It Doesn’t Take A Political Genius To Fix A Medica

[JOVIAC]

Canada’s medical services are shooting somewhere between bogy and double bogy golf, in other words, way over par. But since it’s already out to lunch on the golf course maybe it can find a fix there. Did I lose some of you non golfers yet? Just stay with me a little longer… I’m getting to the point.

Everyone knows that business and golf go hand in hand, and what our Healthcare system really needs is some sound business advice. No, I’m not talking about a 2 tier system, at least not yet, but I am talking about EFFICIENCY.

There is no business in the world that can survive when it becomes drastically inefficient. This obviously is what’s happening, or should I say happened, with Healthcare. Just listen to the complaints: long lines, slow treatment, under staffed facilities, and more and more patients because of our aging population.

A business does not fix an inefficient problem with cash. In fact the very nature of inefficiency means it is already taking more money to do the job correctly. A business would look at this problem like this. If it were operating at 50% efficiency then it is only doing half of what its capacity is. Capacity means you can produce or process a certain number of units without expanding your factory size, purchasing extra factory equipment, or hiring more employees. For Healthcare, this means without more doctors, MRI machines, or hospitals, our system could be treating many more patients. Ok, this doesn’t come to any big surprise. We have all waited at emergency at sometime in the last few years till all hours in the morning getting a first hand glimpse at the bottled necked system. But the real question is how do we change it?

A good business would hire an efficiency expert. They would come in and find ways to increase the output without hindering quality. The fact of the matter is this would reduce the marginal costs. It would actually save more money. This is exactly what all hospitals need. They should create a full time efficiency position. Hire some MBA’s. Get them to ‘crack the whip’ so to speak. You can bet the ‘for profit’ systems do exactly this.

What I’m really sick of is the political chatter year after year. Every politician has the answers during an election year, but has anyone actually fixed the system? We have seen what happens when more money is infused into the system. Nothing! Some mysterious black hole swallows it up… cough cough… see the sponsorship scandal, gun registry or other federal fiascos! It’s not going to take a political genius to fix a medical problem, or what I’m really suggesting is an efficiency problem. Follow the business model and get our Healthcare system back to full capacity.

But what do I know… I’m Just One Voice In A Crowd.

-JOVIAC-

http://spaces.msn.com/members/joviac/

[Yaro]

Your post betrays a dramatic misreading of the current reality as it applies to medical care in Canada.

There is no business in the world that can survive when it becomes drastically inefficient. This obviously is what’s happening, or should I say happened, with Healthcare. Just listen to the complaints: long lines, slow treatment, under staffed facilities, and more and more patients because of our aging population.

None of the items you listed in this paragraph are issues of efficiency, in fact they are just the opposite.

Long Lines, slow treatment

As any efficiency expert will tell you long lines are a sign of efficiency, they are a primary signal of low downtime. Systems with no lineups are the ones that tend to be inefficient as workers have a great deal of downtime.

Understaffed Facilities

Understaffed medical facilities will result in increased efficiencies so long as they don't result in the disuse of property (something that has happened) or less then optimal use of other resource types (something that hasn't happened). Thus so long as efficiency is limited by other factors (equipment and space) there isn't really any argument for "understaffed Facilities. Although there are inefficiencies created by the disuse of facilities primarily operating bays, this is a sign of under funding not systematic dysfunction.

A business does not fix an inefficient problem with cash. In fact the very nature of inefficiency means it is already taking more money to do the job correctly. A business would look at this problem like this. If it were operating at 50% efficiency then it is only doing half of what its capacity is. Capacity means you can produce or process a certain number of units without expanding your factory size, purchasing extra factory equipment, or hiring more employees. For Healthcare, this means without more doctors, MRI machines, or hospitals, our system could be treating many more patients. Ok, this doesn’t come to any big surprise. We have all waited at emergency at sometime in the last few years till all hours in the morning getting a first hand glimpse at the bottled necked system. But the real question is how do we change it?

This paragraph is the heart of your misunderstanding of our problem.

The healthcare system in Canada has been rated by the WHO as being near the best in the world in efficiency. Once again long lineups are a sign of an efficient system. Every major indicator of high levels of efficiency and critical outcome effectiveness such as long life expectancy are at close to the highest levels in the world.

