Decide for yourself. If this article was about a hospital in Toronto, how would you have all responded?

- – - – -

R.I. Hospital Fined For 3rd Brain Surgery Mistake
(CBS) PROVIDENCE, R.I. Rhode Island Hospital has been fined $50,000 and reprimanded by the state Department of Health after its third instance this year of a doctor performing brain surgery in the wrong side of a patient’s head.

“We are extremely concerned about this continuing pattern,” health department director David R. Gifford said in a statement Monday.

The hospital issued a statement saying it was re-evaluating its training and policies, providing more oversight, giving nursing staff the power to ensure procedures are followed, among other steps.

….continues

http://wbztv.com/topstories/local_story_331110858.html

- – - – -

I’m sorry Heather, but I’ve got to call you on that one. For half the cost of the U.S. there are millions of healthcare service transactions provided per year from physicals, to flu shots, to prescriptions, to subsidized nursing homes, to emergency services, etc., etc., etc. all currenty at $0 out-of-pocket for those requiring service (again important to contrast vs the U.S. system where they often forget to add their cash costs on top of their deductibles on top of their insurance premium costs on top of their tax contributions). There may be instances where we don’t get Westin-level service for our money but that doesn’t negate the fact that based on our relatively small investment (on a per capita basis) we get a tremendous amount of coverage especially when contrasted to U.S. spending and their entitlements.

By the way, just to go back to a previous comment in which we were in agreement which was that the doctor shortage regardless of the single-payer system dramatically impacts our systems capabilities, I think we need to define what that staffing level should be. At present we are in a position where we as potential patients are competing for scarce doctors. That needs to be reversed so that doctors are numerous enough they start competing for us. Now if you follow that logic through (especially when you include the provision of user fees we agreed upon earlier) what that means is that even with relatively flat budget spending, service levels could rise dramatically very quickly as more doctors actually fight for positions (which in turn could actually create health industry wage deflation).

You are right, the electorate will decide what the government is for.

At the moment, whether the Canadian health care system is SUPPOSED to help us or not – it can’t.

Necessity being the mother of all inventions… perhaps a new system will emerge.

Chevy, I haven’t even touched on the mess of billing in the Canadian health care system… whole other article there!

Heather

Alright where were we?

1) Med School Enrollment increase – Looks like a point of agreement. Again, my fundamental problem with measuring Canadian “system” results is I believe it’s very hard to measure any system if it’s chronically understaffed. It would be like measuring a hockey team who only played 4 players (sorry, couldn’t resist using the hockey analogy in a U.S. forum ). Of note, for Richard your comment re: the Canadian System I think falls into this category. It’s not “designed” to cause difficulty to transition to specialist care. There are difficulties because it’s understaffed.

RE: Canadian-Trained Healthcare providers moving to the United States for higher salaries – First, I think with the revaluation of the $CAD vs $USD, I do not see that trend occurring nearly as much as we did in the 80′s when it was a significant problem. That being said, I think there’s an easy solution to that. As most Americans may not know, Canada heavily subsidized post-secondary education, and most heavily medical field training. Under the current system, those individuals are allowed to take that subsidized training (which should be accounted for in our healthcare costs) and relocate anywhere in the world without restriction making the Canadian taxpayer investment ROI equal to exactly zero. If we are going to continue a medical training subsidy, the structure needs to modified so that students are billed at full rates during their training and then are granted loan forgiveness over a period of 10-years or so. The end result is to create a barrier to bolting to other jurisdictions after receiving upwards of $200,000 in educational subsidization from Canadian Taxpayers.

RE: What Canadian Med Schools teach: The other problem I have is of the graduates, we are generating far too many vanity-focused doctors and too few emergency specialists. Our $200,000, and most importantly that key medical school spot is going to train someone who is going to open something akin to a high-end spa providing cosmetic enhancements such as botox, breast enhancements, skin peels, etc. I have no problem if doctors choose to go this route, however such specialization should not be subsidized as it’s not part of what we really need.

