Canada's health care system sucks

[Michael Hardner]

For those who aren't aware the best stats available (IMO) are with CIHI - the Canadian Institute for Health Information.

Here's an example from 2010.

http://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=download_form_e&cw_sku=WTTACP10PDF&cw_ctt=1&cw_dform=N

There are still lots of problems - there are few year-over-year results beyond 1 year, and the metrics constantly change, and are footnoted to death.

For 2010, for example, these are the provinces that provided surgeries within the targets for 75% of patients.

Hip Replacement/ Knee Replacement/ Cataract/ Hip Fracture/ Cancer-Radiation Treatment

N.L. No No Yes Yes*

P.E.I. Yes No Yes Yes

N.S. No No No Yes No

N.B. Yes No Yes Yes Yes

Que. Yes Yes Yes

Ont. Yes Yes Yes Yes Yes

Man. No No Yes Yes Yes

Sask. No No Yes Yes Yes

Alta. Yes No No Yes No

B.C. Yes Yes Yes Yes Yes

Those targets are:

Hip replacement, knee replacement: surgery within 26 weeks

Cataract surgery: surgery within 16 weeks

Hip fracture: surgery within 48 hours

Cancer: within 4 weeks

That's 29 of a possible 50 categories reporting 75% (ONLY 75%) meeting standards.

There's no year over year comparison but if you look at the 2009 report:

http://secure.cihi.ca/cihiweb/products/wait_times_tables_aib_e.pdf

Hip replacement: PEI improved and came above 75% but NB declined - so 5 provinces providing service within targets.

Knee replacement: PEI declined and fell below 75%, and BC improved past 75%- SO still only 3 provinces providing service within targets. NL has an unexplained

Cataract replacement: NS was at 75% and fell below 75%, NB and PEI improved.

Cancer treatment: all provinces reported meeting targets, but now 2 provinces are not meeting targets, so a decline.

No fracture statistics available.

Finally, for 2009 the 3-year trend is:

Hip replacement: all indicators indicate a decline in service times

Knee replacement:all indicators indicate a decline in service times

Cataract surgery:all indicators indicate a decline in service times

Edited August 4, 2010 by Michael Hardner

[Wilber]

!

I'd tread carefully, my man.....

[edit]: never mind, I see that no offense was taken.

No offense was taken. It was a valid comment but one needs to know how the system is working if they are to avoid these surprises. It won't happen again. I'm thinking that possibly the reason for it was each time she was treated in emergency and released but if they don't notify your family doctor or recommend follow ups, they should tell you that and make it clear you should do it on your own.

[bloodyminded]

No offense was taken. It was a valid comment but one needs to know how the system is working if they are to avoid these surprises. It won't happen again. I'm thinking that possibly the reason for it was each time she was treated in emergency and released but if they don't notify your family doctor or recommend follow ups, they should tell you that and make it clear you should do it on your own.

True, communication can't hurt. (Surely!)

[wyly]

Sorry but it is sheer fantasy.

ya the fantasy is all yours I'm happy to say, mrs wyly is in hospital management so I BBQ and sup with all sorts of MDs and administrative staff...management can be let go at any time, hers and other managers wages have been frozen for two years to the point where unionized staff wages are near equal and some cases passing those of their supervisors...

Shortages of professional staff, be they doctors or otherwise are also a management issue. In many cases they have been artificially created. Again the draconian business concepts of manipulating supply and demand come into play.

no those are politcal issues, politcians and their appointed reps/lap dogs make all those decisions not management...training of medical personel is provincial matter (Universities) University budgets are tied to the Provincial government/elected officials...

what comes into play is taxation and how the taxes collected are allocated...everyone bitches about the healthcare but then they bitch even more if it requires more tax dollars to correct...

[wyly]

Something has to give or by the year 2030 $.70 of every 1 tax dollar collected will go to health care if we continue down the same road we're on now.

I don't know if the figures are correct but so what if they are?..is there anything more important than your health and that of your family?..if someone has a seriously ill child no amount of money is too much, I'd give every cent I have if it would save one of my kids...

It just isn't sustainable, something has to change. The only way it'll change is if we start charging a small fee every time people go to the Dr. Some people run to the Dr. for a runny nose, this is absurd. It's this sort of waste we need to cut out. People will think twice before going if they have to pay a small fee each time. This is just one idea but the system as it is now cannot support itself, impossible.

it won't have any effect on those can pay and you'll only hurt those who can least afford it...plus how do you know it's just a runny nose? I had an acquaintance who had "just" a runny nose/cold, it killed him a week later...

and it's a myth anyways most Canadians don't go to the doctor often enough to the point where it costs us incredible amounts of money due to late diagnosis, preventative medicine saves us money catching illness early before it needs expensive medical intervention...removing a suspicious mole early saves the government hundreds of thousands if it avoids chemotherapy...

