Manitoba Wait Times Rising for Heart Surgery

[Smallc]

Well, ok. Manitoba is adding Primary Health Care centers and ACCESS (whatever that acronym means) centres to keep people out of doctors offices and hospitals where possible and to clear up space in hospital for those who need it. There are many other innovative things being done in all of the provinces.

[Michael Hardner]

Well, ok. Manitoba is adding Primary Health Care centers and ACCESS (whatever that acronym means) centres to keep people out of doctors offices and hospitals where possible and to clear up space in hospital for those who need it. There are many other innovative things being done in all of the provinces.

That sounds good. Do you have a link ?

[Smallc]

That sounds good. Do you have a link ?

From the small community where I grew up and live at the moment:

http://www.waterhen.ca/index.php?id=16

It's the final thing on the page. Health consultations as well as various tests can be done there. It brings healthcare into small communities and takes pressure off of regional centres. There are also various clinics (diabetes, heart health, nutrition, pap smear, etc) that visit throughout the year. These are also appearing within the regional centres themselves, often attached to hospitals.

The ACCESS centres seem to be harder to find info on. They are, as far as I know, Winnipeg and Brandon versions of the centres that provide more services.

Edited May 21, 2010 by Smallc

[Michael Hardner]

From the small community where I grew up and live at the moment:

http://www.waterhen.ca/index.php?id=16

It's the final thing on the page. Health consultations as well as various tests can be done there. It brings healthcare into small communities and takes pressure off of regional centres. There are also various clinics (diabetes, heart health, nutrition, pap smear, etc) that visit throughout the year. These are also appearing within the regional centres themselves, often attached to hospitals.

The ACCESS centres seem to be harder to find info on. They are, as far as I know, Winnipeg and Brandon versions of the centres that provide more services.

Uh. The page doesn't have anything but a picture and short description of the facility.

What about a link to the project. And how do you know so much about various clinics and so on to be able to rhyme off the services that are provided ? Do you have a relative who works there ?

I'm not trying to be suspicious here, but trying to find out the basis of your knowledge as its relevant to the discussion.

[Smallc]

I spend hours every week researching infrastructure projects, healthcare, and military spending and projects. I enjoy it. Anything I can't find out, I write and inquire about. It's of interest to me, because I enjoy seeing improvements.

Here, I managed to dig up the release for you:

http://www.gov.mb.ca/chc/press/top/2004/12/2004-12-01-03.html

[Michael Hardner]

I spend hours every week researching infrastructure projects, healthcare, and military spending and projects. I enjoy it. Anything I can't find out, I write and inquire about. It's of interest to me, because I enjoy seeing improvements.

We are kindred spirits then. Although my politics are centre-left I have worked in business management (IT) and organization is my area of interest.

Here, I managed to dig up the release for you:

http://www.gov.mb.ca/chc/press/top/2004/12/2004-12-01-03.html

Press releases are a common form of communication about Healthcare. Not the best, however the ones you have here are better than the Ontario PR items I have read.

They have the amount being spent - basically "we're spending $400K to build a healthcare facility". The outlined information is there. It's very basic though.

[Smallc]

They have the amount being spent - basically "we're spending $400K to build a healthcare facility". The outlined information is there. It's very basic though.

There's a reason for that. According to what I know, they weren't sure what type of services they would be providing in the facility. The hope was to keep the current Community Health Nurse (we did, she became the Community LPN) and to add a Nurse Practitioner. It would have worked perfectly, because the nurse practitioner could have written prescriptions and a pharmacy from the region's major centre could have delivered the prescription, as they already do for other medication prescribed by doctors.

That unfortunately didn't happen, and for a time, all there was at the facility was the LPN and a worker with the Manitoba Baby First program. Over time, we got a part time RN, and now a permanent RN (I was in Winnipeg for most of that time, so I don't know all of the details) who will later this year go on maternity leave, and hopefully they can find someone to work here. They still have been unable to find an NP to come even part time, though they are starting to become more common, and there is hope that some day that will happen. The addition of the RN to the facility was important though, as now immunizations can be given to students without bringing in outside help, and blood samples can be taken and sent away for testing at the Dauphin Regional Health Centre.

