Hasten registration of foreign trained medical professionals

[eyeball]

10 minutes ago, SpankyMcFarland said:

Doug Ford met the Maritime premiers on the health care crisis:

https://www.thestar.com/politics/provincial/2022/08/22/status-quo-is-just-not-working-doug-ford-rallies-maritime-premiers-in-push-to-change-how-health-care-is-delivered.html

There is agreement that something has to change, but what? More private delivery of publicly funded care or, dare I say it, more outright private care? I think the latter is coming. 

I could care less if it's private so long as it's still universally accessible and covered by my public medical plan.

[ExFlyer]

7 hours ago, SpankyMcFarland said:

Doug Ford met the Maritime premiers on the health care crisis:

https://www.thestar.com/politics/provincial/2022/08/22/status-quo-is-just-not-working-doug-ford-rallies-maritime-premiers-in-push-to-change-how-health-care-is-delivered.html

There is agreement that something has to change, but what? More private delivery of publicly funded care or, dare I say it, more outright private care? I think the latter is coming. 

 

No, it is private delivery of privately funded care.

What are you going to complain about if this happens (or happens more)? The doctors (and medical staff) now have more choice of where to work.

My best friend (we are in Ontario) is on a waiting list to see a specialist for hip replacement. He has not yet even had the CT/MRI's yet as he has to wait for those. He has been in pain and on pain killing drugs for almost 2 years. Enough was enough. He went to a private clinic in Montreal.  Next week he is getting his hip replacement, for $25K. From time of first consultation to surgery will be 2 months (and that is because he has to wean off the medications).

[eyeball]

3 hours ago, ExFlyer said:

No, it is private delivery of privately funded care.

He went to a private clinic in Montreal.  Next week he is getting his hip replacement, for $25K. From time of first consultation to surgery will be 2 months (and that is because he has to wean off the medications).

Privately provided healthcare can be publicly funded and should be, by the federal government.

[myata]

6 hours ago, ExFlyer said:

Next week he is getting his hip replacement, for $25K. From time of first consultation to surgery will be 2 months (and that is because he has to wean off the medications).

We could have broadly available health insurance contributed by residents and governments for that. But nah too easy. Better have an eternal conversation (and crisis) about don't privatize it horror horror (compare to the status quo a look on the colleague's from Switzerland face after waiting eight hours in ER with a broken foot and it was a decade back) and the next killer solution is here that will fix all our problem: appoint a new federal adviser.

That's the only way it works. It's the only way it knows how to work and it's been a long while since it knew anything else.

Edited August 23, 2022 by myata

[ExFlyer]

2 hours ago, eyeball said:

Privately provided healthcare can be publicly funded and should be, by the federal government.

??

The point is, there is a market for this.

There are doctors that choose to do it in the private sector rather than work in the publicly funded and restrictive sector.

[ExFlyer]

1 hour ago, myata said:

We could have broadly available health insurance contributed by residents and governments for that. But nah too easy. Better have an eternal conversation (and crisis) about don't privatize it horror horror (compare to the status quo a look on the colleague's from Switzerland after waiting eight hours in ER with a broken foot and it was a decade back) and the next killer solution is here that will fix all our problem: appoint a new federal adviser.

That's the only way it works. It's the only way it knows how to work and it's been a long while since it knew anything else.

Sorry, I can never really get what you are trying to convey.

What are you saying??

[myata]

1 minute ago, ExFlyer said:

What are you saying??

OK made easy:

1. Solutions exist.

2. They aren't impossible or terribly difficult.

3. They require non-trivial adaptation and change.

4. That is impossible. In this country. Never happened.

5. Ergo: plugging and propping status quo is the only possible solution.

Quod erat demonstrandum. Case closed (again).

[ExFlyer]

4 minutes ago, myata said:

OK made easy:

1. Solutions exist.

2. They aren't impossible or terribly difficult.

3. They require non-trivial adaptation and change.

4. That is impossible. In this country. Never happened.

5. Ergo: plugging and propping status quo is the only possible solution.

Quod erat demonstrandum. Case closed (again).

1. What solutions?

2. Oh?

3. Who is "they"?

4. what is impossible?