Maybe the government needs to get out of health care altogether. Have it run privately with public/private dollars, get some private sponsorship. Keep government guidelines and rules of coarse but take Doctors and nurses of the public payroll. This will save many Billions of dollars.

it won't save us anything we'll pay more for private insurance and the treatment won't be any better for most and worse for many more...

Doing this will force the unions to bring their wages down instead of holding the government hostage, every couple years. If they were private the hospital could just fire them and rehire new people.

economic reality is those unionized workers have to live in the same cities as the rest of us and bear the same cost of living...firing important medical personel for those unable to do the work isn't a smart idea...

Same thing for education, private sponsorship partnered with public dollars will save Billions.

whether the dollar comes out of you left pocket or right does it matter?

[Sir Bandelot]

ya the fantasy is all yours I'm happy to say, mrs wyly is in hospital management so I BBQ and sup with all sorts of MDs and administrative staff...management can be let go at any time, hers and other managers wages have been frozen for two years to the point where unionized staff wages are near equal and some cases passing those of their supervisors...

No way you will convince me it's the norm. Who does the hiring and firing? You think any management is going to cut off it's own head? No way. Simple logic. And direct experience working in major hospitals, and networking with hundreds of people across Canada has shown me otherwise.

But, not surprised that they would bitch about their own situation, the upper echelon, MD's and administrators, while they BBQ and sup with one another. Don't forget to raise the pinky while sipping your mamosas, and bemoaning how you don't make as mush as the CEO of Ontario Power Generation... etc.

You don't want to believe it, but just check out the list of the 100-thousand dollar club, provincial report card of all public sector employees making more than $100k. huge list, keeps growing every year, NOT ONLY IN NUMBER OF PEOPLE ON THE LIST, BUT LEVEL OF THEIR SALARIES is going through the roof. Pretty soon, they'll have to call it the 200-thousand dollar club because it's getting ridiculous.

no those are politcal issues, politcians and their appointed reps/lap dogs make all those decisions not management...training of medical personel is provincial matter (Universities) University budgets are tied to the Provincial government/elected officials...

what comes into play is taxation and how the taxes collected are allocated...everyone bitches about the healthcare but then they bitch even more if it requires more tax dollars to correct...

Haha, the same people who are in management as CEO's of hospitals also sit on boards for the government, and move around in the highest levels of job bioth within the hospitals and without. Like a bad penny, they just keep turning up in the fanciest of positions. Who is Tom Closson? Who is Alan Hudson? Robert Bell.

My advice, stop throwing money at it. The current system is a bottomless hole sucking wheelbarrels of cash. Money is not what's needed.

[Sir Bandelot]

Case in point, evidence.

http://www.digitaljournal.com/article/289856

Stick that on your BBQ...

[wyly]

No way you will convince me it's the norm. Who does the hiring and firing? You think any management is going to cut off it's own head? No way. Simple logic. And direct experience working in major hospitals, and networking with hundreds of people across Canada has shown me otherwise.

But, not surprised that they would bitch about their own situation, the upper echelon, MD's and administrators, while they BBQ and sup with one another. Don't forget to raise the pinky while sipping your mamosas, and bemoaning how you don't make as mush as the CEO of Ontario Power Generation... etc.

You don't want to believe it, but just check out the list of the 100-thousand dollar club, provincial report card of all public sector employees making more than $100k. huge list, keeps growing every year, NOT ONLY IN NUMBER OF PEOPLE ON THE LIST, BUT LEVEL OF THEIR SALARIES is going through the roof. Pretty soon, they'll have to call it the 200-thousand dollar club because it's getting ridiculous.

Haha, the same people who are in management as CEO's of hospitals also sit on boards for the government, and move around in the highest levels of job bioth within the hospitals and without. Like a bad penny, they just keep turning up in the fanciest of positions. Who is Tom Closson? Who is Alan Hudson? Robert Bell.

My advice, stop throwing money at it. The current system is a bottomless hole sucking wheelbarrels of cash. Money is not what's needed.

top management are largely politcal appointments...the thousands that get fired are middle and lower management are hired on merit...