On this though, there is something of a pet peeve that I have. The community of Waterhen is the centre for the area. It has an Infrastructure and Transportation satellite yard, a Manitoba Conservation satellite yard, the largest of 3 fire departments in the area, the community constable for the area, and the only ambulance within 40 minutes (which transports people to hospital about an hour away..though that will soon be changing to a facility 40 minutes away which has regained the ability to accept patients from a wider area after again becoming a fully staffed two physician Hospital). It's too bad that until recently, this wasn't really recognized. A small community to the south got an indoor rink facility, and that facility was recently upgraded. As the centre, that should have been ours. Even more maddening is the fact that there is another, large health centre 20 kms down the road in the Skownan Reserve. The resources for the facilities, built only about 2 years apart, should have been pooled. Now I realize that these facilities are run by separate levels of government, and I thought that was the reason. recently however, this community became (and is further becoming) the community that treats and distributes water to the other Manitoba run communities in the area. More important though, it became the sewage treatment area for an even larger area that including at least one of the Manitoba Rural Municipalities in the area (a system that we are just too far north to be part of) and the Skownan Reserve. The project was jointly paid for by Manitoba Aboriginal and Northern Affairs (the department that this community falls under), Manitoba Infrastructure and Transportation, and the Department of Indian and Northern Affairs Canada.

That type of arrangement should have been used to make a health centre for the whole region...but it seems it was before the beginning of greater cooperation. It's really too bad, as money could have been saved. I know this arrangement is now used for a Government of Canada hospital on the Peguis Reserve. Manitoba and Canada both pay for upgrades because the hospital is used by people from both the reserve and the surrounding communities.

Oh, I found the release for the first ACCESS Centre:

http://news.gov.mb.ca/news/index.html?archive=2007-01-01&item=1021

And here is another such innovation:

http://news.gov.mb.ca/news/index.html?archive=&item=921

This clinic (which was private) is now owned by the Winnipeg Regional Health Authority, and operated by a charitable foundation. The minor injury clinic (for children and adults) runs 8 to 10 hours a day. Surgery is also done there, along with rehab work, and non emergency X-Ray and MRI scans...all outside of a hospital. More facilities like this should be looked at:

http://www.panamclinic.org/index.asp

Edited May 21, 2010 by Smallc

[Michael Hardner]

There's a reason for that. According to what I know, they weren't sure what type of services they would be providing in the facility. The hope was to keep the current Community Health Nurse (we did, she became the Community LPN) and to add a Nurse Practitioner. It would have worked perfectly, because the nurse practitioner could have written prescriptions and a pharmacy from the region's major centre could have delivered the prescription, as they already do for other medication prescribed by doctors.

They ... built a building in order to keep the nurse there ?

"We don't want you to quit, so we built you a new building ?"

The would have worked perfectly because ... she could have written prescriptions ? I don't get that either.

That unfortunately didn't happen, and for a time, all there was at the facility was the LPN and a worker with the Manitoba Baby First program. Over time, we got a part time RN, and now a permanent RN (I was in Winnipeg for most of that time, so I don't know all of the details) who will later this year go on maternity leave, and hopefully they can find someone to work here. They still have been unable to find an NP to come even part time, though they are starting to become more common, and there is hope that some day that will happen. The addition of the RN to the facility was important though, as now immunizations can be given to students without bringing in outside help, and blood samples can be taken and sent away for testing at the Dauphin Regional Health Centre.

They had to build a building because now they don't have to bring in somebody from outside to immunize students ?

