Finest Medicare in the World?

[Scotty]

All the time huh? Well , we both know that isnt true

We do, do we? And how do "we" know that? The government's own statistics show average waiting periods, at least in Ontario, which is far from the bottom of the pile, of 6-12hr across the province. I've personally experienced 10hr waits with others on three occasions, all for broken limbs. A friend from Quebec spent much of the day and night at a hospital across the river trying to get her son, who had a high fever, seen. She finally gave up and came across to our side.

Six seconds, but probably 20 minutes of trying to find the perfect link to attempt to make a point.

I meant what I said. Arguing the quality of health care with a zealous, `rah-rah` booster of Canadian health care isn't worth much effort since nothing, absolutely nothing will ever convince them we don't have the finest, most shining, most perfect system the planet has ever or will ever know.

Im guessing you didnt think anyone would bother to read your link.

Let me translate.

People entered the queue as "office contacts" means lardass was seen by their Dr....and the Dr. realized lardass was being lazy on the diet attempts.....start the clock now on lardass getting in for surgery, and it'll be some time too.....not many hoists in hospitals to get lardass up and on a table.

I'm curious, as an aside, why do you hate obese people? It's not that I approve or really understand how people get that obese. But clearly you have a real hate for them, to the point you don't give a damn if they die or not.

In any event, it was the first I came across, and since it mentioned years, which flatly contradicted your statement that no Canadian waits years for necessary surgery, I thought it more than adequate.

Wait times

[guyser]

I think you mis-read , or I wasnt clear, what I said Wild Bill.

Guyser, there's some truth in what you say but it hardly covers the entire story. I've sat a number of times for hours in a Hamilton ER and seen what goes on.

No doubt, as I have too .

I wasnt arguing that it didnt occur, I was just not buying the line that its as horrible a scotty wanted to portray. The hyperbolic reasons he presented were anathema to a system that has problems but does work fairly well.

Do you have any kids yourself? If so, surely you know that kids NEVER run a fever during office hours! That eliminates going to a walk-in clinic. There's no other alternative than ER. What's more, a high fever is usually not that serious but it CAN be something like meningitis! So what else is a patient to do?

Call E-Health or whatever the hotline is. Learn better parenting skills.

Look WB, I am under no illusions some people will have to go to ER at times, but lets both acknowledge that some parents are horrible at what they do, lousy at figuring out what they should do, and far too many just say "oh well, ER is open" Hell, my own aunt was either letting her kids swallow an entire medicine cabinet or running off to the ER cuz her son (my cousin) sneezed. Not a joke at all. (all true too-the woman was just plain dumb)

What's more, refer to my opening post. The story was NOT about some lardass with the sniffles! Even if the 'lardasses' were clogging up the ER system surely after the DAYS she spent in the hallway they could have found her a real bed!

No no, I was not referring to your op with the lardass talk.

That was directed at scotty's post and his 'proof' there is a problem cuz some people wait over a year for surgery. His example was bariatric surgery, or what I call lardass getting his stomach stapled or the band put on. Of course I didnt suggest they either staple his stomach or cut off the arms as a cheaper alternative. But he was right, it does take over a year, and to me at least for that type of surgery, I have no problems with it.

I make no comment on your friends condition.

Accepting that it's all the fault of frivolous visits is sure a great excuse to let politicians off the hook, however. If you're waiting for 10 hours with your leg hanging off they can just duck the issue and do absolutely nothing!

"There is no problem! The system is perfect! It's just that some lardasses are abusing it! Of course, we are not going to turn the lardasses away ourselves! We're civil servants and can't do that!"

Its not the frivolous visits that are our problem per se. But if we start there then we can make some headway couldnt we? The med community has Telhealth Ontario for people to call in and discuss health issues with a nurse.

I have not nor will make the problems of our system the fault of Jenny's sniffles or other frivolous visits and sure as hell wont let politicians off for such silly reasons. But I mock anyone who comes up with silly arguments using gastric banding as the point man for our problems in health.Thus my lardass comments.