[Bonam]

No offense was taken. It was a valid comment but one needs to know how the system is working if they are to avoid these surprises. It won't happen again. I'm thinking that possibly the reason for it was each time she was treated in emergency and released but if they don't notify your family doctor or recommend follow ups, they should tell you that and make it clear you should do it on your own.

Definitely, I agree here. However, I think that patients and their relatives should expect the worst rather than the best, even if they are getting pretty good service. When my grandmother (who does not speak English very well) had cancer, my mother and I went to her appointments with her, and we badgered the doctors with tons of questions, made sure we knew everything. While, ideally, perhaps the system should take care of these things for you, the reality is, you can't leave your health or the health of your relatives to a bureaucracy, where, even if it has the best of intentions, people can fall through the cracks. There is no substitute for constant attention and active participation by people who actually care about the patient on a personal level. Basically, with anything important enough, always assume the worst and prepare for it, that way you won't be disappointed or caught off guard.

This is actually something critical that I guess I've had drilled into me since a young age. Whenever dealing with doctors, always, always, ask every question you can possibly think of. Most will not tell you everything unless asked. If you have a certain condition, make yourself an expert on it, so that you can converse with your doctor about it on as near an equal level as possible.

[Wilber]

This is actually something critical that I guess I've had drilled into me since a young age. Whenever dealing with doctors, always, always, ask every question you can possibly think of. Most will not tell you everything unless asked. If you have a certain condition, make yourself an expert on it, so that you can converse with your doctor about it on as near an equal level as possible.

In todays hospitals, finding a doctor you can ask a question is getting increasingly more difficult unless you have the time to hang around all day. The vast majority of people who work in them are great but I have come to the conclusion that hospitals are places to be avoided if at all possible. If you have a chronic condition you should learn as much as you can about it but most of us are not instant experts on everything that comes up. Thats why we need professionals to explain it to us.

[Argus]

Case in point, evidence.

http://www.digitaljournal.com/article/289856

Stick that on your BBQ...

No one has yet pointed out to me how the job of administering a hospital should draw a salary three or four times that of the prime minister of this country. It's also quite a bit higher than that of the governor of the bank of Canada, for example, or any of the deputy ministers.

[Wilber]

My sister got some interesting info from a social worker at the hospital my mother was in. If a doctor doesn't have visiting rights at a hospital (most don't) they have no more authority than any other visitor when it comes to their patient while they are in hospital. Resident doctors rotate and every time there is a rotation, the incoming doctor will have to get up to speed on all the cases they will be responsible for. There is no follow up from the hospital. They will give a patient a written report to give their doctor when they are discharged. They don't send anything to your doctor unless your doctor requests it. For him to do that he will have to know you are in hospital. You or someone else will have to tell him, the hospital doesn't. Your chances of getting information from the hospital is not good unless you go there in person and demand it. This is just great for the nursing staff, they not only have to look after patients but irate relatives as well. That said, when I requested the doctor on shift call me after he had seen my mother, he did although it was to tell me she was being released. Couldn't get there fast enough.

One more small thing, if you call the phone number of a hospital that is in the directory, you will not get that hospital but a central answering service for the health district who then reroutes the call.

This is how it is done in BC.

[P. McGee]

If a big part of the problem is the supply of doctors, why not raise medical school subsidies but tie them to subsequent work in needed areas? That way, doctors who work in remote areas would have their debts forgiven the fastest, urban doctors would have theirs forgiven after a few more years of service, and doctors who move out of the country after graduating would owe the entire unsubsidized cost of their education.

Also, isn't the whole hospital model of sticking all the sick people into one big building getting a bit dated, especially with all the concern over disease outbreaks? How many people get an infectious disease at the hospital?

[Michael Hardner]

If a big part of the problem is the supply of doctors, why not raise medical school subsidies but tie them to subsequent work in needed areas? That way, doctors who work in remote areas would have their debts forgiven the fastest, urban doctors would have theirs forgiven after a few more years of service, and doctors who move out of the country after graduating would owe the entire unsubsidized cost of their education.

Also, isn't the whole hospital model of sticking all the sick people into one big building getting a bit dated, especially with all the concern over disease outbreaks? How many people get an infectious disease at the hospital?

Perhaps we should also plan for health care salaries to decline at the same rate as manufacturing and IT workers, by bringing in qualified replacements from overseas.

[Smallc]

If a big part of the problem is the supply of doctors, why not raise medical school subsidies but tie them to subsequent work in needed areas?

That's already being done in many provinces, but it doesn't seem to make a huge amount of difference.