On this though, there is something of a pet peeve that I have. The community of Waterhen is the centre for the area. It has an Infrastructure and Transportation satellite yard, a Manitoba Conservation satellite yard, the largest of 3 fire departments in the area, the community constable for the area, and the only ambulance within 40 minutes (which transports people to hospital about an hour away..though that will soon be changing to a facility 40 minutes away which has regained the ability to accept patients from a wider area after again becoming a fully staffed two physician Hospital). It's too bad that until recently, this wasn't really recognized. A small community to the south got an indoor rink facility, and that facility was recently upgraded. As the centre, that should have been ours. Even more maddening is the fact that there is another, large health centre 20 kms down the road in the Skownan Reserve. The resources for the facilities, built only about 2 years apart, should have been pooled. Now I realize that these facilities are run by separate levels of government, and I thought that was the reason. recently however, this community became (and is further becoming) the community that treats and distributes water to the other Manitoba run communities in the area. More important though, it became the sewage treatment area for an even larger area that including at least one of the Manitoba Rural Municipalities in the area (a system that we are just too far north to be part of) and the Skownan Reserve. The project was jointly paid for by Manitoba Aboriginal and Northern Affairs (the department that this community falls under), Manitoba Infrastructure and Transportation, and the Department of Indian and Northern Affairs Canada.

It all sounds overly complex and politically motivated to me. Also over managed.

That type of arrangement should have been used to make a health centre for the whole region...but it seems it was before the beginning of greater cooperation. It's really too bad, as money could have been saved. I know this arrangement is now used for a Government of Canada hospital on the Peguis Reserve. Manitoba and Canada both pay for upgrades because the hospital is used by people from both the reserve and the surrounding communities.

Overly complicated and byzantine arrangements to me.

I would say that a new planning authority needs to be started that supplants other areas of concern.

Oh, I found the release for the first ACCESS Centre:

http://news.gov.mb.ca/news/index.html?archive=2007-01-01&item=1021

And here is another such innovation:

http://news.gov.mb.ca/news/index.html?archive=&item=921

This clinic (which was private) is now owned by the Winnipeg Regional Health Authority, and operated by a charitable foundation. The minor injury clinic (for children and adults) runs 8 to 10 hours a day. Surgery is also done there, along with rehab work, and non emergency X-Ray and MRI scans...all outside of a hospital. More facilities like this should be looked at:

http://www.panamclinic.org/index.asp

There should be a standard table of information for each facility that shows the costs and benefits for each project. The press releases are interesting but it's only one face of what is happening.

In business, they have reports that indicate the cost per customer, the waiting time per customer and so on. Managers use this information to decide what's working and what isn't.

[Smallc]

They ... built a building in order to keep the nurse there ?

No, they built the building in order to expand services.

The would have worked perfectly because ... she could have written prescriptions ? I don't get that either.

Nurse Practitioners can write perscriptions. RNs and LPNs can't.

They had to build a building because now they don't have to bring in somebody from outside to immunize students ?

That is only one of the services. Before, they were using a small room for the LPN. Now, they have a building out of which a variety of health and social services are operated and coordinated.

I would say that a new planning authority needs to be started that supplants other areas of concern.

When dealing with different levels of government that is difficult. In Manitoba, there are federal services of reserve, the umbrella organization for the province, the Regional Health Authorities of Manitoba, and the 11 regional health authorities.

There should be a standard table of information for each facility that shows the costs and benefits for each project. The press releases are interesting but it's only one face of what is happening.

In business, they have reports that indicate the cost per customer, the waiting time per customer and so on. Managers use this information to decide what's working and what isn't.

I'm sure such things exist (though in rural areas, that isn't always the primary concern. Since we aren't managers though, i don't see why we need to see such detail.

[Michael Hardner]

No, they built the building in order to expand services.

Ok. That seems clear but from this:

"According to what I know, they weren't sure what type of services they would be providing in the facility. The hope was to keep the current Community Health Nurse"

It doesn't sound like they had an idea what was needed, or what the goals were for their project.

Nurse Practitioners can write perscriptions. RNs and LPNs can't.

Ok. Seems like this project is somehow tied to keeping the NP in town or something. Why do they need the NP to be able to write prescriptions ? Are there others in town that do that now ?

That is only one of the services. Before, they were using a small room for the LPN. Now, they have a building out of which a variety of health and social services are operated and coordinated.

Like I said - there should be a catalogue of what is provided, how many people are served, and costs, and who is paying for it. It should be online and the data should be provided from data that is already collected.