So how do we fix the problem, Guyser? Seems to me you've left only one possible solution. Since we know that the hospital folks can't turn any citizen away then I guess we'll have to do it ourselves. If we are in emergency we will have to point out the lardasses and tell them "Hey! You're clogging up the system for the rest of us! Get the hell out of here!"

Assuming that they are in much worse physical shape than ourselves, we will probably have to shove them outside ourselves. This should leave lots of spaces for REAL patients!

I'm curious, however. If we're wrong about a lardass having just a case of the sniffles and they actually die from something serious, could we be sued?

We do need to to turn some people away. I bet we all agree there. It isnt easy but we should do it.

Again, lardass isnt in the ER for gastric banding, but may be due to complications arising from obesity, from a heart attack to stroke to diabetes, and the only proper place for lardass IS at the ER.

Fix the problem? Not sure I know how, not sure I know what all the problems are, but I know we have plenty of them.

That said, we could start by getting accurate wait times, no....not for banding, but honest wait times and use that measurement to see the whys and whats that we have.

We have a lack of Dr's in Orangeville , Parry Sound , and plenty other places. Lets find out why?

Lets look at the College of Physicians and Surgeons, lets look at the rules the CMA operates under, lets look at the availibility of Dr's from other countries that live here doing other jobs.

And before anyone gives me the high hat about "Do you wannna let your kids see a Dr from Romania or some other poor nation?" ....just know this. Canadian born and bred kids are studying in Romania and other poor nations as we speak . And when they graduate they are coming back home and opening in an office near you !

Indian and Iranian Drs are well trained. (I had an Iranian Dr as a kid) Its is the CMA et al who control who can be a Dr and they make the rules up for what seems like no apparent reason except to keep others out and the pay higher.

WB, you were an electronic genius in an earlier life (well maybe you still are) and if some young man from some far off country that you knew didnt have the same electronics exposure you would want came and asked for a job, you would hesitate.

But then you go....hey kid, travel with me while I make the rounds this week. Lets see what you know. You , I am betting, would easily be able to figure out if the young man had the chops.

So , lets replace this with a Dr from India or whereever.

A Doc wants to come to Canada. Ok....

heres the rules.

1) You report to Orangeville Hospital (dictates where they live by way of this)

2) You will be assigned to Dr. Smith for 6 months.

3) Your pay will be minimal (in Drs terms)

4) You will be assessed daily, weekly monthly for the next six months.

5) Exemplary report and you will be transferred to a region needing family Docs.

6) Less than exemplary and you will be re-assigned for another 6 month term.

Yes I know a Dr isnt the same as many professions as the outcomes can be horrible , but is that a reason to just not even try?

To your last question , yes anyone can be sued and many cases are frivolous, including Drs.

It isnt losing the lawsuit thats expensive, its the cost of defence, even if it doesnt progress beyond dicovery.

[guyser]

We do, do we? And how do "we" know that?

Personal anecdotes.

I meant what I said. Arguing the quality of health care with a zealous, `rah-rah` booster of Canadian health care isn't worth much effort since nothing, absolutely nothing will ever convince them we don't have the finest, most shining, most perfect system the planet has ever or will ever know.

I'm looking around and cant find that person. Wann point that person out to me?

Our system has problems, and they will only get worse as the whole of us age. But , and we all have them, my personal interaction with the med community suggests we do have one of the finest and amazing system on the planet.

I spent 3 years in a Hospital ....daily. I knew everyone who worked at St. Joe's down on the Lakeshore. From the ICU to the dialysis clinic to the post op for heart surgery room to the regular nurses on the nephrology unit floor. I knew them by name and they new me by name. I wasnt the patient.

The care rec'd was exemplary, caring, and not the slightest bit frustrating. (Heres a free hint....feed the nurse's station with chocolate, fruit and cookies and the worlds your oyster)

The patient ran the gamut too.....

-Aneurysm

-renal failure

-triple bypass

-hospital super virus

-thrombosis

....and I could list a few more. And you know, if I had been asked if a procedure was to be done, I would have said no. Dont waste the money .The triple by-pass I did question , and the reply was it was needed. If the drive train cant be fixed, why work on the headers now ?