[punked]

That's already being done in many provinces, but it doesn't seem to make a huge amount of difference.

Also because outside of the military it really doesn't stand up in court. You know the whole indentured servitude thing being illegal in Canada. The doctors take the money but then leave the job after a short time and the provinces can't really get them to pay the money back in anyway.

[Michael Hardner]

Also because outside of the military it really doesn't stand up in court. You know the whole indentured servitude thing being illegal in Canada. The doctors take the money but then leave the job after a short time and the provinces can't really get them to pay the money back in anyway.

As I said above, there is likely a large supply of qualified health professionals we can bring to the task.

Also, the UK has started web initiatives to get people talking about healthcare:

Patient Opinion

We should do the same.

[dre]

A while ago, I was pushing the idea that the Government should start allowing medicare to cover procedures done in foriegn countries, and split the savings with the patient. This would save the system a pile of money and reduce pressure, waiting lists, etc.

Well thats exactly what some companies are starting to do.

http://money.cnn.com/2010/08/11/news/companies/health_care_medical_travel/index.htm?source=cnn_bin&hpt=Sbin

Desperate to bring down health care costs, some companies will even pay workers a percentage of savings from overseas treatment and waive co-pays and deductibles.

I believe that this will be the future of healthcare in Canada and the US. Theres simply no reason to do major procedures here anymore unless the patient cant travel... they often cost 10 times as much or more.

[Michael Hardner]

And... again... why not bring the doctor HERE and cut down on travel costs as well ?

Is it so obvious an idea that no one deems it necessary to respond ?

[Michael Hardner]

Speaking of data visualizations - some opportunists have used this tool to depict the US healthcare system as overcomplicated according to O'Reilly.com (no relation to Bill O'Reilly)

image

Edited August 11, 2010 by Michael Hardner

[punked]

And... again... why not bring the doctor HERE and cut down on travel costs as well ?

Is it so obvious an idea that no one deems it necessary to respond ?

Those country cost less because there is no repercussions if the doctor does them wrong. No malpractice costs and no medical insurance cost for the doctor. So bringing them here wont do crap.

[Michael Hardner]

Those country cost less because there is no repercussions if the doctor does them wrong. No malpractice costs and no medical insurance cost for the doctor. So bringing them here wont do crap.

Malpractice costs are insignificant in the US and about twice as insignificant in Canada.

Our problem is supply, inflexibility, and increasing costs.

[dre]

And... again... why not bring the doctor HERE and cut down on travel costs as well ?

Is it so obvious an idea that no one deems it necessary to respond ?

Because medical associations have lobbied to make sure that foreign trained doctors degrees are not honored here.

So you can bring him here... But he would be driving cab... like the majority of indian doctors in Canada.

But theres other things in play besides the massive web of protectionism that protects the medical industry from foreign competition.

Lets look at the life cycle of a medical facility in India VS one in Canada or the US.

1. A piece of land is purchased to build the hospital on. (the land in Canada costs 10 times what it does in india).

2. A permitting and approval process takes place (this costs 10 times as much in Canada as it does in india).

3. A surveyor comes in and surveys the property (this costs ten times as much in Canada).

4. An excavation company digs the hole and prepares the property for construction (this costs ten times as much in Canada).

5. A civil contruction company installs sewers, drains, and water mains (this costs ten times as much in Canada).

6. A crew comes in to build the foundation (this costs ten times as much In Canada).

7. A construction crew builds the building (10X as much).

8. A roofer roofs it (10X as much).

9. A painter paints it (10X as much).

10. Electrical and plumbing (10X as much).

11. Janitorial staff is hired (10X as much).

12. Doctors (10X as much).

I gotta stop because you already get the idea.

Every single part of the operation costs way way more. Every resource costs way way more here from janitors, to nurses, to doctors, right up to administrators.

CANADA

CAN

NOT

COMPETE.

[dre]

Those country cost less because there is no repercussions if the doctor does them wrong. No malpractice costs and no medical insurance cost for the doctor. So bringing them here wont do crap.

No, those countries cost less because literally EVERY SINGLE WIDGET, PRODUCT, SERVICE, MATERIAL involved is way cheaper.

Those countries cost less for the EXACT SAME REASON why a pair of underpants, or a dvd player made in Canada would cost 5 or 10 times what a pair made overseas would cost.

[Michael Hardner]

CANADA

CAN

NOT

COMPETE.

Like I said, how hard can it be to bring over non-Canadians to fill these roles ?

Lobbying can't make problems go away, and somebody needs to point that out.