'Good For What Ails Us'

Everybody seems to know exactly how to fix health care in this country.

There appears to be two camps when it comes to the issue of how to "fix" health care in this country - the first camp seeming to believe that the only thing to do is turn our entire health care system (or at least a large portion of it) over to the private sector while the second camp seem to think that the federal government just needs to keep turning more money earmarked for health care over to the provinces.  Ask either group and you will likely hear the same thing, their solution is just the ticket, the way to solve all our problems.

Which is why I was so smitten taken with this opinion piece in Wednesday's Chronicle Herald.  

Although I must confess that I do have to question the accuracy of some of Professor Ghose's assertions (particularly since he offers no references to back up his "facts") such as, for example, his statements that our health system is the second most expensive of the 28 OECD countries [when even the right wing Fraser Institute's data would place Canada in the number six position], that the cost of prescription drugs is increasing at a rate of 10% to 15% per year [whereas this 2008 report places the rate of increase in prescription drug costs between 1998 and 2007 at 5.1% and the Fraser Institute would have us believe that after adjusting for inflation, prices for existing patented medicines have actually decreased in real terms in 19 of the last 22 years] and that the price of generic drugs in Canada is among the highest in OECD countries and is still rising [although Professor Ghose notes Nova Scotia's and Ontario's moves to cap the cost of generic drugs, he fails to mention that both British Columbia and Saskatchewan have already gone that route].

But let's not quibble and instead take a look at Professor Ghose's thoughts on how to control what he sees as the three fastest-growing items in Canada's health care budget; namely, prescription drugs, the compensation of doctors and CEOs and the funding of hospitals.

With regard to prescription drugs, Ghose's solution is a universal-access national pharmacare program that would cover only inexpensive but potent generic drugs, secure the best prices by bulk purchasing, stop payback practices that jack up prices, curtail inappropriate and over-prescription and monitor drug activity to weed out ineffective and harmful drugs.

Professor Ghose would also eliminate our standard "fee for service" method of compensating doctors, which tends to encourage seeing more patients by spending less time with them (I think many of us can attest to the truth of that statement). Instead he proposes a rationalized salary system based on performance and productivity to cut cost and improve care. He also suggests linking hospital CEO compensation to performance criteria (what a concept!), with changes in compensation requiring justification and online posting (public accountability ... say it isn't so!).

Last, but certainly not least, Professor Ghose notes the cost of delivering primary health care via ERs and tertiary care hospitals and proposes that instead it be delivered through primary care centres, working 24/7.  Such centres should also be facilities for preventative medicine, provide immunizations and actively promote health and healthy lifestyles and would be staffed by nurses and paramedics outside of office hours. [Although he doesn't specifically state it, I assume a doctor would be on call during these times.] 

His plan would also change how hospitals are funded - changing the current lump-sum funding to a method that would take into account the number of patients treated, treatment outcomes and compliance with benchmarks for improving care. Tertiary care hospitals would deliver centralized and disease-based care following the comprehensive cancer care model. 

I don't know about you but, in general, I like the way this man thinks.

As just one example, Canada has desperately needed a national pharmacare system for a very long time.  And for just how long have they been promising us that?

And the rest of it? Sounds good to me, too. 

I'm with the good doctors on this one -

"The idea that we would just put more money into the same health-care system that we have now, without stopping for a minute to consider how we could or should improve it, and what kind of big changes we could make with that money, I think is a missed opportunity," he said.

. . .

A health-care agency to provide strong oversight and long-term planning, well beyond the current four-year election cycle, would go a long way to strengthen the administration of the system, he said.