I'm curious, as an aside, why do you hate obese people?

I dont. They didnt call me 'Lumpy' growing up for nothing.

In any event, it was the first I came across, and since it mentioned years, which flatly contradicted your statement that no Canadian waits years for necessary surgery, I thought it more than adequate.

Wait times

scotty , all mocking from me aside, it still doesnt contradict my statement.

That example mocks your own assertion.

Yes, it is deemed 'necessary'..........but nothing is happening to worsen the situation , you know, except for lardass stuffing tim bits in his craw every thirty seconds.

[Wild Bill]

I think you mis-read , or I wasnt clear, what I said Wild Bill.

No doubt, as I have too .

I wasnt arguing that it didnt occur, I was just not buying the line that its as horrible a scotty wanted to portray. The hyperbolic reasons he presented were anathema to a system that has problems but does work fairly well.

Call E-Health or whatever the hotline is. Learn better parenting skills.

Look WB, I am under no illusions some people will have to go to ER at times, but lets both acknowledge that some parents are horrible at what they do, lousy at figuring out what they should do, and far too many just say "oh well, ER is open" Hell, my own aunt was either letting her kids swallow an entire medicine cabinet or running off to the ER cuz her son (my cousin) sneezed. Not a joke at all. (all true too-the woman was just plain dumb)

No no, I was not referring to your op with the lardass talk.

That was directed at scotty's post and his 'proof' there is a problem cuz some people wait over a year for surgery. His example was bariatric surgery, or what I call lardass getting his stomach stapled or the band put on. Of course I didnt suggest they either staple his stomach or cut off the arms as a cheaper alternative. But he was right, it does take over a year, and to me at least for that type of surgery, I have no problems with it.

I make no comment on your friends condition.

Its not the frivolous visits that are our problem per se. But if we start there then we can make some headway couldnt we? The med community has Telhealth Ontario for people to call in and discuss health issues with a nurse.

I have not nor will make the problems of our system the fault of Jenny's sniffles or other frivolous visits and sure as hell wont let politicians off for such silly reasons. But I mock anyone who comes up with silly arguments using gastric banding as the point man for our problems in health.Thus my lardass comments.

We do need to to turn some people away. I bet we all agree there. It isnt easy but we should do it.

Again, lardass isnt in the ER for gastric banding, but may be due to complications arising from obesity, from a heart attack to stroke to diabetes, and the only proper place for lardass IS at the ER.

Fix the problem? Not sure I know how, not sure I know what all the problems are, but I know we have plenty of them.

That said, we could start by getting accurate wait times, no....not for banding, but honest wait times and use that measurement to see the whys and whats that we have.

We have a lack of Dr's in Orangeville , Parry Sound , and plenty other places. Lets find out why?

Lets look at the College of Physicians and Surgeons, lets look at the rules the CMA operates under, lets look at the availibility of Dr's from other countries that live here doing other jobs.

And before anyone gives me the high hat about "Do you wannna let your kids see a Dr from Romania or some other poor nation?" ....just know this. Canadian born and bred kids are studying in Romania and other poor nations as we speak . And when they graduate they are coming back home and opening in an office near you !

Indian and Iranian Drs are well trained. (I had an Iranian Dr as a kid) Its is the CMA et al who control who can be a Dr and they make the rules up for what seems like no apparent reason except to keep others out and the pay higher.

WB, you were an electronic genius in an earlier life (well maybe you still are) and if some young man from some far off country that you knew didnt have the same electronics exposure you would want came and asked for a job, you would hesitate.

But then you go....hey kid, travel with me while I make the rounds this week. Lets see what you know. You , I am betting, would easily be able to figure out if the young man had the chops.

So , lets replace this with a Dr from India or whereever.

A Doc wants to come to Canada. Ok....

heres the rules.

1) You report to Orangeville Hospital (dictates where they live by way of this)

2) You will be assigned to Dr. Smith for 6 months.