RE: Alberta specifically – I don’t what to say on this issue. I have two sets of uncles and aunts and five cousins in Alberta and they say things very similar to you. That being said I think it’s primarily a mismanagement issue as opposed to anything else and I put most of that Klein and now Stelmach. I used to sell custom software into the oilsands projects and in 2005 flew out to Fort McMurray and received facilities tours of both Syncrude and Suncor. I was absolutely baffled by the lack of forward planning across-the-board considering the long-term planning timelines surrounding oil sands development. The fact Klein hadn’t put money to expand the 2-lane highway from Alberta which regularly resulted in unnecessary traffic accident deaths, as well as the urban planning mismanagement within Fort McMurray were mind-blowing. As a side note, the recent oil royalty review by Stelmach was another mindnumbing read. Bottom Line: I’m not there, but considering the fact your province is generating fiscal surpluses of billions per annum, I find your provincial government’s management of most folios….let’s call it confusing. My gut instinct is that if you put someone like Gwyn Morgan (former Encana CEO for those who don’t know) in charge and I think your provincial services could be 100% better in very short order. Good Lord, I’ve got Dalton in charge and as awful as he is, I wouldn’t trade you for Stelmach, and I’d trade Dalton for a ripe turnip.

Matthew.

P.S. Just for some additional background information, my grandmother needed an emergency hip replacement after a fall and she received that within 48-hours of that fall. She subsequently received comprehensive physiotherapy to heal all of which costs $0.00 out of pocket. She now lives in an assisted living nursing home that is subsized by the provincial government. I flag this because nursing home subsidies constitute an ever-larger portion of healthcare spending but its inclusion is often omitted from the debate. In the last year, I have a female friend who is a hotel sales rep in Niagara Falls whose mom was diagnosed with breast cancer and she was in chemo within 2-weeks and I talked to her just about every day during the treatments and the service was apparently outstanding. The biggest problem that exists in Ontario remains Emergency Room wait times and again that has to do with understaffing. Fix the understaffing and suddenly things aren’t too bad. Sadly I don’t expect Dalton to do anything smart in this respect but it’s important to recognize that “the system” cannot really be separated from the provincial leadership and management.

“There does not seem to be any method of getting joe and josephine
to take good care of themselves possibly lowering overall healthcare costs in both countries. Would you care to comment?”

It can be difficult to legislate any sort of healthy living. Which will cost more: a man who smokes all his life and doesn’t get sick until he’s in his 70′s and dies six months later (like my grandfather) or a marathon runner who has two knee replacements by the age of 40 and then goes on to require the normal amount of health care that any senior does.

There is a lot to being sick or healthy that is genetic. Not that that removes any responsibility, it just means that people with genetic marks against them are more likely to be less healthy.

First you’d have to determine which level of government should be responsible for helping us get healthier. The provinces control health care spending, but the Canada Health Act is federal legislation. Then you have regions in each province that actually deliver the health care.

But really, getting Joe and Joesephine Canuck to take better care of themselves starts with Joe and Josephine valuing health and having them realize without a shadow of a doubt that it is NOT and should not be up to the government to take care of them regardless of their health situation.

Digression: There was a senior in Calgary who recently hit his head and went into a coma. Doctors issued a DNR (do not resuscitate) and the family disagreed, eventually getting a court order to block the DNR and allow her to get a second opinion. (Don’t forget, Canadians have to go through their current doctor to get to a specialist… if their current doctor won’t refer them, they are stuck. Obviously this man’s doctor had written him off.) The man has now recovered to the extent that he can write his name, speak and recognize family. The Calgary Health Region is still fighting the court decision because they don’t want to set a “dangerous precident”.

Sorry… back to your question…

There are very few things Canada has attempted to put into place:

Tax benefits for the parents of kids enrolled in sports. Called the “Children’s Fitness Tax Credit” of a credit up to $500 a child (http://www.cra-arc.gc.ca/fitness/)

Focusing on vaccinations, getting every child they can vaccinated before Kindergarten.

Re-doing Canada’s Food Guide to “better reflect evolving eating patterns and food markets, an increasingly ethnic population and new scientific findings”. (http://www.hc-sc.gc.ca/fn-an/nutrition/fiche-nutri-data/rationale-raison_d_etre_e.html)

Uh… that’s all I can think of. This past week someoen from the Calgary Health Region basically stated “we need you all to take care of yourselves… because we can’t do it.”

It is easiest for me to speak about Alberta, where the government pays $3695 per person per year on health care and where the wait times are the longest. Our overall unemployment is the lowest in the country and the health care staffing crisis is critical.

