Overhauling health-care system tops agenda at annual meeting of Canada's doctors
By Jennifer Graham (CP) – 6 days ago
SASKATOON — The incoming president of the Canadian Medical Association says this country's health-care system is sick and doctors need to develop a plan to cure it.
Dr. Anne Doig says patients are getting less than optimal care and she adds that physicians from across the country - who will gather in Saskatoon on Sunday for their annual meeting - recognize that changes must be made.
"We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize," Doing said in an interview with The Canadian Press.
"We know that there must be change," she said. "We're all running flat out, we're all just trying to stay ahead of the immediate day-to-day demands."
The pitch for change at the conference is to start with a presentation from Dr. Robert Ouellet, the current president of the CMA, who has said there's a critical need to make Canada's health-care system patient-centred. He will present details from his fact-finding trip to Europe in January, where he met with health groups in England, Denmark, Belgium, Netherlands and France.
His thoughts on the issue are already clear. Ouellet has been saying since his return that "a health-care revolution has passed us by," that it's possible to make wait lists disappear while maintaining universal coverage and "that competition should be welcomed, not feared."
In other words, Ouellet believes there could be a role for private health-care delivery within the public system.
He has also said the Canadian system could be restructured to focus on patients if hospitals and other health-care institutions received funding based on the patients they treat, instead of an annual, lump-sum budget. This "activity-based funding" would be an incentive to provide more efficient care, he has said.
Doig says she doesn't know what a proposed "blueprint" toward patient-centred care might look like when the meeting wraps up Wednesday. She'd like to emerge with clear directions about where the association should focus efforts to direct change over the next few years. She also wants to see short-term, medium-term and long-term goals laid out.
"A short-term achievable goal would be to accelerate the process of getting electronic medical records into physicians' offices," she said. "That's one I think ought to be a priority and ought to be achievable."
A long-term goal would be getting health systems "talking to each other," so information can be quickly shared to help patients.
Doig, who has had a full-time family practice in Saskatoon for 30 years, acknowledges that when physicians have talked about changing the health-care system in the past, they've been accused of wanting an American-style structure. She insists that's not the case.
"It's not about choosing between an American system or a Canadian system," said Doig. "The whole thing is about looking at what other people do."
"That's called looking at the evidence, looking at how care is delivered and how care is paid for all around us (and) then saying 'Well, OK, that's good information. How do we make all of that work in the Canadian context? What do the Canadian people want?' "
Doig says there are some "very good things" about Canada's health-care system, but she points out that many people have stories about times when things didn't go well for them or their family.
"(Canadians) have to understand that the system that we have right now - if it keeps on going without change - is not sustainable," said Doig.
"They have to look at the evidence that's being presented and will be presented at (the meeting) and realize what Canada's doctors are trying to tell you, that you can get better care than what you're getting and we all have to participate in the discussion around how do we do that and of course how do we pay for it."
Copyright © 2009 The Canadian Press. All rights reserved.
---------------
August 20, 2009
Canadians visit U.S. to get health care
Deal lets many go to Michigan hospitals
BY PATRICIA ANSTETT
FREE PRESS MEDICAL WRITER
Hospitals in border cities, including Detroit, are forging lucrative arrangements with Canadian health agencies to provide care not widely available across the border.
Agreements between Detroit hospitals and the Ontario Ministry of Health and Long-Term Care for heart, imaging tests, bariatric and other services provide access to some services not immediately available in the province, said ministry spokesman David Jensen.
The agreements show how a country with a national care system -- a proposal not part of the health care changes under discussion in Congress -- copes with demand for care with U.S. partnerships, rather than building new facilities.
Michael Vujovich, 61, of Windsor was taken to Detroit's Henry Ford Hospital for an angioplasty procedure after he went to a Windsor hospital in April. Vujovich said the U.S. backup doesn't show a gap in Canada's system, but shows how it works.
"I go to the hospital in Windsor and two hours later, I'm done having angioplasty in Detroit," he said. His $38,000 bill was covered by the Ontario health ministry.
Canada eyed in the health care debate
Dany Mercado, a leukemia patient from Kitchener, Ontario, is cancer-free after getting a bone marrow transplant at the Barbara Ann Karmanos Cancer Institute in Detroit.
Told by Canadian doctors in 2007 he couldn't have the procedure there, Mercado's family and doctor appealed to Ontario health officials, who agreed to let him have the transplant in Detroit in January 2008.
The Karmanos Institute is one of several Detroit health facilities that care for Canadians needing services not widely available in Canada.
Canada, for example, has waiting times for bariatric procedures to combat obesity that can stretch to more than five years, according to a June report in the Canadian Journal of Surgery.
As a result, the Ontario Ministry of Health and Long-Term Care in April designated 13 U.S. hospitals, including five in Michigan and one more with a tentative designation, to perform bariatric surgery for Canadians.
The agreements provide "more immediate services for patients whose health is at risk," Jensen said.
Three Windsor-area hospitals have arrangements with Henry Ford Hospital, Detroit, to provide backup, after-hours angioplasty. Authorities will clear Detroit-Windsor Tunnel traffic for ambulances, if necessary. The Detroit Medical Center also provides Canadians complex trauma, cancer, neonatal and other care.
"In the last few years, we've seen more and more Canadian patients," said Dr. J. Edson Pontes, senior vice president of international medicine at the DMC. They include Canadians such as Mercado, whose care is reimbursed by Canada's health system, as well as people who pay out of pocket to avoid waiting in Canada.
Pontes declined to give revenue figures for the DMC's international business, but said the program "always has been a profitable entity." About 300 of the DMC's 400 international patients last year came from Canada, he said.
Tony Armada, chief executive officer of Henry Ford Hospital, said the hospital received $1 million for cardiac care alone.
Critics of a health care system like Canada's -- a publicly funded system that pays for medically necessary care determined by provinces -- often cite gaps in Canada's care to argue that the United States should not allow its current debate over health care to move it to a socialized system.
No plan currently under discussion in Congress calls for a universal plan like Canada's, but opponents fear socialized medicine, anyway.
Canada's U.S. backup care "speaks volumes to why we don't need government to take over health care," Scott Hagerstrom, the state director in Michigan for Americans for Prosperity, said of the Canadian arrangements with Michigan hospitals. "Their system doesn't work if they have to send us their patients."
But Dr. Uwe Reinhardt, a Princeton University health economist who has studied the U.S. and Canadian health systems, said arrangements with cities like Detroit "are a terrific way to manage capacity" given Canada's smaller health care budget.
"This is efficient," he said. "At least in Canada, you don't worry about going broke to pay for health care. You do here."
Pat Somers, vice president of operations at Windsor's Hotel-Dieu Grace Hospital, one of the hospitals that sends patients to Henry Ford, said the issue of finding ways to pay for and prioritize care requests is not in only Windsor.
"The ministries are quite aware of" waits for care in Sarnia and Hamilton, she said. "That's why we are investing in a wait list strategy" to best determine how to prioritize cases for people who need hip and knee replacements, cataract surgery and treatment for cancer, for example.
Mercado, 26, faced a longer wait because he could not find a matching blood donor, even though his family conducted a broad search.
He said doctors told him money was limited for transplants, particularly ones using unmatched donors, which are riskier.
After his family's doctor wrote the Ontario ministry, the agency agreed to pay $200,000 for the operation.
The family, their church and Mercado's school, Conestoga College in Kitchener, raised another $51,000 to cover expenses going back and forth to Detroit.
"I think of this every day as a gift from God," Mercado said.