3) Your pay will be minimal (in Drs terms)

4) You will be assessed daily, weekly monthly for the next six months.

5) Exemplary report and you will be transferred to a region needing family Docs.

6) Less than exemplary and you will be re-assigned for another 6 month term.

Yes I know a Dr isnt the same as many professions as the outcomes can be horrible , but is that a reason to just not even try?

To your last question , yes anyone can be sued and many cases are frivolous, including Drs.

It isnt losing the lawsuit thats expensive, its the cost of defence, even if it doesnt progress beyond dicovery.

Okay, you're making more sense to me now. Except I think you're missing something about your suggestion to qualify a foreign trained doctor.

You see, at least here in Ontario, the government doesn't want any more doctors! Way back in Bob Rae's time they figured out that limiting the number of doctors was an easy and not too obvious way to reduce OHIP medicare billings.

First, he limited the number of student openings at medical school. Then he put a billing cap on what doctors could charge. All along the government had control in that every doctor needs a billing number to be able to charge OHIP. No new billing numbers, no new doctor charges!

This game has worked great so far! The billing cap was an easy sell. It was based on GROSS dollars and not net income. Since the average person doesn't understand the difference it sounded like it was a way to keep greedy doctors from becoming millionaires. When a doctor hit the cap of course he wasn't going to accept any new patients or spend any more time with his existing ones.

All governments since that of Bob Rae have left his changes in place!

If more people had access to a family doctor then the Ontario government would have to pay more into the medicare budget. Meanwhile, we literally have hundreds of thousands of Ontarioans in Ontario without a family doctor!

THAT's a big part of the reason so many go to ER! They have to use ER as a substitute for a family GP!

[guyser]

Meanwhile, we literally have hundreds of thousands of Ontarioans in Ontario without a family doctor!

THAT's a big part of the reason so many go to ER! They have to use ER as a substitute for a family GP!

Agreed 100%

[guyser]

You see, at least here in Ontario, the government doesn't want any more doctors! Way back in Bob Rae's time they figured out that limiting the number of doctors was an easy and not too obvious way to reduce OHIP medicare billings.

First, he limited the number of student openings at medical school. Then he put a billing cap on what doctors could charge. All along the government had control in that every doctor needs a billing number to be able to charge OHIP. No new billing numbers, no new doctor charges!

All governments since that of Bob Rae have left his changes in place!

That was changed in 2000 Wild Bill.

40 more slots for Dr.'s every year in Ont Med schools , even more now with the opening awhile ago of the NOSM. (Northern Ont School fo Medicine.)

[wyly]

If more people had access to a family doctor then the Ontario government would have to pay more into the medicare budget. Meanwhile, we literally have hundreds of thousands of Ontarioans in Ontario without a family doctor!

THAT's a big part of the reason so many go to ER! They have to use ER as a substitute for a family GP!

I'd really question that...people go to er's usually because walk-in clinics are closed and even if they have an MD their not likely to get in on short notice, if people have no MD they're more likely to go to a walk-in...my MD's office hours are open 6hrs per day so the other 18hrs it's walk-in clinics and when they close the ER...

[dre]

I'd really question that...people go to er's usually because walk-in clinics are closed and even if they have an MD their not likely to get in on short notice, if people have no MD they're more likely to go to a walk-in...my MD's office hours are open 6hrs per day so the other 18hrs it's walk-in clinics and when they close the ER...

I got to the walkin even though I have a family doctor because I can show up there an see someone within an hour with no appointment.

[Wild Bill]

That was changed in 2000 Wild Bill.

40 more slots for Dr.'s every year in Ont Med schools , even more now with the opening awhile ago of the NOSM. (Northern Ont School fo Medicine.)

2000? Man, I really gotta get out more!

[Michael Hardner]

Ontario increased health care funding by about $9 Billion under McGunity. Some much-watched waiting lists have declined but others have increased. It has not resulted in any dramatic improvements.

I believe I have posted the waiting list data that Ontario posted for the past year. There was no marked improvement or decline, but the waits do NOT meet the targets set forth by the government.

