Les Perreaux wrote in “Medical association chief calls for incentive-based funding”, (Globe and Mail, Jun.20, 2009):
“The head of the Canadian Medical Association is pushing for new methods of health-care financing and enforced accountability that could flip the incentives in the system.
Robert Ouellet went to Europe earlier this year to find out how five countries manage to keep wait times for specialized health care to mere days.
It turns out pesky patients are the key.
To start, hospitals and other health institutions should be financed based on the number and type of patients they see instead of the current lump funding that creates no incentive to boost efficiency, he said.
An "activities-based" funding system was adopted in England six years ago and Dr. Ouellet considers it key to a dramatic reduction in waits there.
"It meant that patients were seen as a source of revenue for hospitals and not an expense. Patients were sought after and not seen simply as a drain on hospital budgets," Dr. Ouellet said yesterday in a speech launching his campaign, "Time to Transform Health Care."
"Here, the ideal hospital has a budget and zero patients. We have to rethink the way it works. Why can't the concept of customer service become part of Canadian health care?"
Dr. Ouellet toured Denmark, Belgium, France, England and the Netherlands earlier this year. He said European health-care leaders were stunned to hear unattained Canadian wait-list goals were far longer than their upper limits.
Dr. Ouellet and a coalition of medical specialists working under the CMA unveiled a report on Canadian wait times yesterday, reporting only spotty progress in five key areas targeted for wait reductions.
The provinces and Ottawa targeted waits for hip and knee replacements, cataract surgery, radiation oncology, cardiac care and diagnostic scans under a 2004 agreement.
Five-and-a-half billion dollars later, "there remains a lot of unfinished business for wait times in Canada," said Lorne Bellan, co-chair of the Wait Times Alliance. Not only are wait lists still long, several provinces have lagged in proper reporting and disclosure.
British Columbia, Manitoba and Ontario have shown the most progress, both in tracking and making modest gains cutting wait times.
Waiting lists in specialties outside the five high-profile, priority areas remain stubbornly high, the report said, particularly in psychiatry, obstetrics and gynecology, gastroenterology, plastic surgery, anesthesiology and emergency care.
"We had hoped [the five priorities] would be a starting point," Dr. Bellan said. "There are significant waits well beyond the original five areas and they all need to be addressed in order to provide quality care for Canadians."
Dr. Ouellet said close tracking has boosted accountability in Europe, where hospital directors can be fired for poor performance.
The European countries on Dr. Ouellet's tour generally use more private medicine than the Canadian system. But Dr. Ouellet insisted he's not pushing for a turn toward U.S.-style private medicine, with its spiralling costs and gaps in coverage that leave 46 million Americans without insurance.
"The U.S. is a very poor performer," Dr. Ouellet said. "Why look to a system that ranks below ours for lessons?"
How Canada measures up
The head of the Canadian Medical Association recently completed a fact-finding trip to five European countries, where he found negligible waiting lists for most medical procedures. Here are some comparisons with Canada:
France is in the midst of an MRI crisis because people are waiting an average of 35 days for a scan. In Manitoba - one of the best-performing provinces with reliable, published data - the average wait is 70 days. In Ontario, the average wait is 105 days.
The average wait for orthopedic surgery in Ontario is 26 weeks. In England, the average wait for orthopedic treatment is 12 weeks. This is one of the slowest-performing specialties in the English National Health System.
In England, 93 per cent of all specialized treatments begin within 18 weeks of the first doctor's visit. In Canada, 50 to 91 per cent of Canadians blow past the 18-week marker while waiting for specialized treatment.
Ophthalmology is the worst performer in Canada, with 91 per cent of patients waiting more than 18 weeks (The average wait is 450 days). Gastroenterology is the best-performing specialty. About half of patients are treated within 18 weeks.”
I wonder which politician will listen to, and endorse, the further serious contemplation and measured eventual implementation, of Dr. Ouellet’s sensible proposals? Which politician will acknowledge that health care really does need serious, anti-nanny-state reform in Ontario? And which hyperbolic politician will fearmonger and bluster that this would lead to the collapse of mankind as we know it...?
Certainly, Ontario’s wasteful and inefficient state-run system, under tax-happy Liberal Premier Dalton McGuinty's flawed monopolist ideology, cares more about propping up a failed ideology than about accountability.
St. Catharines Liberal MPP (and smug health care monopolist) Jim Bradley has shown he thinks only his Liberals have the divine right to monopolize health care delivery in Ontario; Bradley most likely would be the first to start sanctimoniously bleating as soon as the word privatization is mentioned. But, examining Dr. Ouellet's ideas, we see that he's talking about a reasonable hybrid system; the kind of system, by the way, that smug, chest-pounding nationalist Liberals and status-quo-change-fearing protectionist socialists have been obstructing for years.
Will our local MPP, and cabinet minister, Jim Bradley (who once strangely/smugly claimed he hated doctors!?) bother to comment on Dr.Ouellet’s ideas and proposals? Let’s ask Bradley for a response! Is adhering to their failed health care monopolism enough justification for Bradley's Liberals to force Ontario patients to wait 26 weeks for orthopedic surgery, or 105 days for an MRI? Come on!!
Bradley more likely will run and hide from comment, preferring to rather baffle us with his windy populist rhetoric and tired old proletarian good-ole-boy shtick… “blah…bla…Tommy Douglas…blah blah…slippery slope…blah..bla…siphon from one system to another….blah bla blah… so: vote Liberal!”
McGuinty's Liberals cannot be trusted to deliver anything better than their tired, failing old monopolist ideology, reeking of Liberal healthcare duplicity.
We must listen to Dr. Ouellet's ideas.