Healthcare talks

[Omni]

3 minutes ago, Argus said:

Canada is a vast empty land, but the great majority of the people live in a narrow strip of territory about 100 miles wide along the US border with Ontario and Quebec, and another strip of land along the US border between BC and Winnipeg. So in that sense it's not that big.

That narrow strip is over 4000 miles long.

[Argus]

3 minutes ago, Omni said:

That narrow strip is over 4000 miles long.

Really? That's like, 400,000 square kilometers. Say isn't that pretty much similar to Germany?

[Omni]

9 minutes ago, Argus said:

Really? That's like, 400,000 square kilometers. Say isn't that pretty much similar to Germany?

A little geography lesson for you.

 

Canada (9,984,670 sq km) andGermany (357,022 sq km).

[Argus]

2 minutes ago, Omni said:

A little geography lesson for you.

 

Canada (9,984,670 sq km) andGermany (357,022 sq km).

But that's based on huge tracts of empty tundra and forests and not the 100 by 4000 km territory we were just talking about.

Edited December 21, 2016 by Argus

[Smallc]

And people live in those empty places!  That's what costs so much.

[Omni]

16 minutes ago, Argus said:

But that's based on huge tracts of empty tundra and forests and not the 100 by 4000 km territory we were just talking about.

And scattered all over those tracts are towns and cities that often can't provide the care that seriously injured or ill people need so they must be transported and that costs a lot of money.

[TimG]

1 hour ago, Omni said:

Take a look at what Bryan just posted. We have about one half the population of Germany spread over more than 25 times the area. Proximity to the US border has little to do with anything.

Did you read what I wrote? 80% of Canadians live in urban areas. The land area of where 80% of Canadians live is no bigger than Germany. The question is how much is the cost of providing care to the remaining 20% affects the over all cost of the system. I don't think it is as much of a fact as you claim.

Edited December 21, 2016 by TimG

[Omni]

8 minutes ago, TimG said:

Did you read what I wrote? 80% of Canadians live in urban areas. The land area of where 80% of Canadians live is no bigger than Germany. The question is how much is the cost of providing care to the remaining 20% affects the over all cost of the system. I don't think it is as much of a fact as you claim.

Flying patients around by air ambulance gets expensive.

[TimG]

Just now, Omni said:

Flying patients around by air ambulance gets expensive.

Where is the data to back up that claim? I think the cost is tiny compared to the cost of providing services to the vast majority of the population that live in urban areas.

[?Impact]

1 hour ago, TimG said:

Where is the data to back up that claim? I think the cost is tiny compared to the cost of providing services to the vast majority of the population that live in urban areas.

In Ontario, Ornge costs about $175million/year, and transports around 18,000 patients. That works out to about $9700 per patient transported. While it is a significant cost per patient, it represents less than one half a percent of total health care spending. I can't find numbers for total patient transport in the province, that would be the most relevant to compare to. There are numbers out there for EMS services, usually paid by the municipalities, but they are not relevant for comparison purposes.

 

 

Edited December 21, 2016 by ?Impact

[Argus]

3 hours ago, Smallc said:

And people live in those empty places!  That's what costs so much.

Not very many so it can't cost all that much.

[Argus]

1 hour ago, ?Impact said:

In Ontario, Ornge costs about $175million/year, and transports around 18,000 patients.

That's chump change, and let's be honest, Orange is yet another government program the Liberals completely and utterly screwed up.

[Smallc]

8 minutes ago, Argus said:

Not very many so it can't cost all that much.

It's not all that much in terms of the total, but it takes up a lot more money per person than city dwellers.  Manitoba has something like 30 ambulances for 700K people in Winnipeg, and 160 of them for the 600K outside of the city.

[Omni]

All provinces and territories have air ambulance services contracted out to various operators. I haven't found actual dollar costs but just having their aircraft on standby has to add to the budget costs. And of course it goes up each time they are used.

[Argus]

3 minutes ago, Omni said:

All provinces and territories have air ambulance services contracted out to various operators. I haven't found actual dollar costs but just having their aircraft on standby has to add to the budget costs. And of course it goes up each time they are used.

Do you imagine the Germans and French don't do the same?