If we take this as a model for the country, increasing health funding by $30 billion across the country would also not result in dramatic improvements. We'd have to look at something like a $60-$100 billion annual spending increase to be reasonably sure we'd get marked improvements.

This is because we're not focussed on costs, only wait times. You can keep shoveling money in but where is that money going ? What is really happening ?

Managers aren't succeeding, so the time has come for them to open up the books and explain what is happening.

[Michael Hardner]

Six seconds of googling brought the following:

Scotty - Google is a terrible place to find health stats, unless it leads you to one of the performance statistics sites from the Ministries of Health or CIHI - Canadian Institute for Health Information.

If you have good links, please share them.

[Michael Hardner]

I dont think most people are doing that. Most people realize that theres some problems with our system, and that some of the wait times are not acceptable to a lot of people.

They're not acceptable to the governments themselves, at least the government of Ontario where I live.

But in general I think we get roughly the value we should get for what we spend. Iv been watching over the years stats on how much country spends, and where they get ranked, and Iv seen Canada everywhere from 4th to 30th in rankings. If you look at what we spend we're about 15th.

Found some stats right here.

# 1 United States: 4,271

# 2 Switzerland: 3,857

# 3 Norway: 3,182

# 4 Denmark: 2,785

# 5 Luxembourg: 2,731

# 6 Iceland: 2,701

# 7 Germany: 2,697

# 8 France: 2,288

# 9 Japan: 2,243

# 10 Netherlands: 2,173

# 11 Sweden: 2,145

# 12 Belgium: 2,137

# 13 Austria: 2,121

# 14 Canada: 1,939

# 15 Australia: 1,714

# 16 Finland: 1,704

# 17 Italy: 1,676

# 18 United Kingdom: 1,675

# 19 Israel: 1,607

# 20 Ireland: 1,569

Good list, but you need to source that with a link.

Also, we need ONGOING stats to see how performance (and costs) are doing. Once-in-awhile surveys and articles don't cut it.

[Michael Hardner]

We do, do we? And how do "we" know that? The government's own statistics show average waiting periods, at least in Ontario, which is far from the bottom of the pile, of 6-12hr across the province.

Scotty - I agree completely.

One thing we can do here on MLW to improve the debate is use the government's own stats. Nobody can argue then that these are "acceptable" as you can see from the GTA numbers below (and these are rolled up into provincial at the top) that the numbers are simply not being met.

Wait Times for GTA ERs

I meant what I said. Arguing the quality of health care with a zealous, `rah-rah` booster of Canadian health care isn't worth much effort since nothing, absolutely nothing will ever convince them we don't have the finest, most shining, most perfect system the planet has ever or will ever know.

And they will keep arguing that until we're 1% "better" than the US system. It's odd, though, since these people are so against US healthcare yet that's the only yardstick they use. They do it because they're quietly fighting against the private option. But by defending a declining system, and not offering any options - they're effectively ensuring that the US system will eventually be adopted here.

Edited March 20, 2011 by Michael Hardner

[Michael Hardner]

Fix the problem? Not sure I know how, not sure I know what all the problems are, but I know we have plenty of them.

That said, we could start by getting accurate wait times, no....not for banding, but honest wait times and use that measurement to see the whys and whats that we have.

Guyser - the problem starts and ends with you. You want accurate wait times - but have you looked ? Do you know that the Ontario government has started posted trends on wait times ? Do you know the morass that is healthcare information in Canada ?

If you're just waiting for somebody to deliver better wait time data, then it won't happen. You should demand it. Talk about it with your friends, on facebook, write your MPP. Talking about problems brings sunlight and sunlight is the best disinfectant.

[Scotty]

Managers aren't succeeding, so the time has come for them to open up the books and explain what is happening.

