Barry’s Fix for our Health Care System
How Barry would fix Canada’s Health Care System
The health care system in this country keeps needing more and more of our tax dollars. Life expectancy keeps on increasing and people are taking drugs for longer periods of time. Everything is increasing; surgical procedures, doctor’s visits, maintenance prescriptions and those very expensive end of life drugs that keep dying people alive for another 2 or 3 weeks.
Our government has an obligation to care of the health of its people from the cradle to the grave and if nothing changes, most of our tax dollars will be spent on health care leaving less and less for education, infrastructure such as roads and bridges and all the funds needed to maintain government oversight of our food supply and our safety.
Somewhere down the road we may have to opt into a two tiered medical health system in which higher income people who want immediate attention for their conditions would be paying for the procedures out of their own pockets. In the meanwhile there are many ways in which the system can be improved and the following are ways in which I think the system should be changed.
Hospitals should return to their original function
Under our present system, if you need surgery to repair a knee, hip, shoulder or sinus cavity it is considered to be “elective surgery”. This means that it is not an emergency and your physician sets a date for the operation. Your physician is allowed an operating room in the hospital once every 2 or 3 months for one day. During that day he performs as many procedures as he can and the rest of his patients have to wait until the next time he is given an operating room. However, one crash on the Burlington Skyway or a shooting in downtown Hamilton and the room is taken over for emergency victims and all the operations are postponed.
This whole scenario can be replaced by specialized clinics which work very well. We already have an eye surgery clinic operated by St.Joseph’s Health Care in Stoney Creek; a specialized health care facility dedicated to eye surgery containing all the necessary medical equipment on site and all the different types of eye specialists. In Toronto there is the Shouldice Clinic which only repairs hernias and is considered one of the finest facilities in the world. We could build clinics for knees, clinics for hips and so on and each clinic would have all the necessary diagnostic tools, MRI’s CT scans, ultrasound and X-ray to do their job. They could operate 7 days a week and waiting lists would disappear. The question that arises is; where would you get the money to build these facilities? The answer would be to take it away from the over-inflated budgets of our existing hospitals. They are loaded with administrators, fundraisers, lobbyists and clerical staffs that outnumber medical personnel by a two to one margin.
Every time a hospital performs a procedure it uses up some of their funds. It is not in their interest to perform as many procedures as possible because they do not have enough money. On the other hand, if a clinic was paid by our government for each procedure they would want to do as many operations as they could to maximize their income.
Once you remove elective surgery from the hospital they return to their original function. That means they take care of emergencies such as heart attacks, gun shot wounds, victims of automobile crashes and any other life-threatening emergencies that arise. Babies do not have to be born in hospitals. We could even have special pre-natal, natal and post-natal clinics dedicated only to the care of mothers and their children. Although this idea would not save the system money, it would certainly end waiting time and make the whole system more efficient.
Electronic Medical Records
When it comes to computerized medical records and even the use of computers there is no group more behind the times than our physicians. Just look at the wall when you walk in. Thousands of folders loaded with paper records of the last ten years or so. Eighty year old grandmothers figure out how to email their grandchildren and share photos on line and yet doctors refuse to communicate with their patients via email. Wouldn’t it be nice if a physician sat down at the end of a day and answered all his patient’s questions in a simple and straightforward manor?
If all the physicians were hooked up onto a secure network, your family doctor could look online and hook you up with a specialist in a matter of weeks rather than waiting for his school buddy to have an opening in 6 months to a year. When you visited any physician your Ontario Health Card would be swiped and all your medications and medical history would appear; never to be stored anywhere except on your Health Card which only you carry in your possession.
Our Ontario government recently threw away one billion dollars trying to make a system when these systems already exist. Pharmacists have a very secure system that links them in their own secure network to their providers. Lawyers have a very secure system that allows them to do title searches on properties and even the Police have their own secure networks. It is not expensive and not difficult to do. The biggest stumbling block is allowing physicians to opt out and keep their records on loose leaf paper in their offices.
Once again waiting times to see specialists would be drastically reduced and the whole system would become more people friendly but the costs would be about the same.
At the present time prescription drugs are close to eating up almost half of our health care budget. Most of that 31 billion dollars worth of drugs is money down the drain because we do not have an incentive system to keep people healthy. The majority of prescription drugs dispensed to seniors over 65 and those people on social assistance are cholesterol lowering drugs, blood pressure medications, heart medications and drugs for Type II diabetes. All of these conditions are totally preventable and even reversible with a daily regimen of exercise and a reasonably healthy diet. Yet these conditions account for the majority of office visits to physicians.
In order to get people off their couches and eventually off their drugs we have to give them some goals and I believe they should be financial. When you fill out your income tax you should get an extra tax deduction if you are a non-smoker, say $1000. Belonging to a gym and fees spent for recreational sports such as tennis, baseball or hockey should be tax deductible along with the cost of equipment. Even running shoes for walkers and joggers should be tax deductible.
If your BMI (Body Mass Index) is in the healthy range you should deduct another $1000 from your income tax. If you do not have any more than 6 office visits with your physician per year then deduct another $1000. With financial incentives in place everybody has a very good reason to get healthy and stay healthy.
Generic Prescription Drugs
The Ontario Drug Benefit Formulary is just too full of too many useless and expensive drugs. How many cholesterol-lowering drugs do we need? Once they have been on the market for a long time and have been replaced by a low-cost generic, the pharmaceutical company makes a slight change in the formula or adds an innocuous compound and the public is back to paying the high price. Nearly all “new” drugs are in reality “me-too” drugs which are just more expensive versions of the original drugs that have been replaced with the low cost generics. Provincial governments could slash our country’s health bill by at least 20 billion dollars if they were more discerning about which drugs they allow into their formularies.
There is a whole category of anti-inflammatory drugs that are supposed to be used to reduce the pain and inflammation of an injury over a 7 to 14 day period. But the majority of these drugs are prescribed for arthritis and taken by patients for a lifetime. Because they upset the stomach this creates the need for a second expensive class of drugs to counter the side-effects of the anti-inflammatory.
Expensive osteoporosis drugs like Actonel and Fosomax have been replaced with less expensive generics but then the pharmaceutical companies add a little Vitamin D to their product and the expensive brand name version ( Fosavance) is back in the formulary.
End of Life Care and End of Life Drugs
In most cases more money will be spent on your health care during the last month of your life than the seventy or eighty years preceding it. Physicians and their patients seem to think that gigantic heroic measures of all kinds should be used to try and prevent a death and this costs the whole system billions of dollars. A person dying from lung cancer is exactly that; a person dying from lung cancer and death is inevitable. We have very unique special drugs that can cost up to $40,000 a month and they may keep that person alive for another 4 or 5 weeks. In my opinion this is wrong. You know you are going to die. Go home. Be with your loved ones and your family and at least try and be conscious of your surroundings and not drugged up in a coma. This way of thinking may not be for everybody but it should be encouraged over very expensive end of life treatments that inevitably fail.
Health Care is like insurance. We all have automobile insurance policies but we try and drive in a safe manor to avoid any collisions with pedestrians or people. Most of us do not drive with reckless abandonment because we have insurance. And yet that is how the majority of Canadians perceive our health care system. Eat any kind of crappy food. Who cares if it is loaded with salt and sugar? Why bother to exercise and eat healthy because if you do develop high blood pressure, Type II diabetes or heart disease it will be taken care of by our medical system…
If we are ever going to change our health care system we have to change our attitudes. Rather than become dependant on medications and an array of physicians to keep us functioning, we should take charge of our own health and although it is the right thing to do there is nothing like a big deduction on your tax return to keep you heading in that direction.