While it could be argued that Canadians as a whole have become used to an unsustainable level of healthcare as supported by massive borrowing in the 70's and 80's it is far more likely that budget cuts taken to deal with the massive deficits created during that time has created a circumstance where all Canadians have to make due with less. Your anger is more appropriately directed at the people who put Trudeau and Mulroney into office (although Trudeau did have some excuses for his spending).

A good business would hire an efficiency expert. They would come in and find ways to increase the output without hindering quality. The fact of the matter is this would reduce the marginal costs. It would actually save more money. This is exactly what all hospitals need. They should create a full time efficiency position. Hire some MBA’s. Get them to ‘crack the whip’ so to speak. You can bet the ‘for profit’ systems do exactly this.

The medical system is regularly overviewed by efficiency experts, as I said before our numbers are solid it is the expectations that are the issue. As to the value of MBA's, they aren't worth the scrap of paper that supposedly qualifies them. There is no single educational stamp used in society today as uselessly overblown as the MBA.

What I’m really sick of is the political chatter year after year. Every politician has the answers during an election year, but has anyone actually fixed the system? We have seen what happens when more money is infused into the system. Nothing! Some mysterious black hole swallows it up… cough cough… see the sponsorship scandal, gun registry or other federal fiascos! It’s not going to take a political genius to fix a medical problem, or what I’m really suggesting is an efficiency problem. Follow the business model and get our Healthcare system back to full capacity.

That is because there is no simple answer, there is no real problem with the system that can be easily fixed. As for the sponsorship scandal, well that’s a miniscule amount of money, an amount so small it would have no appreciable effect on the medical system which requires an increase of between 20-25 billion dollars a year to begin meeting the expectations of the majority of Canadians.

[mirror]

Yaro

What's the matter, having trouble paying off your MBA student loan?

[BHS]

JOVIAC and Yaro:

Great posts. You've given me a lot t think about.

[mirror]

BHS

I agree it is a good dialogue going on here.

[Renegade]

Everyone knows that business and golf go hand in hand, and what our Healthcare system really needs is some sound business advice. No, I’m not talking about a 2 tier system, at least not yet, but I am talking about EFFICIENCY.

It's hard to compare healthcare to a business. With a business, for the most part the goal is a profit. What is the goal for our healthcare system? Keeping people alive the longest, the best healthcare service, having the healthiest population, or spending the least while still having what the population considers acceptable care?

I'm not sure we all even agree on the goal. Depending upon what the goal is, the actions required to change the system vary.

If the goal is "spending the least while still having what the population considers acceptable care", then I'm probably ok to wait 4 hours in emergency for treatment because I only do it once every couple of years, and I'd rather wait 4 hours than pay an additional $1000/year in additional taxes.

How do we measure efficiency when we haven't stated the goal?

[ian5]

In many ways the problem with our health care system is us. As a society we have listened far too long and too frequently to commercials and advertisements selling us poor health. There is a cost attached to the way we eat, act and behave. We have an incredible amount of scientific studies and reports that show that our eating patterns and activity levels are not healthy. We spend a great deal of money treating medical problems that could to some degree have been prevented. I know that eating the food that I eat is not healthy, but I still eat it. Anyways, I think it is a tragedy that we are forced to spend so much on healthcare merely because we (and I definitely include myself in this category) are not smart enough to prevent it. If we looked after ourselves we could focus on helping people with real illnesses.

My thoughts.

Ian

[mirror]

Good points. The fundamental problem with the health care system is that the incentives are designed to keep you sick, hooked on the system with drugs, tests, etc. That's the problem when we allow the corporate (read: pharmaceutical industry) community to take over.

Somehow we need to reverse the situation and the major health care focus should be on preventing illness and the use of drugs. Perhaps doctors should be paid based on how well their patients are, instead of the number of sick patients they have or see.

Put the nurses in charge and we would see a drastically different and healthier medical system. Why do you think we have all this pressure on our government system? It is coming primarily from the rich doctors, the people who run the system.

Like cigarettes, OUTLAW FAT PEOPLE, I say!

[err]

Canada’s medical services are shooting somewhere between bogy and double We have all waited at emergency at sometime in the last few years till all hours in the morning getting a first hand glimpse at the bottled necked system.  But the real question is how do we change it?