5. Staying the same is the solution??

Plena Stercore is my take on your post.

[myata]

And so the healthcare is in crisis... again. And the government admits it.

And it's taking a bold action, look! Three... two.. one.. by appointing a general nursing officer!

Ahm... no nothing comes to mind. What is this country? Is it a parody, joke already and hasn't even noticed the transition?

[ExFlyer]

23 minutes ago, myata said:

And so the healthcare is in crisis... again. And the government admits it.

And it's taking a bold action, look! Three... two.. one.. by appointing a general nursing officer!

Ahm... no nothing comes to mind. What is this country? Is it a parody, joke already and hasn't even noticed the transition?

The health care system, from a personnel issue only, will be in crisis as long as there is talk about forcing medical personnel to work where they don't want to.

Any profession or industry would be in crises if the workers are going to be told they have to go to a place they don't want to be.

We stopped making people go to where the work is. We pay them for sitting at home instead of going to where there is work.
No parody, no joke.  What transition???

Edited August 23, 2022 by ExFlyer

[eyeball]

2 hours ago, ExFlyer said:

??

The point is, there is a market for this.

The point is that a universal system is far preferable and a two-tiered system undermines that. IMO putting profits ahead of people the way a private user pay system does is the least desirable option.  

[ExFlyer]

39 minutes ago, eyeball said:

The point is that a universal system is far preferable and a two-tiered system undermines that. IMO putting profits ahead of people the way a private user pay system does is the least desirable option.  

For sure but, seems some are demanding different.

[eyeball]

6 minutes ago, ExFlyer said:

For sure but, seems some are demanding different.

Only because they've given up on government and ever making it work properly.

[ExFlyer]

18 minutes ago, eyeball said:

Only because they've given up on government and ever making it work properly.

Making what work properly?

There is nothing wrong with the medical system in general in Canada except for a personnel "shortage".

It is provincial governments that are responsible for the health in the provinces and each province has very unique personnel issues.

 

[eyeball]

27 minutes ago, ExFlyer said:

Making what work properly?

Government, mainly by working on the profound issues of mistrust that have developed over the decades and that have lead to so much divisiveness, paralysis, inability and even unwillingness to cooperate.

[myata]

2 hours ago, ExFlyer said:

We stopped making people go to where the work is. We pay them for sitting at home instead of going to where there is work.

Even worse. We created a system that works primarity for itself, to is own objectives, capacities and requirements. It needs not and doesn't want any feedback only nuisance. It won't need the public very soon down this road. Just megabillions in and pretty paperwork out. No need to worry.

And this is no exaggeration at least anecdotally. Own experience, three years, quarterly letter no couldn't find you a doctor but trying our best. How long it would go for? Why wouldn't it go on forever, who's looking and who's interested?

[SpankyMcFarland]

14 hours ago, ExFlyer said:

No, it is private delivery of privately funded care.

What are you going to complain about if this happens (or happens more)? The doctors (and medical staff) now have more choice of where to work.

My best friend (we are in Ontario) is on a waiting list to see a specialist for hip replacement. He has not yet even had the CT/MRI's yet as he has to wait for those. He has been in pain and on pain killing drugs for almost 2 years. Enough was enough. He went to a private clinic in Montreal.  Next week he is getting his hip replacement, for $25K. From time of first consultation to surgery will be 2 months (and that is because he has to wean off the medications).

I’m a medical consumer too so why should I complain if my health care options improve? And that’s an ‘if’ we have to watch out for. As I see it, there are two basic options:

1. Private delivery of publicly funded care. Really just an extension of what we have already. 
 

2. Private delivery of privately funded care. I think this is coming in many parts of the country. The provincial health care budgets cannot go up any further so people are going to have to pay out of their pockets. I wouldn’t have been keen on this ten years ago but I’m afraid I see little option now in my part of the world. There are many pitfalls with this - my relatives have experienced them in the UK. For example, if you let one surgeon run both the private and the public list, then extortion can easily occur where people are forced to pay for timely care on the private list. We should watch out for that but I think it’s coming anyway. 