When dealing with different levels of government that is difficult. In Manitoba, there are federal services of reserve, the umbrella organization for the province, the Regional Health Authorities of Manitoba, and the 11 regional health authorities.

Exactly. Artificial agencies ostensibly created to 'manage' things end up confusing things.

I'm sure such things exist (though in rural areas, that isn't always the primary concern. Since we aren't managers though, i don't see why we need to see such detail.

We are - in business speak - stakeholders. If the system is a mess (and I believe that it is) then we need to push the hot button on something.

[Smallc]

It doesn't sound like they had an idea what was needed, or what the goals were for their project.

They had an idea what they wanted, they just weren't sure what they'd be able to get.

Ok. Seems like this project is somehow tied to keeping the NP in town or something. Why do they need the NP to be able to write prescriptions ? Are there others in town that do that now ?

We don't have an NP. We have an LPN and an RN. There is currently no one within a 40 minute vicinity that can write prescriptions. NPs are becoming a preferred way to deal with minor medical problems, as they don't cost as much as MDs (they make about half the money at 100K per year).

Like I said - there should be a catalogue of what is provided, how many people are served, and costs, and who is paying for it. It should be online and the data should be provided from data that is already collected.

Well, different regional health authorities general provide different amounts of information. Some of that information can be found in the Community Health Report from the PRHA and other authorities.

Exactly. Artificial agencies ostensibly created to 'manage' things end up confusing things.

Well, there is a reason for their creation. RHAM and the regional health authorities are not government. They are in fact semi private. Government only pays for care and sometimes equipment, they don't really provide it. So Manitoba Health is public, the health authorities are semi private, and the charitable and non profit organizations the run the health facilities (outside of public health facilities, such as the one that we're talking about) are private.

e are - in business speak - stakeholders. If the system is a mess (and I believe that it is) then we need to push the hot button on something.

I disagree that things are generally a mess. If there's something wrong, I raise an issue. If I get a satisfactory answer, then I'm happy. If I don't, I continue to pursue the issue. Wait times for example - generally, provinces only report nationally bench marked data. They keep stats for pretty much all procedures. If I want to know, I simply ask.

[Michael Hardner]

They had an idea what they wanted, they just weren't sure what they'd be able to get.

I don't see anything in there beyond "We're building a facility for $x. These would be labeled as 'unstated requirements' on a real project. Those are always scary, because it means they invested money trying to do something without explicitly saying what it was.

Now when you STATE in a project plan what you want to get done, it sometimes doesn't get communicated clearly so imagine what happens when you do it secretly.

We don't have an NP. We have an LPN and an RN. There is currently no one within a 40 minute vicinity that can write prescriptions. NPs are becoming a preferred way to deal with minor medical problems, as they don't cost as much as MDs (they make about half the money at 100K per year).

That is still very expensive in this labour market. Part of the problem is that the labour market is rife with regulation and it makes the market inflexible. I don't understand why building a building is necessary to put an NP there. They could just hire one to work there.

Well, different regional health authorities general provide different amounts of information. Some of that information can be found in the Community Health Report from the PRHA and other authorities.

That's a problem. They need to standardize how they report and share information nationally. This is part of what CIHI was supposed to do. Now they just report on the differences, and there doesn't seem to be a plan to resolve them.

Well, there is a reason for their creation. RHAM and the regional health authorities are not government. They are in fact semi private. Government only pays for care and sometimes equipment, they don't really provide it. So Manitoba Health is public, the health authorities are semi private, and the charitable and non profit organizations the run the health facilities (outside of public health facilities, such as the one that we're talking about) are private.

Regional health authority sounds like a govt. organization. They are semi-private ? Is there a diagram somewhere that outlines this ? Charities run a semi private organization ? What ?

I disagree that things are generally a mess. If there's something wrong, I raise an issue. If I get a satisfactory answer, then I'm happy. If I don't, I continue to pursue the issue. Wait times for example - generally, provinces only report nationally bench marked data. They keep stats for pretty much all procedures. If I want to know, I simply ask.

You just gave me an example of a project where they spent half a million dollars without having a clear goal as to what they were trying to achieve. That alone would be enough to get two people fired in a normal organization.