<{POST_SNAPBACK}>

I've sat with my children in emergency for hours, with one doctor coming in every half hour and seeing one of the 16 people waiting in line... There is a serious problem with understaffing at our hospitals. We need to hire more doctors... it doesn't take a genius to figure that out ...

And why don't we have more doctors.... because they are not paid well enough, and hence disappear to the USA where they are paid better for treating the priveleged few.

We all hear about health care costs going way up. And the province's books will show you that this is a truth. In Ontario, the Harris/Eves Tories claimed on their way out, that they spent more than any previous government in Ontario on health care. The sickening part is, that this is partially true. They paid for construction companies (who donated to their party) to tear down wings of hospitals. They paid for construction companies to build new wings on hospitals, new emergency wards, etc... A lot of money was spent on buildings, but I'm afraid not a whole lot more on doctors and nurses.

One of Ontario's largest health care providers is Ellis-Don Construction.... (yes, the same Ellis Don who was the leader of the Ontario Liberal party...)

Our health care system is still less than half of the price per capita of the US system, and they have 40 million people with no health insurance. They have millions of people afraid to lose their jobs because they will lose their health insurance....

We probably dont need to throw too much more money at it...but we shouldn't be afraid to do what needs to be done. The big thing is that the spending needs to be monitored. We need to spend the money on health care - Doctors and nurses.... not buildings, built by friends of politicians....

[Guest eureka]

One step that would go a long way would be to reduce the paperwork of Doctors. I heard one specialist talking of that aspect of practise and saying that it would not be too difficult for doctors to see 10% more patients if unecessary office work were not a requirement.

That 10% would, he was talking of Northern Ontario, completely fill the shortage of doctors there. Obvioulsy, the impact on shortages would be even greater in less remote regions.

Waiting times at hospitals would equally obviously, become manageable.

[BHS]

Wouldn't allowing some services to be performed in private facilities take pressure off of the public system? Why do we have to be the only democratic country in the world that insists on government control over health care?

[mirror]

Wouldn't allowing some services to be performed in private facilities take pressure off of  the public system? Why do we have to be the only democratic country in the world that insists on government control over health care?

<{POST_SNAPBACK}>

Because we have the best system in the world and we don't want to go slumming with the US, and other countries who don't have as good a system as we have. Why do you think Toyota recently located their plant here?

[err]

Wouldn't allowing some services to be performed in private facilities take pressure off of  the public system? Why do we have to be the only democratic country in the world that insists on government control over health care?

<{POST_SNAPBACK}>

If you wanted to pay more money to a private system, sure, it would, at first, appear to take pressure off the public system. However, since the private system is "for profit", and given equal pay to the doctors, the private system will cost more for the same service. Then there is less money left for our public system... So why not just pay what it costs to do it in the PUBLIC system.

Instead of giving all of our tax dollars to corporate Canada in tax cuts, lets spend some of our tax dollars on doctors and nurses. Corporate Canada pays 4% less in taxes than their American counterparts... and a lot less than personal tax rates in Canada. Instead of giving further tax cuts to the corporations at the expense of our medical system, lets tell Paul Martin that our health care is number 1....

His email address is [email protected]

[Renegade]

However, since the private system is "for profit", and given equal pay to the doctors, the private system will cost more for the same service. Then there is less money left for our public system

I'm not following your logic on how having a private system for some services leaves less money in the public system. Please explain.

[Yaro]

Wouldn't allowing some services to be performed in private facilities take pressure off of the public system? Why do we have to be the only democratic country in the world that insists on government control over health care?

I am in no way morally opposed to private health care, my personal interest are in the most effective system.

Unfortunately to a large extent we are being deceived by a large lobby that is pushing private health care for there own economic benefit. I have no problem with the notion of people making a buck where they can but a few interesting facts about our health care system.

1. We spend a little over half as much as the US does per capita in total (public + private money)

2. Our critical care outcomes are in most cases BETTER then theirs.

3. A study done by the US government in 1998 found that Canada's health care administrative overhead was at just about 2%, while the US administrative overhead was almost 12%. Although our overhead has risen to 5.5% in the last 7 years.

4. We pay our health care professionals almost twice as much as they would earn in Europe, and still a little less then they would earn in the US.

5. The US leaves a total of almost 80 million people (including illegal immigrants*) uncovered by medical care.

I am of the opinion that public or private isn't really relevant, what is relevant is the fact that all of the world’s top systems are 90%+ public.