 

Edited August 24, 2022 by SpankyMcFarland

[eyeball]

1 hour ago, SpankyMcFarland said:

There are many pitfalls with this - my relatives have experienced them in the UK. For example, if you let one surgeon run both the private and the public list, then extortion can easily occur where people are forced to pay for timely care on the private list. We should watch out for that but I think it’s coming anyway. 

If it comes to that to get treatment it probably won't be long before desperate people resort to kidnapping and holding hostage doctor's kids.

Save my kid or else.

 

[ExFlyer]

14 hours ago, SpankyMcFarland said:

I’m a medical consumer too so why should I complain if my health care options improve? And that’s an ‘if’ we have to watch out for. As I see it, there are two basic options:

1. Private delivery of publicly funded care. Really just an extension of what we have already. 
 

2. Private delivery of privately funded care. I think this is coming in many parts of the country. The provincial health care budgets cannot go up any further so people are going to have to pay out of their pockets. I wouldn’t have been keen on this ten years ago but I’m afraid I see little option now in my part of the world. There are many pitfalls with this - my relatives have experienced them in the UK. For example, if you let one surgeon run both the private and the public list, then extortion can easily occur where people are forced to pay for timely care on the private list. We should watch out for that but I think it’s coming anyway. 

 

There is no "Private delivery of publicly funded care.".

It is either publicly funded or privately funded. One government the  other directly out off your pocket done outside of the system.

It is already available and done in all provinces and if you think not, you are not looking..

Edited August 24, 2022 by ExFlyer

[myata]

We are confusing fairness of access with public / private and other irrelevant stuff of talking head shows forever. Ultimately if we end up with a de facto third world system what would be the worth of "fairness" who would benefit? The status quo system cannot deliver quality, delivery and access performance to modern standards. That is the problem that needs to be addressed, not ownership. For publicly funded, maintain transparent, priority-based service with a reasonable standard of access for everyone. Not calculus. For private, develop standards of fairness and quality. Doable.

But who's going to do anything here? Why? Things are working perfect - for them, as they are.

[SpankyMcFarland]

3 hours ago, ExFlyer said:

There is no "Private delivery of privately funded care.".

It is either publicly funded or privately funded. One government the  other directly out off your pocket done outside of the system.

It is already available and done in all provinces and if you think not, you are not looking..

 

Sorry, I’ll provide some clarification. Actually, Andrew Coyne does a better job:

Quote

The Liberals are taking a pasting in the press for their latest attempt to demagogue the health care issue, once again pretending to be scandalized at the thought of the private sector playing a role in a health care system that has always assigned a large role to the private sector – not least under the Liberals.

Squads of critics have pointed out that nearly a third of Canadian health care spending is private – that medicare only covers a comparatively limited range of “medically necessary” services, while excluding whole categories of care such as vision care, dental care, and drugs (except as dispensed in a hospital).

More to the point, much of what is spent publicly on health care goes to private providers, from the makers of the latest advanced machinery in the hospitals, to the specialized clinics offering diagnostic and other services, to the nation’s doctors, the vast majority of whom are private businesses.

 

The crucial distinction to be made is around who pays. At the moment we have loads of examples of publicly funded, privately provided care. Indeed, technically, many physicians run private companies for tax ‘efficiency’ purposes within the publicly funded system. But large corporations have also gotten in on the act which is different, e.g. diagnostic services. Another scenario would be allowing groups of doctors or even hospitals to compete for contracts to provide services within the public system. Imagine if GPs had a bigger say over where health care spending on each of their patients occurs via capitation:

 

Quote

It’s certainly true that health care should be priced – for without prices, efficient use of resources is impossible. Somebody in the system, at some level, ought to be paying them. But it needn’t, and shouldn’t, be patients. Rather, what’s needed are patient surrogates, empowered to negotiate with hospitals, specialists and other providers on patients’ behalf. And who better to do so than their GPs?

That’s the idea behind the capitation-based models that are slowly being rolled out across the country. Groups of providers are given a block of funds for every patient they enrol (with extra funds for patients from high-risk groups), out of which to pay for whatever services the patient needs.