"If there's something wrong I raise an issue" - How do you do that ?

If you want to know, you ask. Who do you ask and how does that work ?

I emailed several healthy organizations in Toronto when the Swine Flu vaccine debacle was on. Nobody emailed ME back.

[Smallc]

I don't see anything in there beyond "We're building a facility for $x. These would be labeled as 'unstated requirements' on a real project. Those are always scary, because it means they invested money trying to do something without explicitly saying what it was.

No, they did say what it was...just not in that release.

That is still very expensive in this labour market. Part of the problem is that the labour market is rife with regulation and it makes the market inflexible. I don't understand why building a building is necessary to put an NP there. They could just hire one to work there.

When you are talking about health professionals, that isn't really that expensive. A building is necessary because there was nothing there before. The building has an examination room, offices, and conference facilities that are necessary for carrying out the work in a clean environment.

Regional health authority sounds like a govt. organization. They are semi-private ? Is there a diagram somewhere that outlines this ? Charities run a semi private organization ? What ?

I don't know if I can find the information, but that's the way it works.

You just gave me an example of a project where they spent half a million dollars without having a clear goal as to what they were trying to achieve. That alone would be enough to get two people fired in a normal organization.

They had clear goals. They simply didn't communicate all of them in the release.

"If there's something wrong I raise an issue" - How do you do that ?

Letters.

If you want to know, you ask. Who do you ask and how does that work ?

Manitoba Health. I communicate a problem, and I get a response...eventually. They get a lot of letters.

emailed several healthy organizations in Toronto when the Swine Flu vaccine debacle was on. Nobody emailed ME back.

That would seem to be a violation of their rules. If you communicate in writing, from what I understand, they should be responding.

[Michael Hardner]

No, they did say what it was...just not in that release.

If you have a link pass it on. I'd be interested in seeing.

When you are talking about health professionals, that isn't really that expensive. A building is necessary because there was nothing there before. The building has an examination room, offices, and conference facilities that are necessary for carrying out the work in a clean environment.

Health professionals may be overpaid in this case. The market is pretty inflexible and over regulated, which are both impediments to filling positions.

I don't know if I can find the information, but that's the way it works.

The question is - If I lived in MB and wanted to find out how my local health organizations were run, could I easily find out ?

They had clear goals. They simply didn't communicate all of them in the release.

See above.

That would seem to be a violation of their rules. If you communicate in writing, from what I understand, they should be responding.

They have 'email us with questions' links all over the place. If my emails end up in a giant black hole, why would I take the time to actually write a letter and mail it ?

Answer: I wouldn't.

[Smallc]

If you have a link pass it on. I'd be interested in seeing.

The information was in news stories from 6 years ago. I doubt I can find it.

Health professionals may be overpaid in this case. The market is pretty inflexible and over regulated, which are both impediments to filling positions.

Health professionals spend a long time getting ready to do what they do. To pay back the money they've spent, they require high wages.

The question is - If I lived in MB and wanted to find out how my local health organizations were run, could I easily find out ?

Yes, it would simply take a question to Manitoba Health.

They have 'email us with questions' links all over the place. If my emails end up in a giant black hole, why would I take the time to actually write a letter and mail it ?

Answer: I wouldn't.

It doesn't work that way here. Responses may take quite a while, but they always come.

[Michael Hardner]

The information was in news stories from 6 years ago. I doubt I can find it.

Ok. News stories, press releases - these provide an initial summary of information but they're inadequate ways to publicize project plans. There are standards for how such things are done and I'm sure they're being followed but a) are they being published ? b ) if not, why not ? c) if so, where are they ? d) why don't we know ?

Health professionals spend a long time getting ready to do what they do. To pay back the money they've spent, they require high wages.

We don't pay salaries according to how long people study for it, we pay according to a labour market. Further to that, how much education is required for the position and why ?

Are these things listed somewher e?

Yes, it would simply take a question to Manitoba Health.

You mean writing a letter ? That's not good enough, IMO.

It doesn't work that way here. Responses may take quite a while, but they always come.

