Tuesday, September 14, 2010

Re-focussing the health care equations

The OECD ( The Organization of Economic Development) based on Paris has reported that Canada, while having stable "conservative" banks, is facing a crisis in its health care budget and recommends that with the date for renegotiating the terms of the pact between the federal and provincial governments looming in 2014, it is time to change the way the system operates.
They are recommending the introduction of both co-pay and greater participation by the private (for profit)system, in order to create increased competition as two ways to help fund the health care for a bulging number of senior citizens where a large proportion of health care dollars are spent.
First, the co-pay. It is a matter of certain national pride that no Canadian "pays a cent" directly for a visit to the doctor. Is there statistical evidence that because we do not pay, and do not know the specific cost of the specific care, the patients abuse the system? Perhaps.
Could Canada come to accept a co-payment with each doctor visit? Probably.
Could Canada come to accept the provision of care from the private sector? Probably.
Are we letting perfection be or become an enemy of the good? In some cases, there is some evidence that this may be our "speck in our national eye" while we decry the private insurance company provisions of care (the plank in their eye) "American" way of doing things, in our grasping at national pride.
However a far greater correction in the funding of the system would come from changing the way doctors bill the system (per patient visit). When the system is based on the frequency of visits, the system pays on the basis of "sickness" or "illness" and not wellness.
Why can we not create a new equation to measure the effectiveness of a doctor's preventive interventions and measure the overall health and wellness of the patients in his/her care? How many patients under a doctor's care lost weight, stopped smoking, ate healthier diets, exercised more, joined supportive and creative activities, wrote books (or even blogs) and thereby at least theoretically, enhanced their lifestyle and reduced their dependence on the national health care system?
What are the terms of a social contract with those of us above sixty, for example, that would assure us of access to modest, appropriate, quality care as we age, without bankrupting our childrens' and our grandchildrens'  access to the same quality of care, when needed? That is a social contract which requires the detailed attention, research and debate initiated, hopefully, by all political parties worthy of the name "national party" prior to the next election, in order for medical practitioners and patients and health care planners to be able to adjust to the new realities post 2014.
And in that new social contract, personal responsibility must be an integral "x" factor to be included in the equation.
Individual and family responsibilty for health, wellness and well-being are not something we can either take for granted, nor afford not to include in the new cost and pay equations.
Smokers, heavy drinkers, abusers of non-prescription drugs, the un-and underemployed....many are suffering from high levels of stress and many of those stressors are exacerbated by the conditions of their employment, but the conditions of the market place which places boundless pressures to "extend" our own credit beyond our capacity to sustain such debt.
But, will there be a critical examination of the underlying structure of individual and family life-style as part of the re-creation of the health care funding formula? One has to doubt such "linking of the dots" in a society that prefers "specialization" and separate files for every public issue.
It is our collective acceptance of this separation of issues into disconnected files, like the separation of the various "internal systems" in the body (neural, digestive, reproductive, breathing, skeletal, psychiatric etc.) without a co-ordinating dot-linking doctor to put the pieces together in one template for each individual that may have assisted the formal training of doctors but certainly complicates our treatment, and imposes additional and unnecessary costs on the system. However, that system of dividing the parts from the centre or the core, misses some very fundamental and necessary information...how each system is impacting the whole person.
It is the whole person that the health care system must address...and equations to strive to reach the inclusion of that "entity" in the calculations are neither evident in the public mind, nor seemingly contemplated by those making the recommendations and doing the research.
There is also far too much focus on the economics, the financial models available, and not enough focus on the best, most balanced and most effective premises, principals and ethical insights integral to our national health goals.
Here is a very welcome postscript from the meeting of Health Ministers.
By Joanna Smith, Toronto Star, September 15, 2010
ST. JOHN’S, N.L.—The federal health minister says the solution to the soaring costs of health care in this country is to help make sure people avoid getting injured or sick in the first place.

“If we are going to sustain health care in the long-term in Canada, we need to put some energy into . . . childhood obesity and start dealing with preventable illnesses,” Health Minister Leona Aglukkaq said following her annual meeting with her provincial and territorial counterparts in St. John’s, N.L. on Tuesday.
“If you look at the chronic conditions and illnesses in Canada, many of those are preventable, which are going to be causing us a huge strain on our health care system if we do not start addressing them now.”
The health ministers signed a declaration agreeing to make prevention a priority in the battle to guarantee the sustainability of the health care system.

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