That distributes decisions about care down to the patient level – rather than remote government health departments, or scarcely-less-remote regional health authorities..

https://www.theglobeandmail.com/opinion/article-private-delivery-of-health-care-yes-please-private-funding-no-thanks/

Basically, the premiers have run out of money and they’re looking for ways to stop this monster cost train bearing down upon all of them. In the first instance we should try to shore up our Medicare system. I, for one, would be prepared to pay a substantial monthly fee that goes directly to health care. However, unless there’s some breakthrough in thinking and spending, I think we will soon see a parallel private system for medically necessary services in this country. 

 

 

Edited August 24, 2022 by SpankyMcFarland

[SpankyMcFarland]

1 hour ago, myata said:

We are confusing fairness of access with public / private and other irrelevant stuff of talking head shows forever. Ultimately if we end up with a de facto third world system what would be the worth of "fairness" who would benefit? The status quo system cannot deliver quality, delivery and access performance to modern standards. That is the problem that needs to be addressed, not ownership. For publicly funded, maintain transparent, priority-based service with a reasonable standard of access for everyone. Not calculus. For private, develop standards of fairness and quality. Doable.

But who's going to do anything here? Why? Things are working perfect - for them, as they are.

I think the capitation model can bring some progress esp. in large urban centres where there is the possibility of competition between hospitals. FPs can see where services are being provided well and quickly far better than governments can. They can distinguish concise, accurate reports from waffling and good clinical care too. They would be useful gatekeepers to protect the interests of their patients and ensure money is being spent more efficiently. 

https://hbr.org/2016/07/the-case-for-capitation

One big problem in health care is the huge asymmetry in expertise and power between patient and provider, i.e. buyer and seller. It’s not like purchasing a washing machine. You may have one chance to get your care right and Google doesn’t really help that much. This is why an unrestricted private system is both bad and highly inefficient. Unscrupulous doctors can sell you all sorts of procedures that are unnecessary or even harmful, a perennial problem in the US. Our public system is well worth preserving as the basis of health care here if it can be tweaked. 

Edited August 24, 2022 by SpankyMcFarland

[myata]

1 minute ago, SpankyMcFarland said:

One big problem is health care is the huge asymmetry in expertise between patient and provider. It’s not like buying a washing machine. You may have one chance to get your care right and Google doesn’t really help that much.

We have recurring issues even with simplest systems like clean drinking water. What's the hope of getting this conundrum right?

3 minutes ago, SpankyMcFarland said:

This is why an unrestricted private system is both bad and highly inefficient.

Probably. And now we learned that the other extreme: a system insulated from the reality, with no intelligent responses or feedback isn't working great either. It was probably a given from the get go. Some mechanisms of connection to expected standards of quality and access, of matching the demand had to be in from the start. But no. Everything in this country has to be a hierarchical top down behemoth. And here's just another result.

7 minutes ago, SpankyMcFarland said:

Our public system is well worth preserving as the basis of health care here if it can be tweaked. 

Not for the sake of it, and not at all cost. Not a sacred cow on the banner, only a system paid for by the taxpayers for whom it should work to the necessary standard. If it can be adapted to the realities of the society around it.

[SpankyMcFarland]

4 hours ago, myata said:

 

Not for the sake of it, and not at all cost. Not a sacred cow on the banner, only a system paid for by the taxpayers for whom it should work to the necessary standard. If it can be adapted to the realities of the society around it.

I think moving to a purely private system in Canada would be too big a change. Australia, for example, has a mixed system. 
 

http://www.familydoctorsforontario.ca/wp-content/uploads/The-comparative-performance-of-the-Canadian-and-Australian-Health-Systems.pdf

[myata]

1 hour ago, SpankyMcFarland said:

I think moving to a purely private system in Canada would be too big a change. Australia, for example, has a mixed system. 

And again, the chief issue here is not the mechanism that could work better but a will to do non-trivial, serious and essential change. That will is very hard to come by here, and the reason is obvious: for any government it's both safer and more rewarding to show token, superficial effort rather than take responsibility for a meaningful change and visible improvement for the citizens. But even that wouldn't be the full answer. What is missing in this system is a customer. Someone who can make a meaningful choice and aim for the best outcome, not be feed whatever is available. In such a system improvement is really a rare event.