadian health-care system were a corporation, it would be among the biggest in the world” and “the worst-run industry in Canada”.
Canadian Business says, “As costs and dissatisfaction mount, most Canadians believe the problem is rooted in either insufficient funding, demographic overload or corporate profiteering. But according to a growing chorus of health economists, policy analysts and doctors, the real issue is mismanagement — horrible, pervasive inefficiency that is preventing the system from running even close to as well as it could.”
In August 2010 Auditor General Sheila Fraser told the Canadian Medical Association, Canadians have no way of judging whether the health-care system is providing good value for their tax dollars because of a lack of solid information to assess its performance.
Ontario’s Auditor General followed Fraser with a report that spotlighted the comfortable industry which has developed for health care consultants. Ontario is spending over $100 million a year on consultants. To illustrate how kind the system’s golden handshakes have become for departing colleagues, the Auditor General pointed to an executive, who retired from his $140,000-a-year hospital position, and returned 30 days later as a $240,000-a-year consultant. There was no indication of what happened to this individual’s knowledge base to justify a $100,000 / 75 percent pay increase.
Given the poor ratings of health care administrators by think tanks and others in know, why isn’t Nova Scotia looking at cutting our overheads? Other provinces have. Nova Scotia has ten health care authorities. That’s ten sets of executives basically making the same decisions. Plus there is substantial costs related to their office support. In Kentville, for example, Valley Regional Health Authority executives have two sets of offices in the same town: one set in their corporate bunker in the Industrial Park and another set in the hospital. Why not operate from front-line offices in the hospital? If they need meeting space they have two classrooms and a private dining room to work with in the hospital.
In comparison, British Columbia, which has five times the population and 17 times the geography of Nova Scotia functions with six health authorities. Ontario has 14. PEI’s one health authority serves the same sized population that takes three health authorities in Nova Scotia. New Brunswick cut back from eight authorities to two. And Alberta sliced a billion dollars off their health care budget by cutting back from eight health authorities to one. Alberta is going back to five – still down from before – to see if the system could be more responsive. Responsiveness is important, but doesn’t seem to be a trait in Nova Scotia’s system. In December 2009, an 81-year-old man had a heart attack across the street from Soldiers Memorial Hospital in Middleton. His 83-year-old wife ran into the hospital for help and was told to call 9-1-1 or carry him in herself. When the incident made national headlines the local health authority promised a policy response to this incident. 17 months later I can’t find an announcement for that policy, and Middleton hospital workers I spoke with didn’t know of one. In our family after a contradictory diagnosis I asked for an explanation and was ignored. So eight months later, December 15, 2010, I wrote the VP of Medicine with our questions and concerns. I followed up on February 15, 2011 and April 15th. As of June 5th, I have had no response. A Cape Breton man told me he had to wait 19 months for his father’s autopsy report. These delays are absurd. What do these executives do with their days, go to meetings?
In Nova Scotia we have 42 health care vice presidents. Using Capital Health’s top vice presidential pay rate of $208,000, we could have 30 registered nurses for every ten VPs we eliminate plus have money left over.
What are we getting for all this bureaucracy? A 2010 Commonwealth Fund study ranked us last among public systems. We are behind the Dutch, Brits, Australians, Germans and New Zealanders. Only the United States delivered worse care to its patients.
According to the Canadian Adverse Events Study, 24,000 Canadians die in hospital each year due to “reversible medical errors”. In other words, mistakes. To put this into gruesome perspective, today more Canadians die due to hospital medical errors than died in uniform in WWII! During six years of war, 44,093 Canadians died in service to King and country. That’s an average of 7,348 deaths per year. Even allowing for population differences, our current hospital death figure is higher. And even now we may be under-reporting actual deaths because while we use 7.5 percent “incident” rate, the Americans discovered their adverse incident rates were actually 30 percent of hospital admissions. Given the thick veil of secrecy surrounding health care, will we ever know the real figures? It’s worth asking if the privacy laws mask a serious problem?
Our failure to question those in charge allows the system to become complacent. So on this round of health care consultations let’s have a real look at costs and operations. Let’s hear from those who have used the system. And let’s direct more of our budgets away from the boardrooms to front line care.
helphealthcare 
It’s a complicated issue, you’ve hit on some of the problems, I’m trying to highlight some more. I think I would say this: we need to take the money out of the boardrooms and put it into health prevention. Nova Scotia is a sick province. We have some of the highest rates of chronic disease in the country. We live in a society where buying milk costs twice as much as buying pop – and we are not a rich society either. Every time we pay a doctor $192 dollars an hour to look after someone who will then go home to the exact conditions that made them ill in the first place, we are going further down the rabbit hole.
There will never be enough nurses and doctors if the our population continues with the rates of obesity, high blood pressure and other risk factors that cause diabetes, cancer, heart disease and other medical conditions. Yes, we require some personal responsibility – I agree (I’m bringing up this argument because everyone does). But if you are a family trying to make ends meet and you’ve just lost your job, or a senior living on a fixed income – you have tough choices to make – do I pay my rent or buy healthy food? Do I take my diabetes meds or eat? Those choices affect your health. And that affects healthcare.
Ultimately, we need to fix healthcare with more *health*. When that discussion finally makes it onto the table – well, let’s just say I’ll be pleasantly surprised:)