wait times in health care

[STIgirl]

So...I'm curious as to how people would respond.

 

'If you were a health care minister, what measures would you take to reduce wait times for... (insert medical need here--surgeries, ER, primary physician appointments..)

 

I know this is a broad topic, and there are different ways to answer depending on the type of service needed.

[The Law]

I would instantly try to make it easier for doctors from other countries to come to this country to practice. The UK has a surplus of specialists, while we are starved of them. I would try to make an incentive to bring some of them over.

 

I would also start increasing the number of med school spaces across the country, and also the number of spaces in residency as well, to provide a long term solution. I would also attempt to make it more appealing for these doctors to stay in the country once they graduate. This increase needs to be drastic to allow us to have a sustainable heatlh care system in the future.

[AMmd]

I would instantly try to make it easier for doctors from other countries to come to this country to practice. The UK has a surplus of specialists, while we are starved of them. I would try to make an incentive to bring some of them over.

 

I would also start increasing the number of med school spaces across the country, and also the number of spaces in residency as well, to provide a long term solution. I would also attempt to make it more appealing for these doctors to stay in the country once they graduate. This increase needs to be drastic to allow us to have a sustainable heatlh care system in the future.

I agree with law for once

true dat homie!

[The Law]

Thanks, vote for Law/AM 2008!

[STIgirl]

What about applying Advanced access theory? I know that there are primary care clinics that have adopted this to reduce waits to see family physician, but is their a way to incorporate this into specialized areas of surgery, diagnostics (like MRIs and CTs) etc?

 

I guess the other thing is funding...can't reduce waits at the ER until there are more beds in wards for chronic care and elderly patients;can't have more beds until there are more nurses and docs to take care of them; can't have more nurses and docs unless there are more trained, or more are retained from larger centres; which all requires funding!!!

[Darla]

Funding is a HUUUUUGGGGEEE problem. The federal government passes on funding to the provinces in a big block to cover both education and health care, so the provinces are in a tough position-use it for health care at the expense of adding spots/increasing the education level of the province? We're getting more money into health care into Ontario, but tuition is increasing at a rate that is 2X that of inflation at some universities.

 

So what would I do? I'd increase the reliance on health care teams and provide for nurse practitioners under OHIP. In theory, b/c the NPs don't have the office costs etc, the procedures they take care of cost the gov't less, plus gps will be able to see more patients and spend time with them, **possibly** decreasing the number sent to specialists. In theory anyway:D

[AMmd]

Thanks, vote for Law/AM 2008!

haha yeah, we should so run for president of something...

[STIgirl]

Thanks for your thoughts Darla. There are so many things that could be improved upon that impact other areas...it's good to hear different perspectives.

[The Law]

Funding is a HUUUUUGGGGEEE problem. The federal government passes on funding to the provinces in a big block to cover both education and health care, so the provinces are in a tough position-use it for health care at the expense of adding spots/increasing the education level of the province? We're getting more money into health care into Ontario, but tuition is increasing at a rate that is 2X that of inflation at some universities.

 

So what would I do? I'd increase the reliance on health care teams and provide for nurse practitioners under OHIP. In theory, b/c the NPs don't have the office costs etc, the procedures they take care of cost the gov't less, plus gps will be able to see more patients and spend time with them, **possibly** decreasing the number sent to specialists. In theory anyway:D

 

Great ideas Darla!

What type of increase in reliance did you have in mind?

Funding is definitely a huge problem, and I think this is one of the main issues that make governments turn to privatization. To fix our health care system, they need to invest a LOTTTTTT of money. It's so tempting for them to give up and just try to privatize everything.

[Darla]

I'm an econ major so I tend to make all these decisions about money

My classmates are tired of hearing my rants on the way health care is run...

[The Law]

I'm an econ major so I tend to make all these decisions about money

My classmates are tired of hearing my rants on the way health care is run...

 

I totally agree with you. I can't really comment on it in depth because I don't have the econ background, but I definitely know how huge of an issue this is. What's more frustrating is health care still isn't on the agenda... arghhh...

[Satsuma]

Actually, I don`t think funding itself is the hugest issue. I think the bigger problem is HOW the money is spent. IMO this is often the result of WHO is making these decisions...people that don`t actually work in healthcare.

 

I have seen large amounts of money wasted at hospitals, most of which could have been avoided if the people making the decisions knew more about what healthcare workers need/do or bothered to communicate with them and actually listen.

 

As for waitlists...caution is needed when interpreting waitlists as a measure of quality or outcome of healthcare. There is no standard way of measuring a waitlists, so studies that report on waitlists aren`t often measuring the same thing. Doctors put patients on waitlists even before they know they might need a service and may find out later they dont and take them off. People cancel appointments and don`t show up and stay on the lists longer. And just cause you had to wait a bit longer than you might think you should, well it might not have affected your outcome anyway.