I wonder how much of the cost is because of the insurance system method we use to pay for things. Ie, every time you go to a hospital or to a doctor, they have to draw up an invoice listing every single thing they did and everything they gave you and bill your insurance company, even if it is the government. I wonder if it wouldn't be cheaper to just put them on salaries. What is the point, given the government pays for everything anyway, to have all this accounting so that the government insurance corporation can be the government hospital corporation? I wonder what the cost savings would be if the hospitals and nursing homes and clinics didn't have to keep an itemized accounting breakdown of everything they did for each individual patient.

[Scotty]

Scotty - Google is a terrible place to find health stats, unless it leads you to one of the performance statistics sites from the Ministries of Health or CIHI - Canadian Institute for Health Information.

If you have good links, please share them.

Unfortunately, the provincial ministries don't seem eager to share a lot of information. Generally, you need to plug in the hospital, and the particular surgical or medical procedure, and then it will give you the wait time for that and only that. To get wait times all across the board seems more difficult, not to mention across the country. Where are wait times in Canada the worst? I don't know. I hear nothing good about Quebec, though. I did come across this, but certain people will gag on it because it's from Satan, yes, Satan himself. It does go across the country, but only 12 broad categories are listed. Within each category, some procedures will have much longer or much shorter waits.

he Fraser Institute’s twentieth annual waiting list survey finds that province-wide wait times for surgical and other therapeutic treatments have increased in 2010. The total waiting time between referral from a general practitioner and delivery of elective treatment by a specialist, averaged across all 12 specialties and 10 provinces surveyed, has risen from 16.1 weeks in 2009 to 18.2 weeks in 2010. Compared to 1993, the total waiting time in 2010 is 96 percent longer.

Waiting Times in Canada

[Michael Hardner]

I wonder how much of the cost is because of the insurance system method we use to pay for things. Ie, every time you go to a hospital or to a doctor, they have to draw up an invoice listing every single thing they did and everything they gave you and bill your insurance company, even if it is the government.

Actually, that's one of the factors that's usually brought up in explaining why the US system is more expensive.

[Michael Hardner]

Unfortunately, the provincial ministries don't seem eager to share a lot of information. Generally, you need to plug in the hospital, and the particular surgical or medical procedure, and then it will give you the wait time for that and only that.

Even then, the Ontario government is giving us more than they have in the past.

To get wait times all across the board seems more difficult, not to mention across the country. Where are wait times in Canada the worst? I don't know. I hear nothing good about Quebec, though. I did come across this, but certain people will gag on it because it's from Satan, yes, Satan himself. It does go across the country, but only 12 broad categories are listed. Within each category, some procedures will have much longer or much shorter waits.

The Fraser Institute’s twentieth annual waiting list survey finds that province-wide wait times for surgical and other therapeutic treatments have increased in 2010. The total waiting time between referral from a general practitioner and delivery of elective treatment by a specialist, averaged across all 12 specialties and 10 provinces surveyed, has risen from 16.1 weeks in 2009 to 18.2 weeks in 2010. Compared to 1993, the total waiting time in 2010 is 96 percent longer.

Waiting Times in Canada

You won't find buy-in from a lot of people using Fraser Institute information.

This is the site that contains the best data I have found:

http://cihi.com/CIHI-ext-portal/internet/EN/Home/home/cihi000001

The Canadian Institute for Health Information (CIHI) is an independent, not-for-profit organization that provides essential information on Canada’s health system and the health of Canadians.

[guyser]

I wonder how much of the cost is because of the insurance system method we use to pay for things. Ie, every time you go to a hospital or to a doctor, they have to draw up an invoice listing every single thing they did and everything they gave you and bill your insurance company, even if it is the government.

My understanding is they dont graw up an invoice everytime. FOr the most part when you are swiped in that verifies your in the system, then your treatment is coded which includes the itmes needed.

Do you know with clinics , if you are a patient of a clinic your Doc gets paid a stipend even if you dont come in . On the other hand if you go to another clinic the Ministry claws back some funds from the Dr.

I wonder if it wouldn't be cheaper to just put them on salaries. What is the point, given the government pays for everything anyway, to have all this accounting so that the government insurance corporation can be the government hospital corporation?

Not a chance.

Efficient operation of a Dr office means the better ones make money.