[Omni]

1 minute ago, Argus said:

Do you imagine the Germans and French don't do the same?

I'm sure they do, and how much area do they cover?

 

[WestCoastRunner]

Saskatchewan has a budget of around 25 million for air ambulance and services. Their total budget is around 5 billion so yes it is a very small percentage of total budget. 

[Smallc]

33 minutes ago, Argus said:

Do you imagine the Germans and French don't do the same?

Not in the same numbers, no.  Geography and the sparse population outside of Canada's very urban areas is a huge challenge.

[Argus]

3 hours ago, Smallc said:

Not in the same numbers, no.  Geography and the sparse population outside of Canada's very urban areas is a huge challenge.

Evidence?

[Smallc]

Well, CIHI thought so much of it, they put it in the opening paragraph of this report:

Health expenditure per capita varies among provinces/territories because of different age distributions. xii Population density and geography also affect health expenditure, particularly in the case of the territories.

https://secure.cihi.ca/free_products/4.0_TotalHealthExpenditureProvTerrEN.pdf

Canadian Foundation for Healthcare Improvement:

Spending is much higher in the territories than in the provinces, reflecting stark differences in geography, population density, healthcare needs, and delivery models.

http://www.cfhi-fcass.ca/SearchResultsNews/10-02-10/42054d49-16fb-4764-be05-1d03e6ff3bbb.aspx

Canadian Centre for Policy Alternatives

The challenges facing a proposed National Health Care System include: 1) Canada's distinctive geography and demography; 2 )Canada's history and social conditions; 3) the accelerating rate of growth of Canada's health care spending; and 4) its sustainability.

 

- See more at: https://www.policyalternatives.ca/publications/monitor/real-crisis-medicare#sthash.6kkWI5Cu.dpuf

They all seem to feel it's important, but it's hard to come up with numbers.

[Argus]

A doctor's take on improving wait times.

According to a 2013 survey, 15 per cent of Canadian surgeons considered themselves under-employed, and 64 per cent cited poor access to operating rooms. Last year,178 fully trained orthopedic surgeons in Canada were unemployed. Dr. Robert Hollinshead, former president of Canadian Orthopedic Association, found that 80 per cent of residents from his Calgary residency training program left for the United States, largely due to lack of work in Canada.

If orthopedic surgeons were given access to additional “private” operating room time, wait times could be shortened for all Canadians. To ensure that physicians did not abandon the public system, they could be required to work – perhaps 25 to 30 hours per week – in the public system in order to retain their government reimbursement for malpractice insurance.

http://ottawacitizen.com/opinion/columnists/shaver-heres-how-to-reduce-hospital-wait-times-in-canada

[?Impact]

4 hours ago, Argus said:

If orthopedic surgeons were given access to additional “private” operating room time, wait times could be shortened for all Canadians.

Then  create more "public" operating rooms and staff

[Michael Hardner]

How would Canadians even know things are better/worse, more/less efficient ?  There isn't a way to discuss healthcare yet.  Public discourse doesn't include costs or service levels to the point where they are widely understood.

[Bryan]

50 minutes ago, ?Impact said:

Then  create more "public" operating rooms and staff

Easy to say, tough to pay for. The reason that those professionals are unemployed (or under employed) is we ration our care based on ability/willingness to pay. We don't present it as an ability to pay issue the way that we would private care, but it still is. Waiting lists for surgery or diagnostics don't happen because facilities are at capacity, they happen because the budgets don't allow for the capacity to be met.

[Bryan]

19 minutes ago, Michael Hardner said:

How would Canadians even know things are better/worse, more/less efficient ?  There isn't a way to discuss healthcare yet.  Public discourse doesn't include costs or service levels to the point where they are widely understood.

They only know if the service they are getting is up to their expectations. If they have ever received privately delivered care, then they certainly would see a stark difference in efficiency.

As an example, one of my favourite sports medicine clinics* used to be privately owned and run, but it was bought out by the province and is now entirely public. Two things were apparent to the user: 1) Substantially more money was being spent (renovations, expansions, new furniture, more staff, etc) and 2) The efficiency and quality of the service provided dropped off a cliff.

* when you and your kids all play and coach contact sports, you tend to see sports medicine specialists regularly enough to be able to see the difference in the facilities.