 

Waitlists are something the media likes to play up though. And I guess if you were a political party interested in getting or staying elected, you might want to play into that. But I would really investigate which waitlists actually need to shortened in order to impact outcome. If the outcome isn't going to change, then could be best to invest money elsewhere.

[The Law]

I think it's a combination of funding along with effective funding.

I do think we need to put more money in, but agree, that sometimes the money could be spent more wisely.

[KT Dreaming MD]

I think that what has been said is true—we do need to increase funding to a certain threshold across the province in order to alleviate wait times in hospitals for various procedures/services including: hip replacement surgery, cataract surgery, cancer surgery, etc. The other thing that is also required to make the increased funding worthwhile is ACCOUNTABILITY for where and how the extra money is being spent. If people are not held accountable for health care spending, money could be wasted needlessly.

 

Allowing the public to view wait time progress once funding has been received is a great way to ensure hospitals are utilizing their financial resources appropriately. By publishing wait time data from different hospitals across the province, I think this will motivate various hospitals to spend their given money wisely for the benefit of all.

 

Look at the business world… public companies must make available their audited financial statements to the public in order to be held accountable for costs/expenditures. People will not invest their money into a company who is not able to control their costs despite a lot of revenue being made. The same principle should apply in the health care world—people need to be held accountable for where and how extra money given by the government is spent. We need measurable deliverables—wait time comparisons across different hospitals is a great way to ensure each hospital is held accountable for their finances.

 

Public awareness is also key to ensuring funding is being utilized appropriately. In order to be able to question or criticize the current utilization of resources, patients need to be made aware that such comparisons are occurring as we speak—check out:

 

http://www.health.gov.on.ca/transformation/wait_times/wait_mn.html

 

I didn’t even know about this website until a colleague pointed it out this week. Information is power and I encourage everyone to look at this…..

[andros]

I think we desperately need more nurses, nursing home beds, and hospital beds. It is so frustrating seeing admitted patients tie up emerg beds for days because there are no beds available on the floor... and there are no beds available on the floor because poor old Mrs. Jones had a UTI, as been ALC for weeks and is on the medical floor because there's no one to care for her at home and it will take 9 months to get her into a nursing home.

 

I also think that "they" should look at going back to a 2 year diploma in nursing instead of having to do a BScN for 4 years. I don't see why someone has to take things like philolsophy and wrack up 4 years of undergrad debt for nursing. I think that's probably a huge deterrent for people considering going into nursing.

[UBCstu]

A lot of you have mentioned spending money more wisely. Exactly what kind of changes are you thinking about that would accomplish this?

[The Law]

A lot of you have mentioned spending money more wisely. Exactly what kind of changes are you thinking about that would accomplish this?

 

Well I think we need to have people overseeing the efficacy of various programs implemented by hospitals. More accountability for the way the money is being spent. I don't know what kinds of checks and balances are in place right now- but I'm sure that things could be even better.

[Ève]

Here's another question:

 

Some people are in the hospital because no one can take care of them at home (their family is working or they live alone, for instance). Many people are in nursing homes for the same reasons.

 

Yet, many families would like to take care of their sick or dying or recovering family members.

 

Instead of hospitalizing those people, if we gave a sort of decent financial support in the form of, say, unemployment insurance to one family member who would take a leave of absence from work, or, say, X number of weekly or daily hours from helpers/staff (non-medical and/or medical) who would visit regularly and help with cooking/cleaning/errands/checkup/pain control, how much money could we save? How many beds could we free, in your opinion?

 

Could this have a significant impact on the wait lists? (well, maybe not the surgeries per say).

 

Someone knows how much it costs to keep a patient in the hospital per day or per year? I've heard around 50 000 a year, but I'm not sure about that.

[Darla]

A lot of you have mentioned spending money more wisely. Exactly what kind of changes are you thinking about that would accomplish this?

I would consider a plan similar to what is in place in the UK. *to the best of my knowledge* g.ps are given x amount of money at the beginning of the year to use for testing their patients. There is still a great incentive for the physician to treat their patient well (and keep their liscence and patient billing hours)but now there's another incentive to find the most economical way of obtaining a test (ie. is the testing facility reliable?Do they cost less than a similar facility?). Also, to be booked into a bed in a hospital, the patient must first be cleared by a physician who essentially just makes sure that all patients are being cared for in the most logical order (ie by need).

 

In Canada, b/c of how hospitals bill the gov't for services (one lump sum) it is almost impossible for someone to give you an accurate response to "how much does it cost to give Darla an MRI?" By changing the way that hospitals are paid (as TimmyMax suggests through acountability) the hospitals have an incentive to choose most economically if there is a threat of being penalized. Now there is an incentive for hospitals to do what is "sexiest" to avoid the ****storm from the media.

 

**again, this is to the best of my knowledge. I took a health economics course 2 years ago where we compared the UK/Canada/Australia/US systems** Even if I'm mistaken about how does what and where, I think this reassigns money effectively.

 

Oh and nurse practictioners! (flog that dead horse!!)