In Calgary, 20% of us have no family doctor (my husband included, since my older doctor doesn’t take men) and the city apparently needs 300 more physicians to remain out of a crisis situation. (http://www.missoulian.com/articles/2007/11/25/news/local/news05.txt)

My family is probably very typical. Busy. Two kids. Husband and Wife both working. Child care costs are high. I have a gym membership that I don’t use because I can’t find the time. With a promotion at work I find myself busier than ever and it’s tough to tear myself away for an hour to work out. And getting up in the morning? Puh-leeze… when the baby still wakes up a couple times each night I like all the sleep I can get. Then I’m sitting and writing until 11 pm or so.

What’s the solution? How can the government encourage me to be healthier? Oh, wait, gee… maybe it’s not up to the government to help me. Maybe Canadians just have to let go of that notion that the government CAN and WILL help them.

Richard: I do know Americans who are self-employed (writers) who have their own insurance. So it’s not that insurance is not portable, it’s that the insurance that is portable is wildly expensive. From my understanding.

Right now it would SEEM that the system provides basic care well, but I would have to disagree. When your doctor comes in and only talks to you for three minutes because she’s too busy … and you can’t switch doctors or get access to a specialist without having your doctor’s OK, then the system doesn’t work very well at all.

As a physician and as someone who was once un-insured, I see both sides of the healthcare coverage issue. You would think that being a physician I should have always had health insurance, but in fact I did not have insurance coverage for two years; I could not afford the high premiums and pay for my new private practice at the same time. I also had an eye opening experience when I helped an un-insured niece through a life threatening illness for which I am still paying in excess of $330,000 in medical bills. The cute little thing is worth every penny but her medical bills total would have been no more than a measly $100,000 had she been insured.
It is undeniable that having millions of uninsured Americans is morally unacceptable and financially unsustainable for many Americans. It is regrettable, however, that we are constantly trying to address this problem by waiting for drastic solutions to materialize. We neglect the many smaller scale, less costly, options available to us now. Many of these interventions cost very little when compared to the holy grail of healthcare reform, the “universal healthcare”. Most importantly, we probably could implement many of these simple measures right away and with minimal controversy. Below is an outline of some of these quick and small scale fixes that in my humble opinion deserve more attention and consideration.

Families spend thousands of dollars on medical bills and health insurance premiums but are often unable to tax deduct these expenses. It would be worth considering removing some of the many restrictions that preclude the tax deduction of health related expenses, knowing that it would deprive the government of highly addictive tax dollars.

Hospitals and doctors, like me, have a peculiar billing system. The first ground rule is that they are not allowed to charge insured patients anything beyond what their insurance dictates by contract. This is in contrast to dentists who can bill patients for whatever the insurance doesn’t cover or underpay; something that makes dental insurance obsolete in my opinion, but that’s another story. You would think that all medical bills sent to the insurance companies would therefore be for the exact amount allowed, but they rarely are. These bills often contain charges that are more (much more in case of Hospitals) than the allowable amount for the medical service rendered. A Hospital that is billing $2,750 for a service that only pays $750 (per the insurer) is only going to get paid $750. The difference between the charges on the bill and the actual money paid is called an adjustment. So why bill higher if they’re only getting a pre-set amount, you may ask. There are many reasons for this billing practice, one of them is that the insurers periodically adjust the allowable payment rates based on actual unadjusted bills, and so Hospitals and physicians try to bill the actual desired amount rather than the allowable amount. For the insured person this is a harmless exercise except for the confusion when he or she reads a copy of the bill. Most patients eventually realize that they are not paying anything beyond what their insurance allows, and so there is no harm done.
In the case of uninsured patients this harmless billing discrepancy turns into sanctioned over-billing across the board. By law, hospitals and physicians must bill every patient equally for the same services. Therefore they must send uninsured patients the same unadjusted high bill they usually send the insurance companies. There is no adjustment to follow however, as there is no contract in place to mandate such adjustment. Ironically, the law designed to ensure equal billing is mandating inequality in billing for the uninsured. Simply put, in our previous example, the uninsured patient gets the $2,750 bill and has to pay the total amount. In comparison, the insured patient would get the $2,750 bill but the payment is only $750, as determined by the insurance company. Ironically most Americans, including politicians, are unaware of the shocking fact that there is no law on the books to protect the uninsured from this systematic over-billing. In the United States of America un-insured patients are charged much more than their insured counterparts and there is no law against it–shouldn’t this be a headline?
The only time an adjustment is offered is when the uninsured patient requests it, and if the Hospital feels generous enough to grant it. Physician bills are much smaller compared to hospital bills but the same legal principles apply. Each doctor’s office has a policy on how to deal with bill adjustments and ride-off for the un-insured and many make provisions for such patients, but they are not obligated by law to do so. Clinics with sliding scale payments and some government sponsored partnership programs with hospitals have no such issues of over-billing.
It would be great if presidential candidates or other politicians and activists were to show interest in tackling this simple issue of equal and fair billing for the uninsured. It would be quite reasonable to pass a law that requires hospitals and doctors not to charge the un-insured anything beyond what they expect from their best paying insurance. That would mean that the hospitals and physicians would still get to bill at the most generous rate available, and the un-insured will be spared the unfair over-billing.