You get a response every time ? How did you first find out where you should write to ?

Edited May 21, 2010 by Michael Hardner

[Michael Hardner]

Since you know so much about MB, I've been inspired to do a quick review of the Manitoba Health website. Luckily, it's pretty easy to navigate.

First thing I went to on their website was the promising subsection called 'reports and expenses':

http://www.gov.mb.ca/health/expenses/index.html

Guess what ? It's the health minister's personal expenses. He/she didn't travel out of the province in 2007/2008 by the way but spent 293.51 in accomodations in province. Not helpful.

Next it was on to the 'waiting times' section. As with other similar sites I've been to, it's limited.

For example the cancer surgery section: http://www.gov.mb.ca/health/waittime/cancer/surgery/index.html

It only shows 'head and neck' cancer surgery wait times.

It doesn't show comparative data for other time periods, or other parts of Canada.

Anyway, I also emailed them to ask them why they didn't provide the other information. Let's see what happens.

[Smallc]

We don't pay salaries according to how long people study for it, we pay according to a labour market. Further to that, how much education is required for the position and why ?

LPN - 15 to 24 months, RN 48 months, NP 60 months. I really don't know why, since I'm not any of those things.

Are these things listed somewhere?

The salaries are listed on the Manitoba Nurses Union website. The education time is listed at the appropriate educational institution

You mean writing a letter ? That's not good enough, IMO.

It seems to have worked for me.

You get a response every time ? How did you first find out where you should write to ?

I've gotten responses to my first 4 letters, but not yet for the latest one. It's been a while now, it it will probably come eventually. I simply write to the minister's office, and I get a response.

[Michael Hardner]

LPN - 15 to 24 months, RN 48 months, NP 60 months. I really don't know why, since I'm not any of those things.

A 5-year degree doesn't really guarantee a 100K salary in most industries. It makes me think that there are opportunities there to lower wages for people.

It seems to have worked for me.

It's not good enough.

We need the general public to be aware of these things to a greater degree than they have been. As such, these institutions need to disseminate information - to publish their practices, their budgets and who is making decisions, and how.

It's not enough to say "write us a letter Mr. Smallc and we'll get back to you". Since they're already gathering that data, they need to show it to us - after all we pay for it.

I've gotten responses to my first 4 letters, but not yet for the latest one. It's been a while now, it it will probably come eventually. I simply write to the minister's office, and I get a response.

This isn't 1830 so I can't say I'm impressed with this method of passing out information. You're not going to get more than a handful of concerned citizens writing in from time to time. We need to engage the public so that healthcare is revitalized.

[Dave_ON]

See it's not just Canucks fascinated with Yankees...

The term "Yankee" technically refers to those north of the Mason Dixon line during the civil war. AKA the war of Northern Agression if you south of the aforementioned line.

As for BC, I'm not so convinced competition is the answer. We need look no further than the government forced breakup of Ma Bell in the US. It was supposed to improve service via healthy competition. What it did instead is set telecommunications back in the US, and they were even behind little ol' Canada. Now we see monopolies are slowly creeping back in through various mergers and consolidations.

Competition in Canada's health care isn't the problem really, we need to look at new solutions that include more private clinics. A private pay system isn't the bereft of it's own myriad of flaws. It's why health care costs are increasing in the US, and why those costs are so very administration heavy.

[bush_cheney2004]

The term "Yankee" technically refers to those north of the Mason Dixon line during the civil war. AKA the war of Northern Agression if you south of the aforementioned line.

True, but the term is much older than that, dating back to Dutch and British origins / usage.

As for BC, I'm not so convinced competition is the answer. We need look no further than the government forced breakup of Ma Bell in the US. It was supposed to improve service via healthy competition. What it did instead is set telecommunications back in the US, and they were even behind little ol' Canada. Now we see monopolies are slowly creeping back in through various mergers and consolidations.

Canada is poorly serviced for higher fees than in the US...including cable television.

Competition in Canada's health care isn't the problem really, we need to look at new solutions that include more private clinics. A private pay system isn't the bereft of it's own myriad of flaws. It's why health care costs are increasing in the US, and why those costs are so very administration heavy.