It’s unfortunately a circumstance where the voice of self interest dominates, and in this case those with the most to gain are on the side of the generally less efficient private care facilities.

It should be noted though that to a great extent even a private system in Canada would be far better then the US because of our limits on insurance premiums.

[BHS]

I think a major factor in US health care costs arises from American tort law. While there is an inherently regulatory benefit in allowing patients to sue doctors and pharmaceutical companies over malpractice and drug failures, the awards that have been granted have done little more than to jack the overall costs for healthcare through the ceiling. I don't see the same thing happening in Canada, due to our history of limiting these sorts of awards.

[SirSpanky]

Interesting point. I guess it would depend on where the $$ amount is taken from. Whether from the doctors bill, or the patients cost.

I don't really see it jacking up the figure that much though.

[JOVIAC]

Long Lines, slow treatment

As any efficiency expert will tell you long lines are a sign of efficiency, they are a primary signal of low downtime. Systems with no lineups are the ones that tend to be inefficient as workers have a great deal of downtime.

Yaro - Would you call a corroded pipe an efficient way to transfer water from one container to another? By your definition, because it creates a ‘line-up’ of water before going through the pipe, it should be efficient.

In my opinion, cleaning out the corrosion will transfer a lot more water without the need for another pipe.

Eureka makes a good observation

One step that would go a long way would be to reduce the paperwork of Doctors. I heard one specialist talking of that aspect of practise and saying that it would not be too difficult for doctors to see 10% more patients if unecessary office work were not a requirement.

This is just one of many ways to increase efficiency.

It's hard to compare healthcare to a business. With a business, for the most part the goal is a profit. What is the goal for our healthcare system? Keeping people alive the longest, the best healthcare service, having the healthiest population, or spending the least while still having what the population considers acceptable care?

Renegade - The point to take from the competitive business model is EFFICIENCY. Public systems are inherently inefficient. Why? Because they are run like a monopoly. There is no competition taking away their business, and no consequences for over spending, or mismanaging.

Once again, I’m not ready to suggest a two tiered system for Healthcare. What I am saying is that our public system needs better efficiency control measures, the likes of which for profit competitors in all market places naturally creates. The goal remains the same which is to create the best nationally affordable health for all citizens. Are we there yet? Not a chance. If we were then there wouldn't be any debate.

[err]

I'm not following your logic on how having a private system for some services leaves less money in the public system. Please explain.

<{POST_SNAPBACK}>

Let's explain it this way... You want a pie...

You could go to the bakery and buy the pie, or you could get your mom to make it..... If your mom pays the same amount for her eggs and flour as the bakery does, and because you are a nice guy, you pay your mom for her time making the pie.... Which one is going to cost you more.... I'm not sure you'll get this one so I'll tell you... The bakery wants to make a profit... so they charge a few extra bucks.

Now if you pay the bakery $8 for the pie, or you pay your mom $5 for the pie, which one is going to cost you more....

Now if you take the money out of your wallet to pay for the pie, one of your choices is going to leave you more money to buy whipped cream or whatever else you may need or want.

Now, if you were to take this analogy and apply it to a health-care system, and you have to pay a profit to the private health-care provider, which one will take more out of the provincial wallet.... leaving less money for other people's health care services.....

[err]

Comparison of Efficiency of Private vs. Public

A major part of the diference in efficiencies of the US system vs. the Canadian system is that the US has higher administrative costs. The US system has around 1500 private insurance companies. Each hospital has to devote enormous clerical, professional time and office space... often an entire hospital floor to the job of billing patients and collecting from insurance companies... which all offer different insurance plans... Often more than one insurance company is involved, and it is necessary to assess the amount of payment covered by each insurer, and that owed by the patient.

In Canada, where the provincial government is the only inusurer, the processing of health claims is much less complicated, and less labour-intensive. Add the fact that private insurers take a profit out of their revenues.... In 1987, the administrative costs were beetween $400 and $497 per person (Woodlander & Himmelstien, New England Journal of Medicine, 1991). The equivalent cost in Canada came to $117 to $156 (US) per person. The (American) authors concluded "Reducing our administrative costs to Canadian levels would save enough money to fund coverage for all uninsured and underinsured Americans."

