Lately Alberta and Quebec's big healthcare announcements have been generating a lot of headlines and handwringing about the state of healthcare in this country. The prime minister is seemingly caught between his albertan roots and his new suburban powerbase.

This is weird, b/c canada has had a secret 2 tier healthcare system for some time now and it hasnt been reported at all.

I had a patient a few weeks ago who broke his wrist, and when the cast came off, he had no movement whatsoever. I referred him to a hand surgeon in vancouver and was told he would be seen in AUGUST!!!!! This is obviously ridiculous as he can't even work right now.
I then phoned around to see if I could get an earlier appt for him. All the hand surgeons had similar waiting lists. However, I was told by several people, "For $500 I'll see him next week" What??? Yes, that's right. And for a couple thousand he can have his surgery a week later.

There is at least one and probably several private ORs operating in Vancouver right now. You can get shoulder or knee surgery with the country's best docs. Old hip getting you down? BC health care kicking you while you're there? No problem, pony up the cash and they'll throw in a cataract operation for half price.

I don't understand why this is not making headlines when the political announcements are such big news and are encountering so much opposition.

A word to the Tommy Douglas fans of today... you have already missed the boat.
Healthcare in canada is severely broken. Our local hospital is grinding to a halt. Perhaps the answer includes some level of private healthcare delivery, and it's not just the debate that has been forced on us, it is the reality. However, healthcare will never recover without a fundamental restructuring of care delivery, and a shift in emphasis from caring for sick people to caring for well people and preventing them from getting sick.

Millions of dollars are wasted in the healthcare system every year through inefficiencies, bureaucracy, protection of regional budgets at the expense of total spending, and general silly decisions made by people in boardrooms who have no idea what is needed to run a hospital.

Two quick examples:
1. radiology departments routinely shut down their imaging overnight to save money in their individual budgets. This leads to patients waiting for days in a hospital bed for a test or procedure they need right away. In addition to the cost of keeping the patient in hospital for an extra week, the patient is likely to get sicker while waiting, or contract an infection from a neighbour and end up in ICU or on crazy expensive antibiotics or some other silly expense. Or they could save the system some money and die. The important thing is that the radiology department stayed under budget.
2. A common barrier to discharge of patients from the hospital is lack of community resources. Many patients wait around in hospital when they are better b/c they are unable to care for themselves at home. Home care budgets have been slashed across BC leaving homecare nurses overworked and underpaid. This leads to patients staying in hospital much longer than necessary and in addition to the cost of keeping the patient in hospital etc. etc. But the important thing is that we are saving money that used to go to those greedy homecare nurses.

I can think of 3 or 4 more offhand examples as above, and a well coordinated study/survey could probably come up with hundreds.


So class, what have we learned today?
Here's the bottom line for all you management/accounting folks.

We already have a 2 tier system.

Our current system will not survive and will not be able to take care of you when you are old and sick unless it is drastically overhauled from the bottom up.

What should we do? Any suggestions?
marc