No, health care costs will always rise when being chased by private and public insurance dollars. The real competition will come when hard choices have to be made about services, costs, and what/who will be denied limitless access.

[Michael Hardner]

The term "Yankee" technically refers to those north of the Mason Dixon line during the civil war. AKA the war of Northern Agression if you south of the aforementioned line.

The British used it during the war of 1812, when stymied by Andrew Jackson at Mobile, Alabama. "THESE Yankees know how to fight."

As for BC, I'm not so convinced competition is the answer. We need look no further than the government forced breakup of Ma Bell in the US. It was supposed to improve service via healthy competition. What it did instead is set telecommunications back in the US, and they were even behind little ol' Canada. Now we see monopolies are slowly creeping back in through various mergers and consolidations.

How were they behind us ? Our rates were sky-high years after competition reduced theirs.

[Michael Hardner]

No, health care costs will always rise when being chased by private and public insurance dollars. The real competition will come when hard choices have to be made about services, costs, and what/who will be denied limitless access.

Also, labour competition. The US does better at (using a euphemism here) ensuring labour efficiency.

[dre]

The real problem with healthcare costs isnt so much the healthcare system, its that Canada is a shitty place to produce products and services that are competitive. Also much like the US the healthcare industry is riddled with protectionism.

If the government really wanted to lower healthcare costs and improve paient outcomes it would be really easy... hire less Canadian doctors, and move the patients out of the country whenever possible for treatment.

The cost of surgery in India, Thailand or South Africa can be one-tenth of what it is in the United States or Western Europe, and sometimes even less. A heart-valve replacement that would cost $200,000 or more in the US, for example, goes for $10,000 in India--and that includes round-trip airfare and a brief vacation package. Similarly, a metal-free dental bridge worth $5,500 in the US costs $500 in India, a knee replacement in Thailand with six days of physical therapy costs about one-fifth of what it would in the States, and Lasik eye surgery worth $3,700 in the US is available in many other countries for only $730. Cosmetic surgery savings are even greater: A full facelift that would cost $20,000 in the US runs about $1,250 in South Africa

Canadian doctors and healthcare workers in many cases cost 10 times what doctors with similar qualifications cost elsewhere in the world. They are able to pricegouge because they have effectively lobbied the government to protect them from competition. For example... a steal worker would NOT be able to charge 10 times what his foreign counterparts charge because in a global economy nobody would hire him.

The solution to the problem is two-fold.

1. Flood Canada with dirt cheap foreign doctors. Theres hundreds of thousands of doctors around the world that would love to come to Canada and work for 40 - 60 thousand dollars. They cant come now because various trade associations have lobbied for overly ownerous certification processes even though many of these doctors were trained right here in Canadian medical schools. We need to make it way way way easier for foreign doctors to come here, and the best way to do it is to CRUSH various medical associations and trade associations.

2. Move the patients offshore whenever possible. A heart valve replacement can cost over a hundred thousand dollars in Canada and 200 thousand in the US. You can get it for 10 thousand in india in a JCI accredited facility where patient outcomes are comparable. For 20 thousand you can get the airfare, the operation, a week of recovery time in the hospital, and then a nice little 2 week stay at a resort to finish healing up and maybe enjoy yourself a little bit.

What that means is that every time a heart valve replacement is done in Canada 80 thousand dollars is flushed down the toilet. And we wonder why costs are high?

Radiology scans can be read in India by doctors with equal skills to our own that make 30 000 dollars per year. But in most cases we cant do that because the associations that represent radiologists have lobbied for regional certification rules to protect them from competiton. In many cases you couldnt even sent an electronic radiology scan to the next city to be read. LOL.

This isnt rocket science... we know how to bring down costs, and the way to do it in the medical industry is not different than how we reduced the costs of electronic goods, textiles, and tennis shoes. You remove as may Canadians and Americans from roles in the production and delivery as you possibly can, then the prices will go down fast.

[Michael Hardner]

I think dre just mentioned the elephant in the room...