Last but not least, there is the matter of the sky rocketing health insurance premiums. I find myself dealing with high premiums for my own employees, just like any other business. I can’t help but find it wasteful to pay the hefty premiums when most of my employees never end up needing a physician or hospital care. For my personal insurance I have a $5000 deductible insurance that has a premium of under $300 per month. That’s a total of ~$8600 per year, assuming I use up all the money set aside for the deductible. The ~$5000 I am allowed to deposit in my health saving account is totally tax deductible and I use it for my dental care, medial bills, and medication purchases, etc. Any remaining money in the health saving account carries over to the following year and it even earns interest. After depositing $5000 the first year I can either supplement it with smaller amounts the following years or deposit the maximum ~$5000 allowed each year, creating a cushion for future years. This money never goes to waste and can even be inherited.
I considered the same insurance option for my employees but I realized that there is a constant problem and that is that most people who can not afford the high health insurance premiums can not afford to set aside $5000 for their health saving account to cover the high deductible. Without having this money set aside in reserve in the health saving account they risk having to pay for unexpected medical expenses of up to the maximum $5000 deductible out of pocket. Most employers want to help but can not afford to step in and contribute the full $5000 per employee towards their individual health saving account as that can add up to a large sum of money. This becomes a major barrier for use of this seemingly reasonable healthcare insurance option. If small businesses or businesses in general, were allowed to have a business health saving account to cover employees in lieu of individual health saving accounts then the amount of money that has to be set aside by the employer can be set to be much less and still have a large sum of money on aggregate to be used toward employee high deductibles, and still enjoy the lower premiums offered by the high deductible insurance. Businesses can accumulate money, tax free, in the business heath saving account overtime to be used for various healthcare expenses. This is yet another option that should be considered by politicians and advocates even by those who believe in working towards universal coverage.

Being a geriatrician, I deal with the US versions of government sponsored healthcare as most of my patients are insured by Medicare, Medicaid, and the VA. These programs provide universal coverage for select groups, the elderly, the poor, and the veterans. I also had first hand experience with national universal healthcare when I practiced Medicine in Eastern Europe at one point in my life.
The grass is greener on the other side, as they say, but for those involved in the healthcare industry it is no secret that countries with national universal healthcare are moving towards fee for service models to supplement their universal systems. Private healthcare in these countries is readily available and is accessed by the wealthy unsatisfied with the long waits and the inevitable rationing of healthcare resources. Rationing healthcare resources often seem very reasonable to planners and proponents of universal healthcare until these individuals are themselves the ones waiting an extra couple of months for chemotherapy or are denied expensive life saving measures. The wealthy have no such worries as they will always have the option of paying for their healthcare or traveling to wherever the needed medical care is available. They are also more likely to use their influence to improve their access to any universal healthcare system, resulting in even longer waits for the rest of the population. I also worry that expenditures on the elderly will likely be considered a second tier priority, as spending healthcare dollars on children and younger adults will most likely be considered more cost effective. Ultimately, Americans who choose universal healthcare should ask themselves if they believe that Medicaid, Medicare and the VA is the way to go for all Americans. Hopefully any major overhaul of healthcare in the USA will be a result of deliberate analysis and debate, and not just because it’s better than nothing. In the meantime, I think it’s reasonable for all sides of this debate to press forward with what little we can do for the uninsured now, even if it is done piecemeal.

As a Canadian, I can tell you that our health care system is a very important item in our daily life.”

I am so sorry to hear that Canadians are so sickly. In my visits to and trips through your fine country, I never noticed how many of you were ill or injured. You always seemed an especially robust group to me. May I wish you good fortune in solving this almost unbearable problem.