In 1990, Blue Cross of Massachusetts, which provides coverage for 2.7 million subscribers, employed 6682 workers. By contrast, British Columbia managed to administer its health-care system for more than 3 million residents with a much leaner staff.... less than 1 fifteenth of the size.... 435 civil servants.

Excerpt borrowed from Linda McQuaig's "The Wealthy Banker's Wife"

[Renegade]

I'm not following your logic on how having a private system for some services leaves less money in the public system. Please explain.

<{POST_SNAPBACK}>

Let's explain it this way... You want a pie...

You could go to the bakery and buy the pie, or you could get your mom to make it..... If your mom pays the same amount for her eggs and flour as the bakery does, and because you are a nice guy, you pay your mom for her time making the pie.... Which one is going to cost you more.... I'm not sure you'll get this one so I'll tell you... The bakery wants to make a profit... so they charge a few extra bucks.

Now if you pay the bakery $8 for the pie, or you pay your mom $5 for the pie, which one is going to cost you more....

Now if you take the money out of your wallet to pay for the pie, one of your choices is going to leave you more money to buy whipped cream or whatever else you may need or want.

Now, if you were to take this analogy and apply it to a health-care system, and you have to pay a profit to the private health-care provider, which one will take more out of the provincial wallet.... leaving less money for other people's health care services.....

<{POST_SNAPBACK}>

There is a real problem with your analogy. You are assuming that you have the choice of either paying the bakery or your mom. In our system, funding for healthcare is taken forcibly via taxes.

So to relate it to your analogy, you are forced to pay your mom $5 regardless of if you care for her pie or not. But let's say that you got a bonus at work and you had an additional $8 in your wallet. Let's further say that you didn't care much for your mom's pie and that she was too busy to make it right away so you had to wait. Why shouldn't you be able to take your $8, walk to the bakery and buy your pie (as a side effect you are saving your mom some effort)

[BHS]

err and Renegade (re: Renegade's last post):

A couple of additional points I'd like to flesh out:

err's post appears to imply that the public pays for health care service either way. Renegade's post indirectly opposes this statement, by stating that private health care is paid for out of pocket in addition to the taxes paid to cover the public service. I would just like to reaffirm my belief that Renegade is correct. Nobody arguing for a "two tier" system is arguing that public spending on health care should decrease. The argument against the "two tier" system is that this will inevitably lead to a funding shortfall in the public system. I disagree.

Furthermore, I'd just like to emphasized a point in Renegade's post that a major difference betweent the $5 pie and the $8 pie is the wait time. Saving money on pie won't do you much good if you starve to death waiting for it, which is in keeping with the logic behind the Supreme Court's decision in Quebec.

[Argus]

Just to throw this into the mix

International comparison by Fraser Institute

Canada spends more on health care than most European and Asian nations but has some of the longest waiting times and worst access to physicians in the world, concludes a report comparing 27 countries that all guarantee access to health care, regardless of ability to pay.

Spending High, Services Poor

[err]

International comparison by Fraser Institute

Canada spends more on health care than most European and Asian nations but has some of the longest waiting times and worst access to physicians

<{POST_SNAPBACK}>

The Fraser Institute's opinion on social services... That's like asking Hitler for an opinon on Jewish innovation.

[err]

So to relate it to your analogy, you are forced to pay your mom $5 regardless of if you care for her pie or not.  But let's say that you got a bonus at work and you had an additional $8 in your wallet. Let's further say that you didn't care much for your mom's pie and that she was too busy to make it right away so you had to wait. Why shouldn't you be able to take your $8, walk to the bakery and buy your pie (as a side effect you are saving your mom some effort)

<{POST_SNAPBACK}>

Let's get the analogy a little more in line with the situation. If you want the pie, but don't have your own money to pay for it, what are you going to do... Your mom has offered to bake the pie for you. She tells you that if she lends you $8 to buy the pie at the private bakery, there won't be enough money in her wallet to bake a pie for the rest of the family.... What are you going to do... force her to give you the money and make your family starve, or work within a framework that will allow everyone to eat pie...

Alternately, if you do have enough money (of your own) in your pocket to buy a pie at the bakery, then who's stopping you (from going to the USA for your pie)... But it would be ridiculous to ask your mom for a refund on the ingredients she paid for that went into the family pie because you bought your own pie...